Schiffrin and Parikh, 19854477 young people with type 1 diabetes on treatment with CSII and multiple daily injections (MDI)
Aged 13–18 years
Investigation into the effect of 45 min of cycle ergometer exercise at 55% VO2 on glucose regulation 2 hours after morning insulin and breakfast. Studied on 5 different days in a random order
  1. Resting/control day
  2. Postprandial exercise preceded by the usual dose of insulin
  3. Postprandial exercise preceded by half the usual dose of insulin
  4. Postprandial exercise preceded by two-thirds the usual dose of insulin
  5. Postprandial exercise without the usual preceding dose of insulin
When exercise was performed without change in usual insulin dose there was a significant fall in blood glucose in both CSII and MDI groups
CSII 57 ± 5 mg/dl (mean ± SEM) p < 0.05 compared with rest, with hypoglycaemia in 4 patients
MDI 65 ± 10 mg/dl (mean ± SEM) p < 0.05 compared with rest, with hypoglycaemia in 3 patients
When exercise was performed with half or two-thirds of the usual insulin dose the plasma glucose profile observed during exercise in both groups was not statistically different from that observed during the rest day
When exercise was performed without the usual insulin dose there was significant hyperglycaemia in both groups, p< 0.01
Study conclusions: reducing insulin dose by 50–66% in anticipation of postprandial exercise of moderate intensity resulted in near normal glycaemia values and prevented hypoglycaemia
With unplanned postprandial exercise of 45 min duration the intake of 25–3 g of glucose may prevent hypoglycaemia
Case–control studyII
Koivisto and Felig, 197844811 adults with type 1 diabetes
Aged 20–29 years
Effect of leg exercise on absorption of insulin injected to various places in the body (leg, abdomen or arm)Insulin disappearance from the leg increased by 135% during first 10 min of leg exercise, p < 0.05, and remained 50% above resting levels after 60 min, p < 0.02
Leg exercise had no effect on insulin disappearance from the arm
Insulin disappearance from the abdomen was reduced during the post-exercise recovery period, p < 0.02
Arm injection reduced the hypoglycaemic effect of exercise by 57% compared with leg injection, p < 0.02
Abdominal injections reduced the hypoglycaemic effect of exercise by 89% compared with leg injection, p < 0.005
Within-person comparisonIII
Berger et al, 197744911 male patients with type 1 diabetes and 6 healthy controls
Aged 17–33 years
3-hour bicycle ergometer test of comparable, mild work intensity
One group of patients with moderate glycaemic control given 2/3 of their usual evening insulin dose on preceding day and the other in ketosis due to insulin withdrawal due to insulin being withheld 18 to 48 hours before test
In patients with moderately controlled glycaemic control, blood glucose concentration fell and the blood fatty acid levels increased
In patients who were in ketosis exercise led to increases in ketone bodies, glucagon and cortisol levels
Significant correlations were found between the exercise effect on blood glucose and initial blood levels of glucose, free fatty acids, ketone bodies and branch-chained amino acids
Non-randomised controlled trialIIa
Campaigne et al, 198445019 children with type 1 diabetes
Aged 5–11 years
30-min vigorous physical exercise (n = 9)
control group, who performed no exercise (n = 10)
Trial length: 3 times a week for 12 weeks
  1. HbA1
  2. Fasting blood glucose
  3. Oxygen consumption through treadmill testing and analysis of expired air
  1. 11.3 ± 0.50% vs. 13.3 ± 0.54%, p < 0.05
  2. 190 ± 32 vs. 292 ± 27mg/dl, no significant difference (mean difference −5.7 mmol/l, 95% CI −10.3 to 1.1 mmol/l, converted from mg/dl )
  3. 50.49 ± 1.30 vs. 48.20 ± 1.61 ml/kg/min, p < 0.01
No description of randomisationRCTIb
Huttunen et al, 198945132 children and young people with type 1 diabetes
Aged 8.2–16.9 years
Training for 1 hour per week (n = 16)
non-physical activities for 1 hour a week (n = 16)
Trial length: 3 months
  1. Urine glucose
  2. Oxygen consumption peak VO2max
  1. 10.5 ± 2.5% vs. 9.7 ± 2.2%, no significant difference
  2. 210 ± 319 vs. 244 ± 238 μmol/min/m2, no significant difference
  3. 43.8 ± 8.6 vs. 42.7 ± 8.0 ml/min/kg, no significant difference
No description of randomisationRCTIb

From: Evidence tables

Cover of Type 1 Diabetes
Type 1 Diabetes: Diagnosis and Management of Type 1 Diabetes in Children and Young People.
NICE Clinical Guidelines, No. 15.2.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2004 Sep.
Copyright © 2004, National Collaborating Centre for Women’s and Children’s Health.

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