Influence of Physical Activity on Metabolic State Within a 3-h Interruption of Continuous Subcutaneous Insulin Infusion in Patients with Type 1 Diabetes

Abstract

The influence of physical activity during a 3-h interruption of insulin pump treatment is evident, especially in the increase in plasma levels of non-esterified fatty acids and ketone bodies. Correction bolus leads to a rapid increase in insulinemia; however, normalization of blood glucose and ketone bodies is achieved within another 90 min.

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

“…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.…”

“…Three publications did not clearly comment on preceding physical activity [28,29,35]. In addition, three protocols [30,32,33] checked for the absence of hypoglycemia during the hours or days prior to the exercise sessions and postponed the study in the case of recent hypoglycemic events.…”

“…Exercise intensity was measured through %V0 2max , i-e. the percentage of a subject's maximal oxygen uptake (V0 2max ). Intensities reported in Jankovec et al [32] and Soo et al [36] via heart rate reserve (HRR; 60 and 50 %, respectively) were transformed to their equivalent %V0 2max values (55 and 46 % V0 2ma x) based on previous studies [38,39]. For Yamanouchi et al [37], we imputed an intensity of 20 % ^0 2max as corresponding to the range 90-110 beats per minute [40].…”

“…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.…”

“…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). 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.…”