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Brar G, Carmody S, Lumb A, Shafik A, Bright C, Andrews RC. Practical considerations for continuous glucose monitoring in elite athletes with type 1 diabetes mellitus: A narrative review. J Physiol 2024; 602:2169-2177. [PMID: 38680058 DOI: 10.1113/jp285836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/08/2024] [Indexed: 05/01/2024] Open
Abstract
Type 1 diabetes mellitus (T1DM) refers to a metabolic condition where a lack of insulin impairs the usual homeostatic mechanisms to control blood glucose levels. Historically, participation in competitive sport has posed a challenge for those with T1DM, where the dynamic changes in blood glucose during exercise can result in dangerously high (hyperglycaemia) or low blood glucoses (hypoglycaemia) levels. Over the last decade, research and technological development has enhanced the methods of monitoring and managing blood glucose levels, thus reducing the chances of experiencing hyper- or hypoglycaemia during exercise. The introduction of continuous glucose monitoring (CGM) systems means that glucose can be monitored conveniently, without the need for frequent fingerpick glucose checks. CGM devices include a fine sensor inserted under the skin, measuring levels of glucose in the interstitial fluid. Readings can be synchronized to a reader or mobile phone app as often as every 1-5 min. Use of CGM devices is associated with lower HbA1c and a reduction in hypoglycaemic events, promoting overall health and athletic performance. However, there are limitations to CGM, which must be considered when being used by an athlete with T1DM. These limitations can be addressed by individualized education plans, using protective equipment to prevent sensor dislodgement, as well as further research aiming to: (i) account for disparities between CGM and true blood glucose levels during vigorous exercise; (ii) investigate the effects of temperature and altitude on CGM accuracy, and (iii) explore of the sociological impact of CGM use amongst sportspeople without diabetes on those with T1DM.
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Affiliation(s)
| | - Sean Carmody
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Alistair Lumb
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Claverton Down, Oxford, UK
| | - Andrew Shafik
- Department of Health, University of Bath, Claverton Down, Bath, UK
| | | | - Robert C Andrews
- Institute of Biomedical and Clinical Sciences, Medical Research, University of Exeter Medical School, Royal Devon and Exeter Hospital, Exeter, UK
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2
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Hall B, Żebrowska A, Sikora M, Siatkowski S, Robins A. The Effect of High-Intensity Interval Exercise on Short-Term Glycaemic Control, Serum Level of Key Mediator in Hypoxia and Pro-Inflammatory Cytokines in Patients with Type 1 Diabetes-An Exploratory Case Study. Nutrients 2023; 15:3749. [PMID: 37686781 PMCID: PMC10490106 DOI: 10.3390/nu15173749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Type 1 diabetes (T1D) is associated with hyperglycaemia-induced hypoxia and inflammation. This study assessed the effects of a single bout of high-intensity interval exercise (HIIE) on glycaemia (BG) and serum level of pro-inflammatory cytokines, and an essential mediator of adaptive response to hypoxia in T1D patients. The macronutrient intake was also evaluated. Nine patients suffering from T1D for about 12 years and nine healthy individuals (CG) were enrolled and completed one session of HIIE at the intensity of 120% lactate threshold with a duration of 4 × 5 min intermittent with 5 min rests after each bout of exercise. Capillary and venous blood were withdrawn at rest, immediately after and at 24 h post-HIIE for analysis of BG, hypoxia-inducible factor alpha (HIF-1α), tumour necrosis factor alpha (TNF-α) and vascular-endothelial growth factor (VEGF). Pre-exercise BG was significantly higher in the T1D patients compared to the CG (p = 0.043). HIIE led to a significant decline in T1D patients' BG (p = 0.027) and a tendency for a lower BG at 24 h post-HIIE vs. pre-HIIE. HIF-1α was significantly elevated in the T1D patients compared to CG and there was a trend for HIF-1α to decline, and for VEGF and TNF-α to increase in response to HIIE in the T1D group. Both groups consumed more and less than the recommended amounts of protein and fat, respectively. In the T1D group, a tendency for a higher digestible carbohydrate intake and more frequent hyperglycaemic episodes on the day after HIIE were observed. HIIE was effective in reducing T1D patients' glycaemia and improving short-term glycaemic control. HIIE has the potential to improve adaptive response to hypoxia by elevating the serum level of VEGF. Patients' diet and level of physical activity should be screened on a regular basis, and they should be educated on the glycaemic effects of digestible carbohydrates.
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Affiliation(s)
- Barbara Hall
- School of Physiological and Medical Sciences, Department of Physiology, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland; (A.Ż.); (M.S.)
| | - Aleksandra Żebrowska
- School of Physiological and Medical Sciences, Department of Physiology, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland; (A.Ż.); (M.S.)
| | - Marcin Sikora
- School of Physiological and Medical Sciences, Department of Physiology, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland; (A.Ż.); (M.S.)
| | - Szymon Siatkowski
- Institute of Healthy Living, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland;
| | - Anna Robins
- School of Health and Society, University of Salford, Allerton Building, 43 Crescent, Salford M5 4WT, UK;
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Annan SF, Higgins LA, Jelleryd E, Hannon T, Rose S, Salis S, Baptista J, Chinchilla P, Marcovecchio ML. ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1297-1321. [PMID: 36468223 DOI: 10.1111/pedi.13429] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 12/07/2022] Open
Affiliation(s)
- S Francesca Annan
- Paediatric Division, University College London Hospitals, London, UK
| | - Laurie A Higgins
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Elisabeth Jelleryd
- Medical Unit Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden
| | - Tamara Hannon
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Shelley Rose
- Diabetes & Endocrinology Service, MidCentral District Health Board, Palmerston North, New Zealand
| | - Sheryl Salis
- Department of Nutrition, Nurture Health Solutions, Mumbai, India
| | | | - Paula Chinchilla
- Women's and Children's Department, London North West Healthcare NHS Trust, London, UK
| | - Maria Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Cigrovski Berkovic M, Bilic-Curcic I, La Grasta Sabolic L, Mrzljak A, Cigrovski V. Fear of hypoglycemia, a game changer during physical activity in type 1 diabetes mellitus patients. World J Diabetes 2021; 12:569-577. [PMID: 33995845 PMCID: PMC8107983 DOI: 10.4239/wjd.v12.i5.569] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
Hypoglycemia limits optimal glycemic management of patients with type 1 diabetes mellitus (T1DM). Fear of hypoglycemia (FoH) is a significant psychosocial consequence that negatively impacts the willingness of T1DM patients to engage in and profit from the health benefits of regular physical activity (e.g., cardiometabolic health, improved body composition, cardiovascular fitness, quality of life). Technological advances, improved insulin regimens, and a better understanding of the physiology of various types of exercise could help ameliorate FoH. This narrative review summarizes the available literature on FoH in children and adults and tools to avoid it.
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Affiliation(s)
- Maja Cigrovski Berkovic
- Department of Endocrinology, Diabetes, Metabolism and Clinical Pharmacology, University Hospital Dubrava, Zagreb 10000, Croatia
| | - Ines Bilic-Curcic
- Department of Pharmacology, Faculty of Medicine, University of J. J. Strossmayer Osijek, Osijek 31000, Croatia
| | - Lavinia La Grasta Sabolic
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Hospital Centre Sestre Milosrdnice, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Department of Medicine, Merkur University Hospital, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
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Wolkowicz KL, Aiello EM, Vargas E, Teymourian H, Tehrani F, Wang J, Pinsker JE, Doyle FJ, Patti M, Laffel LM, Dassau E. A review of biomarkers in the context of type 1 diabetes: Biological sensing for enhanced glucose control. Bioeng Transl Med 2021; 6:e10201. [PMID: 34027090 PMCID: PMC8126822 DOI: 10.1002/btm2.10201] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/16/2022] Open
Abstract
As wearable healthcare monitoring systems advance, there is immense potential for biological sensing to enhance the management of type 1 diabetes (T1D). The aim of this work is to describe the ongoing development of biomarker analytes in the context of T1D. Technological advances in transdermal biosensing offer remarkable opportunities to move from research laboratories to clinical point-of-care applications. In this review, a range of analytes, including glucose, insulin, glucagon, cortisol, lactate, epinephrine, and alcohol, as well as ketones such as beta-hydroxybutyrate, will be evaluated to determine the current status and research direction of those analytes specifically relevant to T1D management, using both in-vitro and on-body detection. Understanding state-of-the-art developments in biosensing technologies will aid in bridging the gap from bench-to-clinic T1D analyte measurement advancement.
