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TYPE 1 DIABETES: Aerobic Exercise
Dr. Matthew D. Campbell
Ph.D, ACSM CEP, BSc (hons)
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
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
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
