TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med...

TYPE 1 DIABETES: Aerobic Exercise

Dr. Matthew D. Campbell

Ph.D, ACSM CEP, BSc (hons)

m.d.campbell@leedsbeckett.ac.uk

www.researchgate.net/profile/Matthew_Campbell6

@Campbell_MD

Glucose

Inte

rstitia

l g

luco

se

(m

mo

l.l-1

)

2

3

4

5

6

7

8

9

141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24

Time (hours)

Glucose

Inte

rstitia

l g

luco

se

(m

mo

l.l-1

)

2

3

4

5

6

7

8

9

141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24

Time (hours)

Glucose

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rstitia

l g

luco

se

(m

mo

l.l-1

)

2

3

4

5

6

7

8

9

141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24

Time (hours)

0

10

20

30

40

50

160

170

Se

rum

insu

lin (

pm

ol.l-1

)

Insulin

Glucose

Inte

rstitia

l g

luco

se

(m

mo

l.l-1

)

2

3

4

5

6

7

8

9

141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24

Time (hours)

0

10

20

30

40

50

160

170

Se

rum

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lin (

pm

ol.l-1

)

Insulin

Glucose

Inte

rstitia

l g

luco

se

(m

mo

l.l-1

)

2

3

4

5

6

7

8

9

141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24

Time (hours)

0

10

20

30

40

50

160

170

Se

rum

insu

lin (

pm

ol.l-1

)

Insulin

I’M HUNGRY

Glucose

Inte

rstitia

l g

luco

se

(m

mo

l.l-1

)

2

3

4

5

6

7

8

9

141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24

Time (hours)

0

10

20

30

40

50

160

170

Se

rum

insu

lin (

pm

ol.l-1

)

Insulin

I’M HUNGRY

Glucose

Inte

rstitia

l g

luco

se

(m

mo

l.l-1

)

2

3

4

5

6

7

8

9

141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24

Time (hours)

0

10

20

30

40

50

160

170

Se

rum

insu

lin (

pm

ol.l-1

)

Insulin

Glucose

Inte

rstitia

l g

luco

se

(m

mo

l.l-1

)

2

3

4

5

6

7

8

9

141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24

Time (hours)

0

10

20

30

40

50

160

170

Se

rum

insu

lin (

pm

ol.l-1

)

Insulin

Glucose

I’M HUNGRY

Inte

rstitia

l g

luco

se

(m

mo

l.l-1

)

2

3

4

5

6

7

8

9

141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24

Time (hours)

0

10

20

30

40

50

160

170

Se

rum

insu

lin (

pm

ol.l-1

)

Insulin

Inte

rstitia

l g

luco

se

(m

mo

l.l-1

)

2

5

8

11

14

17

20

23

14Rest 1 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24

Time (hours post-exercise)

Glucose concentrations

Inte

rstitia

l g

luco

se

(m

mo

l.l-1

)

2

5

8

11

14

17

20

23

14Rest 1 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24

Time (hours post-exercise)

Glucose concentrations

Glucose concentrations

Inte

rstitia

l g

luco

se

(m

mo

l.l-1

)

2

5

8

11

14

17

20

23

14Rest 1 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24

Time (hours post-exercise)

Glucose concentrations

Inte

rstitia

l g

luco

se

(m

mo

l.l-1

)

2

5

8

11

14

17

20

23

14Rest 1 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24

Time (hours post-exercise)

13:00 14:00

Rest 0 5 15 30 60

Sample Point (minutes)

Scan J Med Sci Sports 2015: 25:216-222

DOI: 10.1111/sms.12193

Blo

od

glu

cose

(m

mo

l.l-1

)

-6

-5

-4

-3

-2

-1

0

1

2

Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic

responses in T1DM patients

M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN

13:00 14:00

Sample Point (minutes)

Aerobic

Blo

od

glu

cose

(m

mo

l.l-1

)

-6

-5

-4

-3

-2

-1

0

1

2

Rest 0 5 15 30 60

Scan J Med Sci Sports 2015: 25:216-222

DOI: 10.1111/sms.12193

Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic

responses in T1DM patients

M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN

13:00 14:00

Sample Point (minutes)

