Absence of exercise-induced hypoglycaemia in type i (insulin-dependent) diabetic patients during maintenance of normoglycaemia by short-term, open-loop insulin infusion

• Published in: Diabetologia 1982-10, Vol.23 (4), p.336-342
• Main Authors: Martin, M J, Robbins, D C, Bergenstal, R, LaGrange, B, Rubenstein, A H
• Format: Article
• Language: English
• Subjects: 3-Hydroxybutyric Acid; Adult; Blood Glucose - analysis; Diabetes Mellitus - blood; Diabetes Mellitus - drug therapy; Fatty Acids, Nonesterified - blood; Glucagon - blood; Glycerol - blood; Humans; Hydroxybutyrates - blood; Hypoglycemia - etiology; Insulin - blood; Insulin Infusion Systems; Lactates - blood; Lactic Acid; Male; Physical Exertion
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/BF00253741

To assess the risk and possible mechanisms of hypoglycaemia during moderate exercise in Type I (insulin-dependent) diabetic patients receiving constant insulin infusion, five insulin-dependent male diabetic patients were exercised 18 h after their last meal and 30 h after their last injection of intermediate acting insulin. Intravenous insulin was initially delivered via a closed-loop infusion system programmed to lower mean blood glucose from 11.3 +/- 1.8 to 4.8 +/- 0.4 mmol/l over approximately 3.5 h. Blood glucose was then maintained at this level for 4 h. At this time, the closed-loop infusion was discontinued and replaced by an open-loop system. The average amount of insulin infused per min during the 4 h normoglycaemic closed-loop period was calculated and this amount was infused at a constant rate during both a 30 min period of exercise on a bicycle ergometer (approximately 65% maximum oxygen uptake) and a 30 min rest period which followed. Five nondiabetic males served as control subjects. Despite significantly higher free insulin concentrations (p less than 0.05) and identical pre-exercise blood glucose concentrations, blood glucose rose during exercise only in the diabetic group (0.5 +/- 0.2 mmol/l; p less than 0.01). Changes in the serum concentrations of lactate, glycerol, glucagon, cortisol, non-esterified fatty acids and growth hormone were similar in the two groups and did not account for the increment of blood glucose in the diabetic patients. Beta-hydroxybutyrate concentrations were, however, higher in the diabetic patients at the onset of exercise (p less than 0.01) and decreased significantly more than the control subjects during exercise. We conclude that exercise under these conditions in diabetic patients is not attended by hypoglycaemia.