Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin.

Diabetes Care (Impact Factor: 8.42). 10/2006; 29(10):2200-4. DOI: 10.2337/dc06-0495
Source: PubMed


Strategies for preventing hypoglycemia during exercise in children with type 1 diabetes have not been well studied. The Diabetes Research in Children Network (DirecNet) Study Group conducted a study to determine whether stopping basal insulin could reduce the frequency of hypoglycemia occurring during exercise.
Using a randomized crossover design, 49 children 8-17 years of age with type 1 diabetes on insulin pump therapy were studied during structured exercise sessions on 2 days. On day 1, basal insulin was stopped during exercise, and on day 2 it was continued. Each exercise session, performed from approximately 4:00-5:00 p.m., consisted of four 15-min treadmill cycles at a target heart rate of 140 bpm (interspersed with three 5-min rest breaks over 75 min), followed by a 45-min observation period. Frequently sampled glucose concentrations (measured in the DirecNet Central Laboratory) were measured before, during, and after the exercise.
Hypoglycemia (< or = 70 mg/dl) during exercise occurred less frequently when the basal insulin was discontinued than when it was continued (16 vs. 43%; P = 0.003). Hyperglycemia (increase from baseline of > or = 20% to > or = 200 mg/dl) 45 min after the completion of exercise was more frequent without basal insulin (27 vs. 4%; P = 0.002). There were no cases of abnormal blood ketone levels.
Discontinuing basal insulin during exercise is an effective strategy for reducing hypoglycemia in children with type 1 diabetes, but the risk of hyperglycemia is increased.

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Available from: Kathleen F Janz
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    • "While many clinicians may recommend temporary reductions in overnight basal rates in pump-treated patients to reduce the risk of hypoglycemia on nights after afternoon exercise, there are no clear guidelines for the duration and extent of reduction in basal rates, which is likely to vary from patient to patient and depends on the type of exercise. It is not surprising that previous reports have shown that use of this strategy often results in nocturnal hyperglycemia (22,23). "
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    ABSTRACT: OBJECTIVE Afternoon exercise increases the risk of nocturnal hypoglycemia (NH) in subjects with type 1 diabetes. We hypothesized that automated feedback-controlled closed-loop (CL) insulin delivery would be superior to open-loop (OL) control in preventing NH and maintaining a higher proportion of blood glucose levels within the target blood glucose range on nights with and without antecedent afternoon exercise.RESEARCH DESIGN AND METHODS Subjects completed two 48-h inpatient study periods in random order: usual OL control and CL control using a proportional-integrative-derivative plus insulin feedback algorithm. Each admission included a sedentary day and an exercise day, with a standardized protocol of 60 min of brisk treadmill walking to 65-70% maximum heart rate at 3:00 p.m.RESULTSAmong 12 subjects (age 12-26 years, A1C 7.4 ± 0.6%), antecedent exercise increased the frequency of NH (reference blood glucose <60 mg/dL) during OL control from six to eight events. In contrast, there was only one NH event each on nights with and without antecedent exercise during CL control (P = 0.04 vs. OL nights). Overnight, the percentage of glucose values in target range was increased with CL control (P < 0.0001). Insulin delivery was lower between 10:00 p.m. and 2:00 a.m. on nights after exercise on CL versus OL, P = 0.008.CONCLUSIONSCL insulin delivery provides an effective means to reduce the risk of NH while increasing the percentage of time spent in target range, regardless of activity level in the mid-afternoon. These data suggest that CL control could be of benefit to patients with type 1 diabetes even if it is limited to the overnight period.
    Full-text · Article · Jun 2013 · Diabetes care
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    • "Fifteen grams of carbohydrates may be administered as a readily absorbed sugar if blood glucose levels are <100 mg/dL during the period of exercise [22]. The DirecNet study group has also found that discontinuing basal insulin during exercise is an effective strategy in those using insulin pumps for reducing hypoglycemia [31]. In addition, they have also found that overnight hypoglycemia after exercise is common in children with TIDM and recommend modifying diabetes management following afternoon exercise to reduce the risk of hypoglycemia [32]. "
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    ABSTRACT: Objective. We sought to identify amount of physical activity and relationship of physical activity to glycemic control among adolescent females 11 to 19 years of age with type 1 diabetes mellitus (T1DM). We also sought to evaluate associations of age and ethnicity with physical activity levels. Research Design and Methods. Adolescent females ages 11-19 years (n = 203) were recruited during their outpatient diabetes appointment. Physical activity was obtained by self-report and was categorized as the number of days subjects had accumulated 60 minutes of moderate-to-vigorous physical activity during the past 7 days and for a typical week. Results. Girls reported being physically active for at least 60 minutes per day on 2.7 +/- 2.3 days in the last week, and on 3.1 +/- 2.2 days in a typical week. A greater number of physically active days in a typical week were associated with lower A1c (P = .049) in linear regression analysis. Conclusion. Adolescent females with T1DM report exercising for at least 60 minutes about 3 days per week, which does not meet the international recommendations of 60 minutes of moderate-to-vigorous activity per day. It is particularly important that adolescent girls with T1DM be encouraged to exercise since a greater number of physically active days per week is associated with better glycemic control.
    Full-text · Article · Jun 2010 · International Journal of Pediatrics
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