Aerobic

Blo

od

glu

cose

(m

mo

l.l-1

)

-6

-5

-4

-3

-2

-1

0

1

2

Rest 0 5 15 30 60

Scan J Med Sci Sports 2015: 25:216-222

DOI: 10.1111/sms.12193

Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic

responses in T1DM patients

M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN

13:00 14:00

Sample Point (minutes)

Aerobic

Blo

od

glu

cose

(m

mo

l.l-1

)

-6

-5

-4

-3

-2

-1

0

1

2

Rest 0 5 15 30 60

Scan J Med Sci Sports 2015: 25:216-222

DOI: 10.1111/sms.12193

EAT CHO

Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic

responses in T1DM patients

M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN

13:00 14:00

Sample Point (minutes)

Aerobic

Blo

od

glu

cose

(m

mo

l.l-1

)

-6

-5

-4

-3

-2

-1

0

1

2

Rest 0 5 15 30 60

Scan J Med Sci Sports 2015: 25:216-222

DOI: 10.1111/sms.12193

Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic

responses in T1DM patients

M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN

EAT CHO REDUCE IU

Inte

rsti

tial

glu

cose

(m

mo

l.l-1

)

14:00 23:00 14:00

1 3 5 7 9 11 13 15 17 19 21 23

Time (hours post-exercise)

2

4

6

8

10

12

14

16

18Aerobic

Scan J Med Sci Sports 2015: 25:216-222

DOI: 10.1111/sms.12193

Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic

responses in T1DM patients

M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN

Inte

rsti

tial

glu

cose

(m

mo

l.l-1

)

14:00 23:00 14:00

1 3 5 7 9 11 13 15 17 19 21 23

Time (hours post-exercise)

2

4

6

8

10

12

14

16

18Aerobic

Scan J Med Sci Sports 2015: 25:216-222

DOI: 10.1111/sms.12193

Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic

responses in T1DM patients

M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN

Inte

rsti

tial

glu

cose

(m

mo

l.l-1

)

14:00 23:00 14:00

1 3 5 7 9 11 13 15 17 19 21 23

Time (hours post-exercise)

2

4

6

8

10

12

14

16

18Aerobic

Scan J Med Sci Sports 2015: 25:216-222

DOI: 10.1111/sms.12193

Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic

responses in T1DM patients

M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN

Inte

rsti

tial

glu

cose

(m

mo

l.l-1

)

14:00 23:00 14:00

1 3 5 7 9 11 13 15 17 19 21 23

Time (hours post-exercise)

2

4

6

8

10

12

14

16

18Aerobic

Scan J Med Sci Sports 2015: 25:216-222

DOI: 10.1111/sms.12193

Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic

responses in T1DM patients

M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN

EAT CHO

Inte

rsti

tial

glu

cose

(m

mo

l.l-1

)

14:00 23:00 14:00

1 3 5 7 9 11 13 15 17 19 21 23

Time (hours post-exercise)

2

4

6

8

10

12

14

16

18Aerobic

Scan J Med Sci Sports 2015: 25:216-222

DOI: 10.1111/sms.12193

Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic

responses in T1DM patients

M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN

EAT CHO REDUCE IU

CONSUME 1.g.Kg-1

OF CARBOHYDRATE

60 MINUTES

BEFORE EXERCISE

REDUCE RAPID-

ACTING INSULIN BY

~75%

CONSUME 1.g.Kg-1

OF LOW GI

CARBOHYDRATE 60

MINUTES AFTER

EXERCISE

REDUCE RAPID-

ACTING INSULIN BY

~50%

CONSUME 0.3.g.Kg-1

OF LOW GI

CARBOHYDRATE

BEFORE SLEEPING

OMIT PRANDIAL

INSULIN

ADMINISTRATION

1 2 3APPLY A ~20%

REDUCTION TO

TOTAL-DAILY

BASAL INSULIN

DOSE IN ADDITION

TO PRANDIAL

ADJUSTMENTS

4How to manage

aerobic exercise in

4 steps

Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-

onset hypoglycemia in patients with type 1 diabetes

M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST

Blo

od

glu

cose

(m

mo

l.l-1

)

