Physical exercise (PE) is a strong stimulant of glucose absorption by the skeletal muscles, a phenomenon that results from an increase in the rates of glucose release, transmembranal transport of glucose, and substrate flow at the intracellular level through glycolysis. 1 Although PE is an important tool for maintaining or improving cardiovascular fitness, most studies on the impact of PE on DM1 have not shown objective improvements on glycemic control. 2 It has been described that type 1 diabetic athletes show alterations in their metabolic control compared to sedentary type 1 diabetics.2 The fear of a hypoglycemic event underlies this finding because overcompensation generally occurs in terms of additional carbohydrate intake prior to exercise and excessive reductions to insulin dosages. 2 In fact, in a pediatric population, hypoglycemia during or after exercise is the most frequent specific cause of severe hypoglycemia, with most of the severe events occurring at night. 3It has been established that hypoglycemia associated with exercise is determined by an increase in glucose absorption, the inability of PE per se to decrease insulin levels, and the presence of autonomous diabetic neuropathy. 4 A history of hypoglycemia can deteriorate even further the adrenergic activity in response to hypoglycemia caused by exercise. Abstract Background: Although physical exercise (PE) is recommended for individuals with type 1 diabetes (DM1), participation in exercise is challenging because it increases the risk of severe hypoglycemia and the available therapeutic options to prevent it frequently result in hyperglycemia. There is no clear recommendation about the best timing for exercise. The aim of this study was to compare the risk of hypoglycemia after morning or afternoon exercise sessions up to 36 hours postworkout. Methods: This randomized crossover study enrolled subjects with DM1, older than 18 years of age, on sensor-augmented insulin pump (SAP) therapy. Participants underwent 2 moderate-intensity exercise sessions; 1 in the morning and 1 in the afternoon, separated by a 7 to 14 day wash-out period. Continuous glucose monitoring (CGM) data were collected 24 hours before, during and 36 hours after each session. Results: Thirty-five subjects (mean age 30.31 ± 12.66 years) participated in the study. The rate of hypoglycemia was significantly lower following morning versus afternoon exercise sessions (5.6 vs 10.7 events per patient, incidence rate ratio, 0.52; 95% CI, 0.43-0.63; P < .0001). Most hypoglycemic events occurred 15-24 hours after the session. On days following morning exercise sessions, there were 20% more CGM readings in near-euglycemic range (70-200 mg/dL) than on days prior to morning exercise (P = .003). Conclusions: Morning exercise confers a lower risk of late-onset hypoglycemia than afternoon exercise and improves metabolic control on the subsequent day.

An intervention consisting of an educational program and a basal-bolus insulin regimen in type 1 and type 2 diabetes mellitus patients undergoing PD caused a decrease in HbA1c levels, and mean blood glucose levels as measured from CGM with no significant increases in hypoglycemia episodes.

We report three patients with rheumatoid arthritis (RA) who were treated with anti-TNF-α agents and who developed drug-induced lupus (DIL). Two of them received etanercept and the remainder adalimumab. We also present the favorable response observed with the withdrawal of the anti-TNF-alpha agents and the introduction of rituximab. Through this intervention, we observed a very good control of the activity of both DIL and RA without additional adverse reactions.

Introducción La diabetes mellitus tipo 1 (DM1) es una enfermedad que suele aparecer tempranamente, lo cual implica que los pacientes convivan con ella durante muchos años. Del adecuado control clínico que se logre dependerán los resultados. Como se trata de una condición con potenciales complicaciones serias, es imperativo tener claridad sobre su diagnóstico, su tratamiento y su seguimiento, para minimizar su impacto en la morbilidad, la calidad de vida y la mortalidad.El diagnóstico es relativamente claro en niños y adolescentes, pero, a medida que se avanza en edad, se debe diferenciar entre la presencia de diabetes tipo 1 y la de tipo 2, pues el enfoque terapéutico es diferente y la falta de reconocimiento oportuno puede ocasionar un mal manejo.Por otra parte, es necesario que se genere un consenso para establecer la forma como estos pacientes deben ser evaluados periódicamente, lo cual no solo debe poner de manifiesto el intervalo en el que debe hacerse, sino también, el equipo humano que debe participar en dicho seguimiento.