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Affiliation(s)
- Kelilah L. Wolkowicz
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard UniversityCambridgeMassachusettsUSA
- Sansum Diabetes Research InstituteSanta BarbaraCaliforniaUSA
| | - Eleonora M. Aiello
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard UniversityCambridgeMassachusettsUSA
- Sansum Diabetes Research InstituteSanta BarbaraCaliforniaUSA
| | - Eva Vargas
- Department of NanoengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Hazhir Teymourian
- Department of NanoengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Farshad Tehrani
- Department of NanoengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Joseph Wang
- Department of NanoengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
| | | | - Francis J. Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard UniversityCambridgeMassachusettsUSA
- Sansum Diabetes Research InstituteSanta BarbaraCaliforniaUSA
| | | | - Lori M. Laffel
- Joslin Diabetes Center, Harvard Medical SchoolBostonMassachusettsUSA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard UniversityCambridgeMassachusettsUSA
- Sansum Diabetes Research InstituteSanta BarbaraCaliforniaUSA
- Joslin Diabetes Center, Harvard Medical SchoolBostonMassachusettsUSA
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Müller-Korbsch M, Frühwald L, Heer M, Fangmeyer-Binder M, Reinhart-Mikocki D, Fasching P. Assessment of the "Second Day" Exercise Effect on Glycemic Control, Insulin Requirements, and CHO Intake in Type 1 Diabetes Adults. J Diabetes Sci Technol 2021; 15:127-133. [PMID: 31583900 PMCID: PMC7783009 DOI: 10.1177/1932296819879419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Glucose control during consecutive days of aerobic exercise has not been well studied. We assessed glycemia, insulin requirements, and carbohydrate (CHO) needs during two consecutive days of prolonged cycling in type 1 diabetes (T1D) adults using sensor-augmented insulin pump therapy. METHODS Twenty adults with well-controlled T1D and six healthy adults (for comparison) were enrolled. Assessments were made during two consecutive days of cycling activities (30 miles per day). On day 1 (D1), basal rates were reduced 50% and CHO intake was guided by real-time continuous glucose monitoring (rtCGM) data to maintain a target range (70-180 mg/dL). On day 2 (D2), basal insulin infusion was stopped for the first hour of biking and resumed at a minimal rate during biking. Carbohydrate intake one hour before, during, and ten minutes after biking was recorded. Times within/below target range, glycemic variability, and mean glucose were calculated from rtCGM data. RESULTS Among 17 T1D participants who completed the study, mean glucose levels at the start of cycling were slightly lower on D2 vs D1: 138 ± 16 mg/dL and 122 ± 16, respectively, P = NS. Type 1 diabetes participants achieved near-normal glucose levels at the end of both cycling events; however, the reduction in glucose was most notable at one hour into the event on D2 vs D1. Carbohydrate intake was notably lower during D2 vs D1 with no difference in time <54 mg/dL (both P = NS). CONCLUSIONS Type 1 diabetes individuals using rtCGM-augmented insulin pump therapy can safely engage in consecutive days of prolonged aerobic exercise by significantly reducing insulin dosages with no increase in CHO intake.
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Affiliation(s)
- Michael Müller-Korbsch
- MedVienna Ärztezentrum, Austria
- Michael Müller-Korbsch, MD, MedVienna Ärztezentrum, Sensengasse 3, Vienna 1090, Austria.
| | - Lisa Frühwald
- 5th Medizinische Abteilung für Endokrinologie und Rheumatologie, Wilhelminenspital Austria, Vienna, Austria
| | - Michael Heer
- University of Applied Sciences Technikum Wien, Vienna, Austria
| | - Maria Fangmeyer-Binder
- 5th Medizinische Abteilung für Endokrinologie und Rheumatologie, Wilhelminenspital Austria, Vienna, Austria
| | - David Reinhart-Mikocki
- 5th Medizinische Abteilung für Endokrinologie und Rheumatologie, Wilhelminenspital Austria, Vienna, Austria
| | - Peter Fasching
- 5th Medizinische Abteilung für Endokrinologie und Rheumatologie, Wilhelminenspital Austria, Vienna, Austria
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Roy-Fleming A, Taleb N, Messier V, Suppère C, Cameli C, Elbekri S, Smaoui MR, Ladouceur M, Legault L, Rabasa-Lhoret R. Timing of insulin basal rate reduction to reduce hypoglycemia during late post-prandial exercise in adults with type 1 diabetes using insulin pump therapy: A randomized crossover trial. DIABETES & METABOLISM 2019; 45:294-300. [PMID: 30165156 DOI: 10.1016/j.diabet.2018.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/23/2018] [Accepted: 08/11/2018] [Indexed: 02/07/2023]
Abstract
AIMS To compare the efficacy of three timings to decrease basal insulin infusion rate to reduce exercise-induced hypoglycaemia in patients with type 1 diabetes (T1D) using pump therapy. METHODS A single-blinded, randomized, 3-way crossover study in 22 adults that had T1D > 1 year and using insulin pump > 3 months (age, 40 ± 15 years; HbA1c, 56.3 ± 10.2 mmol/mol). Participants practiced three 45-min exercise sessions (ergocyle) at 60% VO2peak 3 hours after lunch comparing an 80% reduction of basal insulin applied 40 minutes before (T-40), 20 minutes before (T-20) or at exercise onset (T0). RESULTS No significant difference was observed for percentage of time spent < 4.0 mmol/L (T-40: 16 ± 25%; T-20: 26 ± 27%; T0: 24 ± 29%) (main outcome) and time spent in target range 4.0-10.0 mmol/L (T-40: 63 ± 37%; T-20: 66 ± 25%; T0: 65 ± 31%). With T-40 strategy, although not significant, starting blood glucose (BG) was higher (T-40: 8.6 ± 3.6 mmol/L; T-20: 7.4 ± 2.5 mmol/L ; T0: 7.4 ± 2.7 mmol/L), fewer patients needed extra carbohydrates consumption prior to exercise for BG < 5.0 mmol/L (T-40: n = 3; T-20: n = 5; T0: n = 6) as well as during exercise for BG < 3.3 mmol/L [T-40: n = 6 (27%); T-20: n = 12 (55%); T0: n = 11 (50%)] while time to first hypoglycaemic episode was delayed (T-40: 28 ± 14 min; T-20: 24 ± 10 min; T0: 22 ± 11 min). CONCLUSION Decreasing basal insulin infusion rate by 80% up to 40 minutes before exercise onset is insufficient to reduce exercise-induced hypoglycaemia.