08:00 10:45

Rest 60 0 15 30 60

Sample Point (Minutes)

Diabetes Care 2013: 36:2217-2224

DOI: 10.2337/dc13-2467

2

4

6

8

10

12

14

16

18

Blo

od

glu

cose

(m

mo

l.l-1

)

08:00 10:45

Rest 60 0 15 30 60

Sample Point (Minutes)

2

4

6

8

10

12

14

16

18

Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-

onset hypoglycemia in patients with type 1 diabetes

M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST

Diabetes Care 2013: 36:2217-2224

DOI: 10.2337/dc13-2467

Blo

od

glu

cose

(m

mo

l.l-1

)

08:00 10:45

Rest 60 0 15 30 60

Sample Point (Minutes)

2

4

6

8

10

12

14

16

18

Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-

onset hypoglycemia in patients with type 1 diabetes

M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST

Diabetes Care 2013: 36:2217-2224

DOI: 10.2337/dc13-2467

Blo

od

glu

cose

(m

mo

l.l-1

)

Rest 60 0 15 30 60 90 120 150 180 210 240

Sample Point (Minutes)

2

4

6

8

10

12

14

16

1808:00 10:45 13:45

100% Dose

75% Dose

50% Dose

Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-

onset hypoglycemia in patients with type 1 diabetes

M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST

Diabetes Care 2013: 36:2217-2224

DOI: 10.2337/dc13-2467

Blo

od

glu

cose

(m

mo

l.l-1

)

08:00 10:45 13:45

Rest 60 0 15 30 60 90 120 150 180 210 240

Sample Point (Minutes)

2

4

6

8

10

12

14

16

18

*

** *

100% Dose

75% Dose

50% Dose

Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-

onset hypoglycemia in patients with type 1 diabetes

M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST

Diabetes Care 2013: 36:2217-2224

DOI: 10.2337/dc13-2467

Blo

od

glu

cose

(m

mo

l.l-1

)

08:00 10:45 13:45

Rest 60 0 15 30 60 90 120 150 180 210 240

Sample Point (Minutes)

2

4

6

8

10

12

14

16

18

*

** *

100% Dose

75% Dose

50% Dose

Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-

onset hypoglycemia in patients with type 1 diabetes

M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST

Diabetes Care 2013: 36:2217-2224

DOI: 10.2337/dc13-2467

Inte

rsti

tial

glu

cose

(m

mo

l.l-1

)

4 6 8 10 12 14 16 18 20 22 24

2

4

6

8

10

12

14

16

18

Time (hours post-exercise)

15:00 23:00 09:00

* 100% Dose

75% Dose

50% Dose

Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-

onset hypoglycemia in patients with type 1 diabetes

M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST

Diabetes Care 2013: 36:2217-2224

DOI: 10.2337/dc13-2467

Inte

rsti

tial

glu

cose

(m

mo

l.l-1

)

4 6 8 10 12 14 16 18 20 22 24

2

4

6

8

10

12

14

16

18

Time (hours post-exercise)

15:00 23:00 09:00

* 100% Dose

75% Dose

50% Dose

Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-

onset hypoglycemia in patients with type 1 diabetes

M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST

Diabetes Care 2013: 36:2217-2224

DOI: 10.2337/dc13-2467

Inte

rsti

tial

glu

cose

(m

mo

l.l-1

)

4 6 8 10 12 14 16 18 20 22 24

2

4

6

8

10

12

14

16

18

Time (hours post-exercise)

15:00 23:00 09:00

* 100% Dose

75% Dose

50% Dose

Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-

onset hypoglycemia in patients with type 1 diabetes

M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST

Diabetes Care 2013: 36:2217-2224

DOI: 10.2337/dc13-2467

Hypoglycaemia is preventable for <8 hours post-exercise

But at the cost of post-prandial hyperglycaemia

The risk of late-onset hypoglycaemia remains high

What if CHO amount is increased?

What if CHO type is manipulated?

What if exercise is performed in the evening?

