Large pre- and postexercise rapid-acting insulin reductions preserve glycemia and prevent early- but not late-onset hypoglycemia in patients with type 1 diabetes

Matthew D Campbell, Mark Walker, Michael I Trenell, Djordje G Jakovljevic, Emma J Stevenson, Richard M Bracken, Stephen C Bain, Daniel J West, Matthew D Campbell, Mark Walker, Michael I Trenell, Djordje G Jakovljevic, Emma J Stevenson, Richard M Bracken, Stephen C Bain, Daniel J West

Abstract

Objective: To examine the acute and 24-h glycemic responses to reductions in postexercise rapid-acting insulin dose in type 1 diabetic patients.

Research design and methods: After preliminary testing, 11 male patients (24 ± 2 years, HbA1c 7.7 ± 0.3%; 61 ± 3.4 mmol/mol) attended the laboratory on three mornings. Patients consumed a standardized breakfast (1 g carbohydrate · kg(-1) BM; 380 ± 10 kcal) and self-administered a 25% rapid-acting insulin dose 60 min prior to performing 45 min of treadmill running at 72.5 ± 0.9% VO2peak. At 60 min postexercise, patients ingested a meal (1 g carbohydrate · kg(-1) BM; 660 ± 21 kcal) and administered a Full, 75%, or 50% rapid-acting insulin dose. Blood glucose concentrations were measured for 3 h postmeal. Interstitial glucose was recorded for 20 h after leaving the laboratory using a continuous glucose monitoring system.

Results: All glycemic responses were similar across conditions up to 60 min postexercise. After the postexercise meal, blood glucose was preserved under 50%, but declined under Full and 75%. Thence at 3 h, blood glucose was highest under 50% (50% [10.4 ± 1.2] vs. Full [6.2 ± 0.7] and 75% [7.6 ± 1.2 mmol · L(-1)], P = 0.029); throughout this period, all patients were protected against hypoglycemia under 50% (blood glucose ≤ 3.9; Full, n = 5; 75%, n = 2; 50%, n = 0). Fifty percent continued to protect patients against hypoglycemia for a further 4 h under free-living conditions. However, late-evening and nocturnal glycemia were similar; as a consequence, late-onset hypoglycemia was experienced under all conditions.

Conclusions: A 25% pre-exercise and 50% postexercise rapid-acting insulin dose preserves glycemia and protects patients against early-onset hypoglycemia (≤ 8 h). However, this strategy does not protect against late-onset postexercise hypoglycemia.

Trial registration: ClinicalTrials.gov NCT01531855.

Figures

Figure 1
Figure 1
Time-course changes in blood glucose from rest. Data presented as mean ± SEM. Triangles, Full; squares, 75%; diamonds, 50%. Transparent sample point within a condition indicates significant difference from premeal concentrations (P ≤ 0.05). *Significantly different from Full (P ≤ 0.05); **significantly different from Full and 75% (P ≤ 0.05). Thatched area indicates exercise, and vertical dashed line break indicates postexercise intervention. Note that test meal and insulin were administered immediately after rest and 60-min postexercise sample points.
Figure 2
Figure 2
Time-course changes in interstitial glucose throughout the postlaboratory period. Data presented as mean (SEM error bars have been removed for reader clarity). Black line, Full; blue line, 75%; red line, 50%. **Interstitial glucose area under the curve is significantly different from Full and 75% (P ≤ 0.05). Vertical dashed line breaks indicate evening, nocturnal, or morning periods.

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