Impact of Sclerotinia Stem Rot on Yield of Canola.

Sclerotinia sclerotiorum is the causal agent of Sclerotinia stem rot (SSR) of canola (Brassica napus). In North Dakota, the leading canola producer in the United States, SSR is an endemic disease. In order to estimate the impact of this disease on canola yield, field experiments were conducted from 2000 to 2004 at several locations in North Dakota and Minnesota. Experimental plots were either inoculated with laboratory-produced ascospores or infected by naturally occurring inoculum in commercial fields. Applying fungicides at different concentrations and timings during the flowering period created epiphytotics of diverse intensities. Disease incidence was measured once prior to harvesting the crop on 50 to 100 plants per plot. Results of the study indicated that 0.5% of the potential yield (equivalent to 12.75 kg/ha) was lost for every unit percentage of SSR incidence (range of 0.18 to 0.96%). Considering the current cost of fungicide applications and the market value of this commodity, a 17% SSR incidence could cause losses similar to the cost of a fungicide application. Additional efforts are required to improve current levels of tolerance of canola plants to this pathogen.

Efficacy of Fungicides for Control of Sclerotinia Stem Rot of Canola.

Sclerotinia stem rot (SSR), incited by Sclerotinia sclerotiorum, causes yield reductions to canola (Brassica napus) grown in North Dakota and Minnesota. Field trials were conducted in North Dakota and Minnesota from 2000 to 2004 to evaluate the effect of foliar fungicides on SSR and canola yield. Levels of SSR varied among years and location. In general, fungicides that consistently reduced SSR incidence compared with an untreated control were azoxystrobin, benomyl, boscalid, iprodione, prothioconazole, tebuconazole, thiophanate-methyl, trifloxystrobin, and vinclozolin. Significant reductions in SSR incidence with fungicides did not always translate into differences in canola yield, however. Inconsistent results were observed with different timings of applications based on percent bloom. This indicates that application timing should be based on factors in addition to percent bloom.

A pilot study of the continuous glucose monitoring system: clinical decisions and glycemic control after its use in pediatric type 1 diabetic subjects.

OBJECTIVE: To determine whether the continuous glucose monitoring system (CGMS) (MiniMed, Sylmar, CA) could be used to make clinical decisions and whether it has an impact on glycemia in pediatric type 1 diabetic subjects. RESEARCH DESIGN AND METHODS: Pediatric subjects were recruited if they had HbA(1c) >8.0% with management problems (n = 35) or episodes of severe or nocturnal hypoglycemia or hypoglycemia unawareness associated with HbA(1c) < or =8.0% (n = 12). A total of 47 patients with a mean HbA(1c) value of 8.6 +/- 1.6% (mean age 11.8 +/- 4.6 years, youngest 2.7 years, and diabetes duration 5.5 +/- 3.5 years) on three to four insulin injections/day (n = 24) or insulin pump therapy (n = 23) were followed with the CGMS for a mean of 69.5 +/- 28 h. Comparisons were made between the number of high (>150 mg/dl) and low (<70 mg/dl) glucose patterns discerned with the sensor or the logbook, and HbA(1c) levels were evaluated. RESULTS: In patients on injection therapy, 30 high or low glucose patterns were discerned with the logbook records and 120 patterns with the CGMS. Specific alterations of the diabetes regimen were made. An overall significant change in HbA(1c), from 3 months before wearing the sensor to 6 months after (analysis of variance 0.04), was found in the subjects. Post hoc analysis showed a significant change in HbA(1c) from 8.6 +/- 1.5% at baseline to 8.4 +/- 1.3% at 3 months (paired Student's t test 0.03). CONCLUSIONS: The CGMS can be used by pediatric patients to detect abnormal patterns of glycemia. The information that was obtained could be used to alter the diabetes regimen and impact glycemic outcome.

Men and women at promise for scientific excellence: similarity not dissimilarity.

U.S. math-science graduate students possessing world-class talent (368 males, 346 females) were assessed on psychological attributes and personal experiences in order to examine how their talents emerged and developed. Comparisons were made, using similar assessments, with mathematically talented students (528 males, 228 females) identified around age 13 and tracked into adulthood by the Study of Mathematically Precocious Youth (SMPY). Well before college, both samples were academically distinguished: however, the graduate students could be identified during adolescence as a subset of mathematically talented youths based on their nonintellectual attributes. Their profiles corresponded to what earlier psychological studies found to characterize distinguished (and exclusively male) scientists: exceptional quantitative reasoning abilities, relatively stronger quantitative than verbal reasoning ability, salient scientific interests and values, and finally, persistence in seeking out opportunities to study scientific topics and develop scientific skills. On these attributes, sex differences were minimal for the graduate students (but notfor the SMPY comparison groups). Developing exceptional scientific expertise apparently requires special educational experiences, but these necessary experiences are similar for the two sexes.

