Exercise-induced hypoglycaemia in IDDM patients treated with a short-acting insulin analogue

Tuominen, J. A.; Karonen, S.-L.; Melamies, L.; Bolli, Geremia B.; Koivisto, Veikko A.

doi:10.1007/bf02369359

Cited by 102 publications

(70 citation statements)

References 24 publications

(29 reference statements)

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“…Fear of exercise-induced hypoglycaemia poses a significant barrier to active participation in recreational sports and games in patients with type 1 diabetes [1][2][3]. The incidence of hypoglycaemia during an acute bout of moderateintensity exercise in children and adolescents with type 1 diabetes has been recently reported to be up to 30% [4].…”

Section: Introductionmentioning

confidence: 99%

“…During exercise, systemic and to a lesser extent portal insulin concentrations will be higher in patients with type 1 diabetes treated with exogenous insulin than in normal subjects. Therefore, when patients exercise typically with high insulin concentrations [3,10], this may suppress hepatic glucose output [11] with a consequent risk of hypoglycaemia both during and after exercise [11]. Indeed, infusing insulin during exercise in normal volunteers is associated with suppressed splanchnic glucose output [12].…”

Section: Introductionmentioning

confidence: 99%

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Hyperinsulinaemia during exercise does not suppress hepatic glycogen concentrations in patients with type 1 diabetes: a magnetic resonance spectroscopy study

et al. 2007

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Aims/hypothesis We compared in vivo changes in liver glycogen concentration during exercise between patients with type 1 diabetes and healthy volunteers. MethodsWe studied seven men with type 1 diabetes (mean ± SEM diabetes duration 10±2 years, age 33±3 years, BMI 24±1 kg/m 2 , HbA 1c 8.1±0.2% and VO 2 peak 43±2 ml [kg lean body mass] −1 min −1 ) and five non-diabetic controls (mean ± SEM age 30±3 years, BMI 22±1 kg/m 2 , HbA 1c 5.4±0.1% and VO 2 peak 52±4 ml [kg lean body mass] −1 min −1 , before and after a standardised breakfast and after three bouts (EX1, EX2, EX3) of 40 min of cycling at 60% VO 2 peak. 13 C Magnetic resonance spectroscopy of liver glycogen was acquired in a 3.0 T magnet using a surface coil. Whole-body substrate oxidation was determined using indirect calorimetry.Results Blood glucose and serum insulin concentrations were significantly higher (p<0.05) in the fasting state, during the postprandial period and during EX1 and EX2 in subjects with type 1 diabetes compared with controls. Serum insulin concentration was still different between groups during EX3 (p<0.05), but blood glucose concentration was similar. There was no difference between groups in liver glycogen concentration before or after the three bouts of exercise, despite the relative hyperinsulinaemia in type 1 diabetes. There were also no differences in substrate oxidation rates between groups. Conclusions/interpretation In patients with type 1 diabetes, hyperinsulinaemic and hyperglycaemic conditions during moderate exercise did not suppress hepatic glycogen concentrations. These findings do not support the hypothesis that exercise-induced hypoglycaemia in patients with type 1 diabetes is due to suppression of hepatic glycogen mobilisation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hyperinsulinaemia during exercise does not suppress hepatic glycogen concentrations in patients with type 1 diabetes: a magnetic resonance spectroscopy study

et al. 2007

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“…Unfortunately, participation in exercise can also increase the risk of experiencing hypoglycemia in individuals with type 1 diabetes, both during exercise (6,7) and for up to 31 h of recovery (8). Consequently, many individuals with type 1 diabetes feel negatively toward physical activity (9) and are discouraged from participating in sports and games by their parents, school staff, or physicians (10).…”

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confidence: 99%

The Decline in Blood Glucose Levels Is Less With Intermittent High-Intensity Compared With Moderate Exercise in Individuals With Type 1 Diabetes

