A Prospective, Randomized Trial Testing Different Regimens of Carbohydrate Administration to Prevent Major Reduction in Plasma Glucose Follwing a Standardized Bout of Moderate Physical Activity in Patients with Type 1 Diabetes

2020 ◽  
Author(s):  
Hanna Frenzke ◽  
Annette Varnhorn ◽  
Heike Schulze ◽  
Melanie Kahle-Stephan ◽  
Michael A. Nauck
Keyword(s):  
Physical Activity ◽  
Type 1 Diabetes ◽  
Plasma Glucose ◽  
Insulin Dose ◽  
Repeated Administration ◽  
Carbohydrate Intake ◽  
Moderate Physical Activity ◽  
Trial Testing ◽  
Major Reduction

Abstract Aim/Hypothesis It was the aim to prospectively study regimes of “preventive” carbohydrate administration to avoid major reduction in plasma glucose during physical activity. Methods 24 patients with type 1 diabetes (age 41±12 years; 11 women, 13 men; BMI 26.5±4.7 kg/m2; HbA1c 9.1±1.5%; insulin dose 0.64±0.22 IU/kg body weight and day) participated in one experiment without physical activity and in three experiments with a 4 km, 60 min hike starting at 2 p.m.. No “preventive” carbohydrates, 2×10 g or 2×20 g carbohydrates (muesli bars) were taken when starting and after 30 min (randomized order). Plasma glucose was determined. Results Within 30 min after starting physical activity, plasma glucose fell by approximately 70 mg/dl, making additional carbohydrate intake necessary in 70% of the subjects. This drop was not prevented by any regimens of “preventive” carbohydrate intake. After the nadir, plasma glucose rose faster after the 2×20 g carbohydrate regime (the largest amount tested; p=0.0036). With “preventive” administration of carbohydrates, significantly (p<0.05) less additional “therapeutic” carbohydrates needed to be administered in 6 h following the initiation of the hike. Conclusions/Interpretation In conclusion, in the setting of 2 h postprandial exercise in type 1 diabetes, preventive carbohydrate supplementation alone will not completely eliminate the risk of brisk falls in plasma glucose concentrations or hypoglycaemic episodes. Else, higher amounts or repeated administration of carbohydrates may be necessary.

89-LB: The Effect of GIP on Plasma Glucose in a Setting of Prandial Insulin Overdose and Physical Activity after Meal Intake in Patients with Type 1 Diabetes

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 89-LB ◽  
Author(s):  
BJØRN HOE ◽  
SEBASTIAN M. NGUYEN HEIMBÜRGER ◽  
LÆRKE S. GASBJERG ◽  
MADS B. LYNGGAARD ◽  
BOLETTE HARTMANN ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 1 Diabetes ◽  
Plasma Glucose ◽  
Prandial Insulin ◽  
Meal Intake ◽  
Insulin Overdose

scholarly journals Prolonged Honeymoon Period in a Thai Patient With Adult-Onset Type 1 Diabetes Mellitus - Metabolic Flexibility in Autoimmune Diabetes?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A460-A461
Author(s):  
Yotsapon Thewjitcharoen ◽  
Ekgaluck Wanothayaroj ◽  
Waralee Chatchomchuan ◽  
Haruethai Jaita ◽  
Soontaree Nakasatien ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Beta Cell ◽  
Plasma Glucose ◽  
Carbohydrate Intake ◽  
Regular Exercise ◽  
Thai Patient ◽  
Low Carbohydrate ◽  
New Onset

