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Predictive Low-Glucose Suspend Necessitates Less Carbohydrate Supplementation to Rescue Hypoglycemia: Need to Revisit Current Hypoglycemia Treatment Guidelines

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Pinsker, Jordan E., Bartee, Amy, Katz, Michelle, Lalonde, Amy, Jones, Richard, Dassau, Eyal, Wolpert, Howard·2021·Diabetes Technology & Therapeutics
DOI 10.1089/dia.2020.0619PMC PMC8252907
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Abstract

Current guidelines recommend 15–20 g of carbohydrate (CHO) for treatment of mild to moderate hypoglycemia. However, these guidelines do not account for reduced insulin during suspensions with predictive low-glucose suspend (PLGS). We assessed insulin suspensions, hypoglycemic events, and CHO treatment during a 20-h inpatient evaluation of an investigational system with a PLGS feature, including an overnight basal up-titration period to activate the PLGS. Among 10 adults with type 1 diabetes, there were 59 suspensions; 7 suspensions were associated with rescue CHO and 5 with hypoglycemia. Rescue treatment consisted of median 9 g CHO (range: 5–16 g), with no events requiring repeat CHO. No rescue CHO were given during or after insulin suspension for the overnight basal up-titration. To minimize rebound hyperglycemia and needless calorie intake from hypoglycemia overtreatment, updated guidance for PLGS systems should reflect possible need to reduce CHO amounts for hypoglycemia rescue associated with an insulin suspension. The clinical trial was registered with ClinicalTrials.gov (NCT03890003).

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  • Less carbohydrate (5-15 g) may need to be ingested to correct hypoglycemia because the automated insulin delivery system should have already reduced or stopped basal insulin delivery.

    “Less carbohydrate (5-15 g) may need to be ingested to correct hypoglycemia because the automated insulin delivery system should have already reduced or stopped basal insulin delivery (130).”

    From The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2021) · cites this paper as [130]

    The Introduction and Conclusions (pages unavailable) explain that predictive low-glucose suspend systems reduce or stop insulin delivery and that hypoglycemia following suspension may require less carbohydrate. The Abstract reports rescue doses of 5–16 g, not 5–15 g, and the Conclusions limit the recommendation to episodes preceded by insulin suspension rather than all hypoglycemia during automated insulin delivery. (LLM, conf=0.84)

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Research works printed but not linked: 18

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Authors
Pinsker, J. E., Bartee, A., Katz, M., Lalonde, A., Jones, R., Dassau, E., & Wolpert, H.
Affiliations
  • Sansum Diabetes Research Institute (US)
  • Eli Lilly (United States) (US)
  • Eli Lilly and Company, Cambridge, Massachusetts, USA.
Corresponding author
Pinsker, Jordan E.
ORCID
Venue
Diabetes Technology & Therapeutics
Publisher
SAGE Publications
Published
2021-06-29
Volume
23
Issue
7
Pages
512-516
ISSN
  • 1520-9156 (ISSN-L)
  • 1557-8593
DOI
10.1089/dia.2020.0619
PMC
PMC8252907
OpenAlex
W3127859486
Cited by
21
References
8
Citations by year
2026: 3 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 6 · 2021: 3
FWCI
2.80
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Technology & Therapeutics (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
predictive low glucose suspend, hypoglycemia, carbohydrate supplementation, type 1 diabetes, insulin suspension, rebound hyperglycemia, continuous glucose monitoring
MeSH terms
Adult, Blood Glucose, Diabetes Mellitus, Type 1, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Dietary Supplements

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