Effect of Exercise Intensity on Glucose Requirements to Maintain Euglycemia During Exercise in Type 1 Diabetes

Shetty, Vinutha B; Fournier, Paul A.; Davey, Raymond J.; Retterath, Adam; Paramalingam, Nirubasini; Roby, Heather; Cooper, Matthew N.; Davis, Elizabeth A.; Jones, Timothy W.

doi:10.1210/jc.2015-4026

Cited by 56 publications

(59 citation statements)

References 40 publications

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“…However, when plasma insulin is at near basal levels, blood glucose level often remains stable or fall at a low rate in response to exercise of moderate intensity, but not if aerobic exercise is intense since intense aerobic exercise under basal or near basal insulinemic conditions is associated with a rise in blood glucose level . Overall, their appears to be an inverted U‐shape in the relationship between aerobic exercise intensity and muscle glucose disposal, with the highest risk for hypoglycemia likely occurring at about 50% of the individuals’ maximal aerobic capacity …”

Section: The Impact Of Exercise On Blood Glucose Levelsmentioning

confidence: 99%

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ISPAD Clinical Practice Consensus Guidelines 2018: Exercise in children and adolescents with diabetes

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Section: The Impact Of Exercise On Blood Glucose Levelsmentioning

confidence: 99%

“…It is more likely to occur with mod intensity exercise compared with intermittent high intensity exercise. Perhaps counterintuitively, hypoglycemia is less likely with high intensity exercise than with moderate intensity effort …”

Section: Hypoglycemiamentioning

confidence: 99%

ISPAD Clinical Practice Consensus Guidelines 2018: Exercise in children and adolescents with diabetes

et al. 2018

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“…[1], blood glucose generally drops during low- and moderate-intensity exercise in people with type 1 diabetes, but it may even increase during and after high-intensity exercise [7]. Adrenaline and noradrenaline have been shown to be the main regulators to target for avoiding blood glucose decreases during high-intensity exercise due to increased rates of glycogen breakdown.…”

Section: Discussionmentioning

confidence: 99%

“…Shetty et al . [1] found an inverted U-shaped relationship between exercise intensity and glucose requirement investigated via glucose infusion rate in a euglycemic clamp. In line with valuable reviews [2, 3], it is suggested to adapt therapy to avoid exercise-induced hypoglycemia.…”

Section: Introductionmentioning

confidence: 99%

Atypical blood glucose response to continuous and interval exercise in a person with type 1 diabetes: a case report

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BackgroundTherapy must be adapted for people with type 1 diabetes to avoid exercise-induced hypoglycemia caused by increased exercise-related glucose uptake into muscles. Therefore, to avoid hypoglycemia, the preexercise short-acting insulin dose must be reduced for safety reasons. We report a case of a man with long-lasting type 1 diabetes in whom no blood glucose decrease during different types of exercise with varying exercise intensities and modes was found, despite physiological hormone responses.Case presentationA Caucasian man diagnosed with type 1 diabetes for 24 years performed three different continuous high-intensity interval cycle ergometer exercises as part of a clinical trial (ClinicalTrials.gov identifier NCT02075567). Intensities for both modes of exercises were set at 5% below and 5% above the first lactate turn point and 5% below the second lactate turn point. Short-acting insulin doses were reduced by 25%, 50%, and 75%, respectively. Measurements taken included blood glucose, blood lactate, gas exchange, heart rate, adrenaline, noradrenaline, cortisol, glucagon, and insulin-like growth factor-1. Unexpectedly, no significant blood glucose decreases were observed during all exercise sessions (start versus end, 12.97 ± 2.12 versus 12.61 ± 2.66 mmol L−1, p = 0.259). All hormones showed the expected response, dependent on the different intensities and modes of exercises.ConclusionsPeople with type 1 diabetes typically experience a decrease in blood glucose levels, particularly during low- and moderate-intensity exercises. In our patient, we clearly found no decline in blood glucose, despite a normal hormone response and no history of any insulin insensitivity. This report indicates that there might be patients for whom the recommended preexercise therapy adaptation to avoid exercise-induced hypoglycemia needs to be questioned because this could increase the risk of severe hyperglycemia and ketosis.

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“…A clamp study found IV glucose demand changed as the level of physical exercise was increased consecutively. The glucose infusion rate was increased at a moderately intense level of exercise, while the need for IV glucose disappeared during high-intensity exercise [92]. The latter illustrates the complexity involved in attempting to take physical activity into account, as the need for insulin can vary during exercise in ways that are difficult to predict.…”

Section: Methodsmentioning

confidence: 99%

A Review of the Current Challenges Associated with the Development of an Artificial Pancreas by a Double Subcutaneous Approach

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IntroductionPatients with diabetes type 1 (DM1) struggle daily to achieve good glucose control. The last decade has seen a rush of research groups working towards an artificial pancreas (AP) through the application of a double subcutaneous approach, i.e., subcutaneous (SC) continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion. Few have focused on the fundamental limitations of this approach, especially regarding outcome measures beyond time in range.MethodsBased on insulin physiology, the limitations of CGM, SC insulin absorption, meal challenge, and physical activity in DM1 patients, we discuss the limitations of the double SC approach. Finally, we discuss safety measures and the achievements reported in some recent AP studies that have utilized the double SC approach.ResultsMost studies show that a double SC AP increases the time in range compared to a sensor-augmented insulin pump and shortens the time in hypoglycemia. Despite these achievements, the proportion of time spent in hyperglycemia is still roughly 20–40%, and hypoglycemia is still present 1–4% of the time. The main factors limiting further progress are the latency of SC CGM (at least 5–10 min) and the slow pharmacokinetics of SC-delivered fast-acting insulin. The maximum blood insulin level is reached after 45 min and the maximum glucose-lowering effect is observed after 1.5–2 h, while the glucose-lowering effect lasts for at least 5 h.ConclusionsAlthough using a double SC AP leads to significant improvements in glucose control, the SC approach has severe limitations that hamper further progress towards a robust AP.

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Effect of Exercise Intensity on Glucose Requirements to Maintain Euglycemia During Exercise in Type 1 Diabetes

Abstract: Our findings support the predicted inverted-U relationship between exercise intensity and glucose requirement. However, the relationship between iv and oral glucose requirements needs to be investigated to translate these GIR data to clinical practice.

Cited by 56 publications

References 40 publications

ISPAD Clinical Practice Consensus Guidelines 2018: Exercise in children and adolescents with diabetes

ISPAD Clinical Practice Consensus Guidelines 2018: Exercise in children and adolescents with diabetes

Atypical blood glucose response to continuous and interval exercise in a person with type 1 diabetes: a case report

A Review of the Current Challenges Associated with the Development of an Artificial Pancreas by a Double Subcutaneous Approach

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