medwireNews: Modestly increasing glucagon levels when commencing physical activity could be an effective strategy for protecting against exercise-induced hypoglycemia among patients with type 1 diabetes, results of a randomized crossover trial suggest.
A total of 15 physically active adult patients receiving treatment with continuous subcutaneous insulin infusion took part in four 45-minute morning exercise sessions, each with a different strategy for mitigating exercise-induced hypoglycemia.
Participants completed the four sessions in a random order, and the interventions comprised a 150 µg dose of subcutaneous glucagon given at the beginning of exercise (mini-dose glucagon; MDG); a reduction in basal insulin rate to 50%; oral glucose tablets (20 g at the beginning of exercise and 20 g after 30 minutes); and no intervention (control).
During the MDG intervention, patients experienced an increase in mean plasma glucose concentration from 118 mg/dL at baseline to 161 mg/dL at the end of the exercise session. The average plasma glucose concentration also increased when participants received oral glucose tablets, from 115 to 174 mg/dL, but decreased during the insulin reduction and control interventions, from 119 to 85 mg/dL and 120 to 86 mg/dL, respectively.
Average plasma glucagon levels rose from approximately 50 pg/mL at baseline to 424 pg/mL at 30 minutes after receipt of MDG, but “remained unchanged” at approximately 50 pg/mL during the insulin reduction, glucose tablets, and control sessions, report Stephanie DuBose (Jaeb Center for Health Research, Tampa, Florida, USA) and study co-authors.
They add that insulin levels were comparable at baseline during all sessions, and remained unchanged across the four interventions during exercise.
None of the participants experienced hypoglycemia during exercise and the early recovery period when given the MDG or glucose tablets, while five and six patients became hypoglycemic during the insulin reduction and control interventions, respectively. Hyperglycemia occurred in one patient with MDG and in five patients with glucose tablets.
Together, these results suggest that “MDG may be more effective than insulin reduction for preventing exercise-induced hypoglycemia and may result in less postintervention hyperglycemia than ingestion of carbohydrate,” write DuBose and colleagues in Diabetes Care.
The researchers acknowledge, however, that because there are many different strategies for insulin reduction and carbohydrate intake prior to exercise, “it is likely that a strategy not tested in the current study may result in comparable glucose control during exercise as that reported here for MDG.”
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