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Affiliation(s)
- A Roy-Fleming
- Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada; Nutrition department, faculty of medicine, universite de Montréal, 1204-2405, chemin de la Côte-Sainte-Catherine, Montréal, Québec H3T 1A8, Canada
| | - N Taleb
- Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada; Division of biomedical sciences, faculty of medicine, université de Montréal, C.P.6128 Succ. Centre-Ville, Montréal, Québec H3C 3J7, Canada
| | - V Messier
- Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada
| | - C Suppère
- Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada
| | - C Cameli
- Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada
| | - S Elbekri
- Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada
| | - M R Smaoui
- School of computer science, McGill university, Montreal, Québec, Canada
| | - M Ladouceur
- School of public health, social and preventive medicine department, université de Montréal, C.P.6128 Succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada
| | - L Legault
- Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada; Montreal children's hospital, McGill university health centre, 1001 Boul Décarie, Montreal, Québec H4A 3J1, Canada
| | - R Rabasa-Lhoret
- Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada; Nutrition department, faculty of medicine, universite de Montréal, 1204-2405, chemin de la Côte-Sainte-Catherine, Montréal, Québec H3T 1A8, Canada; Centre de recherche du centre hospitalier de l'université de Montréal (CRCHUM), R-900 Saint-Denis, Montreal, Québec H2X 0A9, Canada; Montreal diabetes research centre, R-900 Saint-Denis, Montreal, Québec H2X 0A9, Canada.
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Klaprat N, MacIntosh A, McGavock JM. Gaps in Knowledge and the Need for Patient-Partners in Research Related to Physical Activity and Type 1 Diabetes: A Narrative Review. Front Endocrinol (Lausanne) 2019; 10:42. [PMID: 30787908 PMCID: PMC6372552 DOI: 10.3389/fendo.2019.00042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/17/2019] [Indexed: 12/12/2022] Open
Abstract
Regular physical activity (PA) is a cornerstone in the management of complications associated with type 1 diabetes (T1D). Most national guidelines advocate for regular PA for persons living with T1D, however the evidence to support these recommendations has not be reviewed recently. Additionally, in an era of patient-centered care and patient oriented research, the role of patient partners in the area of PA and T1D interventions has never been explored. The purpose of this narrative review is to overcome these two gaps in the literature. Here we review selected epidemiological evidence and identify gaps in research that would add important information to guide practitioners and future guidelines. We also provide an overview of patient-oriented research projects co-developed with persons living with T1D. Significant gaps in the field include: (1) a lack of adequately powered prospective cohort studies using serial measures of PA and hard chronic disease end-points; (2) no multi-centered, highly powered, randomized controlled trials of PA, and long-term health outcomes; (3) little data on the role of new technologies to support PA-related behavior change, and (4) no trials that involved patients in the design and execution of PA-based clinical trials. This review provides a template for scientists and patient partners to develop future research priorities and agendas in the field.
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Affiliation(s)
- Nika Klaprat
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Andrea MacIntosh
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jonathan M. McGavock
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Diabetes Action Canada SPOR Network, Toronto, ON, Canada
- *Correspondence: Jonathan M. McGavock
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Chetty T, Shetty V, Fournier PA, Adolfsson P, Jones TW, Davis EA. Exercise Management for Young People With Type 1 Diabetes: A Structured Approach to the Exercise Consultation. Front Endocrinol (Lausanne) 2019; 10:326. [PMID: 31258513 PMCID: PMC6587067 DOI: 10.3389/fendo.2019.00326] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 05/07/2019] [Indexed: 12/11/2022] Open
Abstract
Regular physical activity during childhood is important for optimal physical and psychological development. For individuals with Type 1 Diabetes (T1D), physical activity offers many health benefits including improved glycemic control, cardiovascular function, blood lipid profiles, and psychological well-being. Despite these benefits, many young people with T1D do not meet physical activity recommendations. Barriers to engaging in a physically active lifestyle include fear of hypoglycemia, as well as insufficient knowledge in managing diabetes around exercise in both individuals and health care professionals. Diabetes and exercise management is complex, and many factors can influence an individual's glycemic response to exercise including exercise related factors (such as type, intensity and duration of the activity) and person specific factors (amount of insulin on board, person's stress/anxiety and fitness levels). International guidelines provide recommendations for clinical practice, however a gap remains in how to apply these guidelines to a pediatric exercise consultation. Consequently, it can be challenging for health care practitioners to advise young people with T1D how to approach exercise management in a busy clinic setting. This review provides a structured approach to the child/adolescent exercise consultation, based on a framework of questions, to assist the health care professional in formulating person-specific exercise management plans for young people with T1D.
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Affiliation(s)
- Tarini Chetty
- Children's Diabetes Centre, Perth Children's Hospital, Perth, WA, Australia
- *Correspondence: Tarini Chetty
| | - Vinutha Shetty
- Children's Diabetes Centre, Perth Children's Hospital, Perth, WA, Australia
- UWA Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Paul Albert Fournier
- School of Human Sciences, University of Western Australia, Perth, WA, Australia
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
| | - Peter Adolfsson
- Department of Pediatrics, The Hospital of Halland, Kungsbacka, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Timothy William Jones
- Children's Diabetes Centre, Perth Children's Hospital, Perth, WA, Australia
- UWA Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
| | - Elizabeth Ann Davis
- Children's Diabetes Centre, Perth Children's Hospital, Perth, WA, Australia
- UWA Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
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Adolfsson P, Riddell MC, Taplin CE, Davis EA, Fournier PA, Annan F, Scaramuzza AE, Hasnani D, Hofer SE. ISPAD Clinical Practice Consensus Guidelines 2018: Exercise in children and adolescents with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:205-226. [PMID: 30133095 DOI: 10.1111/pedi.12755] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/16/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Peter Adolfsson
- Department of Pediatrics, Kungsbacka Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Craig E Taplin
- Division of Endocrinology and Diabetes, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Princess Margaret Hospital; Telethon Kids Institute, University of Western Australia, Crawley, Australia
| | - Paul A Fournier
- School of Human Sciences, University of Western Australia, Perth, Australia
| | - Francesca Annan
- Children and Young People's Diabetes Service, University College London Hospitals NHS, Foundation Trust, London, UK
| | - Andrea E Scaramuzza
- Division of Pediatrics, ASST Cremona, "Ospedale Maggiore di Cremona", Cremona, Italy
| | - Dhruvi Hasnani
- Diacare-Diabetes Care and Hormone Clinic, Ahmedabad, India
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
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Smart CE, Annan F, Higgins LA, Jelleryd E, Lopez M, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:136-154. [PMID: 30062718 DOI: 10.1111/pedi.12738] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/16/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Carmel E Smart
- Department of Paediatric Endocrinology, John Hunter Children's Hospital, Newcastle, NSW, Australia.,School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
| | | | | | | | | | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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12
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Sigal RJ, Armstrong MJ, Bacon SL, Boulé NG, Dasgupta K, Kenny GP, Riddell MC. Physical Activity and Diabetes. Can J Diabetes 2018; 42 Suppl 1:S54-S63. [PMID: 29650112 DOI: 10.1016/j.jcjd.2017.10.008] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 12/15/2022]
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Reddy R, El Youssef J, Winters-Stone K, Branigan D, Leitschuh J, Castle J, Jacobs PG. The effect of exercise on sleep in adults with type 1 diabetes. Diabetes Obes Metab 2018; 20:443-447. [PMID: 28718987 PMCID: PMC6314304 DOI: 10.1111/dom.13065] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/05/2017] [Accepted: 07/08/2017] [Indexed: 11/30/2022]
Abstract
The aim of this pilot study was to investigate the effect of exercise on sleep and nocturnal hypoglycaemia in adults with type 1 diabetes (T1D). In a 3-week crossover trial, 10 adults with T1D were randomized to perform aerobic, resistance or no exercise. During each exercise week, participants completed 2 separate 45-minutes exercise sessions at an academic medical center. Participants returned home and wore a continuous glucose monitor and a wrist-based activity monitor to estimate sleep duration. Participants on average lost 70 (±49) minutes of sleep (P = .0015) on nights following aerobic exercise and 27 (±78) minutes (P = .3) following resistance exercise relative to control nights. The odds ratio with confidence intervals of nocturnal hypoglycaemia occurring on nights following aerobic and resistance exercise was 5.4 (1.3, 27.2) and 7.0 (1.7, 37.3), respectively. Aerobic exercise can cause sleep loss in T1D possibly from increased hypoglycaemia.
