Preventing Hypoglycemia During Exercise in Type 1 Diabetes on CSII

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The average blood glucose drop during exercise was greater in the -100% basal reduction group than in the -50% and -80% groups.
The average blood glucose drop during exercise was greater in the -100% basal reduction group than in the -50% and -80% groups.
The following article is part of conference coverage from the American Diabetes Association's 78th Scientific Sessions (ADA 2018) in Orlando,Florida. Endocrinology Advisor's staff will report on medical research and technological advances in diabetes and diabetes education, conducted by experts in the field. Check back for the latest news from ADA 2018.

Reducing basal insulin delivery by 50% to 80% 90 minutes before aerobic exercise better prevents risk for hypoglycemia vs basal suspension or disconnection at exercise onset, according to research presented at the American Diabetes Association's 78th Scientific Sessions, held in Orlando, Florida, June 22-26.

Researchers randomly assigned participants with type 1 diabetes taking continuous subcutaneous insulin infusion (Omnipod®, Insulet; n=13) to 3 basal rate reduction strategies before exercise:

  1. -80%, 90 minutes before exercise
  2. -50%, 90 minutes before exercise
  3. -100% at exercise onset

Each participant completed three 60-minute aerobic exercise sessions (walking: ~50% maximum rate of oxygen consumption). Insulin infusion was resumed after exercise to maintain basal rates, and participants took 75% of usual bolus with a standardized meal. Pre-exercise blood glucose level was similar in all groups (9.5 ± 2.8 mmol/L).

The average blood glucose level drop during exercise was greater in the -100% group (-4.2 ± 3.3 mmol/L; P <.05) than in the -50% and -80% groups (-3.3 ± 2.4 vs -2.0 ± 2.1 mmol/L, respectively).

In the -100% group, 54% of participants (n=7) had hypoglycemia vs only 1 occurrence of hypoglycemia in the other 2 groups (8%; P <.001).

“In summary, reducing basal insulin delivery by 50% to 80% 90 minutes before aerobic exercise better mitigates [hypoglycemia] risk vs basal suspension or disconnection at exercise onset,” wrote lead researcher Dessi Zaharieva, MSc. “Basal rate reductions well in advance of exercise do not cause pre-exercise hyperglycemia or meal-related rebound hyperglycemia.”

For more coverage of ADA 2018, click here. 

Reference

Zaharieva D, McGaugh SM, Pooni R, Vienneau T, Ly TT, Riddell M. Reducing basal insulin 90 minutes before exercise protects against hypoglycemia better than insulin suspension at exercise onset in T1D – the OmniTIME results. Presented at: ADA 2018 78th Scientific Sessions; June 22-26, 2018; Orlando, FL. Abstract: 65-OR.

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