title: Insulin pump basal adjustment for exercise in type 1 diabetes: a randomised crossover study.
abstract: The aim of this study was to investigate the effects of exercise, vs rest, on circulating insulin and glucose, following pre-exercise insulin pump basal rate reduction.
  
  
  
  This was an open-label, two-stage randomised crossover study of 14 adults (seven women, seven men) with type 1 diabetes established on insulin pump therapy. In each stage, participants fasted and insulin delivery was halved following a single insulin basal rate overnight. Exercise (30 min moderate-intensity stationary bicycle exercise, starting 60 min post-basal reduction) and rest stages were undertaken in random order at a university hospital. Randomisation was computer-generated, and allocation concealed via sequentially numbered sealed opaque envelopes. Venous blood was collected at 15 min intervals from 60 min pre- until 210 min post-basal rate reduction. Changes in plasma free insulin (the primary outcome), and changes in plasma glucose, with exercise were compared with changes when resting. Outcomes were assessed blinded to group assignment.
  
  
  
  Following basal rate reduction when rested, mean (± SE) free insulin decreased by 4.9 ± 2.9%, 16.2 ± 2.6% and 18.6 ± 3.2% at 1, 2 and 3 h, respectively (p < 0.05 after 75 min). With exercise, relative to rest, mean free insulin increased by 6 ± 2 pmol/l after 15 min and 5 ± 2 pmol/l after 30 min (p < 0.001), then declined post-exercise (p < 0.001). Three participants (mean baseline glucose 5.0 ± 0.1 mmol/l) required glucose supplementation to prevent or treat exercise-related hypoglycaemia. In the other 11 participants (mean baseline glucose 8.4 ± 0.5 mmol/l), glucose increased by 0.8 ± 0.3 mmol/l with exercise (p = 0.028).
  
  
  
  Halving the basal insulin rate 1 h prior to exercise did not significantly reduce circulating free insulin by exercise commencement. Exercise itself transiently increased insulin levels. In participants with low-normal glucose pre-exercise, hypoglycaemia was not prevented by insulin basal rate reduction alone. Greater insulin basal rate reduction and supplemental carbohydrate may be required to prevent exercise-induced hypoglycaemia.
  
  
  
  ANZCTR.org.au ACTRN12613000581763 FUNDING: Australian Diabetes Society, Hugh DT Williamson Foundation, Lynne Quayle Charitable Trust Fund.
authors.affiliation: Department of Medicine, St Vincent's Hospital, University of Melbourne, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia.|Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.
authors.forename: Sybil A
authors.initials: SA
authors.lastname: McAuley
authors.affiliation: Department of Medicine, St Vincent's Hospital, University of Melbourne, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia.
authors.forename: Jodie C
authors.initials: JC
authors.lastname: Horsburgh
authors.affiliation: Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.|Department of Pathology, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Ward
authors.affiliation: Department of Medicine, St Vincent's Hospital, University of Melbourne, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia.|Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.|Sports Cardiology, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
authors.forename: André
authors.initials: A
authors.lastname: La Gerche
authors.affiliation: Department of Medicine, St Vincent's Hospital, University of Melbourne, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia.
authors.forename: Judith L
authors.initials: JL
authors.lastname: Gooley
authors.affiliation: Department of Medicine, St Vincent's Hospital, University of Melbourne, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia.|Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.|NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
authors.forename: Alicia J
authors.initials: AJ
authors.lastname: Jenkins
authors.affiliation: Department of Medicine, St Vincent's Hospital, University of Melbourne, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia.|Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: MacIsaac
authors.affiliation: Department of Medicine, St Vincent's Hospital, University of Melbourne, 29 Regent Street, Fitzroy, Melbourne, VIC, 3065, Australia. dno@unimelb.edu.au.|Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia. dno@unimelb.edu.au.
authors.forename: David N
authors.initials: DN
authors.lastname: O'Neal
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000187:drug effects; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000628:therapy*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Exercise; Hypoglycaemia; Insulin pump; Type 1 diabetes