Hypoglycemic symptoms in insulin-dependent diabetics. A prospective study of the influence of beta-blockade.

Hypoglycemic attack rate, duration and symptomatology were studied in five insulin-dependent diabetics with borderline hypertension all of whom were prone to hypoglycemia. They were treated in a double-blind, cross-over fashion with the cardioselective beta 1-blocking agent metoprolol and placebo. The treatment period on each drug lasted at least three months. No treatment-associated differences in attack rate and duration of hypoglycemic attacks were recorded. Slight, but no severe masking of hypoglycemic symptoms was recorded in one patient on metoprolol. It is concluded that cardioselective beta 1-blocking agents can be used by insulin-dependent diabetics. However, until further direct experience has been gained caution should be exercised in treating patients with obvious clinical signs of autonomic neuropathy with these drugs.