OBJECTIVE -To evaluate and validate appropriate premeal insulin dose reductions for postprandial exercises of different intensities and durations to minimize the risk of exerciseinduced hypoglycemia in type 1 diabetic subjects.RESEARCH DESIGN AND METHODS -Eight male type 1 diabetic patients on a basal-bolus insulin regimen of ultralente (UL) as basal insulin and lispro (LP) as premeal insulin were tested in a randomized, crossover fashion during postprandial exercise at 25% VO 2max for 60 min, 50% VO 2max for 30 and 60 min, and 75% VO 2max for 30 min starting 90 min after a standardized mixed breakfast (600 kcal, 75 g carbohydrates). Each subject served as his own control and was tested after a full dose of insulin LP (LP 100%) and/or 50% (LP 50%) and/or 25% (LP 25%) of the current dose.RESULTS -At all intensities, the full premeal insulin dose was associated with an increased risk of hypoglycemia. At 25% VO 2max for 60 min, a 50% reduction in the premeal insulin dose resulted in plasma glucose of Ϫ0.62 mmol/l compared with baseline at the end of exercise. At 50% VO 2max for 30 and 60 min, 50 and 75% reductions of the premeal insulin dose were associated with plasma glucose of Ϫ0.39 and ϩ0.49 mmol/l, respectively, at the end of the exercise. At 75% VO 2max , a 75% reduction of the premeal insulin dose was required to achieve appropriate postexercise plasma glucose (ϩ0.71 mmol/l). Such reductions in the premeal insulin dose resulted in a 75% decrease in the incidence of exercise-induced hypoglycemia.CONCLUSIONS -In well-controlled type 1 diabetic subjects on intensive insulin therapy with the basal-bolus (UL-LP) insulin regimen, risk of hypoglycemia can be minimized during postprandial exercises of different intensities and different durations by appropriate reduction of premeal insulin LP.

To evaluate the influence of a low glycaemic index (GI), high GI and high fibre diet on glycaemic control and insulin requirement in Type 1 diabetic patients on intensive insulin therapy, nine well-controlled, highly-motivated Type 1 diabetic patients were put on a control diet for 12 days and then randomized in a consecutive manner to 12 days of each diet, in a crossover design. During each experimental diet, the study subjects adjusted their premeal insulin (soluble) dose to maintain their 1-h postprandial capillary glucose at or below 10 mmol l(-1). At the end of each experimental diet, they were submitted to a standardized breakfast of the diet under study, using the same premeal insulin dose as that required for the control diet. The control diet contained 16.0+/-3.0 g of fibre day(-1) with a GI of 77.4+/-2.7 compared to 15.3+/-6.3 and 66.2+/-1.2 for the low GI diet, 17.1+/-7.2 and 92.9+/-3.6 for the high GI diet, and 56.1+/-3.6 (including 15 g of guar) and 73.5+/-2.1 for the high fibre diet. Prebreakfast capillary blood glucose (6.2+/-1.2 mmol l(-1)) on the low GI diet and postbreakfast capillary blood glucose (8.7+/-1.8 mmol l(-1)) on the high fibre diet were significantly lower than the values obtained with the control diet (8.0+/-1.8 and 10.6+/-2.4, respectively; p<0.05). No change in premeal or basal insulin dose was required. During the standardized breakfasts, the incremental area under the curve was 1.6+/-1.5 mmol l(-1) min(-1) for the control diet compared to 1.1+/-1.8 for the low GI diet, 3.2+/-1.4 for the high GI diet (p<0.05 versus low GI and high fibre; p=0.08 versus control), and 1.0+/-0.9 for the high fibre diet. These observations indicate that in well-controlled Type 1 diabetic subjects on intensive insulin therapy, major alterations in the GI and fibre content of meals induce small but significant changes in glucose profile. In everyday life, however, these differences are blunted, and plasma glucose remains within the target range for optimal metabolic control.

OBJECTIVE: To study the effect of¯uoxetine, a speci®c serotonin reuptake inhibitor, on insulin sensitivity in obese patients with non-insulin-dependent diabetes mellitus (NIDDM) independently of its action on body weight. RESEARCH DESIGN AND METHODS: In a randomized, double-blind, placebo-controlled trial, insulin-mediated glucose disposal was measured in 12 obese patients with NIDDM on diet alone before and after four weeks of treatment with either placebo (n 6) or¯uoxetine (n 6) at a dose level of 60 mg once a day. Insulin-mediated glucose disposal was assessed by the 2-step euglycemic hyperinsulinemic clamp technique. Patients were instructed on a weightmaintaining diet. RESULTS: Insulin infusion at 40 mU ? m 72 ? min 71 resulted in insulin levels of 720670 pmol ? L 71 with a mean plasma glucose value of 6.460.2 mmol ? L 71 . Compared to placebo,¯uoxetine increased glucose disposal (M) by 2.4-fold (P`0.05), the insulin sensitivity index (M/I) by 2.7-fold (P`0.03) and the glucose metabolic clearance rate (MCR) by 2.9-fold (P`0.03). Insulin infusion at 400 mU ? m 72 ? min 71 elicited insulin levels of 12 94761 512 pmol ? L 71 with a mean plasma glucose value of 5.660.4 mmol ? L 71 . Compared to placebo,¯uoxetine increased M by 30% (P NS), M/I by 40% (P`0.04) and MCR by 23% (P`0.04). Patient weight remained stable throughout the study with no change in dietary intake. CONCLUSION: Fluoxetine improves insulin-mediated glucose disposal in obese patients with NIDDM independently of weight loss.