Diabetes management for intense exercise

Current Opinion in Endocrinology, Diabetes and Obesity

Volumn 16, Issue 2, 2009, Pages 150-155

  Lumb, Alistair N ^a   Gallen, Ian W ^b  

^a CHURCHILL HOSPITAL   (United Kingdom)

^b WYCOMBE HOSPITAL   (United Kingdom)

Author keywords

Exercise; Sport; Type 1 diabetes

Indexed keywords

ALPHA ADRENERGIC RECEPTOR; CATECHOLAMINE; GLUCAGON; GLUCOSE; GLUCOSE TRANSPORTER 4; GLYCOGEN; INSULIN;

AEROBIC EXERCISE; ANAEROBIC EXERCISE; ATHLETE; ATHLETIC PERFORMANCE; CARBOHYDRATE INTAKE; CATECHOLAMINE BLOOD LEVEL; DRUG DOSE REDUCTION; DRUG DOSE REGIMEN; ENDURANCE SPORT; EXERCISE PHYSIOLOGY; GLUCAGON BLOOD LEVEL; GLUCONEOGENESIS; GLUCOSE BLOOD LEVEL; GLUCOSE OXIDATION; GLUCOSE TRANSPORT; GLYCEMIC CONTROL; HEALTH; HUMAN; HYPERGLYCEMIA; HYPERINSULINEMIA; HYPOGLYCEMIA; INSULIN BLOOD LEVEL; INSULIN DEPENDENT DIABETES MELLITUS; INSULIN PUMP; METABOLIC REGULATION; METABOLISM; REVIEW; SPORT; ANIMAL; EXERCISE; PATHOPHYSIOLOGY; PHYSIOLOGY;

ANIMALS; ATHLETIC PERFORMANCE; DIABETES MELLITUS, TYPE 1; EXERCISE; HUMANS; SPORTS;

EID: 66149084488     PISSN: 1752296X     EISSN: None     Source Type: Journal    
DOI: 10.1097/MED.0b013e328328f449     Document Type: Review

References (44)

