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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

Lookup NU author(s): Professor Mark Walker, Professor Mike TrenellORCiD, Dr Daniel WestORCiD

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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 (2462 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 similar to 08:00 h and consumed a standardised breakfast carbohydrate bolus (1 g carbohydrate.kg(-1)BM; 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(-1)BM; 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, beta-Hydroxybutyrate, and plasma glucagon, adrenaline, noradrenaline, IL-6, and TNF-alpha 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). beta-Hydroxybutyrate concentrations decreased similarly, such that at 180 minutes post-meal concentrations were lower than rest under Full and 50%. IL-6 and TNF-alpha 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-alpha and IL-6 above fasting levels, or cause other adverse metabolic or hormonal disturbances.

Publication metadata

Author(s): Campbell MD, Walker M, Trenell MI, Luzio S, Dunseath G, Tuner D, Bracken RM, Bain SC, Russell M, Stevenson EJ, West DJ

Publication type: Article

Publication status: Published

Journal: PLoS One

Year: 2014

Volume: 9

Issue: 5

Print publication date: 23/05/2014

Acceptance date: 14/04/2014

Date deposited: 28/08/2014

ISSN (electronic): 1932-6203

Publisher: Public Library of Science

URL: http://dx.doi.org/10.1371/journal.pone.0097143

DOI: 10.1371/journal.pone.0097143

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