The hypoglycemia associated autonomic failure triggered by exercise in the patients with “brittle” diabetes and the strategy for prevention

Abstract

Exercise is a fundamental component of diabetes management. However, choosing inappropriate type or timing of exercise is associated with mild or severe hypoglycemia either during exercise or several hours after exercise. Several studies have shown that impaired counterregulatory responses triggers hypoglycemia. Therefore, in this investigation, we explored the appropriate intensity and time of exercise in patients with diabetes. The mechanisms of counterregulatory responses and hypoglycemia associated autonomic failure (HAAF), as well as the strategies for preventing episodes of hypoglycemia after exercise were also investigated. In this study, we obtained the following results: 1) High intensity interval exercise is more suitable for diabetic patients. 2) Morning exercise reduces nocturnal hypoglycemia risks compared with midday, afternoon and evening exercise. 3) Hypoglycemia can be prevented by dietary approach, reduction or suspension of insulin dose, use of mini dose glucagon, caffeine, mitigation methods, prediction algorithm, autonomic feedback controlled close-loop insulin delivery, real time continuous glucose monitoring. Based on these results we concluded that exercise may cause severe hypoglycemia or induce blunted response in patients with diabetes. For Diabetes Mellitus (DM) patients, the intensity and time of exercise influence the occurrence of hypoglycemia. This review summarizes the clinical characteristics of different types of exercises and time of exercise that can be potentially used to educate and guide patients regarding the role of exercise in standard of care.

Effect of Continuous Subcutaneous Injection of Insulin Analogues in Pregnant Women with Diabetes Mellitus Complicated with Ketoacidosis

“…At the same time, common and multiple 9) 102 ( 9) Diastolic blood pressure (mmHg) 66 ( 7) 67 (9) complications in patients with type 1 diabetes can also occur in the stress state of type 2 diabetes. Diabetes mellitus complicated with ketoacidosis will seriously threaten the life safety of pregnant women and newborns [16,17]. Patients with mild ketoacidosis usually have symptoms such as elevated blood sugar, polyuria, abnormal breathing, headache, oliguria, and moderate and severe gestational diabetes with ketoacidosis.…”

Nutritional Management of Athletes with Type 1 Diabetes: A Narrative Review

“…Different metabolic pathways are involved in hypoglycaemia onset. At the very beginning of PA, hypoglycaemia can occur via the activation of α-adrenergic autonomic afferent pancreatic fibres [ 60 ], a condition known as hypoglycaemia-associated autonomic failure (HAAF) [ 59 , 61 ] irrespective of the reduction of basal insulin infusion rates. As a result, individuals with T1DM typically require an increased carbohydrate intake or an insulin dose reduction, or both, before commencing aerobic EXE.…”

Falla autonómica asociada a hipoglucemia

“…La reducción de la dosis de insulina prandial -en un 25% de la dosis recomendada según relación insulina/carbohidratos y factor de sensibilidad a la insulina pre-ejercicio y la aplicación de un 50% de la dosis de insulina prandial que correspondería a la comida posterior-protegería de la hipoglucemia temprana (dentro de las 8 h de la sesión de ejercicio) pero no de la tardía (principalmente nocturna, dentro de las 24 h posteriores) 82 .…”

“…Se suele recomendar en combinación con la disminución de la insulina pre y post ejercicio, la ingesta de alimentos con carbohidratos y proteínas antes y después del ejercicio para limitar las hipoglucemias tanto durante como inmediatamente después de la actividad física 82 .…”