Use of insulin pump therapy at nighttime only for children 7-10 years of age with type 1 diabetes.

OBJECTIVE: Because of age-related developmental and cognitive issues, children <10 years of age may not be able to wear an insulin pump safely when they are not under direct parental supervision. The purpose of this study was to determine if insulin pump therapy at nighttime only, when children are at home, could improve fasting and nighttime blood glucose levels without adverse effects. RESEARCH DESIGN AND METHODS: The study cohort consisted of 10 children aged 7-10 years. A randomized crossover design was used to compare nighttime-only pump usage from dinner and throughout the night, combined with a prebreakfast injection of intermediate-acting NPH and rapid-acting lispro insulin, with 3 insulin injections per day. Comparisons were made among mean blood glucose values and percentage of blood glucose levels within the target range (70-150 mg/dl) before meals, at bedtime, and at 3:00 A.M.; serum fructosamine levels; and scores on measures of adherence and fear of hypoglycemia. RESULTS: Compared with baseline levels, the use of the pump resulted in a significant decrease in the mean average (P < 0.001), breakfast (P < 0.0001), and 3:00 A.M. (P < 0.003) blood glucose levels. There was a decrease in the percentage of blood glucose values less than the target range (P < 0.01) and in fructosamine (P < 0.01) values and an increase in the percentage of blood glucose levels within the target range (P < 0.03). CONCLUSIONS: Nighttime-only insulin pump therapy may be a viable alternative that young children can use to improve glycemia when they are not capable of independently managing an insulin pump.

Insulin pump therapy in type 1 pediatric patients: now and into the year 2000.

There are a number of medical conditions such as growth failure in children, pregnancy, lipid abnormalities, and early complications that are improved by the meticulous glycemic control that can be achieved with insulin pump therapy (CSII). By using an insulin pump, many patients with severe hypoglycemia, the dawn phenomenon, extremes of glycemic excursion, recurrent diabetic ketoacidosis (DKA) and hypoglycemia unawareness have amelioration of these problems. However, pump therapy involves problems such as weight gain, recurrent ketosis due to pump failure, infections, and risk of hypoglycemia. Owing to many developmental issues, young children may not be able to wear the pump without parental supervision. We have used the pump at night time only in these patients. This has allowed children of 7-10 years of age to benefit from improved nocturnal glycemia without the risk of pump therapy when they are without an adult to help. We have also used the pump in subjects with recurrent DKA and in our general patient population (mean age 13.6+/-3.9 years). In our pump cohort, CSII led to improvement in quality of life, knowledge, adherence, and responsibility. A reduction in hypoglycemia, DKA rate and mean HbA(1c) was associated with pump usage. For this to occur, however, pump education must be geared to the pediatric subject and his/her family. Education materials and tools help in learning how to use the pump and how to deal with the intricacies of basal and bolus dosing, and the effect of exercise, food and illness on diabetes management. The pump has improved since it was first introduced and these modifications have made it easier, more painless and less hazardous. With the development of continuous glucose sensors and implantable pumps, the next century will see pump therapy lead to the artificial pancreas.

The treatment and prevention of diabetic ketoacidosis in children and adolescents with type I diabetes mellitus.

There remain a number of important controversies in the management of pediatric DKA. From the sodium content of the hydrational fluid to the rate of fluid administration that is best able to reverse the hyperosmolar dehydration attendant with DKA with minimal morbidity and mortality, there is no universal agreement on how patients with this devastating metabolic disturbance should be treated. It is still unclear what promotes or protects patients from neurologic insult during DKA reversal. It is appropriate to begin to develop a national approach to eradicating DKA. This would require widespread public and professional education programs aimed at detecting new-onset type I patients prior to the onset of DKA. It would involve promoting diabetes screening programs aimed at detecting patients before the onset of symptomatic disease, and these would most appropriately be centered in the pediatrician's office. In the known patient, DKA still occurs as the result of intercurrent illness and nonadherence to the diabetes regimen due to patient or family chaos and dysfunction. Clearly, more strategies are needed to address these psychological and family patterns and the fact that many tenuous families have insufficient access to appropriate medical care. Those caring for children and adolescents must do all they can to prevent DKA and to treat it optimally to avert the toll this metabolic aberration takes on the pediatric diabetes population.