Abstract Background: ‘Honeymoon’ period among people with type 1 diabetes mellitus (T1DM) refers to the period of time (mostly less than 1 year) which beta-cell is still able to produce insulin to maintain good glycemic control shortly following the development of diabetes. This phenomenon remained incompletely understood but previous studies showed that absence of diabetic ketoacidosis (DKA) at initial presentation, short duration of symptoms, older age at presentation, and strenuous exercise could be potential factors. Herein, we report a 24-year old Thai patient with T1DM who has been in sustained complete remission for more than 5 years while he is maintaining low carbohydrate intake and regular exercise. Clinical Case: A 24-year-old male presented with a 6-month history of polyuria, polydipsia and weight loss of 15 kilograms (baseline BMI at 27.8 kg/m2). His initial laboratory data showed plasma glucose 398 mg/dL and A1C 9.3%. No ketonemia was found. He was diagnosed with stage 3 of Type 1 DM based on clinical presentation and positive pancreatic auto-antibodies (anti-GAD and anti-IA2). Euthyroid Hashimoto’s thyroiditis was also diagnosed based on his enlarged thyroid gland and positive thyroid auto-antibodies. He was started on basal-bolus insulin regimen for only 2 month and then A1C reversed to 5.9% within 2 months. Insulin was gradually withdrawn and completely stopped. Mixed meal stimulation test (MMST) was firstly evaluated at the second year of his diagnosis. The result revealed stimulated C-peptide at 5.5 ng/dL. Next-generation sequencing panel for monogenic diabetes revealed negative results. The patient maintains healthy lifestyle habit with low carbohydrate intake and regular exercise 5–6 times per week. His body weight was maintained at 60–63 kilograms during the past 4 years. His A1C was maintained between 5.0 to 6.0% without any anti-diabetic medication for more than 5 years. Repeated MMST in every 6–12 months still revealed preserved beta-cell functions and normal stimulated plasma glucose. Interestingly, repeated pancreatic auto-antibodies at 3 years after diagnosis showed negative anti-GAD and anti-IA2, but positive anti-ZnT8. The patient was advised to maintain his bodyweight and healthy behavior together with closely regular OPD follow-up. Conclusion: Restored beta-cell function with completely insulin withdrawal in new-onset T1DM has been reported in very few cases which have some common factors as in our patient (low carbohydrate intake with regular exercise). Delaying autoimmune activity by reducing metabolic load in newly diagnosed T1DM might play a role in maintaining a honeymoon period and could lead to an innovative therapeutic option in new-onset T1DM.

scholarly journals Combined Algorithm-Based Adaptations of Insulin Dose and Carbohydrate Intake During Exercise in Children With Type 1 Diabetes: Results From the CAR2DIAB Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Philippe Antoine Lysy ◽  
Hélène Absil ◽  
Emy Gasser ◽  
Hasnae Boughaleb ◽  
Thierry Barrea ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Dose ◽  
Real Life ◽  
Severe Hypoglycemia ◽  
Carbohydrate Intake ◽  
Cardiac Evaluation ◽  
Maximum Effort ◽  
Combined Algorithm ◽  
Fast Acting

ObjectivesTo evaluate the evolution of subcutaneous glucose during two sessions of monitored aerobic exercise in children or adolescents with type 1 diabetes after adaptation of insulin doses and carbohydrate intake according to a combined algorithm.MethodsTwelve patients with type 1 diabetes (15.1 ± 2 years; diabetes duration: 9.5 ± 3.1 years) performed two series of exercise sessions after cardiac evaluation. The first series (TE#1) consisted in a monitored exercise of moderate to vigorous intensity coupled with a bout of maximum effort. The second series of exercises (TE#2) was carried out in real life during exercises categorized and monitored by connected watches. TE#2 sessions were performed after adaptation of insulin doses and fast-acting carbohydrates according to decision algorithms.ResultsPatients did not experience episodes of severe hypoglycemia, symptomatic hyperglycemia, or hyperglycemia associated with ketosis. Analysis of CGM data (15 h) during TE#2 sessions revealed an overall improvement in glycemic average [± standard deviation] (104 ± 14 mg/dl vs. 122 ± 17 mg/dl during TE#1; p &lt; 0.001), associated with a decrease in proportion of hyperglycemia in periods ranging from 4 h to 15 h after performing the exercises. The proportion of hypoglycemia was not changed, except during the TE#2 +4–8 h period, where a significant increase in hypoglycemia &lt;60 mg/dl was observed (25% vs. 6.2%; p = 0.04), yet without concurrent complications.ConclusionIn our pediatric series, the application of algorithmic adaptations of insulin doses and carbohydrate intake has globally improved glycemic control during 15 h after real-time exercises performed by children and adolescents with type 1 diabetes.

