title: Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin.
abstract: 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.
authors.forename: Eva
authors.initials: E
authors.lastname: Tsalikian
authors.forename: Craig
authors.initials: C
authors.lastname: Kollman
authors.forename: William B
authors.initials: WB
authors.lastname: Tamborlane
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
authors.forename: Rosanna
authors.initials: R
authors.lastname: Fiallo-Scharer
authors.forename: Larry
authors.initials: L
authors.lastname: Fox
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Janz
authors.forename: Katrina J
authors.initials: KJ
authors.lastname: Ruedy
authors.forename: Darrell
authors.initials: D
authors.lastname: Wilson
authors.forename: Dongyuan
authors.initials: D
authors.lastname: Xing
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Weinzimer
mesh_terms: 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
chemical_list: D001786:Blood Glucose