Use of a plastic insulin dosage guide to correct blood glucose levels out of the target range and for carbohydrate counting in subjects with type 1 diabetes.

OBJECTIVE: To improve glycemic control, a hand-held plastic Insulin Dosage Guide was developed to correct blood glucose levels outside of the target range. RESEARCH DESIGN AND METHODS: Protocol 1: Some 40 children (mean age 10.6+/-4.6 years) were randomly assigned for 3 months to use a written-on-paper algorithm or the Insulin Dosage Guide to correct abnormal blood glucose levels. Mean HbA1c and blood glucose levels and time to teach insulin dosage correction were compared. Protocol 2: The Insulin Dosage Guide was used by 83 subjects (mean age 11.4+/-4.3 years) for 1 year, and mean HbA1c levels, blood glucose levels, and number of consecutive high blood glucose values taken before and after the year were compared. Protocol 3: Some 20 patients (mean age 10.1+/-3.7 years) using rapid-acting insulin and 64 patients (mean age 15.9+/-3.6 years) using an insulin pump and rapid-acting insulin used the Insulin Dosage Guide and had mean blood glucose levels, HbA1c, and percentage of blood glucose levels outside of the target range determined. RESULTS: Protocol 1: There was a significant reduction in mean HbA1c (P = 0.04) and blood glucose levels (P = 0.05) and in the time needed to teach how to correct blood glucose values using the Insulin Dosage Guide compared with the paper algorithm. Protocol 2: There was a decrease in mean HbA1c levels (P = 0.0001) and a decrease in the mean number of consecutive blood glucose levels (P = 0.001) over the 1-year time period. Protocol 3: With rapid-acting insulin, there was a significant increase in the percentage of blood glucose levels within the target range (1 month, P = 0.04; at 3 months, P = 0.03). With the insulin pump, there was a high rate (90%) of blood glucose levels in the target range during pump initiation when the Insulin Dosage Guide was used. CONCLUSIONS: This inexpensive hand-held plastic card, which is portable and easy to use, may help patients improve glycemia and successfully manage diabetes.

Neurocognitive functioning in children diagnosed with diabetes before age 10 years.

Our objective was to determine scores on tests of neurocognitive functioning in children diagnosed with diabetes before age 10 years and to determine the association of age of diagnosis, duration of diabetes, subtle hypoglycemia, severe hypoglycemia, and history of hypoglycemic seizures with these neurocognitive test scores. Fifty-five of 62 eligible patients with a mean age of 7.9 +/- 1.6 years followed in our center were given the Woodcock-Johnson Psychoeducational Battery, Beery Developmental Test of Visual-Motor Integration, Finger Tapping, Grooved Pegboard, and Verbal Selective Reminding tests to evaluate the following domains: memory/attention, visual-perceptual, broad cognitive function, academic achievement, and fine motor speed/coordination. Fifteen age-matched siblings served as controls. Twenty-seven subjects were less than 5 years of age when diagnosed with diabetes, the mean age at diagnosis was 4.5 +/- 2.1 years of age, and mean diabetes duration was 2.6 +/- 2.0 years. Eighteen patients had a history of severe hypoglycemia, eight of whom had hypoglycemic seizures. The mean HbA1c was 7.8 +/- 1.1% for the year prior to testing. Our results showed that the overall mean scores for the extensive neurocognitive battery were within the normal range and were comparable to the scores of the age-matched sibling controls. Age of diagnosis and duration of diabetes did not relate to neurocognitive test results. Mean HbA1c had a negative association with some tests of memory/attention (p < 0.03-0.04) and academic achievement (p < 0.005-0.03), while number of blood glucose levels less than mg/dL had a positive association with memory/attention (p < 0.004-0.04), verbal comprehension (p < 0.03) and academic achievement (p < 0.018-0.05). There was no association of neurocognitive test scores with severe hypoglycemia, but subjects with history of hypoglycemic seizures had a decrease in scores on tests assessing memory skills (p < 0.03) including short term memory and memory for words. These data suggest that overall neurocognitive test scores were within the normal range and comparable to controls. However, specific aspects of neurocognitive functioning may be adversely affected by having had a hypoglycemic seizure, but not by episodes of severe hypoglycemia without seizure. Lower HbA1c and an increase in the number of blood glucose levels less than 70 mg/ dL (subtle hypoglycemia) which were associated with higher scores in some domains of academic achievement and memory suggests that stable glycemia may influence cognitive abilities and/or that successful diabetes management requires cognitive skills. Strategies to diminish the risk of seizures with hypoglycemia should be investigated.

