Mini-Dose Glucagon as a Novel Approach to Prevent Exercise-Induced Hypoglycemia in Type 1 Diabetes

Objective In type 1 diabetes, autonomic dysfunction may occur early as a decrease in heart rate variability (HRV). In nondiabetic populations, the positive effects of exercise training on HRV are well documented. However, exercise in individuals with type 1 diabetes, particularly if strenuous and prolonged, can lead to sharp glycemic variations, which can negatively impact HRV. This study explores the impact of a 9-day cycling tour on HRV in this population, with a focus on exercise-induced glycemic excursions. Research Design and Methods Twenty amateur athletes with uncomplicated type 1 diabetes cycled 1500km. HRV and glycemic variability were measured by heart rate and continuous glucose monitoring. Linear mixed models were used to test the effects of exercise on HRV, considering concomitant glycemic excursions and subject characteristics as covariates. Results Nighttime HRV tended to decrease with the daily distance traveled. The more time the subjects spent in hyperglycemia, the lower the parasympathetic tone was. This result is striking given that hyperglycemic excursions progressively increased throughout the 9 days of the tour, and to a greater degree on the days a longer distance was traveled, while time spent in hypoglycemia surprisingly decreased. This phenomenon occurred despite no changes in insulin administration and a decrease in carbohydrate intake from snacks. Conclusions <a>In sports enthusiasts with type 1 diabetes</a>, multiday prolonged exercise at moderate-to-vigorous intensity worsened hyperglycemia with the latter being negatively associated with parasympathetic cardiac tone. Considering the putative deleterious consequences on cardiac risks, future work should focus on understanding and managing exercise-induced hyperglycemia.

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Gene therapy for type 1 diabetes: a novel approach for targeted treatment of autoimmunity

Journal of Clinical Investigation ◽

10.1172/jci23168 ◽

2004 ◽

Vol 114 (7) ◽

pp. 892-894 ◽

Cited By ~ 5

Author(s):

Rémi J. Creusot ◽

C. Garrison Fathman

Keyword(s):

Gene Therapy ◽

Type 1 Diabetes ◽

Targeted Treatment ◽

Novel Approach

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Reproducibility of Glucose Fluctuations Induced by Moderate Intensity Cycling Exercise in Persons with Type 1 Diabetes

Journal of Diabetes Research ◽

10.1155/2021/6640600 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Gabriel Tafdrup Notkin ◽

Peter Lommer Kristensen ◽

Ulrik Pedersen-Bjergaard ◽

Andreas Kryger Jensen ◽

Stig Molsted

Keyword(s):

Heart Rate ◽

Type 1 Diabetes ◽

Moderate Intensity ◽

Blood Pressure Monitor ◽

Continuous Training ◽

Pressure Monitor ◽

Continuous Glucose Monitor ◽

Individual Level ◽

Exercise Induced

Aims. The purpose was to assess the reproducibility of glucose changes during three sessions of standardized moderate intensity continuous training of cycling on an individual level in people with type 1 diabetes. Methods. Twelve adults (six females) with type 1 diabetes performed three test sessions on an ergometer bicycle (30 min, 67% of predicted heart rate) on three different days. The participants were 36.5 (26.6-45.5) (median, IQR) years old, and their HbA1c was 65 ± 15 mmol/mol ( mean ± SD ). Two hours before the tests, the participants had a standard meal. Interstitial glucose (IG) and capillary glucose (CG) were measured using an iPro2 Medtronic continuous glucose monitor and the Bayer Contour XT-device, respectively. Prior to the test sessions, resting heart rate was measured using a digital blood pressure monitor to estimate the desired intensity of the exercise. Results. The average within-participant relationship between the average slope in glucose during sessions 2 and 1 was in IG -0.29 (95% CI -1.11; 0.58) and in CG -0.04 (-0.68; 0.77). Between sessions 3 and 2, IG is 0.18 (-0.27; 0.64) and in CG 0.13 (-0.25; 0.55). Between sessions 3 and 1, IG was 0.06 (-0.57; 0.71) and in CG 0.06 (-0.39; 0.52). The results indicate low reproducibility at participant levels and remained unchanged after adjustment for baseline glucose values. Conclusion. On an individual level, the glucose declines during three standardized sessions of PA were not associated with identical responses of the measured IG and CG levels. An overall anticipated decline of glucose concentrations was found in the moderate intensity cycling sessions. This highlights the importance of regular CG measurements during and after physical activity and awareness towards potential exercise-induced hypoglycemia in persons with type 1 diabetes.

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