Managing Impending Nonsevere Hypoglycemia With Oral Carbohydrates in Type 1 Diabetes: The REVERSIBLE Trial

OBJECTIVE Current guidelines recommend initiating treatment for nonsevere (NS) hypoglycemia with 15 g carbohydrates (CHO) at 15-min intervals when blood glucose (BG) reaches <70 mg/dL (3.9 mmol/L). Despite this recommendation, NS hypoglycemia management remains challenging for individuals living with type 1 diabetes (T1D). We aimed to assess the efficacy of 15 g CHO at higher BG levels. RESEARCH DESIGN AND METHODS A total of 29 individuals with T1D participated in an open-label crossover study. After an inpatient subcutaneous insulin-induced decrease in BG in the fasting state, 16 g CHO was administered orally at a plasma glucose (PG) of <70 (3.9), <= 80 (4.5), or <= 90 mg/dL (5.0 mmol/L). The primary outcome was time spent in hypoglycemia (<70mg/dL) after initial CHO intake. RESULTS When comparing the <70 (control) with the <= 80 and <= 90 mg/dL treatment groups, 100 vs. 86 (P = 0.1201) vs. 34% (P < 0.0001) of participants reached hypoglycemia, respectively. These hypoglycemic events lasted 26.0 +/- 12.6 vs. 17.9 +/- 14.7 (P = 0.026) vs. 7.1 +/- 11.8 min (P = 0.002), with a PG nadir of 56.57 +/- 9.91 vs. 63.60 +/- 7.93 (P = 0.008) vs. 73.51 +/- 9.37 mg/dL (P = 0.002), respectively. In the control group, 69% of participants required more than one treatment to reach or maintain normoglycemia (>= 70 mg/dL), compared with 52% in the <= 80 mg/dL group and 31% in the <= 90 mg/dL group, with no significant rebound hyperglycemia (>180 mg/dL) within the first hour. CONCLUSIONS For some impending NS hypoglycemia episodes, individuals with TID could benefit from CHO intake at a higher BG level.