Extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin adjustments in individuals with type 1 diabetes

McCarthy, Olivia, Deere, Rachel, Churm, Rachel, Dunseath, Gareth J., Jones, Charlotte, Eckstein, Max L., Williams, David M., Hayes, Jennifer, Pitt, Jason, Bain, Stephen C., Moser, Othmar and Bracken, Richard M. 2021. Extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin adjustments in individuals with type 1 diabetes. Nutrition, Metabolism & Cardiovascular Diseases 31 (1) , pp. 227-236. 10.1016/j.numecd.2020.07.043

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Abstract

Aim: To detail the extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin dose adjustments in individuals with type 1 diabetes (T1D) using multiple daily injections of insulins aspart (IAsp) and degludec (IDeg). Methods and results: Sixteen individuals with T1D, completed a single-centred, randomised, fourperiod crossover trial consisting of 23-h inpatient phases. Participants administered either a regular (100%) or reduced (50%) dose (100%; 5.1 2.4, 50%; 2.6 1.2 IU, p < 0.001) of individualised IAsp 1 h before and after 45-min of evening exercise at 60 6% V_O2max. An unaltered dose of IDeg was administered in the morning. Metabolic, physiological and hormonal responses during exercise, recovery and nocturnal periods were characterised. The primary outcome was the number of trial day occurrences of hypoglycemia (venous blood glucose 3.9 mmol L 1 ). Inclusion of a 50% IAsp dose reduction strategy prior to evening exercise reduced the occurrence of inexercise hypoglycemia (p Z 0.023). Mimicking this reductive strategy in the post-exercise period decreased risk of nocturnal hypoglycemia (p Z 0.045). Combining this strategy to reflect reductions either side of exercise resulted in higher glucose concentrations in the acute post-exercise (p Z 0.034), nocturnal (p Z 0.001), and overall (p < 0.001) periods. Depth of hypoglycemia (p Z 0.302), as well as ketonic and counter-regulatory hormonal profiles were similar. Conclusions: These findings demonstrate the glycemic safety of peri-exercise bolus dose reduction strategies in minimising the prevalence of acute and nocturnal hypoglycemia following evening exercise in people with T1D on MDI. Use of newer background insulins with current bolus insulins demonstrates efficacy and advances current recommendations for safe performance of exercise.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine Centre for Trials Research (CNTRR)
Publisher:	Elsevier
ISSN:	0939-4753
Date of First Compliant Deposit:	27 September 2023
Date of Acceptance:	29 July 2020
Last Modified:	10 Oct 2023 11:07
URI:	https://orca.cardiff.ac.uk/id/eprint/162786

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