Impact of pre-exercise rapid-acting insulin reductions on ketogenesis following running in Type 1 diabetes

被引:21
作者
Bracken, R. M. [1 ,2 ]
West, D. J. [1 ,2 ]
Stephens, J. W. [2 ]
Kilduff, L. P. [1 ]
Luzio, S. [3 ]
Bain, S. C. [2 ]
机构
[1] Swansea Univ, Sports & Exercise Sci Res Ctr, Sch Engn, Swansea SA2 8PP, W Glam, Wales
[2] Swansea Univ, Diabet Res Grp, Sch Med, Swansea SA2 8PP, W Glam, Wales
[3] Univ Wales Hosp, Ctr Endocrine & Diabet Sci, Diabet Res Unit, Cardiff CF4 4XW, S Glam, Wales
关键词
acid-base balance; carbohydrate supplementation; exercise; ketoacidosis; EXERCISE; LISPRO; HYPOGLYCEMIA; ASPART;
D O I
10.1111/j.1464-5491.2010.03162.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
P>Aim This study examined the effects of reductions to pre-exercise rapid-acting insulin dose on changes in blood beta-hydroxybutyrate, glucose, acid-base balance and counter-regulatory hormone responses to prolonged running in individuals with Type 1 diabetes. Methods Following ethical approval, seven participants with Type 1 diabetes (34 +/- 2 years, BMI 27 +/- 1 kg/m2) completed this study. After preliminary testing, participants attended the laboratory four times, each time consuming a 1.12MJ meal (60 g carbohydrate, 2 g fat, 2 g protein), with randomized amounts of their rapid-acting insulin: Full dose (mean 7.3 +/- 0.2 units), 75% dose (mean 5.4 +/- 0.1 units), 50% dose (mean 3.7 +/- 0.1 units) or 25% dose (mean 1.8 +/- 0.1 units). After 2-h rest, participants completed 45 min running at 70 +/- 1% peak rate of oxygen consumption (VO(2peak)). Blood metabolites and hormones were recorded over the 2-h rest and 3-h recovery. Data were analysed using repeated-measures ANOVA. Results Serum insulin peaked at 60 min in all conditions and was lowest after 25% insulin dose compared with full dose (P = 0.03). After the 25% insulin dose immediately pre-exercise glucose concentration was higher than after the full or 50% dose (P < 0.05). Resting beta-hydroxybutyrate gradually decreased during 2-h rest (P < 0.05) with a similar post-exercise peak of beta-hydroxybutyrate at 3 h (P > 0.05). Post-exercise blood pH increased for 5 min to a similar extent with all insulin doses , but the rise with the 25% dose was less compared with the full dose (P = 0.01). Blood lactate and plasma catecholamines increased after running similarly with all insulin reduction conditions (P < 0.05). Blood glucose area under the curve (BG(auc)) after the 25% insulin dose was greater than after the 75% dose (P = 0.02). Conclusion Ketogenesis following running was not influenced by reductions in pre-exercise rapid-acting insulin dose. This important preparatory strategy aids preservation of blood glucose but poses no greater risk to exercise-induced ketone body formation.
引用
收藏
页码:218 / 222
页数:5
相关论文
共 14 条
[1]   Intraislet hyperinsulinemia prevents the glucagon response to hypoglycemia despite an intact autonomic response [J].
Banarer, S ;
McGregor, VP ;
Cryer, PE .
DIABETES, 2002, 51 (04) :958-965
[2]   CALCULATION OF PERCENTAGE CHANGES IN VOLUMES OF BLOOD, PLASMA, AND RED-CELLS IN DEHYDRATION [J].
DILL, DB ;
COSTILL, DL .
JOURNAL OF APPLIED PHYSIOLOGY, 1974, 37 (02) :247-248
[3]  
Grimshaw J, 2005, EXTENDED PROJECTION, P1
[4]   Comparison of insulin aspart and lispro - Pharmacokinetic and metabolic effects [J].
Homko, C ;
Deluzio, A ;
Jimenez, C ;
Kolaczynski, JW ;
Boden, G .
DIABETES CARE, 2003, 26 (07) :2027-2031
[5]   Preexercise medium-chain triglyceride ingestion does not alter muscle glycogen use during exercise [J].
Horowitz, JF ;
Mora-Rodriguez, R ;
Byerley, LO ;
Coyle, EF .
JOURNAL OF APPLIED PHYSIOLOGY, 2000, 88 (01) :219-225
[6]   POST-EXERCISE KETOSIS [J].
KOESLAG, JH ;
NOAKES, TD ;
SLOAN, AW .
JOURNAL OF PHYSIOLOGY-LONDON, 1980, 301 (APR) :79-90
[7]   CLINICAL FACTORS INFLUENCING THE ABSORPTION OF NPH-I-125 INSULIN IN DIABETIC-PATIENTS [J].
KOLENDORF, K ;
BOJSEN, J ;
DECKERT, T .
HORMONE AND METABOLIC RESEARCH, 1983, 15 (06) :274-278
[8]  
Laffel L, 1999, DIABETES-METAB RES, V15, P412, DOI 10.1002/(SICI)1520-7560(199911/12)15:6<412::AID-DMRR72>3.0.CO
[9]  
2-8
[10]   Glucose response to intense aerobic exercise in type 1 diabetes - Maintenance of near euglycemia despite a drastic decrease in insulin dose [J].
Mauvais-Jarvis, F ;
Sobngwi, E ;
Porcher, R ;
Garnier, JP ;
Vexiau, P ;
Duvallet, A ;
Gautier, JF .
DIABETES CARE, 2003, 26 (04) :1316-1317