Insulin and glucagon combo- Novel approach for blood sugar control in diabetes
Co-administration
of insulin and glucagon provides protection against insulin-induced
hypoglycemia without worsening hyperglycemia in type 1 diabetes (T1D)
patients, according to a recent study published in the ADA journal
Diabetes.This essentially means that this combo will control high blood
sugar along with protection from sudden and severe fall in blood sugar
in type 1 diabetes.
The results were also presented at the American Diabetes Association' (ADA) Virtual 80th Scientific Sessions.
Despite advances in the
pharmacological and technical fields, the risk of hypoglycemia remains
the major concern for the regulation of optimal blood sugar levels in
type 1 diabetes. there is an increasing interest in how the opposing
actions of insulin and glucagon (Gn) may be harnessed to optimize
glycemic control.
Insulin dosing was
designed to control the early rise in plasma glucose (PG) but also to
elicit hypoglycemia in the later phase.
For the purpose, Bruce
W. Bode from Atlanta, GA, and colleagues studied 11 T1D patients (age
36±4y, gender M:F 5:6, BMI 25.0±0.7 kg/m2, disease duration 23±3y, A1C
7.0±0.3%, daily insulin dose 43±3u) on two occasions, under meal
challenge conditions (liquid mixed meal, 100g carbohydrate) during a
phased 6h IV regular insulin infusion with (+Gn) and without (-Gn) IV
glucagon. On both occasions, subjects were treated overnight with low
dose IV insulin prior to the morning meal to prevent antecedent
nocturnal hypoglycemia and to attain near-normal fasting glycemia.
Key findings of the study include:
During +Gn, glucagon was co-administered with insulin at a fixed
molar ratio. At the two visits, fasting PG was similar (-Gn 121±5, +Gn
119±6 mg/dl) and the initial meal-induced PG elevation (0-3h) was
indistinguishable whether glucagon was present or not (peak PG -Gn
224±18, +Gn 228±15 mg/dl; ΔPG 0-180AUC -Gn 10501±3014, +Gn 11537±1778
mg.min/dl).
During the latter phase (3-6h), 7/11 -Gn subjects experienced an
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During +Gn, the fall in PG was attenuated in all cases with a
significant difference observed in PG nadir (-Gn 51.1±4.0, +Gn100.5±11.0
mg/dl).
Appropriate elevations in plasma insulin and glucagon were observed
in keeping with study design.
"To conclude, it is
feasible that insulin and glucagon can be co-administered under specific
conditions allowing protection against insulin-induced hypoglycemia
without impeding hyperglycemic control. This unique observation offers
insight into novel approaches to glucose control in diabetes," wrote the
authors.