Biankin Sandra A, Jenkins Arthur B, Campbell Lesley V, Choi Kin Lam, Forrest Quentin G, Chisholm Donald J
Garvan Institute of Medical Research, St. Vincent's Hospital, Sydney, Australia.
Diabetes Care. 2003 Feb;26(2):297-301. doi: 10.2337/diacare.26.2.297.
To investigate the reproducibility of the plasma glucose (PG) response to exercise in subjects with type 1 diabetes on a nonintensive insulin regimen.
Subjects cycled for 45 min at 50% VO(2max) on two occasions (studies 1 and 2) either 1 h after lunch and usual insulin (protocol A) or after overnight fasting without morning insulin (protocol B). Identical diet, activity, and insulin (twice daily neutral and intermediate) were maintained before and during each study day. A total of 13 type 1 diabetic subjects (6 men and 7 women, BMI 24.0 +/- 0.9 kg/m(2) [means +/- SE], age 42.6 +/- 2.7 years, diabetes duration 14.1 +/- 2.8 years) completed protocol A, and 7 (3 men and 4 women, BMI 25.8 +/- 1.3 kg/m(2), age 39.7 +/- 1.3 years, diabetes duration 14 +/- 4.4 years) completed protocol B.
In protocol A (fed), the fall in PG during exercise was 4.5 +/- 1.0 and 5.0 +/- 0.8 mmol/l in studies 1 and 2, respectively, whereas in protocol B (fasted), it was 0.6 +/- 0.8 and 3.4 +/- 1.6 mmol/l. Regression analysis of the change in PG in protocol A in study 1 versus study 2 showed poor reproducibility (r(2) = 0.12, P = 0.25) despite uniform conditions. In protocol B, the fall in PG was more reproducible (r(2) = 0.81, P = 0.006). In fed subjects, there was better (P = 0.01) and clinically useful reproducibility of the PG at exercise completion (r(2) = 0.77, P = 0.0001) compared with preexercise.
These results indicate poor reproducibility of the change in PG during exercise after feeding in type 1 diabetes on nonintensive insulin regimens but reasonable reproducibility when fasting. Exercise apparently decreases the glycemic variability after feeding, so that PG concentrations after exercise seek a reproducible "target." Thus, the absolute PG level after a typical bout of exercise in the fed state should be a good guide to carbohydrate or insulin adjustment on subsequent occasions.
研究1型糖尿病患者在非强化胰岛素治疗方案下运动后血糖（PG）反应的可重复性。
受试者在午餐后1小时及注射常规胰岛素的情况下（方案A），或在夜间禁食且未注射晨起胰岛素的情况下（方案B），分两次（研究1和研究2）以50%最大摄氧量（VO₂max）进行45分钟的骑行运动。在每个研究日之前及期间，保持相同的饮食、活动及胰岛素用量（每日两次中性胰岛素和中效胰岛素）。共有13名1型糖尿病患者（6名男性和7名女性，体重指数[BMI]24.0±0.9kg/m²[均值±标准误]，年龄42.6±2.7岁，糖尿病病程14.1±2.8年）完成了方案A，7名（3名男性和4名女性，BMI 25.8±1.3kg/m²，年龄39.7±1.3岁，糖尿病病程14±4.4年）完成了方案B。
在方案A（进食后）中，研究1和研究2运动期间PG的下降分别为4.5±1.0和5.0±0.8mmol/L，而在方案B（禁食后）中，分别为0.6±0.8和3.4±1.6mmol/L。尽管条件一致，但对研究1和研究2中方案A的PG变化进行回归分析显示可重复性较差（r² = 0.12，P = 0.25）。在方案B中，PG的下降更具可重复性（r² = 0.81，P = 0.006）。与运动前相比，进食后运动结束时PG的可重复性更好（P = 0.01）且具有临床实用性（r² = 0.77，P = 0.0001）。
这些结果表明，1型糖尿病患者在非强化胰岛素治疗方案下进食后运动期间PG变化的可重复性较差，但禁食时具有合理的可重复性。运动明显降低了进食后的血糖变异性，使得运动后的PG浓度趋向于一个可重复的“目标”。因此，进食状态下典型运动后绝对PG水平应是后续调整碳水化合物或胰岛素用量的良好指导。