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Affiliation(s)
- Ravi Reddy
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon
| | - Joseph El Youssef
- Division of Endocrinology, Department of Medicine, Harold Schnitzer Diabetes Health Center, Oregon Health and Science University, Portland, Oregon
| | - Kerri Winters-Stone
- School of Nursing, Human Performance Laboratory, Oregon Health and Science University, Portland, Oregon
| | - Deborah Branigan
- Division of Endocrinology, Department of Medicine, Harold Schnitzer Diabetes Health Center, Oregon Health and Science University, Portland, Oregon
| | - Joseph Leitschuh
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon
| | - Jessica Castle
- Division of Endocrinology, Department of Medicine, Harold Schnitzer Diabetes Health Center, Oregon Health and Science University, Portland, Oregon
| | - Peter G Jacobs
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon
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14
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Knechtle B, Nikolaidis PT. [Not Available]. PRAXIS 2017; 106:887-892. [PMID: 28795623 DOI: 10.1024/1661-8157/a002750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Wir berichten über einen 64-jährigen Marathonläufer mit bisher 990 erfolgreich gefinishten Marathons, der fälschlicherweise mit Diabetes mellitus Typ 2 diagnostiziert und therapiert wurde. Unter peroraler Therapie mit Metformin kam es zu keiner Reduktion der Blutzuckerwerte. Nach korrekter Diagnose und Therapie mit Insulin ist der Läufer wieder voll im Training, um bald seinen 1000. Marathon zu laufen. Für Sportler mit Diabetes mellitus Typ 1 ist es wichtig, den Blutzucker vor, während und nach Belastung zu messen und die Insulindosis individuell während eines Wettkampfs, wie etwa einem Marathon, zu reduzieren.
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15
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Riddell MC, Gallen IW, Smart CE, Taplin CE, Adolfsson P, Lumb AN, Kowalski A, Rabasa-Lhoret R, McCrimmon RJ, Hume C, Annan F, Fournier PA, Graham C, Bode B, Galassetti P, Jones TW, Millán IS, Heise T, Peters AL, Petz A, Laffel LM. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol 2017; 5:377-390. [PMID: 28126459 DOI: 10.1016/s2213-8587(17)30014-1] [Citation(s) in RCA: 488] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 12/28/2022]
Abstract
Type 1 diabetes is a challenging condition to manage for various physiological and behavioural reasons. Regular exercise is important, but management of different forms of physical activity is particularly difficult for both the individual with type 1 diabetes and the health-care provider. People with type 1 diabetes tend to be at least as inactive as the general population, with a large percentage of individuals not maintaining a healthy body mass nor achieving the minimum amount of moderate to vigorous aerobic activity per week. Regular exercise can improve health and wellbeing, and can help individuals to achieve their target lipid profile, body composition, and fitness and glycaemic goals. However, several additional barriers to exercise can exist for a person with diabetes, including fear of hypoglycaemia, loss of glycaemic control, and inadequate knowledge around exercise management. This Review provides an up-to-date consensus on exercise management for individuals with type 1 diabetes who exercise regularly, including glucose targets for safe and effective exercise, and nutritional and insulin dose adjustments to protect against exercise-related glucose excursions.
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Affiliation(s)
- Michael C Riddell
- Muscle Health Research Centre, York University, Toronto, ON, Canada.
| | - Ian W Gallen
- Royal Berkshire NHS Foundation Trust Centre for Diabetes and Endocrinology, Royal Berkshire Hospital, Reading, UK
| | - Carmel E Smart
- Hunter Medical Research Institute, School of Health Sciences, University of Newcastle, Rankin Park, NSW, Australia
| | - Craig E Taplin
- Division of Endocrinology and Diabetes, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Peter Adolfsson
- Department of Pediatrics, The Hospital of Halland, Kungsbacka, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alistair N Lumb
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
| | - Aaron Kowalski
- Juvenile Diabetes Research Foundation, New York, NY, USA
| | - Remi Rabasa-Lhoret
- Department of Nutrition and Institut de Recherches Cliniques de Montréal, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Rory J McCrimmon
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | | | - Francesca Annan
- Children and Young People's Diabetes Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Paul A Fournier
- School of Sport Science, Exercise, and Health, Perth, WA, Australia
| | | | - Bruce Bode
- Atlanta Diabetes Associates, Atlanta, GA, USA
| | - Pietro Galassetti
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA; AstraZeneca, Gaithersburg, MD, USA
| | - Timothy W Jones
- The University of Western Australia, Perth, WA, Australia; Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia; Telethon Kids Institute, Perth, WA, Australia
| | - Iñigo San Millán
- Department of Physical Medicine and Rehabilitation, University of Colorado, School of Medicine, Aurora, CO, USA
| | | | - Anne L Peters
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Lori M Laffel
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA; Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA, USA
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16
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Bode BW, Kaufman FR, Vint N. An Expert Opinion on Advanced Insulin Pump Use in Youth with Type 1 Diabetes. Diabetes Technol Ther 2017; 19:145-154. [PMID: 28135116 DOI: 10.1089/dia.2016.0354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Among children and adolescents with type 1 diabetes mellitus, the use of insulin pump therapy has increased since its introduction in the early 1980s. Optimal management of type 1 diabetes mellitus depends on sufficient understanding by patients, their families, and healthcare providers on how to use pump technology. The goal for the use of insulin pump therapy should be to advance proficiency over time from the basics taught at the initiation of pump therapy to utilizing advanced settings to obtain optimal glycemic control. However, this goal is often not met, and appropriate understanding of the full features of pump technology can be lacking. The objective of this review is to provide an expert perspective on the advanced features and use of insulin pump therapy, including practical guidelines for the successful use of insulin pump technology, and other considerations specific to patients and healthcare providers.