Association between diabetes control and visits to a multidisciplinary pediatric diabetes clinic.

OBJECTIVE: To determine if there is a relationship between diabetes outcome as measured by HbA1C and the number of multidisciplinary clinic visits per year in children and youth with diabetes. RESEARCH DESIGN AND METHODS: The number of clinic visits per year, the mean HbA1C (by DCA 2000, Miles, Tarrytown, NY), type of insurance, parental marital status, parental age, maximal parental grade level achieved, family income, self-identified race, and scores on adherence and knowledge tests were compared for 1995 in 360 patients with a mean age of 11.6 +/- 4.8 years (1-2 visits, 85 patients; 3-4 visits, 275 patients), for 1996 in 412 patients with a mean age of 11.6 +/- 4.7 years (1-2 visits, 115 patients; 3-4 visits, 297 patients), and for 1997 in 442 patients with a mean age of 11.8 +/- 4.9 years (1-2 visits, 126 patients; 3-4 visits, 332 patients). RESULTS: There was a significant difference in the mean HbA1C levels between subjects with 1 to 2 visits versus 3 to 4 visits during the 3 years of this study. In 1995, the mean HbA1C was 9.0 +/- 2.0% for subjects with 1 to 2 visits and 8.3 +/- 1.6% for subjects with 3 to 4 visits. In 1996, the mean HbA1C was 9.3 +/- 2.0% for subjects with 1 to 2 visits and 8.4 +/- 1.6% in those with 3 to 4 visits, whereas in 1997, the mean HbA1C was 9.1 +/- 1.9% with 1 to 2 visits and 8.3 +/- 1.5% with 3 to 4 visits. There was a significant difference in the number of visits by the age of the subject. The mean age of patients with 1 to 2 visits was 13.6 +/- 4.5 years; it was 10.8 +/- 4.6 years with 3 to 4 visits. However, for age groups <13 years versus >/=13 years, there was still a difference between HbA1C levels for subjects with 1 to 2 visits compared with 3 to 4 visits (8.9 +/- 1.7% versus 8.1 +/- 1.3%, respectively). The only patient/family characteristic that had an association with number of visits was the marital status of the parents. Children from single-parent households had fewer visits. There was no association between health insurance status and number of visits and there was no difference between the number of visits and the mean scores on tests of adherence or knowledge. Multivariate analysis showed that the number of visits was a significant predictor of HbA1C even after controlling for age, duration of diabetes, and scores on adherence and knowledge tests. CONCLUSIONS: The finding that subjects with more frequent visits to a multidisciplinary diabetes clinic had lower HbA1C levels during the 3 years of this study suggests that strategies should be developed to promote adherence with quarterly visits, particularly targeted to children from single-parent households and to teens.

alpha4 and alpha5 integrins costimulate the CD3-dependent proliferation of fetal thymocytes.

Although integrin receptors have been shown to function as costimulatory molecules on mature thymocytes and T cells, it is not known whether these receptors can function as costimulatory molecules on immature thymocytes. Previous studies have shown that the expression of alpha4 and alpha5 integrins were significantly higher on immature, adult CD4(-)CD8(-) thymocytes than on either mature thymocytes or T cells, suggesting that these receptors are involved in early thymocyte development. In this study, we show that day 16 fetal thymocytes express levels of alpha4 and alpha5 equivalent to those of adult CD4(-)CD8(-) thymocytes. Immobilized fibronectin, a ligand for alpha4 and alpha5 integrins, was found to enhance the CD3-dependent proliferation of these fetal thymocytes. In the presence of IL-7, the magnitude of the proliferative response increased with time of incubation, resulting in a dramatic increase in the percentage of gammadelta thymocytes. The enhancement of proliferation by fibronectin was abrogated by soluble antibodies against alpha4 and alpha5, whereas immobilized mAb to alpha4 and alpha5 substituted for fibronectin in enhancing CD3-dependent proliferation, demonstrating that alpha4 and alpha5 integrins were responsible for the enhanced proliferation by fibronectin. Anti-alpha4 mAb enhanced proliferation of fetal thymocytes by 100%, whereas anti-alpha5 mAb and anti-CD28 mAb enhanced proliferation by 25%. Other costimulatory molecules, such as CD2, FcRgamma, and Thy-1, had no effect on the CD3-dependent proliferation of day 16 fetal thymocytes. This study demonstrates that alpha4 and alpha5 integrins are capable of costimulating fetal thymocytes.

