Exercise as it relates to Disease/Type 1 Diabetes and Hypoglycemia post exercise

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This is an analysis of the journal article “Plasma glucose and hypoglycaemia following exercise in people with type 1 diabetes: comparison of three basal insulins, 2009”. V. Arutchelvam, T. Heise, S. Dellweg, B. Elbroend, I. Minns, P.D. Home

Created by u3097633


What is the background to this research?[edit]

Physical activity has significant health benefits and contributes to prevent noncommunicable diseases such as: cardiovascular diseases and diabetes.[2] Diabetes is a group of metabolic diseases characterized by an excess amount of glucose in the bloodstream, associated with ‘diabetes mellitus’. [4] Exercise and diet form the foundations of a healthy lifestyle, in turn exercise changes the absorption and blood-glucose-lowering effectiveness of different types of insulin. [1] The study aims to compare the effects of exercise on plasma glucose excursions in people with type 1 diabetes when using each of three basal insulins. Exercise portrays a positive improvement for those with diabetes by increasing insulin sensitivity in both short and long term, lowering blood sugar levels, reducing body fat whilst improving cardiovascular bodily functioning in turn showing the enormous benefits patients with diabetes can receive. The study population were a multinational, randomised group, sponsored by Novo Nordisk, (age +- SD, 39 +-10 years; 67% male).[1] The group were managed with insulin regimens during 3 distinct periods, incorporating exercise and diet in order to successfully complete the study. Exercise is a key stimulator for maintaining and improving ones health when diabetes arises.


Where is the research from?[edit]

This study was undertaken by Clinical Medical Sciences-Diabetes, Newcastle University, Newcastle upon Tyne, UK, Profile Institute Fur Stoffwechselforschung, Neuss, Germany, and Novo Nordisk, Crawley, UK.

The study is supported by Novo Nordisk, (manufacturer of insulin detemir) along with two of his personal employees.


What kind of research was this?[edit]

The study was randomised in a multinational, open labelled, three-period, cross over clinical trial. With fifty-one participants aged between 29 and 49 years of age with 67% of the participants involved being of the male gender. It involved managing subjects with insulin regimens during three distinct periods.


What did the research involve?[edit]

Each of the 51 participants consented to partaking in the crossover clinical trial and were required to consume insulin regimens during three periods: • Period 1: mealtime insulin (aspart) plus basal insulin detemir (twice daily) • Period 2: With aspart and NPH (twice daily) • Period 3: With Glargine (once daily) Prior to undertaking the exercise programs, the insulin dosage was optimised over a four week period. The participants were required to exercise five hours post consumption of food for a period of 30 minutes for each treatment. [1]

The main focal point of the research was to comprehend plasma glucose and hypoglycaemia levels post exercise by a comparison of three basal insulins.


What were the basic results?[edit]

The study portrayed that insulin detemir was associated with less hypoglycaemia than insulin glargine but not NPH insulin during and post exercise in relatively well controlled people who had type 1 diabetes. [1]


What conclusions can we take from this research?[edit]

Type 1 diabetes, which accounts for only 5-10% of those who suffer from diabetes, results from a cellular-mediated autoimmune destruction of the B-cells of the pancreas ^4, which in turn leaves the person to become insulin-dependent. The results from this study outline which of the three insulin regimens periods leave the participant with altered hypoglycaemia both during and post exercise. In this comparison we can see that insulin detemir is associated with less hypoglycaemia than insulin glargine, however the same results differ for NPH insulin, with this indicating the NPH insulin holding the lowest blood glucose levels out of the three comparison periods. Hypoglycaemia is a current major obstacle to improved glycaemic control in diabetes, despite the development of such studies regarding insulin analogues both short and long-lasting there has been no dramatic change in recent times [6]. Positive results can be taken from the research undertaken, as seen also in closed-loop treatment of those with type 1 diabetes, high-gain pulses of glucagon decreased the frequency of hypoglycaemia occurring [7], which in turn relates closely to results seen during the three-period study.


Practical advice[edit]

In order to nullify the effects hypoglycaemia can impose on the body, partaking in an Adult pre exercise-screening tool will allow the participant to be checked by a professional, prior to engaging in physical activity [5], if these protocols weren’t followed, serious harm may come to an unsuspecting researcher and more importantly the participant. The effects of plasma glucose on those with type 1 diabetes has the ability to cause harm if not handled professionally due to bodily reactions. With insulin detemir being associated with less hypoglycaemia provoked by exercise in people with type 1 diabetes[1] it shows which of the options are deemed to be most effective and therefore would be the most appropriate options for those needing insulin.


Further information/resources[edit]

https://www.healthdirect.gov.au/diabetes

https://professional.diabetes.org/pel/hypoglycemia-english [edit]


References[edit]

[1] [2] [3] [4] [5] [6]

[7]

  1. Plasma glucose and hypoglycaemia following exercise in people with type 1 diabetes: a comparison of three basal insulins,Arutchelvam, T. Heise, S. Dellweg, B. Elbroend, I. Minns, P. D. Home, 2009.
  2. http://www.who.int/mediacentre/factsheets/fs385/en/
  3. Prescribing exercise in general practice. Encourage active community life. D.Browne, 1994.
  4. Diagnosis and Classification of Diabetes Mellitus,American Diabetes Association, 2010 http://care.diabetesjournals.org/content/37/Supplement_1/S81.full
  5. https://www.essa.org.au/for-gps/adult-pre-exercise-screening-system/
  6. Hypoglycemia in Type 1 Diabetes,Rory J. McCrimmon, Robert S. Sherwin, 2010, http://diabetes.diabetesjournals.org/content/59/10/2333.full
  7. Novel Use of Glucagon in a Closed-Loop System for Prevention of Hypoglycemia in Type 1 Diabetes ,Jessica R. Castle, Joseph El Youssef, 2010. http://care.diabetesjournals.org/content/33/6/1282.short