Abstract
Background: Few papers focus on exercise-related blood glucose (BG) in patients on continuous sc insulin infusion (CSII) or multiple daily injections (MDI) with glargine. Aim: The main objective was to evaluate the degree of glycemic control in Type 1 diabetes mellitus adolescents on CSII doing physical activity with pump switched on or off. These findings were also compared with a small group of patients on MDI with glargine. Subjects and methods: Eight patients on CSII (basal rate continued or turned off in alternating sessions) and 5 on MDI joined 4 sessions of moderate-severe exercise. Results: Post-exercise BG significantly increased with the pump off and was unchanged/decreased with the pump on and MDI groups vs baseline. The hypoglycemia rate was not different among the 3 groups at any time. Pump on: hypoglycemias more frequent both at bed-time (p=0.031) and at awakening (p<0.001) than before dinner and at awakening than at bed-time (p=0.044). Pump off: hypoglycemias more frequent both at bed-time (p=0.010) and at awakening (p=0.031) than before dinner. MDI: no differences. Conclusions: Glargine is safe and reducing the prelunch insulin is unnecessary. Subjects on insulin pump should not stop the basal rate. If they stop the pump, some actions are advisable: pre-exercise insulin bolus, pre-sleeping snack rich in carbohydrates, slight reduction of the overnight basal rate. On the other hand, if the basal rate is unmodified, the ingestion of sugary drinks during the exercise, the reduction of the overnight basal rate, a reduction of the pre-dinner insulin bolus and/or a pre-sleeping snack should be considered.
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References
1. American Diabetes Association. Standards of medical care in diabetes—2008. Diabetes Care 2008, 31 (Suppl 1): S12–54.
Silverstein J, Klingensmith G, Copeland K, et al; American Diabetes Association. Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. Diabetes Care 2005, 28: 186–212.
Arslanian S, Nixon PA, Becker D, Drash AL. Impact of physical fitness and glycemic control on in vivo insulin action in adolescents with IDDM. Diabetes Care 1990, 13: 9–15.
Waden J, Tikkanen H, Forsblom C, et al. Leisure time physical activity is associated with poor glycemic control in type 1 diabetic women: the FinnDiane study. Diabetes Care 2005, 28: 777–82.
Sackey AH, Jefferson IG. Physical activity and glycaemic control in children with diabetes mellitus. Diabet Med 1996, 13: 789–93.
Wasserman DH, Zinman B. Exercise in individuals with IDDM. Diabetes Care 1994, 17: 924–37.
Austin A, Warty V, Janosky J, Arslanian S. The relationship of physical fitness to lipid and lipoprotein(a) levels in adolescents with IDDM. Diabetes Care 1993, 16: 421–5.
Riddell MC, Iscoe KE. Physical activity, sport, and pediatric diabetes. Pediatr Diabetes 2006, 7: 60–70.
Massin MM, Lebrethon MC, Rocour D, Gérard P, Bourguignon JP. Patterns of physical activity determined by heart rate monitoring among diabetic children. Arch Dis Child 2005, 90: 1223–6.
Tsalikian E, Mauras N, Beck RW, et al. Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus. J Pediatr 2005, 147: 528–34.
Libman IM, Pietropaolo M, Arslanian SA, LaPorte RE, Becker DJ. Changing prevalence of overweight children and adolescents at onset of insulin-treated diabetes. Diabetes Care 2003, 26: 2871–5.
Raile K, Kapellen T, Schweiger A, et al. Physical activity and competitive sports in children and adolescents with type 1 diabetes. Diabetes Care 1999, 22: 1904–5.
Rachmiel M, Buccino J, Daneman D. Exercise and type 1 diabetes mellitus in youth; review and recommendations. Pediatr Endocrinol Rev 2007, 5: 656–65.
Conn VS, Hafdahl AR, Lemaster JW, Ruppar TM, Cochran JE, Nielsen PJ. Meta-analysis of health behavior change interventions in type 1 diabetes. Am J Health Behav 2008, 32: 315–29.
Nordfeldt S, Ludvigsson J. Fear and other disturbances of severe hypoglycaemia in children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2005, 18: 83–91.
Holloszy JO. Exercise-induced increase in muscle insulin sensitivity. J Appl Physiol 2005, 99: 338–43.
Tansey MJ, Tsalikian E, Beck RW, et al; Diabetes Research in Children Network (DirecNet) Study Group. The effects of aerobic exercise on glucose and counterregulatory hormone concentrations in children with type 1 diabetes. Diabetes Care 2006, 29: 20–5.
Wolfsdorf JI. Children with diabetes benefit from exercise. Arch Dis Child 2005, 90: 1215–7.
McMahon SK, Ferreira LD, Ratnam N, et al. Glucose requirements to maintain euglycemia after moderate-intensity afternoon exercise in adolescents with type 1 diabetes are increased in a biphasic manner. J Clin Endocrinol Metab 2007, 92: 963–8.
Marliss EB, Vranic M. Intense exercise has unique effects on both insulin release and its roles in glucoregulation: implications for diabetes. Diabetes 2002, 51 (Suppl 1): S271–83.
