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Exercise effects on postprandial glucose metabolism in type 1 diabetes: a triple-tracer approach.

ABSTRACT: To determine the effects of exercise on postprandial glucose metabolism and insulin action in type 1 diabetes (T1D), we applied the triple tracer technique to study 16 T1D subjects on insulin pump therapy before, during, and after 75 min of moderate-intensity exercise (50% V?o2max) that started 120 min after a mixed meal containing 75 g of labeled glucose. Prandial insulin bolus was administered as per each subject's customary insulin/carbohydrate ratio adjusted for meal time meter glucose and the level of physical activity. Basal insulin infusion rates were not altered. There were no episodes of hypoglycemia during the study. Plasma dopamine and norepinephrine concentrations rose during exercise. During exercise, rates of endogenous glucose production rose rapidly to baseline levels despite high circulating insulin and glucose concentrations. Interestingly, plasma insulin concentrations increased during exercise despite no changes in insulin pump infusion rates, implying increased mobilization of insulin from subcutaneous depots. Glucagon concentrations rose before and during exercise. Therapeutic approaches for T1D management during exercise will need to account for its effects on glucose turnover, insulin mobilization, glucagon, and sympathetic response and possibly other blood-borne feedback and afferent reflex mechanisms to improve both hypoglycemia and hyperglycemia.

SUBMITTER: Mallad A

PROVIDER: S-EPMC4469811 | biostudies-other | 2015 Jun

REPOSITORIES: biostudies-other

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Exercise effects on postprandial glucose metabolism in type 1 diabetes: a triple-tracer approach.

Mallad Ashwini A Hinshaw Ling L Schiavon Michele M Dalla Man Chiara C Dadlani Vikash V Basu Rita R Lingineni Ravi R Cobelli Claudio C Johnson Matthew L ML Carter Rickey R Kudva Yogish C YC Basu Ananda A

American journal of physiology. Endocrinology and metabolism 20150421 12

To determine the effects of exercise on postprandial glucose metabolism and insulin action in type 1 diabetes (T1D), we applied the triple tracer technique to study 16 T1D subjects on insulin pump therapy before, during, and after 75 min of moderate-intensity exercise (50% V̇o2max) that started 120 min after a mixed meal containing 75 g of labeled glucose. Prandial insulin bolus was administered as per each subject's customary insulin/carbohydrate ratio adjusted for meal time meter glucose and t ...[more]

PMID: 25898950

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Project description:Resistance exercise during the postprandial period lowers venous glucose concentrations in individuals with type 2 diabetes, but the impact of resistance exercise on interstitial glucose concentrations is not well understood. The objective of this study was to compare subcutaneous adipose tissue interstitial glucose and venous blood glucose concentrations during postprandial resistance exercise in patients with type 2 diabetes. Eleven individuals completed two trials in a random order including a no-exercise (NoEx) and a postprandial resistance exercise trial (M-Ex). During the trials, the individuals consumed a meal and either remained sedentary (NoEx) or performed a session of resistance training beginning 45 min after the meal (M-Ex) while interstitial and venous glucose concentrations were simultaneously measured. Venous glucose during exercise was ~11% lower ( P = 0.05) during M-Ex (8.0 ± 0.5 mmol/l) compared with NoEx (9.0 ± 0.5 mmol/l) whereas interstitial glucose during M-Ex (10.4 ± 0.7 mmol/l) was not different compared with interstitial glucose during NoEx (10.1 ± 0.7 mmol/l). Bland-Altman plots revealed that the difference (bias) between interstitial and venous glucose during exercise was more than twofold greater during M-Ex (2.36 ± 2.07 mmol/l) compared with NoEx (1.11 ± 1.69 mmol/l). The mean (33.8 ± 6.2 mmol/l) and median (34.7 ± 6.3 mmol/l) absolute relative difference during exercise were 73% and 78% greater compared with the mean (19.5 ± 4.1 mmol/l) and median (19.5 ± 4.1 mmol/l) absolute relative difference during NoEx ( P = 0.04). Resistance exercise has unequal effects on glucose concentrations within different bodily compartments as exercise reduced venous glucose concentrations but not adipose tissue interstitial glucose concentrations in the abdominal region in individuals with type 2 diabetes. NEW & NOTEWORTHY This is the first study to compare subcutaneous adipose tissue interstitial glucose concentrations and venous blood glucose concentrations during postprandial resistance exercise in individuals with type 2 diabetes. We find that resistance exercise effectively reduces systemic venous blood glucose concentrations but not subcutaneous adipose tissue interstitial glucose concentrations in the abdominal region. Resistance exercise has differential effects on glucose concentrations depending on its compartmentalization within the body.

Dataset Information

Exercise effects on postprandial glucose metabolism in type 1 diabetes: a triple-tracer approach.

Publications

Exercise effects on postprandial glucose metabolism in type 1 diabetes: a triple-tracer approach.

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