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Affiliation(s)
- Bruce W Bode
- 1 Atlanta Diabetes Associates , Atlanta, Georgia
| | - Francine R Kaufman
- 2 The Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles , Los Angeles, California
- 3 Medtronic , Northridge, California
| | - Nan Vint
- 4 Lilly USA, LLC, Lilly Corporate Center , US Medical Affairs, Indianapolis, Indiana
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17
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Taleb N, Emami A, Suppere C, Messier V, Legault L, Ladouceur M, Chiasson JL, Haidar A, Rabasa-Lhoret R. Efficacy of single-hormone and dual-hormone artificial pancreas during continuous and interval exercise in adult patients with type 1 diabetes: randomised controlled crossover trial. Diabetologia 2016; 59:2561-2571. [PMID: 27704167 DOI: 10.1007/s00125-016-4107-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/16/2016] [Indexed: 01/26/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to assess whether the dual-hormone (insulin and glucagon) artificial pancreas reduces hypoglycaemia compared with the single-hormone (insulin alone) artificial pancreas during two types of exercise. METHODS An open-label randomised crossover study comparing both systems in 17 adults with type 1 diabetes (age, 37.2 ± 13.6 years; HbA1c, 8.0 ± 1.0% [63.9 ± 10.2 mmol/mol]) during two exercise types on an ergocycle and matched for energy expenditure: continuous (60% [Formula: see text] for 60 min) and interval (2 min alternating periods at 85% and 50% [Formula: see text] for 40 min, with two 10 min periods at 45% [Formula: see text] at the start and end of the session). Blocked randomisation (size of four) with a 1:1:1:1 allocation ratio was computer generated. The artificial pancreas was applied from 15:30 hours until 19:30 hours; exercise was started at 18:00 hours and announced 20 min earlier to the systems. The study was conducted at the Institut de recherches cliniques de Montréal. RESULTS During single-hormone control compared with dual-hormone control, exercise-induced hypoglycaemia (plasma glucose <3.3 mmol/l with symptoms or <3.0 mmol/l regardless of symptoms) was observed in four (23.5%) vs two (11.8%) interventions (p = 0.5) for continuous exercise and in six (40%) vs one (6.25%) intervention (p = 0.07) for interval exercise. For the pooled analysis (single vs dual hormone), the median (interquartile range) percentage time spent at glucose levels below 4.0 mmol/l was 11% (0.0-46.7%) vs 0% (0-0%; p = 0.0001) and at glucose levels between 4.0 and 10.0 mmol/l was 71.4% (53.2-100%) vs 100% (100-100%; p = 0.003). Higher doses of glucagon were needed during continuous (0.126 ± 0.057 mg) than during interval exercise (0.093 ± 0.068 mg) (p = 0.03), with no reported side-effects in all interventions. CONCLUSIONS/INTERPRETATION The dual-hormone artificial pancreas outperformed the single-hormone artificial pancreas in regulating glucose levels during announced exercise in adults with type 1 diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT01930110 FUNDING: : Société Francophone du Diabète and Diabète Québec.
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Affiliation(s)
- Nadine Taleb
- Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, Québec, Canada, H2W 1R7
- Division of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Ali Emami
- Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, Québec, Canada, H2W 1R7
- Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Corinne Suppere
- Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, Québec, Canada, H2W 1R7
| | - Virginie Messier
- Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, Québec, Canada, H2W 1R7
| | - Laurent Legault
- Montreal Children's Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Martin Ladouceur
- Centre de recherche du Centre hospitalier de l'université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Jean-Louis Chiasson
- Centre de recherche du Centre hospitalier de l'université de Montréal (CRCHUM), Montréal, Québec, Canada
- Montreal Diabetes Research Center, Montréal, Québec, Canada
| | - Ahmad Haidar
- Department of Biomedical Engineering, Faculty of Medicine, McGill University, Montréal, Québec, Canada
- Division of Endocrinology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Rémi Rabasa-Lhoret
- Institut de recherches cliniques de Montréal, 110 Avenue des Pins Ouest, Montréal, Québec, Canada, H2W 1R7.
- Montreal Diabetes Research Center, Montréal, Québec, Canada.
- Nutrition department, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.
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18
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Pinsker JE, Kraus A, Gianferante D, Schoenberg BE, Singh SK, Ortiz H, Dassau E, Kerr D. Techniques for Exercise Preparation and Management in Adults with Type 1 Diabetes. Can J Diabetes 2016; 40:503-508. [PMID: 27212045 DOI: 10.1016/j.jcjd.2016.04.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/15/2016] [Accepted: 04/09/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES People with type 1 diabetes are at risk for early- and late-onset hypoglycemia following exercise. Reducing this risk may be possible with strategic modifications in carbohydrate intake and insulin use. We examined the exercise preparations and management techniques used by individuals with type 1 diabetes before and after physical activity and sought to determine whether use of differing diabetes technologies affects these health-related behaviours. METHODS We studied 502 adults from the Type 1 Diabetes Exchange's online patient community, Glu, who had completed an online survey focused on diabetes self-management and exercise. RESULTS Many respondents reported increasing carbohydrate intake before (79%) and after (66%) exercise as well as decreasing their meal boluses before (53%) and after (46%) exercise. Most reported adhering to a target glucose level before starting exercise (77%). Despite these accommodations, the majority reported low blood glucose (BG) levels after exercise (70%). The majority of users of both insulin pump therapy (CSII) and continuous glucose monitoring (CGM) (Combined) reported reducing basal insulin around exercise (55%), with fewer participants adjusting basal insulin when using other devices (SMBG only = 20%; CGM = 34%; CSII = 42%; p<0.001). However, CSII and Combined users reported that exercise makes their BG levels harder to control (p<0.05) and makes them feel less able to predict their BG levels while exercising (p<0.001); they show agreement that fear of low BG levels keeps them from exercising (p<0.01). CONCLUSIONS These findings highlight the need for exercise-management strategies tailored to individuals' overall diabetes management, for despite making exercise-specific adjustments for care, many people with type 1 diabetes still report significant difficulties with BG control when it comes to exercise.
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Affiliation(s)
- Jordan E Pinsker
- William Sansum Diabetes Center, Santa Barbara, California, United States
| | - Amy Kraus
- Type 1 Diabetes Exchange, Boston, Massachusetts, United States
| | | | | | - Satbir K Singh
- Department of Medicine, Santa Barbara Cottage Hospital, Santa Barbara, California, United States
| | - Hallie Ortiz
- University of California Santa Barbara, Santa Barbara, California, United States
| | - Eyal Dassau
- William Sansum Diabetes Center, Santa Barbara, California, United States; Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, United States
| | - David Kerr
- William Sansum Diabetes Center, Santa Barbara, California, United States.
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19
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Lifestyle Therapy for Diabetes Mellitus. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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20
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Franc S, Daoudi A, Pochat A, Petit MH, Randazzo C, Petit C, Duclos M, Penfornis A, Pussard E, Not D, Heyman E, Koukoui F, Simon C, Charpentier G. Insulin-based strategies to prevent hypoglycaemia during and after exercise in adult patients with type 1 diabetes on pump therapy: the DIABRASPORT randomized study. Diabetes Obes Metab 2015; 17:1150-7. [PMID: 26264812 PMCID: PMC5057323 DOI: 10.1111/dom.12552] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/06/2015] [Accepted: 08/06/2015] [Indexed: 12/15/2022]
Abstract
AIMS To validate strategies to prevent exercise-induced hypoglycaemia via insulin-dose adjustment in adult patients with type 1 diabetes (T1D) on pump therapy. METHODS A total of 20 patients randomly performed four 30-min late post-lunch (3 h after lunch) exercise sessions and a rest session: two moderate sessions [50% maximum oxygen consumption (VO2 max)] with 50 or 80% basal rate (BR) reduction during exercise + 2 h and two intense sessions (75% VO2 max) with 80% BR reduction or with their pump stopped. Two additional early post-lunch sessions (90 min after lunch) were analysed to compare hypoglycaemia incidence for BR reduction versus bolus reduction. RESULTS In all, 100 late post-lunch sessions were analysed. Regardless of exercise type and BR reduction, no more hypoglycaemic events occurred in the period until the next morning than occurred after the rest sessions. In the afternoon, no more hypoglycaemic events occurred with 80% BR reduction/moderate exercise or with pump discontinuation/intense exercise than for the rest session, whereas more hypoglycaemic events occurred with 50% BR reduction/moderate exercise and 80% BR reduction/intense exercise. After early post-lunch exercise (n = 37), a trend towards fewer hypoglycaemic episodes was observed with bolus reduction versus BR reduction (p = 0.07). Mean blood glucose fell by ∼3.3 mmol/l after 30 min of exercise, irrespective of dose reduction, remaining stable until the next morning with no rebound hyperglycaemia. CONCLUSION In adults with T1D, to limit the hypoglycaemic risk associated with 30 min of exercise 3 h after lunch, without carbohydrate supplements, the best options seem to be to reduce BR by 80% or to stop the pump for moderate or intense exercise, or for moderate exercise 90 min after lunch, to reduce the prandial bolus rather than the BR.
