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SHR Neuro Cancer Cardio Lipid Metab Microb

McCarthy, O; Deere, R; Churm, R; Dunseath, GJ; Jones, C; Eckstein, ML; Williams, DM; Hayes, J; Pitt, J; Bain, SC; Moser, O; Bracken, RM.
Extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin adjustments in individuals with type 1 diabetes.
NUTR METAB CARDIOVAS. 2021; 31(1): 227-236. Doi: 10.1016/j.numecd.2020.07.043 [OPEN ACCESS]
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Co-authors Med Uni Graz

Eckstein Max Lennart

Moser Othmar

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Abstract:

To detail the extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin dose adjustments in individuals with type 1 diabetes (T1D) using multiple daily injections of insulins aspart (IAsp) and degludec (IDeg). Sixteen individuals with T1D, completed a single-centred, randomised, four-period crossover trial consisting of 23-h inpatient phases. Participants administered either a regular (100%) or reduced (50%) dose (100%; 5.1 ± 2.4, 50%; 2.6 ± 1.2 IU, p < 0.001) of individualised IAsp 1 h before and after 45-min of evening exercise at 60 ± 6% V̇O_2max. An unaltered dose of IDeg was administered in the morning. Metabolic, physiological and hormonal responses during exercise, recovery and nocturnal periods were characterised. The primary outcome was the number of trial day occurrences of hypoglycemia (venous blood glucose ≤ 3.9 mmol L ^-1). Inclusion of a 50% IAsp dose reduction strategy prior to evening exercise reduced the occurrence of in-exercise hypoglycemia (p = 0.023). Mimicking this reductive strategy in the post-exercise period decreased risk of nocturnal hypoglycemia (p = 0.045). Combining this strategy to reflect reductions either side of exercise resulted in higher glucose concentrations in the acute post-exercise (p = 0.034), nocturnal (p = 0.001), and overall (p < 0.001) periods. Depth of hypoglycemia (p = 0.302), as well as ketonic and counter-regulatory hormonal profiles were similar. These findings demonstrate the glycemic safety of peri-exercise bolus dose reduction strategies in minimising the prevalence of acute and nocturnal hypoglycemia following evening exercise in people with T1D on MDI. Use of newer background insulins with current bolus insulins demonstrates efficacy and advances current recommendations for safe performance of exercise. DRKS00013509. Copyright © 2020 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Find related publications in this database (using NLM MeSH Indexing)

Adult -

Biomarkers - blood

Blood Glucose - drug effects

Blood Glucose - metabolism

Circadian Rhythm -

Cross-Over Studies -

Diabetes Mellitus, Type 1 - blood

Diabetes Mellitus, Type 1 - diagnosis

Diabetes Mellitus, Type 1 - drug therapy

Drug Administration Schedule -

Exercise -

Female -

Humans -

Hypoglycemia - blood

Hypoglycemia - chemically induced

Hypoglycemia - epidemiology

Hypoglycemia - prevention & control

Hypoglycemic Agents - administration & dosage

Hypoglycemic Agents - adverse effects

Insulin Aspart - administration & dosage

Insulin Aspart - adverse effects

Insulin, Long-Acting - administration & dosage

Insulin, Long-Acting - adverse effects

Male -

Middle Aged -

Prevalence -

Risk Factors -

Treatment Outcome -

Young Adult -

Find related publications in this database (Keywords)

Type 1 diabetes

Exercise

Insulin aspart

Insulin degludec

Hypoglycemia

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