Effect of cardioselective and non-selective beta-blockade on the hypoglycaemic response in insulin-dependent diabetics

Lancet. 1979 Mar 3;1(8114):458-62. doi: 10.1016/s0140-6736(79)90821-3.


The response to intravenous insulin was studied in seven diabetics after a dose of placebo, propranolol (40 mg), or metoprolol (50 mg). Two of the seven subjects also had a week's course of each of the same agents taken three times daily. Neither of the beta-blockers potentiated the effect of insulin as judged by the rate of reduction in blood-glucose. However, blood-glucose recovery was reduced significantly by propranolol, but not significantly by metoprolol. Propranolol caused severe bradycardia and raised diastolic blood-pressure during hypoglycaemia; these effects were milder with metoprolol. Propranolol inhibited the free-fatty-acid levels after hypoglycaemia to a greater extent than did metoprolol. The results strongly suggest that propranolol (and presumably other non-selective beta-blockers) is hazardous in subjects prone to hypoglycaemia. When diabetics require beta-blockade a cardioselective beta 1-blocker should be used.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Blood Glucose / analysis
  • Blood Pressure / drug effects
  • Bradycardia / chemically induced
  • Clinical Trials as Topic
  • Diabetes Mellitus / drug therapy
  • Diabetes Mellitus / physiopathology*
  • Diastole / drug effects
  • Fatty Acids / antagonists & inhibitors
  • Female
  • Humans
  • Hyperglycemia / drug therapy*
  • Hypoglycemia / chemically induced
  • Injections, Intravenous
  • Insulin / administration & dosage*
  • Male
  • Metoprolol / administration & dosage*
  • Middle Aged
  • Placebos
  • Propanolamines / administration & dosage*
  • Propranolol / administration & dosage*
  • Pulse / drug effects
  • Research Design


  • Blood Glucose
  • Fatty Acids
  • Insulin
  • Placebos
  • Propanolamines
  • Propranolol
  • Metoprolol