Blo

od

glu

cose

(m

mo

l.l-1

)

17:00 19:45 22:45

Rest 60 0 15 30 60 90 120 150 180 210 240

Sample Point (Minutes)

Diabetes Care 2014: 37:1-9

DOI: 10.2337/dc14-0186

2

5

8

11

14

17

20

23

26

High GI

Low GI

A low-glycemic index meal and bedtime snack prevents postprandial hyperycemia and associated rises in inflammation,

providing protection from early but not late-nocturnal hypoglycemia after evening exercise in T1DM

M.D.CAMPBELL, M.WALKER, M.I.TRENELL, E.J.STEVENSON, D.TURNER, R.M.BRACKEN, J.A.SHAW, D.J.WEST

Blo

od

glu

cose

(m

mo

l.l-1

)

17:00 19:45 22:45

Rest 60 0 15 30 60 90 120 150 180 210 240

Sample Point (Minutes)

2

5

8

11

14

17

20

23

26

High GI

Low GI

Diabetes Care 2014: 37:1-9

DOI: 10.2337/dc14-0186

A low-glycemic index meal and bedtime snack prevents postprandial hyperycemia and associated rises in inflammation,

providing protection from early but not late-nocturnal hypoglycemia after evening exercise in T1DM

M.D.CAMPBELL, M.WALKER, M.I.TRENELL, E.J.STEVENSON, D.TURNER, R.M.BRACKEN, J.A.SHAW, D.J.WEST

Blo

od

glu

cose

(m

mo

l.l-1

)

17:00 19:45 22:45

Rest 60 0 15 30 60 90 120 150 180 210 240

Sample Point (Minutes)

2

5

8

11

14

17

20

23

26

*

*

**

*

High GI

Low GI

Diabetes Care 2014: 37:1-9

DOI: 10.2337/dc14-0186

A low-glycemic index meal and bedtime snack prevents postprandial hyperycemia and associated rises in inflammation,

providing protection from early but not late-nocturnal hypoglycemia after evening exercise in T1DM

M.D.CAMPBELL, M.WALKER, M.I.TRENELL, E.J.STEVENSON, D.TURNER, R.M.BRACKEN, J.A.SHAW, D.J.WEST

Inte

rsti

tial

glu

cose

(m

mo

l.l-1

)

4 6 8 10 12 14 16 18 20 22 24

Time (hours post-exercise)

23:45 07:45 18:00

2

5

8

11

14

17

20

23

26

High GI

Low GI

Diabetes Care 2014: 37:1-9

DOI: 10.2337/dc14-0186

A low-glycemic index meal and bedtime snack prevents postprandial hyperycemia and associated rises in inflammation,

providing protection from early but not late-nocturnal hypoglycemia after evening exercise in T1DM

M.D.CAMPBELL, M.WALKER, M.I.TRENELL, E.J.STEVENSON, D.TURNER, R.M.BRACKEN, J.A.SHAW, D.J.WEST

Inte

rsti

tial

glu

cose

(m

mo

l.l-1

)

4 6 8 10 12 14 16 18 20 22 24

Time (hours post-exercise)

23:45 07:45 18:00

2

5

8

11

14

17

20

23

26 *

High GI

Low GI

Diabetes Care 2014: 37:1-9

DOI: 10.2337/dc14-0186

A low-glycemic index meal and bedtime snack prevents postprandial hyperycemia and associated rises in inflammation,

providing protection from early but not late-nocturnal hypoglycemia after evening exercise in T1DM

M.D.CAMPBELL, M.WALKER, M.I.TRENELL, E.J.STEVENSON, D.TURNER, R.M.BRACKEN, J.A.SHAW, D.J.WEST

Inte

rsti

tial

glu

cose

(m

mo

l.l-1

)

4 6 8 10 12 14 16 18 20 22 24

Time (hours post-exercise)

23:45 07:45 18:00

2

5

8

11

14

17

20

23

26 *

High GI

Low GI

A low-glycemic index meal and bedtime snack prevents postprandial hyperycemia and associated rises in inflammation,

providing protection from early but not late-nocturnal hypoglycemia after evening exercise in T1DM

M.D.CAMPBELL, M.WALKER, M.I.TRENELL, E.J.STEVENSON, D.TURNER, R.M.BRACKEN, J.A.SHAW, D.J.WEST

Diabetes Care 2014: 37:1-9

DOI: 10.2337/dc14-0186

Hypoglycaemia is preventable for <8 hours post-exercise

And post-prandial hyperglycaemia can be minimised

Late-onset hypoglycaemia occurs irrespective of CHO amount or type

What else can you try to avoid

late-onset hypoglycaemia?

