Sandoval Darleen A, Guy Deanna L Aftab, Richardson M Antoinette, Ertl Andrew C, Davis Stephen N
Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Am J Physiol Endocrinol Metab. 2006 Jun;290(6):E1331-8. doi: 10.1152/ajpendo.00283.2005. Epub 2006 Jan 31.
Exercise-induced hypoglycemia can occur within hours after exercise in type 1 diabetes mellitus (T1DM) patients. This study tested the hypothesis that an acute exercise bout causes (within hours) blunted autonomic and metabolic responses to subsequent hypoglycemia in patients with T1DM. Twelve T1DM patients (3 W/9 M) were studied during a single-step, 2-h hyperinsulinemic (572 +/- 4 pmol/l) hypoglycemic (2.8 +/- 0.1 mmol/l) clamp 2 h after either a hyperinsulinemic euglycemic (AM EUG) or hypoglycemic clamp (AM HYPO) or after sitting in a chair with basal insulin infusion (AM CON) or 90 min of moderate-intensity exercise (50% Vo(2 max), AM EX). Both AM HYPO and AM EX significantly blunted epinephrine responses and muscle sympathetic nerve activity responses to subsequent hypoglycemia compared with both control groups. Endogenous glucose production was significantly lower and the exogenous glucose infusion rate needed to maintain the hypoglycemic level was significantly greater during subsequent hypoglycemia in AM EX vs. CON. Rate of glucose disposal (Rd) was significantly reduced following AM HYPO. In summary, within 2.5 h, both moderate-intensity AM EX and AM HYPO blunted key autonomic counterregulatory responses. Despite this, glucose Rd was reduced during afternoon hypoglycemia following morning hypoglycemia, indicating posthypoglycemic insulin resistance. After morning exercise, endogenous glucose production was blunted, but glucose Rd was maintained during afternoon hypoglycemia, thereby indicating reduced metabolic defenses against hypoglycemia. These data suggest that exercise-induced counterregulatory failure can occur very rapidly, increasing the risk for hypoglycemia in T1DM within hours.
运动诱发的低血糖可在1型糖尿病（T1DM）患者运动后数小时内发生。本研究检验了这样一个假设：一次急性运动发作（数小时内）会导致T1DM患者对随后发生的低血糖的自主神经和代谢反应减弱。12名T1DM患者（3名女性/9名男性）在高胰岛素正常血糖钳夹（上午正常血糖，AM EUG）、高胰岛素低血糖钳夹（上午低血糖，AM HYPO）后2小时，或基础胰岛素输注坐在椅子上（上午对照，AM CON）或进行90分钟中等强度运动（50%最大摄氧量，AM EX）后，接受单步、2小时的高胰岛素（572±4 pmol/l）低血糖（2.8±0.1 mmol/l）钳夹研究。与两个对照组相比，AM HYPO和AM EX均显著减弱了对随后低血糖的肾上腺素反应和肌肉交感神经活动反应。在AM EX组与CON组随后发生低血糖期间，内源性葡萄糖生成显著降低，维持低血糖水平所需的外源性葡萄糖输注速率显著更高。AM HYPO后葡萄糖处置率（Rd）显著降低。总之，在2.5小时内，中等强度的AM EX和AM HYPO均减弱了关键的自主神经对抗调节反应。尽管如此，早晨低血糖后下午低血糖期间葡萄糖Rd降低，表明低血糖后胰岛素抵抗。早晨运动后，内源性葡萄糖生成减弱，但下午低血糖期间葡萄糖Rd维持不变，从而表明对低血糖的代谢防御降低。这些数据表明，运动诱发的对抗调节失败可能非常迅速地发生，增加了T1DM患者数小时内发生低血糖的风险。
