Guelfi Kym J, Jones Timothy W, Fournier Paul A
School of Human Movement and Exercise Science, University of Western Australia, Crawley, Western Australia, Australia.
Sports Med. 2007;37(11):937-46. doi: 10.2165/00007256-200737110-00002.
Exercise is generally recommended for individuals with type 1 diabetes mellitus since it is associated with numerous physiological and psychological benefits. However, participation in exercise can also increase the risk of experiencing severe hypoglycaemia, a potentially life-threatening condition, both during exercise and for up to 31 hours of recovery. Fortunately, this risk of exercise-induced hypoglycaemia can be managed by adjusting the dosage of self-administered exogenous insulin and nutritional intake to maintain blood glucose levels within the normal physiological range. In order to provide evidence-based guidelines to allow individuals with type 1 diabetes to safely participate in a range of physical activities, much previous research has focused on understanding the metabolic and hormonal responses to exercise. Consequently, it is well established that moderate- and high-intensity exercise have a contrasting effect on blood glucose levels and require different management strategies to maintain euglycaemia. On the other hand, the response of blood glucose levels to a combination of moderate- and high-intensity exercise, a pattern of physical activity referred to as intermittent high-intensity exercise (IHE) has received little research attention. This is despite the fact that this type of exercise characterises the activity patterns of most team and field sports as well as spontaneous play in children. The lack of previous research into the glucoregulatory responses to IHE is reflected in existing guidelines, which either do not address IHE, or suggest similar management strategies for blood glucose levels during and after IHE as for moderate- or high-intensity exercise alone. It is important, however, to appreciate that there are fundamental differences in the metabolic responses to intermittent exercise compared with other types of exercise. Recently, a series of investigations into the glucoregulatory responses to IHE that replicates the work-to-recovery ratios observed in team and field sports have been conducted. The findings of these studies do not support the existing recommendations for managing blood glucose levels during IHE. Hence, the purpose of this article is to discuss the results of these recent studies, which provide new insight into the management of blood glucose levels during and after IHE and have implications for current guidelines aimed at minimising the risk of hypoglycaemia. These findings, along with future investigations, should provide valuable information for health professionals and individuals with type 1 diabetes on the management of blood glucose levels during and after exercise to allow for safe participation in intermittent activities along with their peers.
一般建议1型糖尿病患者进行运动，因为运动对生理和心理有诸多益处。然而，参与运动也会增加严重低血糖的风险，这是一种潜在的危及生命的状况，在运动期间以及长达31小时的恢复过程中都可能出现。幸运的是，这种运动诱发的低血糖风险可以通过调整自行注射的外源性胰岛素剂量和营养摄入来控制，以将血糖水平维持在正常生理范围内。为了提供基于证据的指南，使1型糖尿病患者能够安全地参与一系列体育活动，此前许多研究都集中在了解运动的代谢和激素反应上。因此，众所周知，中等强度和高强度运动对血糖水平有相反的影响，需要不同的管理策略来维持血糖正常。另一方面，血糖水平对中等强度和高强度运动相结合（一种称为间歇性高强度运动（IHE）的身体活动模式）的反应很少受到研究关注。尽管事实上这种运动类型是大多数团队运动和田径运动以及儿童自发玩耍的活动模式的特征。现有指南反映出此前对IHE的糖调节反应缺乏研究，这些指南要么未涉及IHE，要么对IHE期间及之后的血糖水平建议采用与单独的中等强度或高强度运动类似的管理策略。然而，重要的是要认识到，与其他类型的运动相比，间歇性运动的代谢反应存在根本差异。最近，已经进行了一系列关于IHE的糖调节反应的调查，这些调查复制了在团队运动和田径运动中观察到的工作与恢复比率。这些研究的结果不支持IHE期间管理血糖水平的现有建议。因此，本文的目的是讨论这些最新研究的结果，这些结果为IHE期间及之后的血糖管理提供了新的见解，并对旨在将低血糖风险降至最低的现行指南有影响。这些发现以及未来的研究，应该为健康专业人员和1型糖尿病患者提供有关运动期间及之后血糖管理的有价值信息，以便他们能够与同龄人安全地参与间歇性活动。
