Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai 201399, China.
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA.
Endocr J. 2019 Sep 28;66(9):753-762. doi: 10.1507/endocrj.EJ19-0153. Epub 2019 Aug 10.
Exercise is a fundamental component of diabetes management. However, choosing inappropriate type or timing of exercise is associated with mild or severe hypoglycemia either during exercise or several hours after exercise. Several studies have shown that impaired counterregulatory responses triggers hypoglycemia. Therefore, in this investigation, we explored the appropriate intensity and time of exercise in patients with diabetes. The mechanisms of counterregulatory responses and hypoglycemia associated autonomic failure (HAAF), as well as the strategies for preventing episodes of hypoglycemia after exercise were also investigated. In this study, we obtained the following results: 1) High intensity interval exercise is more suitable for diabetic patients. 2) Morning exercise reduces nocturnal hypoglycemia risks compared with midday, afternoon and evening exercise. 3) Hypoglycemia can be prevented by dietary approach, reduction or suspension of insulin dose, use of mini dose glucagon, caffeine, mitigation methods, prediction algorithm, autonomic feedback controlled close-loop insulin delivery, real time continuous glucose monitoring. Based on these results we concluded that exercise may cause severe hypoglycemia or induce blunted response in patients with diabetes. For Diabetes Mellitus (DM) patients, the intensity and time of exercise influence the occurrence of hypoglycemia. This review summarizes the clinical characteristics of different types of exercises and time of exercise that can be potentially used to educate and guide patients regarding the role of exercise in standard of care.
运动是糖尿病管理的基本组成部分。然而，选择不合适的运动类型或时间与运动期间或运动后数小时内的轻度或重度低血糖有关。多项研究表明，受损的代偿性反应会引发低血糖。因此，在这项研究中，我们探讨了糖尿病患者的适当运动强度和时间。我们还研究了代偿性反应和低血糖相关自主神经衰竭（HAAF）的机制，以及预防运动后低血糖发作的策略。在这项研究中，我们得到了以下结果：1）高强度间歇运动更适合糖尿病患者。2）与中午、下午和晚上相比，晨练可降低夜间低血糖风险。3）通过饮食方法、减少或暂停胰岛素剂量、使用小剂量胰高血糖素、咖啡因、缓解方法、预测算法、自主神经反馈控制闭环胰岛素输送、实时连续血糖监测，可以预防低血糖。基于这些结果，我们得出结论，运动可能会导致严重的低血糖或使糖尿病患者的反应迟钝。对于糖尿病（DM）患者，运动的强度和时间会影响低血糖的发生。本综述总结了不同类型的运动和运动时间的临床特点，这些特点可能有助于教育和指导患者了解运动在标准治疗中的作用。