CD28 dependence of T cell differentiation to IL-4 production varies with the particular type 2 immune response.

T cell differentiation to effector cell function is required for the development of a type 2 immune response. The T cell surface molecule, CD28, is widely considered to be the principal costimulatory molecule involved in T cell differentiation to effector function, including IL-4 production, although this has been difficult to directly examine in vivo. We have studied in vivo differentiation to T cell effector function during two type 2 immune responses in CD28 knockout mice: the systemic immune response to goat anti-mouse IgD Ab and the mucosal immune response following oral inoculation with the nematode parasite, Heligmosomoides polygyrus. Our results show that in C57BL/6 CD28 knockout mice elevations in IL-4 gene expression and protein secretion are blocked during the immune response to goat anti-mouse IgD, and associated increases in serum IgG1 and IgE are also inhibited to untreated control levels. In marked contrast, T cell differentiation to IL-4 production is comparable in C57BL/6 CD28 -/- and CD28 +/+ H. polygyrus-inoculated mice, and elevations in both serum IgG1 and IgE levels occur. These results indicate that the specific kind of type 2 immune response determines whether T cell differentiation to IL-4 production is CD28 dependent.

Effects of blocking B7-1 and B7-2 interactions during a type 2 in vivo immune response.

The costimulatory signal provided to T cells through CD28/CTLA-4 interactions is required for in vivo Th cell effector function associated with cytokine production. However, it is uncertain whether the two well-characterized ligands for these molecules, B7-1 and B7-2, differentially influence the consequent development of a type 1 or a type 2 primary response. We have examined the in vivo effects of blocking B7-1 and/or B7-2 ligand interactions on the type 2 mucosal immune response that follows oral infection of mice with the nematode parasite, Heligmosomoides polygyrus. Administration of the combination of anti-B7-1 and anti-B7-2 Abs inhibited H. polygyrus-induced increases in serum IgG1 and IgE levels, the expansion of mesenteric lymph node (MLN) germinal centers, in situ CD4+ T cell expansion, elevated blood eosinophils, and increased intestinal mucosal mast cells. Similarly, both Abs blocked MLN and Peyer's patch cytokine gene expression and elevations in MLN T cell-derived IL-4 protein secretion. However, in the same experiments, administration of either anti-B7-1 or anti-B7-2 Abs alone had little effect on any of these parameters. T cell and B cell activation was also blocked by the combination of anti-B7-2 and a B7-1-specific mutant Y100F CTLA-4Ig construct. These results suggest that to the extent that anti-B7-1 and anti-B7-2 mAbs block B7 interactions, either B7-1 or B7-2 ligand interactions can provide the required costimulatory signals that lead to T cell effector function during a type 2 in vivo immune response.

The function of costimulatory molecules and the development of IL-4-producing T cells.

The development of IL-4-producing effector T cells during a type 2 immune response requires signaling through B7 ligands, but probably not CD40 ligands. Here, William Gause and colleagues review the still controversial role of CD28 and CTLA-4 on T cells, and B7-1 and B7-2 on antigen-presenting cells, and provide a model to incorporate recent findings.

Evaluation of a snack bar containing uncooked cornstarch in subjects with diabetes.