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Affiliation(s)
- S Franc
- Centre for Study and Research for Improvement of the Treatment of Diabetes (CERITD), Evry, France
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France
| | - A Daoudi
- Centre for Study and Research for Improvement of the Treatment of Diabetes (CERITD), Evry, France
| | - A Pochat
- Centre for Study and Research for Improvement of the Treatment of Diabetes (CERITD), Evry, France
| | - M-H Petit
- Centre for Study and Research for Improvement of the Treatment of Diabetes (CERITD), Evry, France
| | - C Randazzo
- Centre for Study and Research for Improvement of the Treatment of Diabetes (CERITD), Evry, France
| | - C Petit
- Centre for Study and Research for Improvement of the Treatment of Diabetes (CERITD), Evry, France
| | - M Duclos
- Department of Sport Medicine and Functional Exploration, Clermont-Ferrand University Hospital, UMR1019 CRNH, Clermont-Ferrand, France
| | - A Penfornis
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France
| | - E Pussard
- Molecular Genetics, Pharmacogenetics and Hormonology Laboratory, Bicêtre University Hospital, Kremlin-Bicêtre, France
| | | | - E Heyman
- 'Physical Activity, Muscle, Health' Research Team, URePSSS, University of Lille, Lille, France
| | - F Koukoui
- Department of Cardiology, Sud-Francilien Hospital, Corbeil-Essonnes, France
| | - C Simon
- Department of Endocrinology, Diabetes and Metabolic Diseases, Lyon Sud University Hospital, Pierre-Bénite, France
| | - G Charpentier
- Centre for Study and Research for Improvement of the Treatment of Diabetes (CERITD), Evry, France
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France
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21
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Armstrong MJ, Sigal RJ. Physical activity clinical practice guidelines: what's new in 2013? Can J Diabetes 2015; 37:363-6. [PMID: 24321715 DOI: 10.1016/j.jcjd.2013.07.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/16/2013] [Accepted: 07/24/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Marni J Armstrong
- Department of Cardiovascular and Respiratory Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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22
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The inflammation, vascular repair and injury responses to exercise in fit males with and without Type 1 diabetes: an observational study. Cardiovasc Diabetol 2015; 14:71. [PMID: 26044827 PMCID: PMC4460651 DOI: 10.1186/s12933-015-0235-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 05/27/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Type 1 diabetes is associated with raised inflammation, impaired endothelial progenitor cell mobilisation and increased markers of vascular injury. Both acute and chronic exercise is known to influence these markers in non-diabetic controls, but limited data exists in Type 1 diabetes. We assessed inflammation, vascular repair and injury at rest and after exercise in physically-fit males with and without Type 1 diabetes. METHODS Ten well-controlled type 1 diabetes (27 ± 2 years; BMI 24 ± 0.7 kg.m(2); HbA1c 53.3 ± 2.4 mmol/mol) and nine non-diabetic control males (27 ± 1 years; BMI 23 ± 0.8 kg.m(2)) matched for age, BMI and fitness completed 45-min of running. Venous blood samples were collected 60-min before and 60-min after exercise, and again on the following morning. Blood samples were processed for TNF-α using ELISA, and circulating endothelial progenitor cells (cEPCs; CD45(dim)CD34(+)VEGFR2(+)) and endothelial cells (cECs; CD45(dim)CD133(-)CD34(+)CD144(+)) counts using flow-cytometry. RESULTS TNF-α concentrations were 4-fold higher at all-time points in Type 1 diabetes, when compared with control (P < 0.001). Resting cEPCs were similar between groups; after exercise there was a significant increase in controls (P = 0.016), but not in Type 1 diabetes (P = 0.202). CEPCs peaked the morning after exercise, with a greater change in controls vs. Type 1 diabetes (+139 % vs. 27 %; P = 0.01). CECs did not change with exercise and were similar between groups at all points (P > 0.05). Within the Type 1 diabetes group, the delta change in cEPCS from rest to the following morning was related to HbA1c (r = -0.65, P = 0.021) and TNF-α (r = -0.766, P = 0.005). CONCLUSIONS Resting cEPCs and cECs in Type 1 diabetes patients with excellent HbA1c and high physical-fitness are comparable to healthy controls, despite eliciting 4-fold greater TNF-α. Furthermore, Type 1 diabetes patients appear to have a blunted post-exercise cEPCs response (vascular repair), whilst a biomarker of vascular injury (cECs) remained comparable to healthy controls.
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23
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Campbell MD, Walker M, Bracken RM, Turner D, Stevenson EJ, Gonzalez JT, Shaw JA, West DJ. Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: a randomized controlled trial. BMJ Open Diabetes Res Care 2015; 3:e000085. [PMID: 26019878 PMCID: PMC4442134 DOI: 10.1136/bmjdrc-2015-000085] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 03/10/2015] [Accepted: 03/17/2015] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Evening-time exercise is a frequent cause of severe hypoglycemia in type 1 diabetes, fear of which deters participation in regular exercise. Recommendations for normalizing glycemia around exercise consist of prandial adjustments to bolus insulin therapy and food composition, but this carries only short-lasting protection from hypoglycemia. Therefore, this study aimed to examine the impact of a combined basal-bolus insulin dose reduction and carbohydrate feeding strategy on glycemia and metabolic parameters following evening exercise in type 1 diabetes. METHODS Ten male participants (glycated hemoglobin: 52.4±2.2 mmol/mol), treated with multiple daily injections, completed two randomized study-days, whereby administration of total daily basal insulin dose was unchanged (100%), or reduced by 20% (80%). Participants attended the laboratory at ∼08:00 h for a fasted blood sample, before returning in the evening. On arrival (∼17:00 h), participants consumed a carbohydrate meal and administered a 75% reduced rapid-acting insulin dose and 60 min later performed 45 min of treadmill running. At 60 min postexercise, participants consumed a low glycemic index (LGI) meal and administered a 50% reduced rapid-acting insulin dose, before returning home. At ∼23:00 h, participants consumed a LGI bedtime snack and returned to the laboratory the following morning (∼08:00 h) for a fasted blood sample. Venous blood samples were analyzed for glucose, glucoregulatory hormones, non-esterified fatty acids, β-hydroxybutyrate, interleukin 6, and tumor necrosis factor α. Interstitial glucose was monitored for 24 h pre-exercise and postexercise. RESULTS Glycemia was similar until 6 h postexercise, with no hypoglycemic episodes. Beyond 6 h glucose levels fell during 100%, and nine participants experienced nocturnal hypoglycemia. Conversely, all participants during 80% were protected from nocturnal hypoglycemia, and remained protected for 24 h postexercise. All metabolic parameters were similar. CONCLUSIONS Reducing basal insulin dose with reduced prandial bolus insulin and LGI carbohydrate feeding provides protection from hypoglycemia during and for 24 h following evening exercise. This strategy is not associated with hyperglycemia, or adverse metabolic disturbances. CLINICAL TRIALS NUMBER NCT02204839, ClinicalTrials.gov.
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Affiliation(s)
- Matthew D Campbell
- Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - Mark Walker
- Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Richard M Bracken
- Diabetes Research Group, College of Medicine, Swansea University, Swansea, UK
| | - Daniel Turner
- Diabetes Research Group, College of Medicine, Swansea University, Swansea, UK
| | - Emma J Stevenson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - Javier T Gonzalez
- Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - James A Shaw
- Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - Daniel J West
- Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK
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24
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Abstract
While being physically active bestows many health benefits on individuals with type 1 diabetes, their overall blood glucose control is not enhanced without an effective balance of insulin dosing and food intake to maintain euglycemia before, during, and after exercise of all types. At present, a number of technological advances are already available to insulin users who desire to be physically active with optimal blood glucose control, although a number of limitations to those devices remain. In addition to continued improvements to existing technologies and introduction of new ones, finding ways to integrate all of the available data to optimize blood glucose control and performance during and following exercise will likely involve development of "smart" calculators, enhanced closed-loop systems that are able to use additional inputs and learn, and social aspects that allow devices to meet the needs of the users.
