Effects of dipeptide administration on hypoglycaemic counterregulation in type 1 diabetes

Summary Objectives To investigate if a dipeptide made of glutamine and alanine is able to contribute to the recovery from insulin-induced hypoglycaemia in type 1 diabetes. Research design and methods: Fifteen adult type 1 patients were randomly assigned to study group (n = 7): intravenous infusion of 20 g Dipeptiven® in normal saline (i.e., 8 g alanine and 13 g glutamine), or control group (n = 8): same infusion, normal saline only. A 150 min gradual hypoglycaemic hyperinsulinemic clamp was administered after 2h of infusion. Counterregularory hormones, symptoms, and cognitive function (4 choice reaction test) were regularly measured during the study. Results Blood glucose and glucose infusion rates were similar in the 2 groups. Circulating levels of alanine and glutamine peaked at 90 min and remained elevated throughout the test. This was associated with significant differences in: glucagonemia 107 ± 20 vs 58 ± 8 pg/ml, and neuroglycopenic symptoms scores: 7 ± 3 vs 18 ± 13, at t 150 min, in study and control group, p Conclusion Intravenous infusion of a dipeptide made of alanine and glutamine is capable to reactivate glucagon secretion during insulin-induced hypoglycaemia and to reduce hypoglycaemic symptoms.