The objective of this study was to determine the effect of a snack bar containing uncooked cornstarch, equivalent to 1 1/2 starch/bread exchanges (bar 1), compared to a control bar (bar 2), on the incidence of nocturnal and morning hypoglycemia in subjects with diabetes. Adolescent campers and counselors with diabetes (n = 79) were randomly assigned to Group A (5 nights of snack bar 1 as the evening snack, followed by 5 nights of snack bar 2) or Group B (5 nights of snack bar 2 as the evening snack, followed by 5 nights of snack bar 1). Midnight and morning finger stick blood glucose levels were compared to determine the incidence of hypoglycemia (< 60 mg/dl) and hyperglycemia (> 250 mg/dl), and events were analyzed for the total cohort, Group A, and Group B and by glycated hemoglobin quartile to determine the effect of each bar on glycemia. For subjects with diabetes there was a significant decrease in the number of hypoglycemic episodes with bar 1 compared to bar 2 at midnight (total cohort and Groups A and B) and in the morning (total cohort and Group A). There was a significant decrease in the number of subjects to ever experience hypoglycemia with snack bar 1 compared to snack bar 2, a significantly lower incidence of hyperglycemic episodes at midnight with snack bar 1, and no difference in the incidence of hypoglycemia by glycated hemoglobin quartile. These data suggest that the snack bar containing uncooked cornstarch can diminish night time and morning hypoglycemia in subjects with diabetes, without causing hyperglycemia.

Changes in Medicare reimbursement for ostomy supplies: an overview.

Medicare reimbursement and utilization for ostomy supplies have undergone dramatic change in the last year. This article provides an introduction for health care professionals to the Medicare system, Durable Medical Equipment Regional Carriers, Medicare participating and nonparticipating suppliers, and practical examples of how reimbursement may affect the selection of ostomy products. The topics covered refer to Medicare Part B. ET nurses must be cognizant of the ongoing changes in reimbursement and must collaborate with suppliers, manufacturers, and other health care professionals to provide patients with the highest quality care, products, and services.

The vitronectin receptor (alpha V beta 3) as an example for the role of integrins in T lymphocyte stimulation.

Integrins are a family of cell surface receptors which mediate the adhesion of cells to each other or to extracellular matrix (ECM) proteins. The interaction of integrins with their ligands or counter-receptors was initially considered to be a one-way process in that cells actively regulate the interaction of integrins with their ligands ('inside-out signal'). In contrast, it was not obvious that cells would receive a signal from the outside via the integrin heterodimers following ligand binding ('outside-in signal'). Recent evidence increasingly supports the active role of integrins in cell activation and proliferation. Many reports describe the effects of integrin-mediated signaling in lymphoid cells. Our studies of gamma/delta T cells, expressing the beta 3 integrin vitronectin receptor (VNR), reflect some of the consequences this active interaction between lymphocytes and the ECM could have for T cell activation and differentiation. The VNR has been described as a T cell costimulatory molecule. We recently reported that the VNR has the potential to stimulate cytokine secretion in T cell hybridomas without involvement of T cell receptor-mediated signals. Further studies demonstrated tyrosine phosphorylation of proteins following VNR cross-linking and the interaction of the VNR with protein kinases. Intensive research focuses on the signal transduction mechanisms of integrins and their interaction with other costimulatory or activation molecules. This knowledge is important to better understand the role of adhesion molecules, the ECM, and the cellular microenvironment for lymphocyte activation and differentiation.

A randomized, blinded trial of uncooked cornstarch to diminish nocturnal hypoglycemia at diabetes camp.

OBJECTIVE: To determine if uncooked cornstarch, as part of the evening snack, can avert nocturnal hypoglycemia in type 1 diabetes. RESEARCH DESIGN AND METHODS: Fifty-one campers and counselors at the American Diabetes Association Camp in San Bernardino, CA were randomly assigned to receive 5 g of uncooked cornstarch as part of the 21:00 evening snack vs. a standard snack of equivalent carbohydrate content. Each snack was given for five nights and the participants and medical personnel were blinded as to assignment. Midnight and 07:00 finger stick blood glucose levels were compared with values <60 mg/dl defined as hypoglycemia and values > 250 mg/dl defined as hyperglycemia. RESULTS: There were 218 midnight and 222 07:00 values for comparison. There were six episodes of hypoglycemia at midnight and nine episodes of hypoglycemia at 07:00 for the cornstarch snack nights vs. 30 hypoglycemia episodes at midnight and 21 at 07:00 for the standard snack nights (P < 0.001 and <0.05, respectively). There was no difference in the number of hyperglycemic events at midnight or 07:00 for the cornstarch vs. standard snack nights. At midnight, 12% of campers had hypoglycemia after the cornstarch snack vs. 46% after the standard snack (P < 0.001), and at 07:00, 16% had hypoglycemia after cornstarch vs. 26% after the standard snack (P = 0.327). CONCLUSIONS: These data suggest that uncooked cornstarch, as part of the evening snack, can diminish the nighttime and morning hypoglycemia associated with type 1 diabetes, without causing hyperglycemia.