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Affiliation(s)
- Sheri R Colberg
- Human Movement Sciences Department, Old Dominion University, Norfolk, VA, USA
| | - Remmert Laan
- William Sansum Diabetes Center, Santa Barbara, CA, USA
| | - Eyal Dassau
- Department of Chemical Engineering, University of California, Santa Barbara, CA, USA
| | - David Kerr
- William Sansum Diabetes Center, Santa Barbara, CA, USA
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Campbell MD, Gonzalez JT, Rumbold PLS, Walker M, Shaw JA, Stevenson EJ, West DJ. Comparison of appetite responses to high- and low-glycemic index postexercise meals under matched insulinemia and fiber in type 1 diabetes. Am J Clin Nutr 2015; 101:478-86. [PMID: 25733632 DOI: 10.3945/ajcn.114.097162] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients with type 1 diabetes face heightened risk of hypoglycemia after exercise. Subsequent overfeeding, as a preventative measure against hypoglycemia, negates the energy deficit after exercise. Patients are also required to reduce the insulin dose administered with postexercise foods to further combat hypoglycemia. However, the insulin dose is dictated solely by the carbohydrate content, even though postprandial glycemia is vastly influenced by glycemic index (GI). With a need to control the postexercise energy balance, appetite responses after meals differing in GI are of particular interest. OBJECTIVES We assessed the appetite response to low-glycemic index (LGI) and high-glycemic index (HGI) postexercise meals in type 1 diabetes patients. This assessment also offered us the opportunity to evaluate the influence of GI on appetite responses independently of insulinemia, which confounds findings in individuals without diabetes. DESIGN Ten physically active men with type 1 diabetes completed 2 trials in a randomized crossover design. After 45 min of treadmill exercise at 70% of the peak oxygen uptake, participants consumed an LGI (GI ∼37) or HGI (GI ∼92) meal with a matched macronutrient composition, negligible fiber content, and standardized insulin-dose administration. The postprandial appetite response was determined for 180 min postmeal. During this time, circulating glucose, insulin, glucagon, and glucagon-like peptide-1 (GLP-1) concentrations and subjective appetite ratings were determined. RESULTS The HGI meal produced an ∼60% greater postprandial glucose area under the curve (AUC) than did the LGI meal (P = 0.008). Insulin, glucagon, and GLP-1 did not significantly differ between trials (P > 0.05). The fullness AUC was ∼25% greater after the HGI meal than after the LGI meal (P < 0.001), whereas hunger sensations were ∼9% lower after the HGI meal than after the LGI meal (P = 0.001). CONCLUSION Under conditions of matched insulinemia and fiber, an HGI postexercise meal suppresses feelings of hunger and augments postprandial fullness sensations more so than an otherwise equivalent LGI meal in type 1 diabetes patients.
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Affiliation(s)
- Matthew D Campbell
- From the Department of Sport, Exercise and Rehabilitation (MDC, JTG, PLSR, DJW, and EJS) and the Brain, Performance and Nutrition Research Centre (JTG and EJS), Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom, and the Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom (MW and JAS)
| | - Javier T Gonzalez
- From the Department of Sport, Exercise and Rehabilitation (MDC, JTG, PLSR, DJW, and EJS) and the Brain, Performance and Nutrition Research Centre (JTG and EJS), Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom, and the Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom (MW and JAS)
| | - Penny L S Rumbold
- From the Department of Sport, Exercise and Rehabilitation (MDC, JTG, PLSR, DJW, and EJS) and the Brain, Performance and Nutrition Research Centre (JTG and EJS), Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom, and the Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom (MW and JAS)
| | - Mark Walker
- From the Department of Sport, Exercise and Rehabilitation (MDC, JTG, PLSR, DJW, and EJS) and the Brain, Performance and Nutrition Research Centre (JTG and EJS), Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom, and the Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom (MW and JAS)
| | - James A Shaw
- From the Department of Sport, Exercise and Rehabilitation (MDC, JTG, PLSR, DJW, and EJS) and the Brain, Performance and Nutrition Research Centre (JTG and EJS), Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom, and the Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom (MW and JAS)
| | - Emma J Stevenson
- From the Department of Sport, Exercise and Rehabilitation (MDC, JTG, PLSR, DJW, and EJS) and the Brain, Performance and Nutrition Research Centre (JTG and EJS), Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom, and the Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom (MW and JAS)
| | - Daniel J West
- From the Department of Sport, Exercise and Rehabilitation (MDC, JTG, PLSR, DJW, and EJS) and the Brain, Performance and Nutrition Research Centre (JTG and EJS), Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom, and the Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom (MW and JAS)
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Quantifying the Acute Changes in Glucose with Exercise in Type 1 Diabetes: A Systematic Review and Meta-Analysis. Sports Med 2015; 45:587-99. [DOI: 10.1007/s40279-015-0302-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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(4) Foundations of care: education, nutrition, physical activity, smoking cessation, psychosocial care, and immunization. Diabetes Care 2015; 38 Suppl:S20-30. [PMID: 25537702 DOI: 10.2337/dc15-s007] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Colberg SR. Exercise as medicine for diabetes: prescribing appropriate activities and avoiding potential pitfalls: preface. Diabetes Spectr 2015; 28:10-3. [PMID: 25717272 PMCID: PMC4334086 DOI: 10.2337/diaspect.28.1.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Sheri R Colberg
- Old Dominion University and Eastern Virginia Medical School, Norfolk, VA
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Robertson K, Riddell MC, Guinhouya BC, Adolfsson P, Hanas R. ISPAD Clinical Practice Consensus Guidelines 2014. Exercise in children and adolescents with diabetes. Pediatr Diabetes 2014; 15 Suppl 20:203-23. [PMID: 25182315 DOI: 10.1111/pedi.12176] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 06/11/2014] [Indexed: 12/25/2022] Open
Affiliation(s)
- Kenneth Robertson
- Greater Glasgow & Clyde Children's Diabetes Service, Royal Hospital for Sick Children, Glasgow, UK
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Campbell MD, Walker M, Trenell MI, Stevenson EJ, Turner D, Bracken RM, Shaw JA, West DJ. A low-glycemic index meal and bedtime snack prevents postprandial hyperglycemia and associated rises in inflammatory markers, providing protection from early but not late nocturnal hypoglycemia following evening exercise in type 1 diabetes. Diabetes Care 2014; 37:1845-53. [PMID: 24784832 DOI: 10.2337/dc14-0186] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the influence of the glycemic index (GI) of foods consumed after evening exercise on postprandial glycemia, metabolic and inflammatory markers, and nocturnal glycemic control in type 1 diabetes. RESEARCH DESIGN AND METHODS On two evenings (∼1700 h), 10 male patients (27 ± 5 years of age, HbA1c 6.7 ± 0.7% [49.9 ± 8.1 mmol/mol]) were administered a 25% rapid-acting insulin dose with a carbohydrate bolus 60 min before 45 min of treadmill running. At 60 min postexercise, patients were administered a 50% rapid-acting insulin dose with one of two isoenergetic meals (1.0 g carbohdyrate/kg body mass [BM]) matched for macronutrient content but of either low GI (LGI) or high GI (HGI). At 180 min postmeal, the LGI group ingested an LGI snack and the HGI group an HGI snack (0.4 g carbohdyrate/kg BM) before returning home (∼2300 h). Interval samples were analyzed for blood glucose and lactate; plasma glucagon, epinephrine, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α); and serum insulin, cortisol, nonesterified fatty acid, and β-hydroxybutyrate concentrations. Interstitial glucose was recorded for 20 h postlaboratory attendance through continuous glucose monitoring. RESULTS Following the postexercise meal, an HGI snack induced hyperglycemia in all patients (mean ± SD glucose 13.5 ± 3.3 mmol/L) and marked increases in TNF-α and IL-6, whereas relative euglycemia was maintained with an LGI snack (7.7 ± 2.5 mmol/L, P < 0.001) without inflammatory cytokine elevation. Both meal types protected all patients from early hypoglycemia. Overnight glycemia was comparable, with a similar incidence of nocturnal hypoglycemia (n = 5 for both HGI and LGI). CONCLUSIONS Consuming LGI food with a reduced rapid-acting insulin dose following evening exercise prevents postprandial hyperglycemia and inflammation and provides hypoglycemia protection for ∼8 h postexercise; however, the risk of late nocturnal hypoglycemia remains.
