Exercise With and Without an Insulin Pump Among Children and Adolescents With Type 1 Diabetes Mellitus

Abstract

ABSTRACT. Background. The use of insulin pumps is becoming a popular technique for insulin delivery among patients with type 1 diabetes mellitus (T1DM), but there is no consensus regarding the guidelines for proper pump use during exercise.Objective. To investigate the physiologic responses and risk of hypoglycemia among children and adolescents with T1DM when exercising with the pump on (PO) (50% of the basal rate) or pump off (PF).Methods. Ten subjects with T1DM (6 female subjects and 4 male subjects), 10 to 19 years of age, performed prolonged exercise (40 -45 minutes) on a cycle ergometer ϳ2 hours after a standard breakfast and an insulin (Lispro) bolus. Complex carbohydrates (20 g) were provided before and after the exercise. Each patient exercised once with PO and once with PF, in a randomized, crossover (single-blind) manner. During exercise and 45 minutes of recovery, subjects were monitored for cardiorespiratory, metabolic, and hormonal responses. Blood glucose concentrations were recorded for 24 hours after exercise, with a continuous glucose monitoring system, to document late hypoglycemic events.Results. During exercise, blood glucose concentrations decreased by 59 ؎ 58 mg/dL (mean ؎ SD: 29 ؎ 24%) with PF and by 74 ؎ 51 mg/dL (35.5 ؎ 18%) with PO (not significant). No significant differences were found in cortisol, growth hormone, or noradrenaline levels between PO and PF. There were no differences in cardiorespiratory parameters, blood lactate concentrations, or free fatty acids concentrations between pump modes. Hypoglycemic events during exercise were asymptomatic and occurred for 2 subjects with PO and 2 with PF. Nine subjects had late hypoglycemia after PO, compared with 6 after PF (not significant).Conclusions. We found no advantage for subjects with either PO or PF during exercise, and we noted that late hypoglycemia was more common than hypoglycemia during exercise. However, PO was associated with a trend of increased risk for late hypoglycemia. We recommend that the pump be removed or turned off during prolonged exercise and that blood glucose concentrations be monitored for several hours after exercise, regardless of the pump mode.

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

“…The real-time availability of CGM data may have also contributed to the relatively low rates of early-and lateonset hypoglycemia. 14,15 Comparing days before versus after morning exercise sessions, we observed an increase in the CGM readings in the euglycemic range, showing the benefits of exercise on glycemic control. When we compared CGM data in days pre-and post-afternoon exercise, this was not evident, but we observed a clear tendency toward more hypoglycemic events.…”

The effects of a single bout of submaximal exercise on rheological properties of the blood in children with type 1 diabetes mellitus

“…Finally, the authors of this study concluded that treatment with 15 g of oral glucose may be often insufficient to control exercise-induced hypoglycemia in adolescent patients. In contrast, Admon et al [7] did not observe any beneficial effects of physical exercise in patients with type 1 diabetes mellitus who exercised with insulin pumps or without. Furthermore, their patients, especially those using insulin pumps, more often presented with late hypoglycemia than hypoglycemia during exercise.…”

“…Furthermore, their patients, especially those using insulin pumps, more often presented with late hypoglycemia than hypoglycemia during exercise. Therefore the authors recommended to turn off the pump during prolonged exercise, and to monitor blood concentration of glucose for several hours post-exercise, regardless of the pump type [7].…”

“…Physical activity as a proposal for a healthy lifestyle may exert beneficial effects on metabolic control, body weight, arterial blood pressure, self-esteem and quality of life in patients with type 1 diabetes, especially in children and young adults. Furthermore, it may reduce the risk for secondary complications, and as such should constitute a key component of lifestyle in diabetic patients [7][8][9][10]. While the effects of regular physical activity on metabolic control are well established, still little is known on the influence of high or moderate intensity short-term exercise being a common element of everyday activities in children [11].…”

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 .…”