Metabolic implications when employing heavy pre- and post-exercise rapid-acting insulin reductions to prevent hypoglycaemia in type 1 diabetes patients: a randomised clinical trial.
Metabolic implications when employing heavy pre- and post-exercise rapid-acting insulin reductions to prevent hypoglycaemia in type 1 diabetes patients: a randomised clinical trial.
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DOI：
10.1371/journal.pone.0097143
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
West DJ
中科院分区：
文献类型：
--
作者：
Campbell MD;Walker M;Trenell MI;Luzio S;Dunseath G;Tuner D;Bracken RM;Bain SC;Russell M;Stevenson EJ;West DJ
研究男性1型糖尿病患者在剧烈跑步运动前后，餐内给予速效胰岛素剂量大幅减少后的代谢、葡萄糖调节激素和炎性细胞因子反应。这是一项单中心、随机、对照、开放标签研究。经过初步测试，8名男性患者（24±2岁，HbA 1c 7.7±0.4%/61±4 mmol.l−1）接受甘精胰岛素和门冬胰岛素或赖脯胰岛素治疗的受试者在两天早上08：00到实验室，并服用标准化早餐碳水化合物餐时胰岛素（1 g碳水化合物. kg −1BM; 380±10 kcal），并在以73.1± 0.9%VO2峰值进行45分钟强化跑步机跑步前60分钟自行给予速效胰岛素剂量减少75%。运动后60分钟，患者进食（1 g碳水化合物. kg − 1 BM; 660±21 kcal），并给予全量或减少50%的速效胰岛素剂量。测量餐后180分钟的血糖和乳酸、血清胰岛素、皮质醇、非酯化脂肪酸、β-羟基丁酸酯和血浆胰高血糖素、肾上腺素、去甲肾上腺素、IL-6和TNF-α浓度。所有参与者都进行了分析。运动后60分钟内，两种情况下的所有血液、代谢、激素和细胞因子反应均相似。运动餐后，血清胰岛素浓度低于50%（p<0.05），导致75%的患者发生高血糖症（血糖≥8.0 mmol.l-1; 50% n = 6，完全n = 3）。 β-羟基丁酸酯浓度以相似方式降低，因此在饱餐和50%下，餐后180分钟浓度低于静息浓度。IL-6和TNF-α浓度在低于50%时保持与空腹水平相似，但在完全剂量下下降。在50%以下，IL-6浓度与血清胰岛素浓度呈负相关（r =-0.484，p = 0.017）。 在剧烈跑步运动前通过碳水化合物推注大量减少速效胰岛素剂量，在剧烈跑步运动后进食可能会导致高血糖症，但不会增加酮血症，使炎性细胞因子TNF-α和IL-6升高至空腹水平以上，或导致其他不良代谢或激素紊乱。ClinicalTrials.gov www.example.com
To examine the metabolic, gluco-regulatory-hormonal and inflammatory cytokine responses to large reductions in rapid-acting insulin dose administered prandially before and after intensive running exercise in male type 1 diabetes patients. This was a single centre, randomised, controlled open label study. Following preliminary testing, 8 male patients (24±2 years, HbA1c 7.7±0.4%/61±4 mmol.l−1) treated with insulin's glargine and aspart, or lispro attended the laboratory on two mornings at ∼08:00 h and consumed a standardised breakfast carbohydrate bolus (1 g carbohydrate.kg−1BM; 380±10 kcal) and self-administered a 75% reduced rapid-acting insulin dose 60 minutes before 45 minutes of intensive treadmill running at 73.1±0.9% VO2peak. At 60 minutes post-exercise, patients ingested a meal (1 g carbohydrate.kg−1BM; 660±21 kcal) and administered either a Full or 50% reduced rapid-acting insulin dose. Blood glucose and lactate, serum insulin, cortisol, non-esterified-fatty-acids, β-Hydroxybutyrate, and plasma glucagon, adrenaline, noradrenaline, IL-6, and TNF-α concentrations were measured for 180 minutes post-meal. All participants were analysed. All glycaemic, metabolic, hormonal, and cytokine responses were similar between conditions up to 60 minutes following exercise. Following the post-exercise meal, serum insulin concentrations were lower under 50% (p<0.05) resulting in 75% of patients experiencing hyperglycaemia (blood glucose ≥8.0 mmol.l−1; 50% n = 6, Full n = 3). β-Hydroxybutyrate concentrations decreased similarly, such that at 180 minutes post-meal concentrations were lower than rest under Full and 50%. IL-6 and TNF-α concentrations remained similar to fasting levels under 50% but declined under Full. Under 50% IL-6 concentrations were inversely related with serum insulin concentrations (r = −0.484, p = 0.017). Heavily reducing rapid-acting insulin dose with a carbohydrate bolus before, and a meal after intensive running exercise may cause hyperglycaemia, but does not augment ketonaemia, raise inflammatory cytokines TNF-α and IL-6 above fasting levels, or cause other adverse metabolic or hormonal disturbances. ClinicalTrials.gov NCT01531855
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