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Affiliation(s)
- Matthew D Campbell
- Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, U.K
| | - Mark Walker
- Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, U.K
| | - Michael I Trenell
- Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, U.K
| | - Emma J Stevenson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, U.K
| | - Daniel Turner
- Applied Sports, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, U.K
| | - Richard M Bracken
- Applied Sports, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, U.K
| | - James A Shaw
- Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, U.K
| | - Daniel J West
- Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, U.K.
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Campbell MD, Walker M, Trenell MI, Luzio S, Dunseath G, Tuner D, Bracken RM, Bain SC, Russell M, Stevenson EJ, West DJ. Metabolic implications when employing heavy pre- and post-exercise rapid-acting insulin reductions to prevent hypoglycaemia in type 1 diabetes patients: a randomised clinical trial. PLoS One 2014; 9:e97143. [PMID: 24858952 PMCID: PMC4032262 DOI: 10.1371/journal.pone.0097143] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 04/14/2014] [Indexed: 12/13/2022] Open
Abstract
Aim To examine the metabolic, gluco-regulatory-hormonal and inflammatory cytokine responses to large reductions in rapid-acting insulin dose administered prandially before and after intensive running exercise in male type 1 diabetes patients. Methods This was a single centre, randomised, controlled open label study. Following preliminary testing, 8 male patients (24±2 years, HbA1c 7.7±0.4%/61±4 mmol.l−1) treated with insulin's glargine and aspart, or lispro attended the laboratory on two mornings at ∼08:00 h and consumed a standardised breakfast carbohydrate bolus (1 g carbohydrate.kg−1BM; 380±10 kcal) and self-administered a 75% reduced rapid-acting insulin dose 60 minutes before 45 minutes of intensive treadmill running at 73.1±0.9% VO2peak. At 60 minutes post-exercise, patients ingested a meal (1 g carbohydrate.kg−1BM; 660±21 kcal) and administered either a Full or 50% reduced rapid-acting insulin dose. Blood glucose and lactate, serum insulin, cortisol, non-esterified-fatty-acids, β-Hydroxybutyrate, and plasma glucagon, adrenaline, noradrenaline, IL-6, and TNF-α concentrations were measured for 180 minutes post-meal. Results All participants were analysed. All glycaemic, metabolic, hormonal, and cytokine responses were similar between conditions up to 60 minutes following exercise. Following the post-exercise meal, serum insulin concentrations were lower under 50% (p<0.05) resulting in 75% of patients experiencing hyperglycaemia (blood glucose ≥8.0 mmol.l−1; 50% n = 6, Full n = 3). β-Hydroxybutyrate concentrations decreased similarly, such that at 180 minutes post-meal concentrations were lower than rest under Full and 50%. IL-6 and TNF-α concentrations remained similar to fasting levels under 50% but declined under Full. Under 50% IL-6 concentrations were inversely related with serum insulin concentrations (r = −0.484, p = 0.017). Conclusions Heavily reducing rapid-acting insulin dose with a carbohydrate bolus before, and a meal after intensive running exercise may cause hyperglycaemia, but does not augment ketonaemia, raise inflammatory cytokines TNF-α and IL-6 above fasting levels, or cause other adverse metabolic or hormonal disturbances. Trial Registration ClinicalTrials.gov NCT01531855
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Affiliation(s)
- Matthew D Campbell
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Mark Walker
- Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Michael I Trenell
- Institute for Ageing and Health, Faculty of Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Steven Luzio
- Diabetes Research Group, College of Medicine, Swansea University Swansea, United Kingdom
| | - Gareth Dunseath
- Diabetes Research Group, College of Medicine, Swansea University Swansea, United Kingdom
| | - Daniel Tuner
- Applied Sports, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, United Kingdom
| | - Richard M Bracken
- Applied Sports, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, United Kingdom
| | - Stephen C Bain
- Diabetes Research Group, College of Medicine, Swansea University Swansea, United Kingdom
| | - Mark Russell
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Emma J Stevenson
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Daniel J West
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
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Sigal RJ, Armstrong MJ, Colby P, Kenny GP, Plotnikoff RC, Reichert SM, Riddell MC. Activité physique et diabète. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.07.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Campbell MD, Walker M, Trenell MI, Jakovljevic DG, Stevenson EJ, Bracken RM, Bain SC, West DJ. Large pre- and postexercise rapid-acting insulin reductions preserve glycemia and prevent early- but not late-onset hypoglycemia in patients with type 1 diabetes. Diabetes Care 2013; 36:2217-24. [PMID: 23514728 PMCID: PMC3714511 DOI: 10.2337/dc12-2467] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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.
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Sigal RJ, Armstrong MJ, Colby P, Kenny GP, Plotnikoff RC, Reichert SM, Riddell MC. Physical activity and diabetes. Can J Diabetes 2013; 37 Suppl 1:S40-4. [PMID: 24070962 DOI: 10.1016/j.jcjd.2013.01.018] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Yardley JE, Iscoe KE, Sigal RJ, Kenny GP, Perkins BA, Riddell MC. Insulin pump therapy is associated with less post-exercise hyperglycemia than multiple daily injections: an observational study of physically active type 1 diabetes patients. Diabetes Technol Ther 2013; 15:84-8. [PMID: 23216304 DOI: 10.1089/dia.2012.0168] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Aerobic exercise typically decreases blood glucose levels in individuals with type 1 diabetes. It is currently unknown if glucose responses to exercise and recovery differ between patients on multiple daily insulin injections (MDI) and continuous subcutaneous insulin infusion (CSII). SUBJECTS AND METHODS Nineteen (16 male, three female) physically active individuals with type 1 diabetes took part in this observational study. Interstitial glucose levels (blinded) were compared during 45 min of standardized aerobic exercise (cycling or running at 60% peak aerobic capacity) and during 6 h of postexercise recovery between individuals using MDI (n=9) and CSII (n=10) therapy. RESULTS Both MDI and CSII groups had similar reductions in glucose levels during exercise, but responses in early and late recovery differed (group × time interaction, P<0.01). Participants using MDI had greater increases in glucose throughout recovery compared with individuals with CSII. Two-thirds of the MDI patients experienced late-onset post-exercise hyperglycemia (blood glucose >12 mmol/L) compared with only 1/10(th) of the CSII patients (P<0.01). CONCLUSIONS Among individuals performing regular moderate-to-heavy intensity aerobic exercise, use of CSII helped to limit post-exercise hyperglycemia compared with MDI therapy and is not associated with increased risk for post-exercise late-onset hypoglycemia.
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Affiliation(s)
- Jane E Yardley
- Human and Environmental Physiology Research Unit, University of Ottawa, Ottawa, Ontario, Canada
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