1. Gallen IW, Redgrave A, Redgrave S. Olympic diabetes. Clin Med 2003; 3:333-337.
2. Robertson K, Adolfsson P, Riddell MC, et al. Exercise in children and adolescents with diabetes. Pediatr Diabetes 2008; 9:65-77. A summary of the International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2006-2007.
3. Riddell MC, Iscoe KE. Physical activity, sport and pediatric diabetes. Pediatr Diabetes 2006; 7:60-70.
4. Wallymahmed ME, Morgan C, Gill CV, MacFarlane IA. Aerobic fitness and hand grip strength in type 1 diabetes: relationship to glycaemic control and body composition. Diabet Med 2007; 24:1296-1299. This observational study demonstrates a negative correlation between aerobic capacity and glycaemic control, although no causal link can be identified due to the nature of the study.
5. Fisher MBM, Cleland JGF, Dargie HJ, et al. Noninvasive evaluation of cardiac function in young patients with type 1 diabetes. Diabet Med 1989; 6:677-681.
6. Wanke T, Formanek D, Auinger M, et al. Pulmonary gas exchange and oxygen uptake during exercise in patients with type 1 diabetes. Diabet Med 1992; 9:252-257.
7. Nugent AM, Steele IC, al-Modaris F, et al. Exercise responses in patients with IDDM. Diabetes Care 1997; 20:1814-1821.
8. Veves A, Saouaf R, Donaghue VM, et al. Aerobic exercise capacity remains normal despite impaired endothelial function in the micro- and macrocirculation of physically active IDDM patients. Diabetes 1997; 46:1846-1852.
9. Koivisto VA. Diabetes and exercise. In: Alberti KGMM, Krall LP, editors. The diabetes annual 6. Amsterdam, The Netherlands: Elsevier Science; 1991. pp. 169-183.
10. Petersen KF, Price TB, Bergeron R. Regulation of net hepatic glycogenolysis and gluconeogenesis during exercise: impact of type 1 diabetes. J Clin Endocrinol Metab 2004; 89:4656-4664.
11. Robertson RP, Halter JB, Porte D Jr. A role for alpha-adrenergic receptors in abnormal insulin secretion in diabetes mellitus. J Clin Invest 1976; 57:791-795.
12. Broadstone VL, Pfeifer MA, Bajaj V, et al. Alpha-adrenergic blockade improves glucose-potentiated insulin secretion in noninsulin-dependent diabetes mellitus. Diabetes 1987; 36:932-937.
13. Thorell A, Hirshman MF, Nygren J, et al. Exercise and insulin cause GLUT-4 translocation in human skeletal muscle. Am J Physiol Endocrinol Metab 1999; 277:E733-E741.
14. Kreisman S, Mew NAH, Halter JB, et al. Norepinephrine infusion during moderate-intensity exercise increases glucose production and uptake. J Clin Enocrinol Metab 2001; 86:2118-2124.
15. Stich V, de Glisezinski I, Berlan M, et al. Adipose tissue lipolysis is increased during a repeated bout of aerobic exercise. J Appl Physiol 2000; 88:1277-1283.
16. Marliss EB, Vranic M. Intense exercise has unique effects on both insulin release and its roles in glucoregulation. Diabetes 2002; 51 (S1):S271-S283.
17. Sigal RJ, Fisher S, Halter JB, et al. The roles of catecholamines in glucose regulation in intense exercise as defined by the islet cell clamp technique. Diabetes 1996; 45:148-156.
18. Koivisto VA, Felig P. Effects of leg exercise on insulin absorption in diabetic patients. N Engl J Med 1978; 298:79-83.
19. Goodyear LJ, Kahn BB. Exercise, glucose transport and insulin sensitivity. Annu Rev Med 1998; 49:235-261.
20. Galassetti P, Tate D, Neill RA, et al. Effect of antecedent hypoglycaemia on counterregulatory responses to subsequent euglycaemic exercise in type 1 diabetes. Diabetes 2003; 52:1761-1769.
21. Sigal RJ, Fisher SJ, Manzon A, et al. Glucoregulation during and after intense exercise: effects of alpha-adrenergic blockade. Metabolism 2000; 49:386-394.
22. MacDonald MJ. Postexercise late-onset hypoglycaemia in insulin-dependent diabetic patients. Diabetes Care 1997; 20:22-25.
23. Kraniou GN, Cameron-Smith D, Hargreaves M. Acute exercise and GLUT4 expression in human skeletal muscle: influence of exercise intensity. J Appl Physiol 2006; 101:934-937.
24. Kraniou GN, Cameron-Smith D, Hargreaves M. Effect of short-term training on GLUT-4 mRNA and protein expression in human skeletal muscle. Exp Physiol 2004; 89:559-563.
25. Sandoval DA, Aftab Guy DL, Richardson MA, et al. Effects of low and moderate antecedent exercise on counterregulatory responses to subsequent hypoglycaemia in type 1 diabetes. Diabetes 2004; 53:1798-1806.
26. McMahon SK, Ferreira LD, Ratnam N, et al. Glucose requirements to maintain euglycaemia after moderateintensity afternoon exercise in adolescents with type 1 diabetes are increased in a biphasic manner. J Clin Endocrinol Metab 2007; 92:963-968. Small numbers because of the complexity of the intervention, but nevertheless an important study quantifying both early and late hypoglycaemia following afternoon exercise in this group, and indicating a link between the onset of late hypoglycaemia and sleep.
27. Konatsu WR, Gabbay MAL, Castro ML, et al. Aerobic exercise capacity in normal adolescents and those with type 1 diabetes mellitus. Pediatr Diabetes 2005; 6:145-149.
