title: Exercise effects on postprandial glucose metabolism in type 1 diabetes: a triple-tracer approach.
abstract: To determine the effects of exercise on postprandial glucose metabolism and insulin action in type 1 diabetes (T1D), we applied the triple tracer technique to study 16 T1D subjects on insulin pump therapy before, during, and after 75 min of moderate-intensity exercise (50% V̇o2max) that started 120 min after a mixed meal containing 75 g of labeled glucose. Prandial insulin bolus was administered as per each subject's customary insulin/carbohydrate ratio adjusted for meal time meter glucose and the level of physical activity. Basal insulin infusion rates were not altered. There were no episodes of hypoglycemia during the study. Plasma dopamine and norepinephrine concentrations rose during exercise. During exercise, rates of endogenous glucose production rose rapidly to baseline levels despite high circulating insulin and glucose concentrations. Interestingly, plasma insulin concentrations increased during exercise despite no changes in insulin pump infusion rates, implying increased mobilization of insulin from subcutaneous depots. Glucagon concentrations rose before and during exercise. Therapeutic approaches for T1D management during exercise will need to account for its effects on glucose turnover, insulin mobilization, glucagon, and sympathetic response and possibly other blood-borne feedback and afferent reflex mechanisms to improve both hypoglycemia and hyperglycemia.
authors.affiliation: Endocrine Research Unit, Division of Endocrinology, Mayo College of Medicine, Rochester, Minnesota;
authors.forename: Ashwini
authors.initials: A
authors.lastname: Mallad
authors.affiliation: Endocrine Research Unit, Division of Endocrinology, Mayo College of Medicine, Rochester, Minnesota;
authors.forename: Ling
authors.initials: L
authors.lastname: Hinshaw
authors.affiliation: Department of Information Engineering, University of Padua, Padua, Italy; and.
authors.forename: Michele
authors.initials: M
authors.lastname: Schiavon
authors.affiliation: Department of Information Engineering, University of Padua, Padua, Italy; and.
authors.forename: Chiara
authors.initials: C
authors.lastname: Dalla Man
authors.affiliation: Endocrine Research Unit, Division of Endocrinology, Mayo College of Medicine, Rochester, Minnesota;
authors.forename: Vikash
authors.initials: V
authors.lastname: Dadlani
authors.affiliation: Endocrine Research Unit, Division of Endocrinology, Mayo College of Medicine, Rochester, Minnesota;
authors.forename: Rita
authors.initials: R
authors.lastname: Basu
authors.affiliation: Department of Health Sciences Research, Mayo College of Medicine, Rochester, Minnesota.
authors.forename: Ravi
authors.initials: R
authors.lastname: Lingineni
authors.affiliation: Department of Information Engineering, University of Padua, Padua, Italy; and.
authors.forename: Claudio
authors.initials: C
authors.lastname: Cobelli
authors.affiliation: Endocrine Research Unit, Division of Endocrinology, Mayo College of Medicine, Rochester, Minnesota;
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Johnson
authors.affiliation: Department of Health Sciences Research, Mayo College of Medicine, Rochester, Minnesota.
authors.forename: Rickey
authors.initials: R
authors.lastname: Carter
authors.affiliation: Endocrine Research Unit, Division of Endocrinology, Mayo College of Medicine, Rochester, Minnesota;
authors.forename: Yogish C
authors.initials: YC
authors.lastname: Kudva
authors.affiliation: Endocrine Research Unit, Division of Endocrinology, Mayo College of Medicine, Rochester, Minnesota; basu.ananda@mayo.edu.
authors.forename: Ananda
authors.initials: A
authors.lastname: Basu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000378:metabolism*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007328:Insulin / Q000008:administration & dosage / Q000378:metabolism*; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: exercise; insulin mobilization; postprandial glucose kinetics