Effects of rapid-acting insulin analogues insulin glulisine and insulin aspart on postprandial glycemic excursion with single bout of exercise in patients with type 2 diabetes.
The analogue insulin glulisine (Glu) shows both more rapid onset and shorter duration of action compared with the other rapid-acting insulin analogues. The current study investigates these properties in regard to the occurrence of hypoglycemia related to exercise. A randomized, single-center, open-label, crossover study was conducted in 12 hospitalized type 2 diabetes patients (all male, mean ± SD age of 51.9 ± 11.3 years; BMI: 25.5 ± 3.9 kg/m2; HbA1c: 11.2 ± 2.4 %). Glu or insulin aspart (Asp) was subcutaneously administered just before breakfast. Insulin dosage was determined as the usual dose of pre-prandial rapid-acting insulin for patients treated with insulin therapy or as 0.1 unit/kg for patients treated with oral anti-hyperglycemic agents. Sixty min after the start of eating, the patients began aerobic exercise on a bicycle ergometer for 30 min at 50% of maximum heart rate. Hypoglycemic episodes (plasma glucose level < 70 mg/dL with or without symptoms) were observed more frequently in Asp group (p < 0.05). Post-exercise plasma glucose levels at 90, 120, and 150 min were significantly lower in Asp group (p < 0.05). In patients with BMI < 25 kg/m2 (n = 6), post-exercise blood glucose levels were significantly lower in Asp group (p < 0.05), while in patients with BMI ≥ 25 kg/m2 (n = 6) the difference was not significant. Glu may therefore be a suitable choice of rapid-acting insulin for patients with type 2 diabetes who are at high risk of post-exercise hypoglycemia.
Department of Diabetes, Osaka City Juso Hospital, Osaka, Japan.
Nagaaki
N
Tanaka
Yoshikazu
Y
Hiura
D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D015992:Body Mass Index; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000628:therapy; D015444:Exercise; D005080:Exercise Test; D006339:Heart Rate; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000209:etiology; D007004:Hypoglycemic Agents; D007328:Insulin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D061267:Insulin Aspart / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; C479079:insulin glulisine; D061267:Insulin Aspart