Bedtime uncooked cornstarch supplement prevents nocturnal hypoglycaemia inintensively treated type 1 diabetes subjects

Objectives, The present study tests two interrelated hypotheses: (1) that b edtime ingestion of uncooked cornstarch exerts a lower and delayed nocturna l blood glucose peak compared with a conventional snack: (2) that bedtime c arbohydrate supplement, administered as uncooked cornstarch, prevents noctu rnal hypoglycaemia without altering metabolic control in intensively treate d type 1 diabetes (IDDM) patients. Design and subjects. The above hypotheses were tested separately (1) by poo ling and analysing data from two overnight studies of comparable groups of patients with non-insulin dependent diabetes mellitus (NIDDM) (14 and 10 pa tients, respectively), and (2) by a double-blind, randomized 4-week cross-o ver study in 12 intensively treated IDDM patients. Setting, Sahlgrenska University Hospital, Goteborg, Sweden. Interventions, (1) Ingestion of uncooked cornstarch and wholemeal bread (0. 6 g of carbohydrates kg(-1) body weight) and carbohydrate-free placebo at 2 2.00 h. (2) Intake of uncooked cornstarch (0.3 g kg(-1) body weight) and ca rbohydrate-free placebo at 23.00 h. Main outcome measures. (1) Nocturnal glucose and insulin levels; (2) freque ncy of self-estimated hypoglycaemia (blood glucose [BG] levels < 3.0 mmol L -1) at 03.00 h, HbA(1c) and fasting lipids. Results. Bedtime uncooked cornstarch ingestion led to a lower (2.9 +/- 0.5 vs. 5.2 +/- 0.6 mM, P = 0.01) and delayed (4.3 +/- 0.6 vs, 2.0 +/- 0.0 h, P < 0.01) BG peak, compared with a conventional snack, in NIDDM patients. Fo ur weeks of bedtime uncooked cornstarch supplement, as compared with placeb o, led to a 70% reduction in the frequency of self-estimated hypoglycaemia at 03.00 h (P < 0.05), without affecting HbA1c or fasting lipids in IDDM pa tients. Conclusions, Uncooked cornstarch, ingested at bedtime, mimicked the nocturn al glucose utilization profile following insulin replacement, with a peak i n blood glucose after 4 h, In IDDM patients, bedtime uncooked cornstarch su pplement diminished the number of self-estimated hypoglycaemic episodes, wi thout adversely affecting HbA1c and lipid levels. Hence, bedtime uncooked c ornstarch ingestion may be feasible to prevent a mid-nocturnal glycaemic de cline following insulin replacement in IDDM and, based on the nocturnal blo od glucose profile, may also be preferable compared with conventional snack s.