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Insulin detemir (IDet) is a novel long acting insulin analogue. Previous studies have shown a reduced frequency of hypoglycaemia and less weight gain with IDet compared with NPH insulin (NPH). To investigate symptoms, counterregulatory hormone response, cognitive function and metabolism during hypoglycaemia with IDet and NPH, 23 patients with type 1 diabetes were enrolled in a double blind, randomised, cross-over trial. Following an overnight fast either IDet or NPH were injected subcutaneously (first 5 subjects: 0.4 U/Kg, subsequent 18 subjects: 0.5 U/Kg) and blood glucose was allowed to decline from a baseline level of 7 mmol/l to a minimum of 2.4 mmol/l. Symptoms of hypoglycaemia (based on the Edinburgh Hypoglycaemia Scale), cognitive function (finger tapping test and four choice reaction time test) and autonomic response (heart rate and blood pressure) were recorded at regular intervals. Blood was frequently sampled for measurement of IDet, human insulin, nonesterified fatty acids and counter-regulatory hormones (glucagon, adrenaline, noradrenaline, growth hormone, cortisol and insulin-like growth factor binding protein 1). The blood glucose profiles following IDet/NPH administration were similar and the expected physiological response to hypoglycaemia was observed with no difference between IDet and NPH in symptoms of hypoglycaemia, cognitive function, autonomic response or counter-regulatory hormone responses. These results are reassuring and important as thousands of patients worldwide are now being treated with insulin detemir. [ABSTRACT FROM AUTHOR]