Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, SA1 8EN, UK.
Department for Health, University of Bath, Bath, BA2 7AY, UK.
Nutr Metab Cardiovasc Dis. 2021 Jan 4;31(1):227-236. doi: 10.1016/j.numecd.2020.07.043. Epub 2020 Aug 6.
To detail the extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin dose adjustments in individuals with type 1 diabetes (T1D) using multiple daily injections of insulins aspart (IAsp) and degludec (IDeg).
Sixteen individuals with T1D, completed a single-centred, randomised, four-period crossover trial consisting of 23-h inpatient phases. Participants administered either a regular (100%) or reduced (50%) dose (100%; 5.1 ± 2.4, 50%; 2.6 ± 1.2 IU, p < 0.001) of individualised IAsp 1 h before and after 45-min of evening exercise at 60 ± 6% V̇O. An unaltered dose of IDeg was administered in the morning. Metabolic, physiological and hormonal responses during exercise, recovery and nocturnal periods were characterised. The primary outcome was the number of trial day occurrences of hypoglycemia (venous blood glucose ≤ 3.9 mmol L ). Inclusion of a 50% IAsp dose reduction strategy prior to evening exercise reduced the occurrence of in-exercise hypoglycemia (p = 0.023). Mimicking this reductive strategy in the post-exercise period decreased risk of nocturnal hypoglycemia (p = 0.045). Combining this strategy to reflect reductions either side of exercise resulted in higher glucose concentrations in the acute post-exercise (p = 0.034), nocturnal (p = 0.001), and overall (p < 0.001) periods. Depth of hypoglycemia (p = 0.302), as well as ketonic and counter-regulatory hormonal profiles were similar.
These findings demonstrate the glycemic safety of peri-exercise bolus dose reduction strategies in minimising the prevalence of acute and nocturnal hypoglycemia following evening exercise in people with T1D on MDI. Use of newer background insulins with current bolus insulins demonstrates efficacy and advances current recommendations for safe performance of exercise.
DRKS00013509.
详细描述在使用多次注射胰岛素的 1 型糖尿病（T1D）患者中，在运动前后调整胰岛素剂量后，运动后和夜间低血糖的程度和发生率，包括门冬胰岛素（IAsp）和地特胰岛素（IDeg）。
16 名 T1D 患者完成了一项单中心、随机、四周期交叉试验，包括 23 小时住院期。参与者在晚上 45 分钟的运动前 1 小时和运动后 1 小时分别给予个体化的 IAsp 100%（5.1±2.4IU）或 50%（2.6±1.2IU）剂量（100%；5.1±2.4，50%；2.6±1.2IU，p<0.001），运动时的代谢、生理和激素反应、恢复和夜间期间的反应进行了特征描述。早上给予不变剂量的 IDeg。试验的主要结局是低血糖（静脉血糖≤3.9mmol/L）的发生次数。在晚上运动前加入 50%IAsp 剂量减少策略，可减少运动中低血糖的发生（p=0.023）。在运动后阶段模仿这种减少策略可降低夜间低血糖的风险（p=0.045）。将该策略结合到运动前后的减少策略中，可导致急性运动后（p=0.034）、夜间（p=0.001）和总体（p<0.001）期间血糖浓度更高。低血糖的深度（p=0.302）以及酮体和拮抗激素谱相似。
这些发现表明，在使用多次注射胰岛素的 T1D 患者中，运动前后给予胰岛素剂量减少策略可降低夜间低血糖的发生率，从而提高运动后的血糖安全性。新型基础胰岛素与当前的胰岛素剂量联合使用，可提高疗效，并推进目前关于安全运动的建议。
DRKS00013509。
