Reproducibility of plasma glucose responses to moderate-intensity exercise in individuals with type 1 diabetes
Corresponding Author
Wayne H. K. Soon
Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
Correspondence
Wayne H.K. Soon, Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.
Email: [email protected]
Search for more papers by this authorPaul A. Fournier
School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
Search for more papers by this authorMary B. Abraham
Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
Search for more papers by this authorGrant J. Smith
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
Search for more papers by this authorNirubasini Paramalingam
Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
Search for more papers by this authorVinutha B. Shetty
Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
Search for more papers by this authorKym J. Guelfi
School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
Search for more papers by this authorTimothy W. Jones
Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
Search for more papers by this authorElizabeth A. Davis
Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
Search for more papers by this authorCorresponding Author
Wayne H. K. Soon
Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
Correspondence
Wayne H.K. Soon, Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.
Email: [email protected]
Search for more papers by this authorPaul A. Fournier
School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
Search for more papers by this authorMary B. Abraham
Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
Search for more papers by this authorGrant J. Smith
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
Search for more papers by this authorNirubasini Paramalingam
Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
Search for more papers by this authorVinutha B. Shetty
Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
Search for more papers by this authorKym J. Guelfi
School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
Search for more papers by this authorTimothy W. Jones
Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
Search for more papers by this authorElizabeth A. Davis
Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
Search for more papers by this authorAbstract
Aim
To examine the within-person variability in plasma glucose responses to moderate-intensity morning exercise in young individuals with type 1 diabetes after overnight fasting and under basal insulin conditions.
Methods
In this pilot study, eight participants completed 40 min of moderate-intensity exercise at 60% V̇O2 peak on three separate days. The within-person standard deviation (SDw) in plasma glucose response was analysed both during and 1 h after exercise using the two visits per participant most closely matched by pre-exercise plasma glucose level.
Results
When the two closest matched visits per individual were included for analysis, mean (±SD) change in plasma glucose level was −1.8 ± 1.1 mmoL/L during exercise and −0.6 ± 1.0 mmoL/L during recovery, with the SDw of these changes being 0.5 mmol (95% CI 0.2, 0.8) during exercise and 0.8 mmoL/L (95% CI 0.4, 1.3) during recovery. The median intra-individual difference in plasma glucose level change was 0.3 mmoL/L [IQR 0.1, 0.7] during exercise and 0.8 mmoL/L [IQR 0.4, 1.0] during recovery.
Conclusion
Within-person plasma glucose responses to moderate-intensity exercise may be reproducible under fasting and basal insulin conditions and similar pre-exercise plasma glucose levels. This finding may assist the design of future studies investigating both the reproducibility of glycaemic responses to exercise and blood glucose management for individuals with type 1 diabetes.
CONFLICTS OF INTEREST
The authors have no conflict of interest to declare.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
REFERENCES
- 1Colberg SR, Laan R, Dassau E, Kerr D. Physical activity and type 1 diabetes: time for a rewire? J Diabetes Sci Technol. 2015; 9(3): 609-618.
- 2Galassetti P, Riddell MC. Exercise and type 1 diabetes (T1DM). Compr Physiol. 2013; 3(3): 1309-1336.
- 3Riddell MC, Taplin CE. Exercise in children with type 1 diabetes. In: A Scaramuzza, C Beaufort, R Hanas, eds. Research into Childhood-Onset Diabetes: from Study Design to Improved Management. Springer International Publishing; 2017: 77-89.
10.1007/978-3-319-40242-0_7 Google Scholar
- 4Wiesinger GF, Pleiner J, Quittan M, et al. Health related quality of life in patients with long-standing insulin dependent (type 1) diabetes mellitus: benefits of regular physical training. Wien Klin Wochenschr. 2001; 113(17–18): 670-675.
- 5Jabbour G, Henderson M, Mathieu ME. Barriers to active lifestyles in children with type 1 diabetes. Can J Diabetes. 2016; 40(2): 170-172.
- 6Beneyto A, Vehi J. Closed-loop blood glucose control using insulin and carbohydrates in front meals and exercise. IFAC-PapersOnLine. 2017; 50(1): 2058-2063.
10.1016/j.ifacol.2017.08.515 Google Scholar
- 7Jacobs PG, El Youssef J, Reddy R, et al. Randomized trial of a dual-hormone artificial pancreas with dosing adjustment during exercise compared with no adjustment and sensor-augmented pump therapy. Diabetes Obes Metab. 2016; 18(11): 1110-1119.
- 8 N Paoletti, KS Liu, SA Smolka, S Lin, eds. Data-driven robust control for type 1 diabetes under meal and exercise uncertainties. Springer International Publishing; 2017.
10.1007/978-3-319-67471-1_13 Google Scholar
- 9Turksoy K, Hajizadeh I, Hobbs N, et al. Multivariable artificial pancreas for various exercise types and intensities. Diabetes Technol Ther. 2018; 20(10): 662-671.
