Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin.
OBJECTIVE
Strategies for preventing hypoglycemia during exercise in children with type 1 diabetes have not been well studied. The Diabetes Research in Children Network (DirecNet) Study Group conducted a study to determine whether stopping basal insulin could reduce the frequency of hypoglycemia occurring during exercise.


METHODS
Using a randomized crossover design, 49 children 8-17 years of age with type 1 diabetes on insulin pump therapy were studied during structured exercise sessions on 2 days. On day 1, basal insulin was stopped during exercise, and on day 2 it was continued. Each exercise session, performed from approximately 4:00-5:00 p.m., consisted of four 15-min treadmill cycles at a target heart rate of 140 bpm (interspersed with three 5-min rest breaks over 75 min), followed by a 45-min observation period. Frequently sampled glucose concentrations (measured in the DirecNet Central Laboratory) were measured before, during, and after the exercise.


RESULTS
Hypoglycemia (< or = 70 mg/dl) during exercise occurred less frequently when the basal insulin was discontinued than when it was continued (16 vs. 43%; P = 0.003). Hyperglycemia (increase from baseline of > or = 20% to > or = 200 mg/dl) 45 min after the completion of exercise was more frequent without basal insulin (27 vs. 4%; P = 0.002). There were no cases of abnormal blood ketone levels.


CONCLUSIONS
Discontinuing basal insulin during exercise is an effective strategy for reducing hypoglycemia in children with type 1 diabetes, but the risk of hyperglycemia is increased.
Tsalikian
Eva
E
Kollman
Craig
C
Tamborlane
William B
WB
Beck
Roy W
RW
Fiallo-Scharer
Rosanna
R
Fox
Larry
L
Janz
Kathleen F
KF
Ruedy
Katrina J
KJ
Wilson
Darrell
D
Xing
Dongyuan
D
Weinzimer
Stuart A
SA
D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D015918:Infusion Pumps, Implantable; D007332:Insulin Infusion Systems; D008297:Male
D001786:Blood Glucose