title: The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes. Carbohydrate requirement and insulin concentration during moderate exercise in type 1 diabetic patients. Effects of High-Intensity Interval Exercise versus Moderate Continuous Exercise on Glucose Homeostasis and Hormone Response in Patients with Type 1 Diabetes Mellitus Using Novel Ultra-Long-Acting Insulin Effects of exercise on the absorption of insulin glargine in patients with type 1 diabetes. Guidelines for premeal insulin dose reduction for postprandial exercise of different intensities and durations in type 1 diabetic subjects treated intensively with a basal-bolus insulin regimen (ultralente-lispro). Glucose or intermittent high-intensity exercise in glargine/glulisine users with T1DM. Continuous glucose monitoring reveals delayed nocturnal hypoglycemia after intermittent high-intensity exercise in nontrained patients with type 1 diabetes.
abstract: OBJECTIVE To compare the response of blood glucose levels to intermittent high-intensity exercise ( IHE ) and moderate-intensity exercise ( MOD ) in individuals with type 1 diabetes . RESEARCH DESIGN AND METHODS Seven healthy individuals with type 1 diabetes were tested on two separate occasions , during which either a 30-min MOD or IHE protocol was performed . MOD consisted of continuous exercise at 40 % Vo(2peak ) , while the IHE protocol involved a combination of continuous exercise at 40 % Vo(2peak ) interspersed with 4-s sprints performed every 2 min to simulate the activity patterns of team sports . RESULTS Both exercise protocol s result ed in a decline in blood glucose levels . However , the decline was greater with MOD ( -4.4 + /- 1.2 mmol/l ) compared with IHE ( -2.9 + /- 0.8 mmol/l ; P < 0.05 ) , despite the performance of a greater amount of total work with IHE ( P < 0.05 ) . During 60 min of recovery from exercise , glucose levels remained higher in IHE compared with MOD ( P < 0.05 ) . Furthermore , glucose levels remained stable during recovery from IHE , while they continued to decrease after MOD ( P < 0.05 ) . The stabilization of blood glucose levels with IHE was associated with elevated levels of lactate , catecholamines , and growth hormone during early recovery from exercise ( P < 0.05 ) . There were no differences in free insulin , glucagon , cortisol , or free fatty acids between MOD and IHE . CONCLUSIONS The decline in blood glucose levels is less with IHE compared with MOD during both exercise and recovery in individuals with type 1 diabetes The lack in control of insulin release combined with an inadequate carbohydrate ( CHO ) ingestion accounts for the occurrence of frequent metabolic unbalances during exercise in type 1 diabetic patients . The aim of the study was to quantify , in these patients , the CHO requirement to prevent hypoglycemia during moderate exercise performed at different time intervals after morning subcutaneous insulin injection . Twelve type 1 diabetic patients and 12 well-matched healthy subjects  cycled 4 times for 1 hour at a constant workload . The rate of glucose oxidation was calculated continuously by indirect calorimetry throughout the exercise , while blood parameters were assessed periodically and orally given CHO were checked . CHO needed by the patients to prevent hypoglycemia decreased as the time elapsed from insulin administration increased , amounting to 0.63 + /- 0.30 , 0.44 + /- 0.32 , 0.28 + /- 0.24 , and 0.14 + /- 0.18 g/kg after 1 , 2.5 , 4 , and 5.5 hours , respectively . Total glucose requirement during moderate exercise ( sum of alimentary and extracellular source ) was correlated ( r = 0.739 , P < .001 ) to plasma insulin concentration , but not with fitness level . Time elapsed from last insulin dose is not a factor influencing the risk of hypoglycemia during exercise when a proportional , appropriate amount of CHO is ingested Introduction We investigated blood glucose ( BG ) and hormone response to aerobic high-intensity interval exercise ( HIIE ) and moderate continuous exercise ( CON ) matched for mean load and duration in type 1 diabetes mellitus ( T1DM ) . Material and Methods Seven trained male subjects with T1DM performed a maximal incremental exercise test and HIIE and CON at 3 different mean intensities below ( A ) and above ( B ) the first lactate turn point and below the second lactate turn point ( C ) on a cycle ergometer . Subjects were adjusted to ultra-long-acting insulin Degludec ( Tresiba/ Novo