Mallad Ashwini, Hinshaw Ling, Schiavon Michele, Dalla Man Chiara, Dadlani Vikash, Basu Rita, Lingineni Ravi, Cobelli Claudio, Johnson Matthew L, Carter Rickey, Kudva Yogish C, Basu Ananda
Endocrine Research Unit, Division of Endocrinology, Mayo College of Medicine, Rochester, Minnesota;
Department of Information Engineering, University of Padua, Padua, Italy; and.
Am J Physiol Endocrinol Metab. 2015 Jun 15;308(12):E1106-15. doi: 10.1152/ajpendo.00014.2015. Epub 2015 Apr 21.
To determine the effects of exercise on postprandial glucose metabolism and insulin action in type 1 diabetes (T1D), we applied the triple tracer technique to study 16 T1D subjects on insulin pump therapy before, during, and after 75 min of moderate-intensity exercise (50% V̇o2max) that started 120 min after a mixed meal containing 75 g of labeled glucose. Prandial insulin bolus was administered as per each subject's customary insulin/carbohydrate ratio adjusted for meal time meter glucose and the level of physical activity. Basal insulin infusion rates were not altered. There were no episodes of hypoglycemia during the study. Plasma dopamine and norepinephrine concentrations rose during exercise. During exercise, rates of endogenous glucose production rose rapidly to baseline levels despite high circulating insulin and glucose concentrations. Interestingly, plasma insulin concentrations increased during exercise despite no changes in insulin pump infusion rates, implying increased mobilization of insulin from subcutaneous depots. Glucagon concentrations rose before and during exercise. Therapeutic approaches for T1D management during exercise will need to account for its effects on glucose turnover, insulin mobilization, glucagon, and sympathetic response and possibly other blood-borne feedback and afferent reflex mechanisms to improve both hypoglycemia and hyperglycemia.
为了确定运动对1型糖尿病（T1D）患者餐后葡萄糖代谢和胰岛素作用的影响，我们应用三重示踪技术，对16名接受胰岛素泵治疗的T1D患者进行研究。这些患者在摄入含有75克标记葡萄糖的混合餐后120分钟开始进行75分钟的中等强度运动（50%最大摄氧量），分别在运动前、运动期间和运动后进行检测。餐时胰岛素大剂量注射按照每位患者根据进餐时血糖仪测得的葡萄糖水平和身体活动水平调整后的习惯胰岛素/碳水化合物比例进行。基础胰岛素输注速率未改变。研究期间未发生低血糖事件。运动期间血浆多巴胺和去甲肾上腺素浓度升高。运动期间，尽管循环胰岛素和葡萄糖浓度较高，但内源性葡萄糖生成速率迅速上升至基线水平。有趣的是，尽管胰岛素泵输注速率没有变化，但运动期间血浆胰岛素浓度增加，这意味着皮下储存库中胰岛素的动员增加。运动前和运动期间胰高血糖素浓度升高。T1D患者运动期间的治疗方法需要考虑其对葡萄糖周转、胰岛素动员、胰高血糖素和交感反应的影响，以及可能的其他血源性反馈和传入反射机制，以改善低血糖和高血糖情况。