Does long-acting (basal) insulin play a role in late-onset hypoglycaemia?

Does manipulating long-acting (basal) insulin cause hyperglycaemia?

Does this comprehensive strategy carry wider clinical implications?

Blo

od

glu

cose

(m

mo

l.l-1

)

17:00 19:45 22:45

Rest 60 0 15 30 60 90 120 150 180 210 240

Sample Point (Minutes)

BMJ Open Diabetes Research and Care 2015: 3;:e000085

DOI: 10.1136/bmjdrc-2015-000085

2

5

8

11

14

17

20

23

26

80% Basal Dose

100% Basal Dose

Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening

exercise in type 1 diabetes: a randomized controlled trial

M.D.CAMPBELL, M.WALKER, R.M.BRACKEN, D.TURNER, E.J.STEVENSON, J.T.GONZALEZ, J.A.SHAW, D.J.WEST

Inte

rsti

tial

glu

cose

(m

mo

l.l-1

)

Time (hours post-exercise)

23:45 07:45 18:00

2

4

6

8

10

12

14

16

18

4 6 8 10 12 14 16 18 20 22 24

*

80% Basal Dose

100% Basal Dose

BMJ Open Diabetes Research and Care 2015: 3;:e000085

DOI: 10.1136/bmjdrc-2015-000085

Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening

exercise in type 1 diabetes: a randomized controlled trial

M.D.CAMPBELL, M.WALKER, R.M.BRACKEN, D.TURNER, E.J.STEVENSON, J.T.GONZALEZ, J.A.SHAW, D.J.WEST

Inte

rsti

tial

glu

cose

(m

mo

l.l-1

)

Time (hours post-exercise)