Nordisk , Denmark ) . Before exercise , st and ardized meals were administered , and short-acting insulin dose was reduced by 25 % ( A ) , 50 % ( B ) , and 75 % ( C ) dependent on mean exercise intensity . During exercise , BG , adrenaline , noradrenaline , dopamine , cortisol , glucagon , and insulin-like growth factor-1 , blood lactate , heart rate , and gas exchange variables were measured . For 24 h after exercise , interstitial glucose was measured by continuous glucose monitoring system . Results BG decrease during HIIE was significantly smaller for B ( p = 0.024 ) and tended to be smaller for A and C compared to CON . No differences were found for post-exercise interstitial glucose , acute hormone response , and carbohydrate utilization between HIIE and CON for A , B , and C. In HIIE , blood lactate for A ( p = 0.006 ) and B ( p = 0.004 ) and respiratory exchange ratio for A ( p = 0.003 ) and B ( p = 0.003 ) were significantly higher compared to CON but not for C. Conclusion Hypoglycemia did not occur during or after HIIE and CON when using ultra-long-acting insulin and applying our method ological approach for exercise prescription . HIIE led to a smaller BG decrease compared to CON , although both exercises modes were matched for mean load and duration , even despite markedly higher peak workloads applied in HIIE . Therefore , HIIE and CON could be safely performed in T1DM . Trial Registration Clinical Trials.gov NCT02075567 http://www . clinical OBJECTIVE To study the effects of exercise on the absorption of the basal long-acting insulin analog insulin glargine ( Lantus ) , administered subcutaneously in individuals with type 1 diabetes . RESEARCH DESIGN AND METHODS A total of 13 patients ( 12 men , 1 woman ) with type 1 diabetes on a basal-bolus insulin regimen were studied .  (125)I-labeled insulin glargine at the usual basal insulin dose was injected subcutaneously into the thigh on the evening ( 2100 ) before the study day on two occasions 1 week apart . Patients were r and omly assigned to 30 min intense exercise ( 65 % peak oxygen uptake [ Vo(2peak ) ] ) on one of these visits . The decay of radioactive insulin glargine was compared on the two occasions using a thallium-activated Nal gamma counter . Blood sample s were collected at regular intervals on the study days to assess plasma glucose and insulin profiles . RESULTS No significant difference was found in the (125)I-labeled insulin glargine decay rate on the two occasions ( exercise vs. no exercise ; repeated- measures ANOVA , P = 0.548 ) . As expected , a significant fall in plasma glucose was observed over the exercise period ( area under curve above fasting [ DeltaAUC ] glucose : -0.39 + /- 0.11 vs. -1.30 + /- 0.16 mmol . l(-1 ) . h(-1 ) ; nonexercise vs. exercise ; P = 0.001 ) , but insulin levels did not differ significantly on the two occasions ( DeltaAUC insulin : -2.1 + /- 3.9 vs. 1.5 + /- 6.2 pmol . l(-1 ) . h(-1 ) ; nonexercise versus exercise ; P = 0.507 ) . CONCLUSIONS An intense 30-min period of exercise does not increase the absorption rate of the subcutaneously injected basal long-acting insulin analog insulin glargine in patients with type 1 diabetes OBJECTIVE To evaluate and vali date appropriate premeal insulin dose reductions for postpr and ial exercises of different intensities and duration s to minimize the risk of exercise-induced hypoglycemia in type 1 diabetic subjects . RESEARCH DESIGN AND METHODS Eight male type 1 diabetic patients on a basal-bolus insulin regimen of ultralente ( UL ) as basal insulin and lispro ( LP ) as premeal insulin  were tested in a r and omized , crossover fashion during postpr and ial exercise at 25 % VO2max for 60 min , 50 % VO2max for 30 and 60 min , and 75 % VOmax for 30 min starting 90 min after a st and ardized mixed breakfast ( 600 kcal , 75 g carbohydrates ) . Each subject served as his own control and was rested after a full dose of insulin LP ( LP 100 % ) and /or 50 % ( LP 50 % ) and /or 25 % ( LP 25 % ) of the current dose . RESULTS At all intensities , the full premeal insulin dose was associated with an increased risk of hypoglycemia . At 25 % VO2max for 60 min , a 50 % reduction in the premeal insulin dose result ed in plasma glucose of -0.62 mmol/l compared with baseline at the end of exercise . At 50 % VO2max for 30 and 60 min , 50 and 75 % reductions of the premeal insulin dose were associated with plasma glucose of -0.39 and + 0.49 mmol/l , respectively , at the end