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- Title
Exercise-Induced Hypoglycemia in IDDM Patients Treated with a Short-Acting Insulin Analogue.
- Authors
Boyle, Patrick J.
- Abstract
Objective. To demonstrate the effect of the insulin analog lispro on exerciseinduced hypoglycemia related to timing of dose in patients with type I diabetes. Design. All patients cycled on a stationary bike on four different mornings. On two of these mornings, exercise occurred 4 0 - 8 0 minutes after the beginning of a 550 kcal breakfast (early exercise). On the other two mornings, exercise occurred 180-220 minutes after breakfast (late exercise). Before one of the early- and one of the late-exercise mornings, an average of 6.3 U of regular human insulin was injected subcutaneously 30 minutes before the meal. An identical amount of lispro was injected 5 minutes before breakfast on the other two days. An additional 30-gram carbohydrate snack was provided at 120 minutes on each of the mornings. Subjects. Ten healthy patients with type 1 diabetes (seven male, three female) with an average duration of diabetes of 18 years and taking an average insulin dose of 49 U/day agreed to participate. All patients were using regular insulin before each meal and NPI1 insulin at bedtime. In addition, three of the patients were also using NPII insulin in the morning with regular insulin before breakfast. Measurements. Plasma glucose concentration was determined at 10- and 20- minute intervals during the 240 minutes after ingestion of breakfast. In addition, serum insulin, glucagon, Cortisol, and catecholamines were determined frequently throughout the study period. Results. Glucose concentrations fell during exercise in all four conditions. During the early exercise periods, the mean glucose concentration fell by ~80 mg/dl ( ~ 4 . 5 mmol/L) in association with lispro administration. A fall of 36 mg/dl followed injection of regular insulin (P < 0.01). One patient in each treatment group required supplemental carbohydrate before exercise due to plasma glucose concentration that fell below 54 mg/dl. During late exercise, mean average glucose concentrations fell by only 18 mg/dl following lispro injection, but by nearly 36 mg/dl in the regular insulin-treated group (P < 0.05). As glucose concentration fell with early exercise, glucagon concentrations were higher after lispro than after regular insulin use. Conclusions. The lispro analog of human insulin can either augment or reduce exercise-induced hypoglycemia, depending on the time interval between insulin injection and exercise.
- Publication
Diabetes Spectrum, 1996, Vol 9, Issue 4, p240
- ISSN
1040-9165
- Publication type
Academic Journal