The best defense against hypoglycemia is to recognize it: is caffeine useful?

Caffeine, 1,3,7trimethylxanthine, is used by 80% of the adult population of the world in its various forms. Even the simple pleasure of consuming this socially acceptable drug has implications for the person with diabetes mellitus. Caffeine may increase an individual's sensitivity to hypoglycemia through the combined effects of reducing substrate delivery to the brain via constriction of the cerebral arteries, whilst simultaneously increasing brain glucose metabolism and augmenting catecholamine production. This article summarizes the evidence supporting the hypothesis that caffeine influences the perception of and physiological response to hypoglycemia. Under laboratory conditions, acute ingestion of caffeine markedly enhances the symptomatic and sympathoadrenal responses to hypoglycemia in both healthy volunteers and patients with type 1 diabetes. Recently a study of free-living people with type 1 diabetes showed that caffeine consumption increased the awareness of hypoglycemia. Caffeine has been associated with a number of negative effects and addiction. Most serious of these associations are ischemic heart disease and hypertension, the relationships have not been clearly established and the evidence to date is controversial. Thus we conclude that in modest doses, caffeine may be a useful adjuvant therapy for patients with hypoglycemia unawareness. For once here is a therapy which is inexpensive, safe, and remarkably popular with its consumers.