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Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: a randomized controlled trial

M. D. Campbell, M. Walker, Richard Bracken Orcid Logo, D. Turner, E. J. Stevenson, J. T. Gonzalez, J. A. Shaw, D. J. West

BMJ Open Diabetes Research & Care, Volume: 3, Issue: 1

Swansea University Author: Richard Bracken Orcid Logo

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DOI (Published version): 10.1136/bmjdrc-2015-000085

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 c...

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Published in: BMJ Open Diabetes Research & Care
ISSN: 2052-4897
Published: 2015
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URI: https://cronfa.swan.ac.uk/Record/cronfa22133
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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&#xB1;2.2&#x2005;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 &#x223C;08:00&#x2005;h for a fasted blood sample, before returning in the evening. On arrival (&#x223C;17:00&#x2005;h), participants consumed a carbohydrate meal and administered a 75% reduced rapid-acting insulin dose and 60&#x2005;min later performed 45&#x2005;min of treadmill running. At 60&#x2005;min postexercise, participants consumed a low glycemic index (LGI) meal and administered a 50% reduced rapid-acting insulin dose, before returning home. At &#x223C;23:00&#x2005;h, participants consumed a LGI bedtime snack and returned to the laboratory the following morning (&#x223C;08:00&#x2005;h) for a fasted blood sample. Venous blood samples were analyzed for glucose, glucoregulatory hormones, non-esterified fatty acids, &#x3B2;-hydroxybutyrate, interleukin 6, and tumor necrosis factor &#x3B1;. Interstitial glucose was monitored for 24&#x2005;h pre-exercise and postexercise.Results Glycemia was similar until 6&#x2005;h postexercise, with no hypoglycemic episodes. Beyond 6&#x2005;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&#x2005;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&#x2005;h following evening exercise. 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spelling 2020-07-06T15:40:28.3993566 v2 22133 2015-06-19 Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: a randomized controlled trial f5da81cd18adfdedb2ccb845bddc12f7 0000-0002-6986-6449 Richard Bracken Richard Bracken true false 2015-06-19 EAAS 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. Journal Article BMJ Open Diabetes Research & Care 3 1 2052-4897 12 5 2015 2015-05-12 10.1136/bmjdrc-2015-000085 COLLEGE NANME Engineering and Applied Sciences School COLLEGE CODE EAAS Swansea University 2020-07-06T15:40:28.3993566 2015-06-19T10:35:01.7517839 Faculty of Science and Engineering School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Sport and Exercise Sciences M. D. Campbell 1 M. Walker 2 Richard Bracken 0000-0002-6986-6449 3 D. Turner 4 E. J. Stevenson 5 J. T. Gonzalez 6 J. A. Shaw 7 D. J. West 8 0022133-15072016115301.pdf Campbell2015.pdf 2016-07-15T11:53:01.1100000 Output 345249 application/pdf Version of Record true 2016-07-15T00:00:00.0000000 false
title Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: a randomized controlled trial
spellingShingle Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: a randomized controlled trial
Richard Bracken
title_short Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: a randomized controlled trial
title_full Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: a randomized controlled trial
title_fullStr Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: a randomized controlled trial
title_full_unstemmed Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: a randomized controlled trial
title_sort Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening exercise in type 1 diabetes: a randomized controlled trial
author_id_str_mv f5da81cd18adfdedb2ccb845bddc12f7
author_id_fullname_str_mv f5da81cd18adfdedb2ccb845bddc12f7_***_Richard Bracken
author Richard Bracken
author2 M. D. Campbell
M. Walker
Richard Bracken
D. Turner
E. J. Stevenson
J. T. Gonzalez
J. A. Shaw
D. J. West
format Journal article
container_title BMJ Open Diabetes Research & Care
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container_issue 1
publishDate 2015
institution Swansea University
issn 2052-4897
doi_str_mv 10.1136/bmjdrc-2015-000085
college_str Faculty of Science and Engineering
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hierarchy_top_title Faculty of Science and Engineering
hierarchy_parent_id facultyofscienceandengineering
hierarchy_parent_title Faculty of Science and Engineering
department_str School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Sport and Exercise Sciences{{{_:::_}}}Faculty of Science and Engineering{{{_:::_}}}School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Sport and Exercise Sciences
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description 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.
published_date 2015-05-12T00:50:46Z
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