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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

Matthew D. Campbell, Mark Walker, Michael I. Trenell, Steven Luzio, Gareth Dunseath Orcid Logo, Daniel Tuner, Richard Bracken Orcid Logo, Stephen C. Bain, Mark Russell, Emma J. Stevenson, Daniel J. West, Steve Luzio Orcid Logo

PLoS ONE, Volume: 9, Issue: 5

Swansea University Authors: Gareth Dunseath Orcid Logo, Richard Bracken Orcid Logo, Steve Luzio Orcid Logo

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DOI (Published version): 10.1371/journal.pone.0097143

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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 o...

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Published in: PLoS ONE
ISSN: 1932-6203
Published: 2014
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Following preliminary testing, 8 male patients (24&#xB1;2 years, HbA1c 7.7&#xB1;0.4%/61&#xB1;4 mmol.l-1) treated with insulin's glargine and aspart, or lispro attended the laboratory on two mornings at &#x223C;08:00 h and consumed a standardised breakfast carbohydrate bolus (1 g carbohydrate.kg-1BM; 380&#xB1;10 kcal) and self-administered a 75% reduced rapid-acting insulin dose 60 minutes before 45 minutes of intensive treadmill running at 73.1&#xB1;0.9% VO2peak. At 60 minutes post-exercise, patients ingested a meal (1 g carbohydrate.kg-1BM; 660&#xB1;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, &#x3B2;-Hydroxybutyrate, and plasma glucagon, adrenaline, noradrenaline, IL-6, and TNF-&#x3B1; 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&amp;#60;0.05) resulting in 75% of patients experiencing hyperglycaemia (blood glucose &#x2265;8.0 mmol.l-1; 50% n&#x200A;=&#x200A;6, Full n&#x200A;=&#x200A;3). &#x3B2;-Hydroxybutyrate concentrations decreased similarly, such that at 180 minutes post-meal concentrations were lower than rest under Full and 50%. IL-6 and TNF-&#x3B1; 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&#x200A;=&#x200A;-0.484, p&#x200A;=&#x200A;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-&#x3B1; and IL-6 above fasting levels, or cause other adverse metabolic or hormonal disturbances.</abstract><type>Journal Article</type><journal>PLoS ONE</journal><volume>9</volume><journalNumber>5</journalNumber><publisher/><issnElectronic>1932-6203</issnElectronic><keywords/><publishedDay>23</publishedDay><publishedMonth>5</publishedMonth><publishedYear>2014</publishedYear><publishedDate>2014-05-23</publishedDate><doi>10.1371/journal.pone.0097143</doi><url/><notes/><college>COLLEGE NANME</college><department>Biomedical Sciences</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>BMS</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2020-07-06T16:14:09.9758302</lastEdited><Created>2016-03-31T20:41:53.5083741</Created><path><level id="1">Faculty of Science and Engineering</level><level id="2">School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Sport and Exercise Sciences</level></path><authors><author><firstname>Matthew D.</firstname><surname>Campbell</surname><order>1</order></author><author><firstname>Mark</firstname><surname>Walker</surname><order>2</order></author><author><firstname>Michael I.</firstname><surname>Trenell</surname><order>3</order></author><author><firstname>Steven</firstname><surname>Luzio</surname><order>4</order></author><author><firstname>Gareth</firstname><surname>Dunseath</surname><orcid>0000-0001-6022-862X</orcid><order>5</order></author><author><firstname>Daniel</firstname><surname>Tuner</surname><order>6</order></author><author><firstname>Richard</firstname><surname>Bracken</surname><orcid>0000-0002-6986-6449</orcid><order>7</order></author><author><firstname>Stephen C.</firstname><surname>Bain</surname><order>8</order></author><author><firstname>Mark</firstname><surname>Russell</surname><order>9</order></author><author><firstname>Emma J.</firstname><surname>Stevenson</surname><order>10</order></author><author><firstname>Daniel J.</firstname><surname>West</surname><order>11</order></author><author><firstname>Steve</firstname><surname>Luzio</surname><orcid>0000-0002-7206-6530</orcid><order>12</order></author></authors><documents><document><filename>0027012-09052018095244.pdf</filename><originalFilename>campbell2014.pdf</originalFilename><uploaded>2018-05-09T09:52:44.8970000</uploaded><type>Output</type><contentLength>426164</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><embargoDate>2018-05-09T00:00:00.0000000</embargoDate><copyrightCorrect>true</copyrightCorrect><language>eng</language></document></documents><OutputDurs/></rfc1807>
spelling 2020-07-06T16:14:09.9758302 v2 27012 2016-03-31 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 fccbba9edcaee08a839a3c5cff8cbe19 0000-0001-6022-862X Gareth Dunseath Gareth Dunseath true false f5da81cd18adfdedb2ccb845bddc12f7 0000-0002-6986-6449 Richard Bracken Richard Bracken true false 01491e1cd582746a654fad9addf0de16 0000-0002-7206-6530 Steve Luzio Steve Luzio true false 2016-03-31 BMS 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&#60;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. Journal Article PLoS ONE 9 5 1932-6203 23 5 2014 2014-05-23 10.1371/journal.pone.0097143 COLLEGE NANME Biomedical Sciences COLLEGE CODE BMS Swansea University 2020-07-06T16:14:09.9758302 2016-03-31T20:41:53.5083741 Faculty of Science and Engineering School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Sport and Exercise Sciences Matthew D. Campbell 1 Mark Walker 2 Michael I. Trenell 3 Steven Luzio 4 Gareth Dunseath 0000-0001-6022-862X 5 Daniel Tuner 6 Richard Bracken 0000-0002-6986-6449 7 Stephen C. Bain 8 Mark Russell 9 Emma J. Stevenson 10 Daniel J. West 11 Steve Luzio 0000-0002-7206-6530 12 0027012-09052018095244.pdf campbell2014.pdf 2018-05-09T09:52:44.8970000 Output 426164 application/pdf Version of Record true 2018-05-09T00:00:00.0000000 true eng
title 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
spellingShingle 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
Gareth Dunseath
Richard Bracken
Steve Luzio
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
author_id_str_mv fccbba9edcaee08a839a3c5cff8cbe19
f5da81cd18adfdedb2ccb845bddc12f7
01491e1cd582746a654fad9addf0de16
author_id_fullname_str_mv fccbba9edcaee08a839a3c5cff8cbe19_***_Gareth Dunseath
f5da81cd18adfdedb2ccb845bddc12f7_***_Richard Bracken
01491e1cd582746a654fad9addf0de16_***_Steve Luzio
author Gareth Dunseath
Richard Bracken
Steve Luzio
author2 Matthew D. Campbell
Mark Walker
Michael I. Trenell
Steven Luzio
Gareth Dunseath
Daniel Tuner
Richard Bracken
Stephen C. Bain
Mark Russell
Emma J. Stevenson
Daniel J. West
Steve Luzio
format Journal article
container_title PLoS ONE
container_volume 9
container_issue 5
publishDate 2014
institution Swansea University
issn 1932-6203
doi_str_mv 10.1371/journal.pone.0097143
college_str Faculty of Science and Engineering
hierarchytype
hierarchy_top_id facultyofscienceandengineering
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
document_store_str 1
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description 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&#60;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.
published_date 2014-05-23T03:32:38Z
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