Prevention of Hypoglycemia During Exercise in Children With Type 1 Diabetes by Suspending Basal Insulin

Abstract

OBJECTIVE -Strategies for preventing hypoglycemia during exercise in children with type 1 diabetes have not been well studied. The Diabetes Research in Children Network (DirecNet) Study Group conducted a study to determine whether stopping basal insulin could reduce the frequency of hypoglycemia occurring during exercise.RESEARCH DESIGN AND METHODS -Using a randomized crossover design, 49 children 8 -17 years of age with type 1 diabetes on insulin pump therapy were studied during structured exercise sessions on 2 days. On day 1, basal insulin was stopped during exercise, and on day 2 it was continued. Each exercise session, performed from ϳ4:00 -5:00 P.M., consisted of four 15-min treadmill cycles at a target heart rate of 140 bpm (interspersed with three 5-min rest breaks over 75 min), followed by a 45-min observation period. Frequently sampled glucose concentrations (measured in the DirecNet Central Laboratory) were measured before, during, and after the exercise.RESULTS -Hypoglycemia (Յ70 mg/dl) during exercise occurred less frequently when the basal insulin was discontinued than when it was continued (16 vs. 43%; P ϭ 0.003). Hyperglycemia (increase from baseline of Ն20% to Ն200 mg/dl) 45 min after the completion of exercise was more frequent without basal insulin (27 vs. 4%; P ϭ 0.002). There were no cases of abnormal blood ketone levels.CONCLUSIONS -Discontinuing basal insulin during exercise is an effective strategy for reducing hypoglycemia in children with type 1 diabetes, but the risk of hyperglycemia is increased.

Reduced Hypoglycemia and Increased Time in Target Using Closed-Loop Insulin Delivery During Nights With or Without Antecedent Afternoon Exercise in Type 1 Diabetes

“…While many clinicians may recommend temporary reductions in overnight basal rates in pump-treated patients to reduce the risk of hypoglycemia on nights after afternoon exercise, there are no clear guidelines for the duration and extent of reduction in basal rates, which is likely to vary from patient to patient and depends on the type of exercise. It is not surprising that previous reports have shown that use of this strategy often results in nocturnal hyperglycemia (22,23). …”

Effects of Glutamine on Glycemic Control During and After Exercise in Adolescents With Type 1 Diabetes

“…Although hypoglycemia decreased by discontinuing the insulin pump during exercise, significant rebound hyperglycemia was observed (3). …”

A Prospective, Randomized Trial Testing Different Regimens of Carbohydrate Administration to Prevent Major Reduction in Plasma Glucose Follwing a Standardized Bout of Moderate Physical Activity in Patients with Type 1 Diabetes

“…Other studies have recently described exercise-induced reductions in plasma glucose of similar magnitude in patients with type 1 diabetes treated with insulin pumps [33]. Moreover, strategies to prevent exercise-induced reductions in plasma glucose by reducing the basal rate of insulin infusion failed [14,15,34] similar to our attempt to achieve this with "preventive" carbohydrate snacks. In our study, the amounts of carbohydrate administered to our patients were substantial and correspond roughly with published recommendations: Nathan et al [16] recommended 13 g of carbohydrates, preferably in the ▶Fig.…”