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Diabetes Metab. 2018 Aug 27. pii: S1262-3636(18)30159-9. doi: 10.1016/j.diabet.2018.08.002. [Epub ahead of print]

Timing of insulin basal rate reduction to reduce hypoglycemia during late post-prandial exercise in adults with type 1 diabetes using insulin pump therapy: A randomized crossover trial.

Author information

1
Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada; Nutrition department, faculty of medicine, universite de Montréal, 1204-2405, chemin de la Côte-Sainte-Catherine, Montréal, Québec H3T 1A8, Canada.
2
Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada; Division of biomedical sciences, faculty of medicine, université de Montréal, C.P.6128 Succ. Centre-Ville, Montréal, Québec H3C 3J7, Canada.
3
Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada.
4
School of computer science, McGill university, Montreal, Québec, Canada.
5
School of public health, social and preventive medicine department, université de Montréal, C.P.6128 Succ. Centre-Ville, Montréal, Québec, H3C 3J7, Canada.
6
Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada; Montreal children's hospital, McGill university health centre, 1001 Boul Décarie, Montreal, Québec H4A 3J1, Canada.
7
Institut de recherches cliniques de Montréal, 110, avenue des Pins Ouest, Montréal, Québec, Canada; Nutrition department, faculty of medicine, universite de Montréal, 1204-2405, chemin de la Côte-Sainte-Catherine, Montréal, Québec H3T 1A8, Canada; Centre de recherche du centre hospitalier de l'université de Montréal (CRCHUM), R-900 Saint-Denis, Montreal, Québec H2X 0A9, Canada; Montreal diabetes research centre, R-900 Saint-Denis, Montreal, Québec H2X 0A9, Canada. Electronic address: remi.rabasa-lhoret@ircm.qc.ca.

Abstract

AIMS:

To compare the efficacy of three timings to decrease basal insulin infusion rate to reduce exercise-induced hypoglycaemia in patients with type 1 diabetes (T1D) using pump therapy.

METHODS:

A single-blinded, randomized, 3-way crossover study in 22 adults that had T1D > 1 year and using insulin pump > 3 months (age, 40 ± 15 years; HbA1c, 56.3 ± 10.2 mmol/mol). Participants practiced three 45-min exercise sessions (ergocyle) at 60% VO2peak 3 hours after lunch comparing an 80% reduction of basal insulin applied 40 minutes before (T-40), 20 minutes before (T-20) or at exercise onset (T0).

RESULTS:

No significant difference was observed for percentage of time spent < 4.0 mmol/L (T-40: 16 ± 25%; T-20: 26 ± 27%; T0: 24 ± 29%) (main outcome) and time spent in target range 4.0-10.0 mmol/L (T-40: 63 ± 37%; T-20: 66 ± 25%; T0: 65 ± 31%). With T-40 strategy, although not significant, starting blood glucose (BG) was higher (T-40: 8.6 ± 3.6 mmol/L; T-20: 7.4 ± 2.5 mmol/L ; T0: 7.4 ± 2.7 mmol/L), fewer patients needed extra carbohydrates consumption prior to exercise for BG < 5.0 mmol/L (T-40: n = 3; T-20: n = 5; T0: n = 6) as well as during exercise for BG < 3.3 mmol/L [T-40: n = 6 (27%); T-20: n = 12 (55%); T0: n = 11 (50%)] while time to first hypoglycaemic episode was delayed (T-40: 28 ± 14 min; T-20: 24 ± 10 min; T0: 22 ± 11 min).

CONCLUSION:

Decreasing basal insulin infusion rate by 80% up to 40 minutes before exercise onset is insufficient to reduce exercise-induced hypoglycaemia.

KEYWORDS:

CSII; Exercise; Hypoglycaemia; Insulin pump; Type 1 diabetes

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