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Disclosures: The authors report no relevant financial disclosures.

July 31, 2020
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Exercise immediately after insulin dosing ‘unsafe’: Pilot study

Source/Disclosures
Disclosures: The authors report no relevant financial disclosures.

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A low insulin level coupled with euglycemia or modest hyperglycemia are the most favorable conditions for exercise for people with type 1 diabetes, findings from a small pilot study suggest.

“It is unsafe to exercise shortly after taking a dose of insulin,” Rita Basu, MD, professor of medicine in the division of endocrinology and clinical education director of the Center for Diabetes Technology at the University of Virginia School of Medicine, told Healio. “Moderate exercise in people with type 1 diabetes to maintain active lifestyle is preferred when their blood glucose levels are normal or modestly elevated, but not when their circulating insulin concentrations are raised, such as shortly after a bolus or prandial dose of insulin.”

Rita Basu, MD, professor of medicine in the division of endocrinology and clinical education director of the Center for Diabetes Technology at the University of Virginia School of Medicine

Basu and colleagues analyzed data from six participants without diabetes (two women) and six participants with type 1 diabetes (three women; mean diabetes duration, 16 years; all using insulin pump therapy), matched for age, fat-free mass measured via DXA, and VO2 max levels determined via exercise test. Participants reported for three visits in the morning after an overnight fast for one of three tests using glucose infusion, conducted in random order: euglycemia, low insulin; euglycemia, high insulin; and hyperglycemia, low insulin. Glucose fluxes were measured using [6,6-2H2]glucose before, during and after 60 minutes of exercise.

Researchers found that the rate of glucose disappearance increased with exercise within groups (P < .01). However, peak rate of glucose disappearance during exercise was lower among participants with type 1 diabetes (P < .01) vs. participants without diabetes (P < .01) during all visits.

Among participants with type 1 diabetes, endogenous glucose production increased with exercise during the euglycemic, low-insulin and hyperglycemic, low-insulin visits, but not during the euglycemic, high-insulin visit.

“This demonstrates that hyperinsulinemia, but not hyperglycemia, blunts the compensatory exercise-induced increase in endogenous glucose production in type 1 diabetes,” the researchers wrote.

Basu said understanding the physiologic mechanisms of exercise in type 1 diabetes is still an unmet need.

“Regular exercise and physical activity are required to maintain a healthy lifestyle; however, many people with type 1 diabetes are fearful of hypoglycemia and/or hyperglycemia and are unable to maintain adequate glucose levels before, during and after exercise,” Basu said. “This requires further study.”

For more information:

Rita Basu, MD, can be reached at the Division of Endocrinology, University of Virginia School of Medicine, 560 Ray C Hunt Drive, Room 3108, Charlottesville, VA 22908; email: basu.rita@virginia.edu.

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