Laboratory of Experimental Medicine and Paediatrics, Member of the Infla-Med Center of Excellence, University of Antwerp, Faculty of Medicine & Health Science, Antwerp, Belgium.
Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Edegem, Belgium.
Diabetes Metab Res Rev. 2022 Sep;38(6):e3537. doi: 10.1002/dmrr.3537. Epub 2022 May 21.
Exercise is part of type 1 diabetes (T1D) management due to its cardiovascular and metabolic benefits. However, despite using continuous glucose monitoring, many patients are reluctant to exercise because of fear for hypoglycaemia.
We assessed trends in glucose, lactate and ketones during anaerobic and aerobic exercise in people with T1D and compared incremental area under the curve (AUC) between both exercises.
Twenty-one men with T1D (median [IQR]: age 29 years [28-38], body mass index (BMI) 24.4 kg/m [22.3-24.9], HbA1c 7.2% [6.7-7.8]), completed a cardiopulmonary exercise test (CPET) and a 60-min aerobic exercise (AEX) at 60% VO peak on an ergometer bicycle within a 6-week period. Subjects consumed a standardised breakfast (6 kcal/kg, 20.2 g CHO/100 ml) before exercise without pre-meal insulin and basal insulin for pump users.
During CPET, glucose levels increased, peaking at 331 mg/dl [257-392] 1-3 h after exercise and reaching a nadir 6 h after exercise at 176 mg/dl [118-217]. Lactate levels peaked at 6.0 mmol/L [5.0-6.6] (max 13.5 mmol/L). During AEX, glucose levels also increased, peaking at 305 mg/dl [245-336] 80 min after exercise and reaching a nadir 6 h after exercise at 211 mg/dl [116-222]. Lactate levels rose quickly to a median of 4.3 mmol/L [2.7-6.7] after 10 min. Ketone levels were low during both tests (median ≤ 0.2 mmol/L). Lactate, but not glucose or ketone AUC, was significantly higher in CPET compared to AEX (p = 0.04).
Omitting pre-meal insulin and also basal insulin in pump users, did prevent hypoglycaemia but induced hyperglycaemia due to a too high carbohydrate ingestion. No ketosis was recorded during or after the exercises.
ClinicalTrials.gov: NCT05097339.
运动是 1 型糖尿病（T1D）管理的一部分，因为它具有心血管和代谢益处。然而，尽管使用连续血糖监测，许多患者还是因为担心低血糖而不愿意运动。
我们评估了 T1D 患者在进行无氧和有氧运动期间血糖、乳酸和酮体的变化趋势，并比较了这两种运动的增量曲线下面积（AUC）。
21 名男性 T1D 患者（中位数[IQR]：年龄 29 岁[28-38]，体重指数（BMI）24.4kg/m[22.3-24.9]，HbA1c 7.2%[6.7-7.8%]）在 6 周内完成心肺运动测试（CPET）和 60%峰值摄氧量的 60 分钟有氧运动（AEX）。受试者在运动前不服用餐前胰岛素和泵使用者的基础胰岛素，摄入标准早餐（6kcal/kg，20.2gCHO/100ml）。
在 CPET 中，血糖水平升高，运动后 1-3 小时达到峰值 331mg/dl[257-392]，运动后 6 小时达到最低点 176mg/dl[118-217]。乳酸水平在 6.0mmol/L[5.0-6.6]时达到峰值（最高 13.5mmol/L）。在 AEX 中，血糖水平也升高，运动后 80 分钟达到峰值 305mg/dl[245-336]，运动后 6 小时达到最低点 211mg/dl[116-222]。乳酸水平在 10 分钟内迅速升高至中位数 4.3mmol/L[2.7-6.7]。在两种测试中，酮体水平均较低（中位数≤0.2mmol/L）。与 AEX 相比，CPET 中的乳酸 AUC 显著更高（p=0.04），但血糖或酮体 AUC 没有显著差异。
在泵使用者中省略餐前胰岛素和基础胰岛素确实可以预防低血糖，但由于摄入了过多的碳水化合物，导致高血糖。在运动期间或之后没有记录到酮症。
ClinicalTrials.gov：NCT05097339。