- 10Kordonouri O, Riddell MC. Use of apps for physical activity in type 1 diabetes: current status and requirements for future development. Ther Adv Endocrinol Metab. 2019; 10: 1-7.
- 11Temple MY, Bar-Or O, Riddell MC. The reliability and repeatability of the blood glucose response to prolonged exercise in adolescent boys with IDDM. Diabetes Care. 1995; 18(3): 326-332.
- 12Kilbride L, Charlton J, Aitken G, Hill GW, Davison RC, McKnight JA. Managing blood glucose during and after exercise in type 1 diabetes: reproducibility of glucose response and a trial of a structured algorithm adjusting insulin and carbohydrate intake. J Clin Nurs. 2011; 20(23–24): 3423-3429.
- 13Riddell MC, Pooni R, Yavelberg L, et al. Reproducibility in the cardiometabolic responses to high-intensity interval exercise in adults with type 1 diabetes. Diabetes Res Clin Pract. 2019; 148: 137-143.
- 14Biankin SA, Jenkins AB, Campbell LV, Choi KL, Forrest QG, Chisholm DJ. Target-seeking behavior of plasma glucose with exercise in type 1 diabetes. Diabetes Care. 2003; 26(2): 297-301.
- 15Abraham MB, Davey RJ, Cooper MN, et al. Reproducibility of the plasma glucose response to moderate-intensity exercise in adolescents with type 1 diabetes. Diabet Med. 2017; 34(9): 1291-1295.
- 16Soon WHK, Guelfi KJ, Davis EA, Smith GJ, Jones TW, Fournier PA. Effect of combining pre-exercise carbohydrate intake and repeated short sprints on the blood glucose response to moderate-intensity exercise in young individuals with type 1 diabetes. Diabet Med. 2019; 36(5): 612-619.
- 17Adolfsson P, Riddell MC, Taplin CE, et al. ISPAD clinical practice consensus guidelines 2018: exercise in children and adolescents with diabetes. Pediatr Diabetes. 2018; 19: 205-226.
- 18Scott SN, Cocks M, Andrews RC, et al. Fasted high-intensity internal and moderate-intensity exercise do not Lead to detrimental 24-hour blood glucose profiles. J Clin Endocrinol Metab. 2019; 104(1): 111-117.
- 19Martin MJ, Robbins DC, Bergenstal R, LaGrange B, Rubenstein AH. Absence of exercise-induced hypoglycaemia in type I (insulin-dependent) diabetic patients during maintenance of normoglycaemia by short-term, open-loop insulin infusion. Diabetologia. 1982; 23(4): 336-342.
- 20Nathan DM, Madnek SF, Delahanty L. Programming pre-exercise snacks to prevent post-exercise hypoglycemia in intensively treated insulin-dependent diabetics. Ann Intern Med. 1985; 102(4): 483-486.
- 21de Bock M, Dart J, Roy A, et al. Exploration of the performance of a hybrid closed loop insulin delivery algorithm that includes insulin delivery limits designed to protect against hypoglycemia. J Diabetes Sci Technol. 2017; 11(1): 68-73.
- 22Bland JM, Altman DG. Statistics notes: measurement error. BMJ. 1996; 313(7059): 744.
- 23Riddell MC, Zaharieva DP, Tansey M, et al. Individual glucose responses to prolonged moderate intensity aerobic exercise in adolescents with type 1 diabetes: the higher they start, the harder they fall. Pediatr Diabetes. 2019; 20(1): 99-106.
- 24Jenni S, Oetliker C, Allemann S, et al. Fuel metabolism during exercise in euglycaemia and hyperglycaemia in patients with type 1 diabetes mellitus--a prospective single-blinded randomised crossover trial. Diabetologia. 2008; 51(8): 1457-1465.
- 25Sacca L, Hendler R, Sherwin RS. Hyperglycemia inhibits glucose production in man independent of changes in glucoregulatory hormones. J Clin Endocrinol Metab. 1978; 47(5): 1160-1163.
- 26Richter EA, Hargreaves M. Exercise, GLUT4, and skeletal muscle glucose uptake. Physiol Rev. 2013; 93(3): 993-1017.
- 27Teich T, Riddell MC. The enhancement of muscle insulin sensitivity after exercise: a Rac1-independent handoff to some other player? Endocrinology. 2016; 157(8): 2999-3001.
- 28Bussau VA, Ferreira LD, Jones TW, Fournier PA. The 10-s maximal sprint: a novel approach to counter an exercise-mediated fall in glycemia in individuals with type 1 diabetes. Diabetes Care. 2006; 29(3): 601-606.
- 29Bussau VA, Ferreira LD, Jones TW, Fournier PA. A 10-s sprint performed prior to moderate-intensity exercise prevents early post-exercise fall in glycaemia in individuals with type 1 diabetes. Diabetologia. 2007; 50(9): 1815-1818.
- 30Guelfi KJ, Jones TW, Fournier PA. The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes. Diabetes Care. 2005; 28(6): 1289-1294.
