title: The effect of exercise on the absorption of inhaled human insulin via the AERx insulin diabetes management system in people with type 1 diabetes.
abstract: OBJECTIVE
  This study investigated the effect of moderate exercise on the absorption of inhaled insulin via the AERx insulin diabetes management system (iDMS).
  
  
  METHODS
  In this randomized, open-label, four-period, crossover, glucose clamp study 23 nonsmoking subjects with type 1 diabetes received a dose of 0.19 units/kg inhaled human insulin followed in random order by either 1) no exercise (NOEX group) or 30 min exercise starting, 2) 30 min after dosing (EX30), 3) 120 min after dosing (EX120), or 4) 240 min after dosing (EX240).
  
  
  RESULTS
  Exercise changed the shape of the free plasma insulin curves, but compared with the NOEX group the area under the curve for free plasma insulin (AUC(ins)) for the first 2 h after the start of exercise was unchanged for EX30 and EX240, while it was 15% decreased for EX120 (P < 0.01). The overall insulin absorption during 6 and 10 h after dosing was 13% decreased for EX30 (P < 0.005), 11% decreased for EX120 (P < 0.01), and unchanged for EX240. Exercise did not influence the maximum insulin concentration (Cmax), while the time to Cmax was 22 min earlier for EX30 (P = 0.04). The AUC for the glucose infusion rate (AUC(GIR)) for 2 h after the start of exercise increased by 58% for EX30, 45% for EX120, and 71% for EX240 (all P < 0.02) compared with the NOEX group.
  
  
  CONCLUSIONS
  Thirty minutes of moderate exercise led to unchanged or decreased absorption of inhaled insulin via AERx iDMS and faster Cmax for early exercise. Thus, patients using AERx iDMS can adjust insulin dose as usual independent of time of exercise, but they should be aware of the faster effect if exercising early after dosing.
authors.affiliation: Department of Internal Medicine, Medical University Graz, Graz, Austria. ashp@novonordisk.com
authors.forename: Astrid H
authors.initials: AH
authors.lastname: Petersen
authors.forename: Gerd
authors.initials: G
authors.lastname: Köhler
authors.forename: Stefan
authors.initials: S
authors.lastname: Korsatko
authors.forename: Andrea
authors.initials: A
authors.lastname: Wutte
authors.forename: Manfred
authors.initials: M
authors.lastname: Wonisch
authors.forename: Ole K
authors.initials: OK
authors.lastname: Jeppesen
authors.forename: Thomas
authors.initials: T
authors.lastname: Sparre
authors.forename: Per
authors.initials: P
authors.lastname: Clauson
authors.forename: Torben
authors.initials: T
authors.lastname: Laursen
authors.forename: Per
authors.initials: P
authors.lastname: Wollmer
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Pieber
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000336:Aerosols; D000368:Aged; D019540:Area Under Curve; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D015444:Exercise; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged
chemical_list: D000336:Aerosols; D007328:Insulin