of the exercise . At 75 % VO2max , a 75 % reduction of the premeal insulin dose was required to achieve appropriate postexercise plasma glucose ( + 0.71 mmol/l ) . Such reductions in the premeal insulin dose result ed in a 75 % decrease in the incidence of exercise-induced hypoglycemia . CONCLUSIONS In well-controlled type 1 diabetic subjects on intensive insulin therapy with the basal-bolus ( UL-LP ) insulin regimen , risk of hypoglycemia can be minimized during postpr and ial exercises of different intensities and different duration s by appropriate reduction of premeal insulin LP INTRODUCTION The effects of glargine/glulisine insulin regimen on exercise blood glucose ( BG ) and strategies to limit exercise-induced hypoglycemia are not well documented . Intermittent high-intensity exercise has been proposed to prevent hypoglycemia , but its effect in participants with type 1 diabetes using glargine/glulisine  is unknown . METHODS The study used a repeated- measures design with three r and omly ordered exercise conditions . Eleven participants completed 60 min of moderate-intensity exercise  at 50 % VO(2peak ) for all conditions . These conditions varied as follows : participants ingested 0 g of glucose preexercise ( 0 G + MOD ) , 30 g of glucose preexercise ( 30 G + MOD ) , or 0 g of glucose preexercise but performed brief high-intensity intervals interspersed every 2 min ( 0 G + MOD/INT ) during exercise . If BG fell < 4 mmol·L(-1 ) , a 20 % dextrose solution was started to maintain BG between 4 and 5 mmol·L(-1 ) . RESULTS Consuming 30 g of glucose before exercise ( 30 G + MOD ) result ed in a higher preexercise BG ( 11.7 ± 2.7 mmol·L(-1 ) ) compared with 0 g of glucose before exercise ( 0 G + MOD , 7.8 ± 4.0 , and 0 G + MOD/INT , 9.2 ± 3.5mmol·L(-1 ) ) , P < 0.05 . A dextrose infusion was required in 7/11 , 4/11 , and 1/11 participants for 0 G + MOD , 0 G + MOD/INT , 30 G + MOD conditions , respectively , P < 0.02 . The duration and the quantity of dextrose infused were greatest in the 0 G + MOD condition , moderate in the to 0 G + MOD/INT condition , and minimal in the 30 G + MOD condition , P < 0.01 . CONCLUSION Our results suggest that both moderate-intensity exercise with a 30-g preexercise glucose beverage or interspersed with intermittent high-intensity sprints may be safe strategies to prevent hypoglycemia in glargine/glulisine users OBJECTIVE Exercise is a cornerstone of diabetes therapy in type 1 diabetes mellitus ( DMT1 ) patients . The type of exercise is important in determining the propensity to hypoglycemia . We assessed , by continuous glucose monitoring ( CGM ) , the glucose profiles during and in the following 20h after a session of two different types of exercise . RESEARCH DESIGN AND METHODS Eight male volunteers with well-controlled DMT1 were studied . They underwent 30min of both intermittent high-intensity exercise ( IHE ) and moderate-intensity exercise ( MOD ) in r and om order . Expired air was recorded during exercise , while metabolic and hormonal determinations  were performed before and for 120 min after exercises . The CGM system and activity monitor were applied for the subsequent 20h . RESULTS Blood glucose level declined during both type of exercise . At 150 min following the start of exercise , plasma glucose content was slightly higher after IHE . No changes were observed in plasma insulin concentration . A significant increase of norepinephrine concentration was noticed during IHE . Between midnight and 6:00 a.m. the glucose levels were significantly lower after IHE than those observed after MOD ( area under the curve , 23.3 ± 3 vs. 16 ± 3 mg/dL/420 min [ P = 0.04 ] ; mean glycemia at 3 a.m. , 225 ± 31 vs. 147 ± 17 mg/dL [ P<0.05 ] ) . The number of hypoglycemic episodes after IHE was higher than that observed after MOD ( seven vs. two [ P<0.05 ] ) . CONCLUSIONS We demonstrate that ( 1 ) CGM is a useful approach in DMT1 patients who undergo an exercise program and ( 2 ) IHE is associated with delayed nocturnal hypoglycemia
target: For blood glucose there was little difference between groups at any time point .
background: Objective Type 1 diabetes mellitus rates are rising worldwide .
  The health benefits of physical exercise in this condition are many , but more than 60 % do not participate , mainly from fear of hypoglycemia .
  This systematic review explores the effects of physical exercise modes on blood glucose levels in adults for hypoglycemia prevention .