Mini-dose glucagon has shown possible superiority to insulin reduction in mitigating hypoglycemia induced by exercise in individuals with type 1 diabetes, according to a study recently published in Diabetes Care.
This randomized crossover trial took place in 4 sessions and included 15 adults with type 1 diabetes. The participants of this study were administered continuous subcutaneous insulin infusion. Randomly assigned into groups of 150-μg subcutaneous glucagon, 40-g glucose tablets taken orally, 50% reduction in basal insulin, or a control group with no treatment, participants exercised for 45 minutes at approximately 55% VO2max in the morning while fasting.
Those administered mini-dose glucagon showed a small increase in plasma glucose during and immediately after exercise, whereas glucose tablets led to a greater increase, and both insulin reduction and control showed a decrease (P <.001). Mini-dose glucagon led to an increase in glucagon (P <.001), but there was no difference in insulin levels across sessions. No participants in the mini-dose glucagon or glucose tablets groups experienced hypoglycemia (plasma glucose <70 mg/dL), compared with 5 participants in the insulin reduction group and 6 in control. The mini-dose glucagon group experienced 1 incident of hyperglycemia (plasma glucose of at least 250 mg/dL), compared with 5 in glucose tablets.
The study researchers conclude that “[mini-dose glucagon] (i.e., ~150 mg of glucagon) may be an effective strategy for the prevention of exercise-induced hypoglycemia in adults with type 1 diabetes. In addition, [mini-dose glucagon] may be more effective for preventing exercise-induced hypoglycemia than insulin reduction that was associated with a similar rate and magnitude of hypoglycemia as no intervention.”
Rickels MR, DuBose SN, Toschi E, et al; for the T1D Exchange Mini-Dose Glucagon Exercise Study Group. Mini-dose glucagon as a novel approach to prevent exercise-induced hypoglycemia in type 1 diabetes [published online May 18, 2018]. Diabetes Care. doi: 10.2337/dc18-0051