2005

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OBJECTIVE -To compare the response of blood glucose levels to intermittent highintensity exercise (IHE) and moderate-intensity exercise (MOD) in individuals with type 1 diabetes. RESEARCH DESIGN AND METHODS-Seven healthy individuals with type 1 diabetes were tested on two separate occasions, during which either a 30-min MOD or IHE protocol was performed. MOD consisted of continuous exercise at 40% VO 2peak , while the IHE protocol involved a combination of continuous exercise at 40% VO 2peak interspersed with 4-s sprints performed every 2 min to simulate the activity patterns of team sports.RESULTS -Both exercise protocols resulted in a decline in blood glucose levels. However, the decline was greater with MOD (Ϫ4.4 Ϯ 1.2 mmol/l) compared with IHE (Ϫ2.9 Ϯ 0.8 mmol/l; P Ͻ 0.05), despite the performance of a greater amount of total work with IHE (P Ͻ 0.05). During 60 min of recovery from exercise, glucose levels remained higher in IHE compared with MOD (P Ͻ 0.05). Furthermore, glucose levels remained stable during recovery from IHE, while they continued to decrease after MOD (P Ͻ 0.05). The stabilization of blood glucose levels with IHE was associated with elevated levels of lactate, catecholamines, and growth hormone during early recovery from exercise (P Ͻ 0.05). There were no differences in free insulin, glucagon, cortisol, or free fatty acids between MOD and IHE.CONCLUSIONS -The decline in blood glucose levels is less with IHE compared with MOD during both exercise and recovery in individuals with type 1 diabetes. Diabetes Care 28:1289 -1294, 2005E xercise is generally recommended for individuals with type 1 diabetes for the same reasons as the rest of the population. That is, regular physical activity has physiological benefits, including improved physical work capacity, body composition, blood pressure, and blood lipid profile (1-3) and is associated with less risk of diabetes complications and mortality in individuals with type 1 diabetes (4). In addition, exercise has psychological benefits, including increased sense of well-being, quality of life, and ability to cope with stress (3). Particularly in children, participation in sports is an important recreational and social activity that benefits both social interaction and peer group assimilation (5).Unfortunately, participation in exercise can also increase the risk of experiencing hypoglycemia in individuals with type 1 diabetes, both during exercise (6,7) and for up to 31 h of recovery (8). Consequently, many individuals with type 1 diabetes feel negatively toward physical activity (9) and are discouraged from participating in sports and games by their parents, school staff, or physicians (10).Existing guidelines to minimize the risk of hypoglycemia associated with exercise are often general (11) and fail to take into account that different precautions are required for exercise of varying type, duration, and intensity. Specifically, there are no evidence-based guidelines for individuals wanting to participate in intermittent high-intensity exercise (IHE...

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“…Nos casos de AF no final da tarde, é a dose da insulina de ação rápida pré-refeição noturna que deverá ser reduzida 48,55,59 .…”

Section: Redução Da Dose De Insulinaunclassified

Physical activity in children with type 1 diabetes

Miculis¹,

Mascarenhas²,

Boguszewski³

et al. 2010

J Pediatr (Rio J)

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Objectives: To discuss the practical aspects of safe physical activity and sports participation in children and adolescents with type 1 diabetes mellitus. Sources:A literature search was conducted using national (SciELO) and international (PubMed/MEDLINE) databases and the reference lists of the articles found, adopting the following limits: articles on physical activity published in the last 10 years, preferably conducted in children and adolescents with type 1 diabetes. Most studies had an experimental design or were meta-analyses. Summary of the findings:Skeletal muscle glucose uptake is greater during aerobic metabolism in order to generate energy for muscle contraction, which suppresses hepatic gluconeogenesis and thus promotes a decrease in blood glucose levels and increased risk of hypoglycemia. Adequate carbohydrate replacement before, during, and after exercise and reduction of preprandial rapid-acting insulin doses are the main allies in avoiding severe hypoglycemic events among diabetic children and adolescents.Conclusions: Type, duration, and intensity of physical activity must be considered when planning carbohydrate replacement and insulin dose reduction, as must the timing of exercise. Nonetheless, physical activity and participation in many individual and team sports is possible and highly recommended in the treatment of type 1 diabetes in children and adolescents.J Pediatr (Rio J). 2010;86(4):271-278: Type 1 diabetes mellitus, exercise, hypoglycemia, children, adolescents. ResumoObjetivo: Abordar os aspectos práticos da realização segura de atividade física e esportes em crianças e adolescentes portadores de diabetes tipo 1. Fontes dos dados:A pesquisa dos artigos foi conduzida em fontes de dados nacionais (SciELO) e internacionais (PubMed/MEDLINE), assim como nas próprias referências dos artigos encontrados, adotando como limites: artigos publicados nos últimos 10 anos, preferencialmente conduzidos em crianças e adolescentes com diabetes tipo 1, sendo em sua maioria estudos experimentais e meta-análises sobre atividade física. Síntese dos dados:Com o metabolismo aeróbico, os músculos esqueléticos consomem maior quantidade de glicose para gerar energia, o que diminui a gliconeogênese hepática, levando a uma diminuição na glicemia e aumentando o risco de hipoglicemia. A reposição de carboidratos antes, durante e após o exercício em quantidade adequada e a redução da dose de insulina de ação rápida (pré-refeição) são os principais aliados da criança e adolescente com diabetes tipo 1 para evitar a ocorrência da hipoglicemia severa.Conclusões: Para a reposição de carboidratos e a redução da dose de insulina, deve-se considerar o tipo, a duração e a intensidade da atividade física, bem como o horário de sua realização. A participação em diversos esportes, coletivos e individuais, e em atividades físicas de intensidades variadas é possível, sendo muito recomendado no tratamento do diabetes infantil. J Pediatr (Rio J) IntroduçãoO diabetes tipo 1 (DM1) é uma doença autoimune caracterizada pela ...

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Exercise-induced hypoglycaemia in IDDM patients treated with a short-acting insulin analogue

Cited by 102 publications

References 24 publications

Hyperinsulinaemia during exercise does not suppress hepatic glycogen concentrations in patients with type 1 diabetes: a magnetic resonance spectroscopy study

Hyperinsulinaemia during exercise does not suppress hepatic glycogen concentrations in patients with type 1 diabetes: a magnetic resonance spectroscopy study

The Decline in Blood Glucose Levels Is Less With Intermittent High-Intensity Compared With Moderate Exercise in Individuals With Type 1 Diabetes

Physical activity in children with type 1 diabetes

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