23:45 07:45 18:00

2

4

6

8

10

12

14

16

18

4 6 8 10 12 14 16 18 20 22 24

*

80% Basal Dose

100% Basal Dose

BMJ Open Diabetes Research and Care 2015: 3;:e000085

DOI: 10.1136/bmjdrc-2015-000085

Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening

exercise in type 1 diabetes: a randomized controlled trial

M.D.CAMPBELL, M.WALKER, R.M.BRACKEN, D.TURNER, E.J.STEVENSON, J.T.GONZALEZ, J.A.SHAW, D.J.WEST

Adjusting basal-bolus insulin & CHO prevent early & late hypoglycaemia

Metabolic, hormonal, and inflammatory biomarkers unaffected

Strategy is easily tailored to the individual person

CONSUME 1.g.Kg-1

OF CARBOHYDRATE

60 MINUTES

BEFORE EXERCISE

REDUCE RAPID-

ACTING INSULIN BY

~75%

CONSUME 1.g.Kg-1

OF LOW GI

CARBOHYDRATE 60

MINUTES AFTER

EXERCISE

REDUCE RAPID-

ACTING INSULIN BY

~50%

CONSUME 0.3.g.Kg-1

OF LOW GI

CARBOHYDRATE

BEFORE SLEEPING

OMIT PRANDIAL

INSULIN

ADMINISTRATION

1 2 3APPLY A ~20%

REDUCTION TO

TOTAL-DAILY

BASAL INSULIN

DOSE IN ADDITION

TO PRANDIAL

ADJUSTMENTS

4How to manage

aerobic exercise in

4 steps

CONSUME 1.g.Kg-1

OF CARBOHYDRATE

60 MINUTES

BEFORE EXERCISE

REDUCE RAPID-

ACTING INSULIN BY

~75%

CONSUME 1.g.Kg-1

OF LOW GI

CARBOHYDRATE 60

MINUTES AFTER

EXERCISE

REDUCE RAPID-

ACTING INSULIN BY

~50%

CONSUME 0.3.g.Kg-1

OF LOW GI

CARBOHYDRATE

BEFORE SLEEPING

OMIT PRANDIAL

INSULIN

ADMINISTRATION

1 2 3APPLY A ~20%

REDUCTION TO

TOTAL-DAILY

BASAL INSULIN

DOSE IN ADDITION

TO PRANDIAL

ADJUSTMENTS

4

CONSUME 1.g.Kg-1

OF CARBOHYDRATE

60 MINUTES

BEFORE EXERCISE

REDUCE RAPID-

ACTING INSULIN BY

~75%

CONSUME 1.g.Kg-1

OF LOW GI

CARBOHYDRATE 60

MINUTES AFTER

EXERCISE

REDUCE RAPID-

ACTING INSULIN BY

~50%

CONSUME 0.3.g.Kg-1

OF LOW GI

CARBOHYDRATE

BEFORE SLEEPING

OMIT PRANDIAL

INSULIN

ADMINISTRATION

1 2 3APPLY A ~20%

REDUCTION TO

TOTAL-DAILY

BASAL INSULIN

DOSE IN ADDITION

TO PRANDIAL

ADJUSTMENTS

4

CONSUME 1.g.Kg-1

OF CARBOHYDRATE

60 MINUTES

BEFORE EXERCISE

REDUCE RAPID-

ACTING INSULIN BY

~75%

CONSUME 1.g.Kg-1

OF LOW GI

CARBOHYDRATE 60

MINUTES AFTER

EXERCISE

REDUCE RAPID-

ACTING INSULIN BY

~50%

CONSUME 0.3.g.Kg-1

OF LOW GI

CARBOHYDRATE

BEFORE SLEEPING

OMIT PRANDIAL

INSULIN

ADMINISTRATION

1 2 3APPLY A ~20%

REDUCTION TO

TOTAL-DAILY

BASAL INSULIN

DOSE IN ADDITION

TO PRANDIAL

ADJUSTMENTS

4

CONSUME 1.g.Kg-1

OF CARBOHYDRATE

60 MINUTES

BEFORE EXERCISE

REDUCE RAPID-

ACTING INSULIN BY

~75%

CONSUME 1.g.Kg-1

OF LOW GI

CARBOHYDRATE 60

MINUTES AFTER

EXERCISE

REDUCE RAPID-

ACTING INSULIN BY

~50%

CONSUME 0.3.g.Kg-1

OF LOW GI

CARBOHYDRATE

BEFORE SLEEPING

OMIT PRANDIAL

INSULIN

ADMINISTRATION

1 2 3APPLY A ~20%

REDUCTION TO

TOTAL-DAILY

BASAL INSULIN

DOSE IN ADDITION

TO PRANDIAL

ADJUSTMENTS

4

Does this work outside the lab?

Inte

rstitia

l g

luco

se

(m

mo

l.l-1

)

Glucose concentrations

2

5

8

11

14

17

20

23

14Rest 1 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24

Time (hours post-exercise)

Inte

rstitia

l g

luco

se

(m

mo

l.l-1

)

Glucose concentrations

2

5

8

11

14

17

20

23

14Rest 1 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24

Time (hours post-exercise)

CONSUME 1.g.Kg-1

OF CARBOHYDRATE

60 MINUTES

BEFORE EXERCISE

REDUCE RAPID-

ACTING INSULIN BY

~75%

CONSUME 1.g.Kg-1

OF LOW GI

CARBOHYDRATE 60

MINUTES AFTER

EXERCISE

REDUCE RAPID-

ACTING INSULIN BY

~50%

CONSUME 0.3.g.Kg-1

OF LOW GI

CARBOHYDRATE

BEFORE SLEEPING

OMIT PRANDIAL

INSULIN

ADMINISTRATION

1 2 3APPLY A ~20%

REDUCTION TO

TOTAL-DAILY

BASAL INSULIN

DOSE IN ADDITION

TO PRANDIAL

ADJUSTMENTS

4