title: Metabolic and hormonal responses to exercise in type 1 diabetic patients during continuous subcutaneous, as compared to continuous intraperitoneal, insulin infusion.
abstract: This study was performed to determine whether metabolic and hormonal responses during moderate exercise differ between continuous intraperitoneal insulin infusion (CIPII) and continuous subcutaneous insulin infusion (CSII). In seven Type 1 diabetic patients, treatment was changed from CSII to CIPII. Prior to the change, these patients performed an ergometer exercise at 60% of VO2max for 40 min followed by a 200-min rest. About one year later, when the procedure was repeated during CIPII, HbA1c had improved from 8.5 to 7.1%. Arterial blood glucose, venous lactate and hormonal responses were analysed. Although a regimen with a higher basal insulin infusion rate was applied during the exercise test on CIPII, corresponding venous insulin levels were lower (28.0 +/- 2.2 vs. 48.1 +/- 7.9 pmol L-1, p = 0.04). Exercise caused a more marked decline in blood glucose during CIPII, with nadir blood glucose at the end of exercise (3.6 +/- 0.4 vs. 5.1 +/- 0.4 mmol L-1, p = 0.005). Both exercise tests yielded significant and similar increases in plasma levels of adrenaline, noradrenaline, cortisol and growth hormone. A significant rise in plasma glucagon (15.1 +/- 4.5 pg mL-1, p = 0.01) was observed during CIPII, but not during CSII (7.4 +/- 3.5, pg mL-1, n.s.). It is concluded that patients on CIPII should reduce their insulin infusion rate during exercise. CIPII appears to have favourable effects on counterregulatory capacity; in particular, a more prominent glucagon response to exercise may prove important.
authors.affiliation: Department of Medicine, Danderyd Hospital, Sweden. Per.Oskarsson@med.ds.sll.se
authors.forename: P R
authors.initials: PR
authors.lastname: Oskarsson
authors.forename: P E
authors.initials: PE
authors.lastname: Lins
authors.forename: H
authors.initials: H
authors.lastname: Wallberg Henriksson
authors.forename: U C
authors.initials: UC
authors.lastname: Adamson
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology*; D004837:Epinephrine / Q000097:blood; D004867:Equipment Design; D015444:Exercise / Q000502:physiology*; D005260:Female; D005934:Glucagon / Q000097:blood; D006442:Glycated Hemoglobin / Q000378:metabolism; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D011674:Pulse
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D004837:Epinephrine; D005934:Glucagon; D006442:Glycated Hemoglobin; D019382:Human Growth Hormone; D006854:Hydrocortisone; D009638:Norepinephrine