28. Jenni S, Oetliker C, Allemann S, et al. Fuel metabolism during exercise in euglycaemia and hyperglycaemia in patients with type 1 diabetes mellitus: a prospective single-blinded randomized crossover trial. Diabetologia 2008; 51:1457-1465. Internally controlled study showing a difference in fuel metabolism in euglycaemia and hyperglycaemia. Contrary to some other studies, fuel metabolism appears to have been controlled by cortisol and growth hormone levels, so also raises important questions.
29. Stettler S, Jenni S, Allemann S, et al. Exercise capacity in subjects with type 1 diabetes mellitus in eu- and hyperglycaemia. Diabetes Metab Res Rev 2006; 22:300-306.
30. Chokkalingham K, Tsintzas K, Norton L, et al. Exercise under hyperinsulinaemic conditions increases whole body glucose disposal without affecting muscle glycogen utilisation in type 1 diabetes. Diabetologia 2007; 50:414-421. Internally controlled study showing that muscle glycogen is not spared during exercise in hyperglycaemic conditions. This suggests that there may be a problem with transport of plasma glucose into exercising muscle in type 1 diabetes.
31. Chokkalingham K, Tsintzas K, Snaar JEM, et al. Hyperinsulinaemia during exercise does not suppress hepatic glycogen concentrations in patients with type 1 diabetes: a magnetic resonance spectroscopy study. Diabetologia 2007; 50:1921-1929. A reasonable theory is that hyperinsulinaemia during exercise would spare liver glycogen stores by inhibiting glycogenolysis, but this study demonstrates that this is not the case.
32. Robitaille M, Dubé M-C, Weisnagel SJ, et al. Substrate source utilisation during moderate intensity exercise with glucose ingestion in type 1 diabetic patients. J Appl Physiol 2007; 103:119-124. This study demonstrates increased muscle glycogen oxidation in exercise in type 1 diabetes, in spite of hyperglycaemia and hyperinsulinaemia. This supports the theory that it is a problem with glucose uptake into muscle that may cause the reduction in maximal exercise capacity sometimes observed in type 1 diabetes.
33. Pederson O, Bak JF, Andersen PH, et al. Evidence against altered expression of GLUT1 or GLUT4 in skeletal muscle of patients with obesity or NIDDM. Diabetes 1990; 39:865-870.
34. Fayolle C, Brun JF, Bringer J, et al. Accuracy of continuous subcutaneous glucose monitoring with the GlucoDay in type 1 diabetic patients treated by subcutaneous insulin infusion during exercise of low versus high intensity. Diabetes Metab 2006; 32:313-320.
35. Gallen IW. Diabetes and sport: managing the complex interactions. Br J Hosp Med 2006; 67:512-515.
36. Harmer AR, Chisholm DJ, McKenna MJ, et al. High intensity training improves plasma glucose and acid-base regulation during intermittent maximal exercise in type 1 diabetes. Diabetes Care 2007; 30:1269-1271. This well designed study demonstrates that training can normalize the metabolic response to anaerobic exercise and reduce the associated hyperglycaemia and acid-base disturbance.
37. Rabasa Lhoret R, Bourque J, Ducors F, Chiasson JL. Guidelines for premeal insulin dose reduction for postprandial exercise of different intensities and dutrations in type 1 diabetic subjects treated intensively with a basal bolus regimen. Diabetes Care 2001; 24:625-630.
38. Mauvais-Jarvis F, Sobngwi E, Porcher R, et al. Glucose response to intense aerobic exercise in type 1 diabetes: maintenance of near euglycaemia despite a drastic decrease in insulin dose. Diabetes Care 2003; 26:1316-1317.
39. Hernandez JM, Moccia T, Fluckley JD, et al. Fluid snacks to help persons with type 1 diabetes avoid late onset postexercise hypoglycaemia. Med Sci Sports Exerc 2000; 32:904-910.
40. Frohnauer M, Liu K, Devlin J. Adjustment of basal Lispro insulin in CSII to minimize glycemic fluctuations caused by exercise [abstract]. Diab Res Clin Pract 2000; 50 (Suppl 1):S80.
41. Tsalikian E, Kollman C, Tamborlane WB, et al. DirecNet Study Group. Prevention of hypoglycaemia during exercise in children with type 1 diabetes by suspending basal insulin. Diabetes Care 2006; 29:2200-2204.
42. Bussau VA, Ferreira LD, Jones TW, Fournier PA. A 10 s sprint performed prior to moderate-intensity exercise prevents early postexercise fall in glycaemia in individuals with type 1 diabetes. Diabetologia 2007; 50:1815-1818. This study provides a quick and easy means of attenuating the drop in blood glucose immediately following exercise.
43. Bussau VA, Ferreira LD, Jones TW, Fournier PA. The 10 s maximal sprint: a novel approach to counter an exercise-mediated fall in glycemia in individuals with type 1 diabetes. Diabetes Care 2006; 29:601-606.
44. DirecNet Study Group. Adiponectin and catecholamine concentrations during acute exercise in children with type 1 diabetes. Pediatr Diabetes 2008; 9:221-227. Adiponectin appears to act as an insulin-sensitizing agent. It is, therefore, interesting that higher levels were associated with a lower risk of hypoglycaemia, although important factors affecting adiponectin were not controlled for.