Admon Gil, Weinstein Yitzhak, Falk Bareket, Weintrob Naomi, Benzaquen Hadassa, Ofan Ragina, Fayman Gila, Zigel Levana, Constantini Naama, Phillip Moshe
Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva 49202, Israel.
Pediatrics. 2005 Sep;116(3):e348-55. doi: 10.1542/peds.2004-2428.
The use of insulin pumps is becoming a popular technique for insulin delivery among patients with type 1 diabetes mellitus (T1DM), but there is no consensus regarding the guidelines for proper pump use during exercise.
To investigate the physiologic responses and risk of hypoglycemia among children and adolescents with T1DM when exercising with the pump on (PO) (50% of the basal rate) or pump off (PF).
Ten subjects with T1DM (6 female subjects and 4 male subjects), 10 to 19 years of age, performed prolonged exercise (40-45 minutes) on a cycle ergometer approximately 2 hours after a standard breakfast and an insulin (Lispro) bolus. Complex carbohydrates (20 g) were provided before and after the exercise. Each patient exercised once with PO and once with PF, in a randomized, crossover (single-blind) manner. During exercise and 45 minutes of recovery, subjects were monitored for cardiorespiratory, metabolic, and hormonal responses. Blood glucose concentrations were recorded for 24 hours after exercise, with a continuous glucose monitoring system, to document late hypoglycemic events.
During exercise, blood glucose concentrations decreased by 59 +/- 58 mg/dL (mean +/- SD: 29 +/- 24%) with PF and by 74 +/- 51 mg/dL (35.5 +/- 18%) with PO (not significant). No significant differences were found in cortisol, growth hormone, or noradrenaline levels between PO and PF. There were no differences in cardiorespiratory parameters, blood lactate concentrations, or free fatty acids concentrations between pump modes. Hypoglycemic events during exercise were asymptomatic and occurred for 2 subjects with PO and 2 with PF. Nine subjects had late hypoglycemia after PO, compared with 6 after PF (not significant).
We found no advantage for subjects with either PO or PF during exercise, and we noted that late hypoglycemia was more common than hypoglycemia during exercise. However, PO was associated with a trend of increased risk for late hypoglycemia. We recommend that the pump be removed or turned off during prolonged exercise and that blood glucose concentrations be monitored for several hours after exercise, regardless of the pump mode.
胰岛素泵的使用正成为1型糖尿病（T1DM）患者中一种流行的胰岛素给药技术，但对于运动期间正确使用泵的指南尚无共识。
研究T1DM儿童和青少年在佩戴胰岛素泵运动（PO，基础率的50%）或不佩戴胰岛素泵运动（PF）时的生理反应和低血糖风险。
10名年龄在10至19岁的T1DM受试者（6名女性受试者和4名男性受试者），在标准早餐和胰岛素（赖脯胰岛素）推注后约2小时，在自行车测力计上进行长时间运动（40 - 45分钟）。运动前后提供复合碳水化合物（20克）。每位患者以随机、交叉（单盲）方式进行一次PO运动和一次PF运动。在运动期间和恢复的45分钟内，监测受试者的心肺、代谢和激素反应。运动后24小时使用连续血糖监测系统记录血糖浓度，以记录迟发性低血糖事件。
运动期间，PF组血糖浓度下降59±58mg/dL（平均值±标准差：29±24%），PO组下降74±51mg/dL（35.5±18%）（无显著差异）。PO组和PF组在皮质醇、生长激素或去甲肾上腺素水平上无显著差异。两种泵模式下的心肺参数、血乳酸浓度或游离脂肪酸浓度无差异。运动期间的低血糖事件无症状，PO组和PF组各有2名受试者发生。PO组有9名受试者出现迟发性低血糖，PF组有6名（无显著差异）。
我们发现PO组或PF组受试者在运动期间均无优势，且注意到迟发性低血糖比运动期间的低血糖更常见。然而，PO组与迟发性低血糖风险增加的趋势相关。我们建议在长时间运动期间取下或关闭胰岛素泵，无论泵的模式如何，运动后都要监测血糖浓度数小时。
