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Propranolol in hypoglycaemia unawareness
Abstract:
The effect of propranolol on the occurrence of hypoglycaemic symptoms was assessed in insulin-dependent diabetic patients with hypoglycaemia unawareness. A double-blind, randomised parallel group study (2:1 fashion) was conducted over 4-week period. The propranolol group (n = 9) received 20 mg (week 1 and 2) and 30 mg (week 3 and 4) twice daily, and the other group (n = 5) a matched placebo for 4 weeks. Patients included had experienced at least two severe hypoglycaemic episodes (coma or seizures) during the previous year, which were characterised by a lack of adrenergic symptoms and required the assistance of another person. The mean number of hypoglycaemias during the study period was similar in both groups (placebo: 13 +/- 2 propranolol: 11 +/- 1), whereas the number of totally asymptomatic hypoglycaemias (< 0.6 g/l) was lower on propranolol than on placebo (3 +/- 1 vs 8 +/- 3, NS) and the number of symptomatic hypoglycaemias was higher (7.2 +/- 2 vs 4.6 +/- 1, NS). Subjective evaluation of treatment by the investigators showed 0/5 successes in the placebo group and 5/9 in the propranolol group (chi2 = 4.32, p = 0.038). The main advantage of propranolol over placebo was an increased incidence of sweating. The ratio [number of hypoglycaemias with sweating/total number of hypoglycaemias] being higher with propranolol (0.28 +/- 0.08 vs 0.06 +/- 0.02, p = 0.06). This pilot study suggests that beta-blockers may be useful in restoring adrenergic symptoms during hypoglycaemia in insulin-dependent diabetic patients without warning symptoms of hypoglycaemia. This beneficial effect seems to be predominantly related to an increase in hypoglycaemia-induced sweating. A larger study is needed to confirm or invalidate these preliminary results.
Insights
Propranolol may help insulin-dependent diabetic patients regain awareness of hypoglycemia symptoms. This pilot study found increased sweating, a key warning sign, in patients taking propranolol compared to placebo.
Area of Science:
- Endocrinology
- Pharmacology
- Diabetology
Background:
- Hypoglycemia unawareness is a significant complication in insulin-dependent diabetes.
- Lack of adrenergic symptoms impairs timely hypoglycemia detection and management.
- Beta-blockers, like propranolol, can mask or alter hypoglycemic symptoms.
Purpose of the Study:
- To assess the effect of propranolol on the occurrence of hypoglycemic symptoms in patients with insulin-dependent diabetes and hypoglycemia unawareness.
- To investigate whether propranolol can restore adrenergic warning symptoms during hypoglycemia.
Main Methods:
- A 4-week, double-blind, randomized parallel group study (2:1) was conducted.
- Nine patients received propranolol (20-30 mg twice daily), and five received a matched placebo.
- Patients had a history of severe hypoglycemic episodes without adrenergic symptoms.
Main Results:
- The mean number of hypoglycemic episodes was similar between groups.
- Propranolol reduced asymptomatic hypoglycemias and increased symptomatic ones, though not statistically significant.
- Investigators reported treatment success in 5/9 propranolol patients versus 0/5 placebo patients (p = 0.038).
- Increased incidence of sweating during hypoglycemia was observed with propranolol (p = 0.06).
Conclusions:
- Propranolol may be beneficial in restoring adrenergic symptoms during hypoglycemia in diabetic patients with unawareness.
- The primary beneficial effect appears to be an increase in hypoglycemia-induced sweating.
- Larger studies are required to confirm these preliminary findings.