title: Low-Carbohydrate Diet Impairs the Effect of Glucagon in the Treatment of Insulin-Induced Mild Hypoglycemia: A Randomized Crossover Study.
abstract: This study compared the ability of glucagon to restore plasma glucose (PG) after mild hypoglycemia in patients with type 1 diabetes on an isocaloric high-carbohydrate diet (HCD) versus a low-carbohydrate diet (LCD).
  
  
  
  Ten patients with insulin pump-treated type 1 diabetes randomly completed 1 week of the HCD (≥250 g/day) and 1 week of the LCD (≤50 g/day). After each week, mild hypoglycemia was induced by a subcutaneous insulin bolus in the fasting state. When PG reached 3.9 mmol/L, 100 µg glucagon was given subcutaneously, followed by 500 µg glucagon 2 h later.
  
  
  
  Compared with the HCD, the LCD resulted in lower incremental rises in PG after the first (mean ± SEM: 1.3 ± 0.3 vs. 2.7 ± 0.4 mmol/L, P = 0.002) and second glucagon bolus (4.1 ± 0.2 vs. 5.6 ± 0.5 mmol/L, P = 0.002). No differences were observed between the diets regarding concentrations of insulin, glucagon, and triglycerides.
  
  
  
  The LCD reduces the treatment effect of glucagon on mild hypoglycemia. Carbohydrate intake should be considered when low-dose glucagon is used to correct hypoglycemia.
authors: Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark ajenthen.ranjan.02@regionh.dk.|Danish Diabetes Academy, Odense, Denmark.
authors: Ajenthen
authors: A
authors: Ranjan
authors: Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.|Danish Diabetes Academy, Odense, Denmark.
authors: Signe
authors: S
authors: Schmidt
authors: Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors: Camilla
authors: C
authors: Damm-Frydenberg
authors: Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.|Danish Diabetes Academy, Odense, Denmark.
authors: Isabelle
authors: I
authors: Steineck
authors: Incretin & Obesity Research, Novo Nordisk A/S, Måløv, Denmark.
authors: Trine Ryberg
authors: TR
authors: Clausen
authors: Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.|Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors: Jens Juul
authors: 0000-0001-6853-3805
authors: JJ
authors: Holst
authors: Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.|Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors: Sten
authors: S
authors: Madsbad
authors: Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors: Kirsten
authors: K
authors: Nørgaard
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000187:drug effects; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy; D050528:Diet, Carbohydrate-Restricted / Q000009:adverse effects*; D005215:Fasting / Q000097:blood; D005260:Female; D005934:Glucagon / Q000008:administration & dosage* / Q000097:blood; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000097:blood; D007328:Insulin / Q000009:adverse effects* / Q000097:blood; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D005934:Glucagon