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Metabolic Implications when Employing Heavy Pre- and Post-Exercise Rapid-Acting Insulin Reductions to Prevent Hypoglycaemia in Type 1 Diabetes Patients: A Randomised Clinical Trial

Votruba, Susanne Breuer, Campbell, Matthew, Walker, Mark, Trenell, Michael I., Luzio, Steven, Dunseath, Gareth, Tuner, Daniel, Bracken, Richard M., Bain, Stephen C., Russell, Mark, Stevenson, Emma J. and West, Daniel J. (2014) Metabolic Implications when Employing Heavy Pre- and Post-Exercise Rapid-Acting Insulin Reductions to Prevent Hypoglycaemia in Type 1 Diabetes Patients: A Randomised Clinical Trial. PLoS ONE, 9 (5). e97143. ISSN 1932-6203

Item Type: Article

Abstract

Aim
To examine the metabolic, gluco-regulatory-hormonal and inflammatory cytokine responses to large reductions in rapid-acting insulin dose administered prandially before and after intensive running exercise in male type 1 diabetes patients.

Methods
This was a single centre, randomised, controlled open label study. Following preliminary testing, 8 male patients (24±2 years, HbA1c 7.7±0.4%/61±4 mmol.l−1) treated with insulin's glargine and aspart, or lispro attended the laboratory on two mornings at ∼08:00 h and consumed a standardised breakfast carbohydrate bolus (1 g carbohydrate.kg−1BM; 380±10 kcal) and self-administered a 75% reduced rapid-acting insulin dose 60 minutes before 45 minutes of intensive treadmill running at 73.1±0.9% VO2peak. At 60 minutes post-exercise, patients ingested a meal (1 g carbohydrate.kg−1BM; 660±21 kcal) and administered either a Full or 50% reduced rapid-acting insulin dose. Blood glucose and lactate, serum insulin, cortisol, non-esterified-fatty-acids, β-Hydroxybutyrate, and plasma glucagon, adrenaline, noradrenaline, IL-6, and TNF-α concentrations were measured for 180 minutes post-meal.

Results
All participants were analysed. All glycaemic, metabolic, hormonal, and cytokine responses were similar between conditions up to 60 minutes following exercise. Following the post-exercise meal, serum insulin concentrations were lower under 50% (p<0.05) resulting in 75% of patients experiencing hyperglycaemia (blood glucose ≥8.0 mmol.l−1; 50% n = 6, Full n = 3). β-Hydroxybutyrate concentrations decreased similarly, such that at 180 minutes post-meal concentrations were lower than rest under Full and 50%. IL-6 and TNF-α concentrations remained similar to fasting levels under 50% but declined under Full. Under 50% IL-6 concentrations were inversely related with serum insulin concentrations (r = −0.484, p = 0.017).

Conclusions
Heavily reducing rapid-acting insulin dose with a carbohydrate bolus before, and a meal after intensive running exercise may cause hyperglycaemia, but does not augment ketonaemia, raise inflammatory cytokines TNF-α and IL-6 above fasting levels, or cause other adverse metabolic or hormonal disturbances.

Trial Registration
ClinicalTrials.gov NCT01531855

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More Information

Depositing User: Leah Maughan

Identifiers

Item ID: 13027
Identification Number: https://doi.org/10.1371/journal.pone.0097143
ISSN: 1932-6203
URI: http://sure.sunderland.ac.uk/id/eprint/13027
Official URL: http://dx.doi.org/10.1371/journal.pone.0097143

Users with ORCIDS

ORCID for Matthew Campbell: ORCID iD orcid.org/0000-0001-5883-5041

Catalogue record

Date Deposited: 28 Jan 2021 14:38
Last Modified: 28 Jan 2021 14:45

Contributors

Author: Matthew Campbell ORCID iD
Author: Susanne Breuer Votruba
Author: Mark Walker
Author: Michael I. Trenell
Author: Steven Luzio
Author: Gareth Dunseath
Author: Daniel Tuner
Author: Richard M. Bracken
Author: Stephen C. Bain
Author: Mark Russell
Author: Emma J. Stevenson
Author: Daniel J. West

University Divisions

Faculty of Health Sciences and Wellbeing > School of Nursing and Health Sciences

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