Effects of Performing Morning Versus Afternoon Exercise on Glycemic Control and Hypoglycemia Frequency in Type 1 Diabetes Patients on Sensor-Augmented Insulin Pump Therapy

Abstract

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.

Greater Adherence to Recommended Morning Physical Activity is Associated With Greater Total Intervention-Related Physical Activity Changes in Bariatric Surgery Patients

“…16–18 Additionally, morning PA, particularly in the fasted state, may contribute to improved metabolic control on the day of and day after exercise. 19,20 Additional research is needed to confirm whether morning exercise confers similar benefits in BS patients, and if such benefits can enhance the effects of exercise on postoperative weight and metabolic outcomes.…”

Reduction in insulin degludec dosing for multiple exercise sessions improves time spent in euglycaemia in people with type 1 diabetes: A randomized crossover trial

“…Interestingly, despite this lack of research, a recent review did not recommend IDeg dose reductions around regular exercise because this might compromise overall glycaemic control . Nocturnal hypoglycaemia, a potentially life‐threatening event, occurs more frequently in people with T1D after performing exercise compared with when daily exercise was not performed because of the extended effect of exercise . The incidence of developing post‐exercise hypoglycaemia after moderate‐intensity exercise has been reported to be up to 66% in individuals with T1D across studies .…”

“…The same is also true for people with T1D performing a week of irregular exercise, such as a skiing week or an activity holiday. 14 15,16 occurs more frequently in people with T1D after performing exercise compared with when daily exercise was not performed because of the extended effect of exercise. 17 The incidence of developing post-exercise hypoglycaemia after moderate-intensity exercise has been reported to be up to 66% in individuals with T1D across studies.…”

De la bomba de insulina y el monitoreo continuo de glucosa al páncreas artificial

“…Uno de los grandes beneficios del uso de tecnología en diabetes es la disminución de la HS o inducida por ejercicio [24][25][26] , especialmente cuando se utiliza SAPT con sistema de suspensión automática de la infusión frente a hipoglicemia [27][28][29] . Se recomienda el uso de SAPT, con o sin suspensión automática de insulina, en aquéllos sujetos en que los episodios de HS sean recurrentes y/o no manifiesten síntomas 30 .…”