Glucose response to low-dose glucagon for insulin-induced mild hypoglycaemia after 12 weeks of high versus low carbohydrate diet. A pilot study

Objective To compare the glucose response to low-dose glucagon after high carbohydrate diet (HCD) versus low carbohydrate diet (LCD). Methods Individuals with insulin pump-treated type 1 diabetes went through 12 weeks of HCD (>250 g/day) and 12 weeks of LCD (<100 g/day) in random order and separated by 12 weeks. At end of each diet, mild hypoglycaemia was induced in the fasting state by a subcutaneous insulin bolus. When plasma glucose (PG) reached 3.9 mmol/L, 100 µg glucagon was given subcutaneously. Results Four of six participants completed both study visits while the remaining two only completed the study visit following LCD. They were 37 (28-52) years old (median (IQR)), had BMI 25.0 (24.5-25.2) kg/m2, and HbA1c 57 (55-59) mmol/mol or 7.4 (7.2-7.5) %. Daily carbohydrate intake was 95 (86-97) g during LCD and 254 (184-259) g during HCD. Compared with HCD, LCD had a significantly lower area under the PG curve from 0-120 min (521 (394-617) vs 663 (546-746) mmol/l x min, p=0.045) and insignificant lower incremental PG peak after the glucagon bolus (1.5 (0.6-3.2) vs 3.0 (2.2-4.2) mmol/L, p=0.317). Conclusion In conclusion, the glucose response to low-dose glucagon was reduced after 12 weeks of LCD compared with HCD.