Koivisto VA. Exercise and diabetes mellitus. In: Pickup JC, Williams G, eds. Textbook of Diabetes 2nd ed. Oxford: Blackwell Science. 1997, 681–68.
Colino E, López-Capapé M, Golmayo L, Alvarez MA, Alonso M, Barrio R. Therapy with insulin glargine (Lantus) in toddlers, children and adolescents with type 1 diabetes. Diabetes Res Clin Pract 2005, 70: 1–7.
Kaplan W, Rodriguez LM, Smith OE, Haymond MW, Heptulla RA. Effects of mixing glargine and short-acting insulin analogs on glucose control. Diabetes Care 2004, 27: 2739–40.
Chase HP, Dixon B, Pearson J, et al. Reduced hypoglycemic episodes and improved glycemic control in children with type 1 diabetes using insulin glargine and neutral protamine Hagedorn insulin. J Pediatr 2003, 143: 737–40.
Low KG, Massa L, Lehman D, Olshan JS. Insulin pump use in young adolescents with type 1 diabetes: a descriptive study. Pediatr Diabetes 2005, 6: 22–31.
Nimri R, Weintrob N, Benzaquen H, Ofan R, Fayman G, Phillip M. Insulin pump therapy in youth with type 1 diabetes: a retrospective paired study. Pediatrics 2006, 117: 2126–31.
Danne T, Battelino T, Kordonouri O, et al. A cross-sectional international survey of continuous subcutaneous insulin infusion in 377 children and adolescents with type 1 diabetes mellitus from 10 countries. Pediatr Diabetes 2005, 6: 193–8.
Zinman B, Ruderman N, Campaigne BN, Devlin JT, Schneider SH; American Diabetes Association. Physical activity/exercise and diabetes. Diabetes Care 2004, 27 (Suppl 1): S58–62.
Admon G, Weinstein Y, Falk B, et al. Exercise with and without an insulin pump among children and adolescents with type 1 diabetes mellitus. Pediatrics 2005, 116: e348–55.
Peter R, Luzio SD, Dunseath G, et al. Effects of exercise on the absorption of insulin glargine in patients with type 1 diabetes. Diabetes Care 2005, 28: 560–5.
Rabasa-Lhoret R, Bourque J, Ducros F, Chiasson JL. Guidelines for premeal insulin dose reduction for postprandial exercise of different intensities and durations in type 1 diabetic subjects treated intensively with a basal-bolus insulin regimen (ultralente-lispro). Diabetes Care 2001, 24: 625–30.
Tsalikian E, Kollman C, Tamborlane WB, et al; Diabetes Research in Children Network (DirecNet) Study Group. Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin. Diabetes Care 2006, 29: 2200–4.
Phillip M, Battelino T, Rodriguez H, Danne T, Kaufman F; European Society for Paediatric Endocrinology; Lawson Wilkins Pediatric Endocrine Society; International Society for Pediatric and Adolescent Diabetes; American Diabetes Association; European Association for the Study of Diabetes. Use of insulin pump therapy in the pediatric age-group: consensus statement from the European Society for Paediatric Endocrinology, the Lawson Wilkins Pediatric Endocrine Society, and the International Society for Pediatric and Adolescent Diabetes, endorsed by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2007, 30: 1653–62.
Cacciari E, Milani S, Balsamo A, et al. Italian cross-sectional growth charts for height, weight and BMI (2 to 20 yr). J Endocrinol Invest 2006, 29: 581–93.
Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of physical activities: an update of activity codes and M ET intensities. Med Sci Sports Exerc 2000, 32: S498–504.
Perrone C, Laitano O, Meyer F. Effect of carbohydrate ingestion on the glycemic response of type 1 diabetic adolescents during exercise. Diabetes Care 2005, 28: 2537–8.
Davis SN, Shavers C, Mosqueda-Garcia R, Costa F. Effects of differing antecedent hypoglycemia on subsequent counterregulation in normal humans. Diabetes 1997, 46: 1328–35.
Galassetti P, Neill AR, Tate D, Ertl AC, Wasserman DH, Davis SN. Sexual dimorphism in counterregulatory responses to hypoglycemia after antecedent exercise. J Clin Endocrinol Metab 2001, 86: 3516–24.
Galassetti P, Tate D, Neill RA, Morrey S, Davis SN. Effect of gender on counterregulatory responses to euglycemic exercise in type 1 diabetes. J Clin Endocrinol Metab 2002, 87: 5144–50.
Galassetti P, Tate D, Neill RA, Morrey S, Wasserman DH, Davis SN. Effect of sex on counterregulatory responses to exercise after antecedent hypoglycemia in type 1 diabetes. Am J Physiol Endocrinol Metab 2004, 287: E16–24.
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Delvecchio, M., Zecchino, C., Salzano, G. et al. Effects of moderate-severe exercise on blood glucose in Type 1 diabetic adolescents treated with insulin pump or glargine insulin. J Endocrinol Invest 32, 519–524 (2009). https://doi.org/10.1007/BF03346499
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DOI: https://doi.org/10.1007/BF03346499