Copenhagen University Hospital-Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark.
J Clin Endocrinol Metab. 2023 Dec 21;109(1):208-216. doi: 10.1210/clinem/dgad427.
Current guidelines for exercise-related glucose management focus on reducing bolus and/or basal insulin doses and considering carbohydrate intake. Yet far less attention has been paid to the potential role of other macronutrients alongside carbohydrates on glucose dynamics around exercise.
To investigate the effects of a low-carbohydrate-high-protein (LCHP) compared with a high-carbohydrate-low-protein (HCLP) pre-exercise meal on the metabolic, hormonal, and physiological responses to exercise in adults with insulin pump-treated type 1 diabetes.
Fourteen adults (11 women, 3 men) with insulin pump-treated type 1 diabetes (median [range] HbA1c of 50 [43-59] mmol/mol (6.7% [6.1%-7.5%]), age of 49 [25-65] years, and body mass index of 24.0 [19.3-27.1] kg/m2) completed an unblinded, 2-arm, randomized, crossover study. Participants ingested isocaloric meals that were either LCHP (carbohydrate 21%, protein 52%, fat 27%) or HCLP (carbohydrate 52%, protein 21%, fat 27%) 90 minutes prior to undertaking 45 minutes of cycling at moderate intensity. Meal insulin bolus was dosed according to meal carbohydrate content but reduced by 25%. Basal insulin rates were reduced by 35% from meal ingestion to end of exercise.
Around exercise the coefficient of variability was lower during LCHP (LCHP: 14.5 ± 5.3 vs HCLP: 24.9 ± 7.7%, P = .001). Over exercise, LCHP was associated with a lesser drop (LCHP: Δ-1.49 ± 1.89 vs HCLP: Δ-3.78 ± 1.95 mmol/L, P = .001). Mean insulin concentration was 30% lower during exercise for LCHP compared with HCLP (LCHP: 25.5 ± 11.0 vs HCLP: 36.5 ± 15.9 mU/L, P < .001).
Ingesting a LCHP pre-exercise meal lowered plasma glucose variability around exercise and diminished the drop in plasma glucose over exercise.
目前与运动相关的血糖管理指南侧重于减少胰岛素推注剂量和（或）基础胰岛素剂量，并考虑碳水化合物的摄入量。然而，对于运动期间除碳水化合物以外的其他宏量营养素对血糖动态的潜在作用，关注较少。
研究低碳水化合物高蛋白（LCHP）与高碳水化合物低蛋白（HCLP）运动前餐相比，对使用胰岛素泵治疗的 1 型糖尿病成人运动代谢、激素和生理反应的影响。
14 名使用胰岛素泵治疗的 1 型糖尿病成人（11 名女性，3 名男性；中位[范围]HbA1c 为 50[43-59]mmol/mol（6.7%[6.1%-7.5%]），年龄 49[25-65]岁，体重指数 24.0[19.3-27.1]kg/m2）完成了一项非盲、2 臂、随机、交叉研究。参与者摄入等热量的食物，分别为 LCHP（碳水化合物 21%，蛋白质 52%，脂肪 27%）或 HCLP（碳水化合物 52%，蛋白质 21%，脂肪 27%），在进行 45 分钟中等强度自行车运动前 90 分钟。根据膳食碳水化合物含量给予膳食胰岛素推注剂量，但减少 25%。从摄入膳食到运动结束，基础胰岛素剂量降低 35%。
运动期间，LCHP 的变异系数较低（LCHP：14.5±5.3%比 HCLP：24.9±7.7%，P=0.001）。在运动期间，LCHP 与血糖下降幅度较小相关（LCHP：Δ-1.49±1.89 比 HCLP：Δ-3.78±1.95mmol/L，P=0.001）。与 HCLP 相比，LCHP 运动期间的平均胰岛素浓度低 30%（LCHP：25.5±11.0 比 HCLP：36.5±15.9mU/L，P<0.001）。
摄入 LCHP 运动前餐可降低运动时血糖变异性，并减少运动期间血糖下降。