Correlation Between Glycemic Control and Physical Activity Level in Adolescents and Children With Type 1 Diabetes

2015 ◽  
Vol 12 (2) ◽  
pp. 232-237 ◽  
Author(s):  
Cristiane Petra Miculis ◽  
Wagner De Campos ◽  
Margaret Cristina da Silva Boguszewski
Keyword(s):  
Physical Activity ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Physical Activity Level ◽  
Sedentary Time ◽  
Insulin Dose ◽  
Fasting Blood Glucose ◽  
Activity Level ◽  
Sleeping Time

Background:The aim of this study was to correlate glycemic control (GC) and variables of physical activity levels (PAL) in children with type 1 diabetes mellitus (T1DM).Methods:Fifty children and adolescents with T1DM were selected. Personal and medical data for the patients were collected. Physical evaluations of body weight and sexual maturation were undertaken. Bouchard’s questionnaire was applied to evaluate PAL as well as for time spent on physical activities.Results:Sixty-four percent of the subjects were sexually mature. Differences were observed between females and males in insulin dose, duration of light physical activity, and sleeping time (P < .05). Ninety percent presented poor GC and 80% had a low PAL. Fasting blood glucose (FBG) was significantly correlated with PAL, with sedentary time, and with sleeping time. Glycated hemoglobin (HbA1c) was significantly correlated with sedentary time and sleeping time. Among the three groups of PAL (insufficient × moderate × active) there were differences in HbA1c (%), FBG (mg/dL), duration of disease (years), and insulin dose (UI/kg/day) (P < 0.001).Conclusion:GC was significantly correlated with PAL. Among the three groups of physical activity level, the most active group was seen to have the best GC.

Effect of yoga on plasma glucose, lipid profile, blood pressure and insulin requirement in a patient with type 1 diabetes mellitus

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Jintu Kurian ◽  
Venugopal Vijayakumar ◽  
A. Mooventhan ◽  
Ramesh Mavathur
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Lipid Profile ◽  
Plasma Glucose ◽  
Insulin Dose ◽  
Health Centre ◽  
Insulin Requirement

Abstract Objectives The objective of the study is to evaluate the short-term effect of yoga on plasma glucose, lipid profile, blood pressure and insulin requirement in a patient with type 1 diabetes mellitus (T1DM). Case presentation A 28-years old female was diagnosed with T1DM at the age of seven. She was under Human Mixtard insulin 30-70, thrice/day for 15-15-15 units. She had a history of poor glycemic control, diabetic ketoacidosis and hypoglycemic shock. At the age of 27, she got admitted with complaints of general weakness, joints stiffness and weight loss in our holistic health centre and underwent two weeks of yoga. Results showed a better reduction in the plasma glucose levels, lipid profile, blood pressure and insulin dose and an increase in hemoglobin levels with no episodes of hypoglycemia after yoga. Conclusions Yoga might be considered as a safer and effective adjuvant in the management of T1DM.

scholarly journals Advantages of physical activity of varying intensity for patients with type 1 diabetes and its influence on glucose metabolism

2021 ◽  
Vol 17 (4) ◽  
pp. 385-392
Author(s):  
T. Yu. Demidova ◽  
V. V. Titova
Keyword(s):  
Physical Activity ◽  
Type 1 Diabetes ◽  
Cardiovascular Mortality ◽  
High Intensity ◽  
Insulin Dose ◽  
Interval Training ◽  
Macrovascular Complications ◽  
Physically Active

Patients with type 1 diabetes mellitus (T1DM) have many benefits from regular exercise, including improved quality of life, lower blood pressure, improved lipid profile, increased insulin sensitivity, decreased insulin dose requirements, improved endothelial function, and reduced risk of micro- and macrovascular complications, as well as overall mortality. Despite these benefits, T1DM patients often do not get enough physical activity (PA) and are less physically active than their non-diabetic peers. The main reason for the low PA in patients with T1DM is the difficulty of glycemic management and the fear of developing hypoglycemia during exercise. Different types of training, such as moderate to high intensity exercise, high intensity interval training, have different effects on glycemic activity during exercise, which can be used to prevent the development of hypoglycemic reactions during and after exercise, along with carbohydrate intake and insulin dose adjustment. Higher-intensity exercise, as well as greater frequency and duration, are associated with a greater reduction in the risk of overall and cardiovascular mortality. Regular physical activity has a positive effect on reducing the risk of micro- and macrovascular complications, general and cardiovascular mortality in patients with type 1 diabetes, regardless of the quality of glycemic control, which can be used for prevention of T1DM complications.

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