Effects of Exercise on the Absorption of Insulin Glargine in Patients With Type 1 Diabetes

Abstract

OBJECTIVE -To study the effects of exercise on the absorption of the basal long-acting insulin analog insulin glargine (Lantus), administered subcutaneously in individuals with type 1 diabetes.RESEARCH DESIGN AND METHODS -A total of 13 patients (12 men, 1 woman) with type 1 diabetes on a basal-bolus insulin regimen were studied.125 I-labeled insulin glargine at the usual basal insulin dose was injected subcutaneously into the thigh on the evening (2100) before the study day on two occasions 1 week apart. Patients were randomly assigned to 30 min intense exercise (65% peak oxygen uptake [VO 2peak ]) on one of these visits. The decay of radioactive insulin glargine was compared on the two occasions using a thallium-activated Nal gamma counter. Blood samples were collected at regular intervals on the study days to assess plasma glucose and insulin profiles. RESULTS -No significant difference was found in the125 I-labeled insulin glargine decay rate on the two occasions (exercise vs. no exercise; repeated-measures ANOVA, P ϭ 0.548). As expected, a significant fall in plasma glucose was observed over the exercise period (area under curve above fasting [⌬AUC] glucose: Ϫ0.39 Ϯ 0.11 vs. Ϫ1.30 Ϯ 0.16 mmol ⅐ l Ϫ1 ⅐ h Ϫ1 ; nonexercise vs. exercise; P ϭ 0.001), but insulin levels did not differ significantly on the two occasions (⌬AUC insulin: Ϫ2.1 Ϯ 3.9 vs. 1.5 Ϯ 6.2 pmol ⅐ l Ϫ1 ⅐ h Ϫ1 ; nonexercise versus exercise; P ϭ 0.507).CONCLUSIONS -An intense 30-min period of exercise does not increase the absorption rate of the subcutaneously injected basal long-acting insulin analog insulin glargine in patients with type 1 diabetes. Diabetes Care 28:560 -565, 2005

Quantifying the Acute Changes in Glucose with Exercise in Type 1 Diabetes: A Systematic Review and Meta-Analysis

“…Information in this regard was not provided in Maran et al [33], whereas Iscoe and Riddell [31] mentioned an absolute fall of approximately -5 mmol/L and ~ 50 % relative decay, although data were not reported explicitly in either text or graphs. The most marked decay rates among the included publications were reported, in this order, by Yamanouchi et al [37] (postbreakfast exercise trial arm), Rabasa-Lhoret et al [35] (50 % V0 2max trial), Peter et al [34], Rabasa-Lhoret et al [35] (75 % V0 2max trial), and Yardley et al [28] (CONT). In view of these data, there does not appear to be an evident direct relationship between the highest blood glucose concentrations at exercise onset and the most substantial ROCE values.…”

“…In the following three cases, patients exercised at levels lower than both conditions in Chokkalingam et al [52]: Jankovec et al [32] (average insulinemia ~ 80 pmol/L and great inter-subject variability, without statistical differences versus REST); Soo et al [36] (basal 84 ± 18 pmol/L, mean ± SEM; authors reported no significant correlation between basal free insulin and glycemic response); and Yamanouchi et al [37] (pre-prandial trial arm [55.3 ± 21.5 pmol/L, mean ± SD]). Peter et al [34] documented an average plasma insulin of ~ 300 pmol/L during both REST and CONT, without statistical differences between trials in terms of area under the curve for insulinemia (p -0.116). Physical activity bouts in the remaining studies took place with values comparable to the 150 pmol/L selected in Chokkalingam et al [52]: Rabasa-Lhoret et al [35] (insulin bolus 90 min prior to exercise onset, peak insulinemia at 188.5 ± 28.0 pmol/L, mean ± SD; peak occurring 30 min pre-exercise), Yamanouchi et al [37] (postprandial trial [insulin bolus 90 min prior to exercise onset, peak at 231.9 ± 162.3 pmol/L, mean ± SD]), Guelfi et al [29] (IHE exercise commenced at 198.1 ± 148.0 pmol/L, mean ± SD; no statistical difference with respect to REST), and Guelfi et al [30] (IHE and CONT exercise commenced, respectively, at approximately 160 and 140 pmol/L; no statistical differences in insulinemia profiles at any point of exercise or recovery).…”

“…During the process of peer review for this report, journal reviewers identified one extra study that fulfilled our inclusion criteria: Yardley et al [28]. Table 1 summarizes the main characteristics of the final ten publications [28][29][30][31][32][33][34][35][36][37] incorporated in this systematic review and meta-analysis.…”

“…Method for glucose measurement is one of these variables. Blood sampling, used in seven of ten studies [28,[32][33][34][35][36][37], constitutes the most accurate and reliable technique. Capillary samples, which were obtained in two studies [29,30], are more prone to error and delays than venous blood determinations.…”

“…Consequently, more pronounced falls could be expected if physical activity was commenced with high glucose values. This was the case for the majority of the included studies, for which exercise took place with concentrations around 10 mmol/L or above: Soo et al [36] (approximate range 12-13 mmol/L), Rabasa-Lhoret et al [35] (50 % V0 2max trial arm [10.7 ± 0.7 mmol/L, mean ± SEM]), Yamanouchi et al [37] (~ 10 mmol/L pre-prandial and ~ 15 mmol/L post-prandial), Peter et al [34] (approximate range 11-12 mmol/L), Guelfi et al [29] (10.9 ± 1.9 mmol/L for REST and 11.0 ± 1.8 mmol/L for IHE, mean ± SD), Guelfi et al [30] (11.0 ± 2.3 mmol/L for CONT and 11.5 ± 3.9 mmol/L for IHE, mean ± SD), and Yardley et al [28] (CONT trial arm [~ 10 mmol/L]). Other studies commenced at more restrained glycemia levels: Jankovec et al [32] (approximate range 7-8 mmol/ L), Rabasa-Lhoret et al [35] (8.8 ± 0.55 mmol/L for their 25 % V0 2ma x trial and 8.5 ± 1.3 mmol/L for 75 % V0 2max , mean ± SEM), and Yardley et al [28] (RESIST trial arm ~8.5 mmol/L).…”