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Atypical blood glucose response to continuous and interval exercise in a person with type 1 diabetes: a case report

Othmar Moser, Gerhard Tschakert, Alexander Mueller, Werner Groeschl, Thomas R. Pieber, Gerd Koehler, Max L. Eckstein, Richard Bracken Orcid Logo, Peter Hofmann

Journal of Medical Case Reports, Volume: 11, Issue: 1

Swansea University Author: Richard Bracken Orcid Logo

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DOI (Published version): 10.1186/s13256-017-1355-7

Abstract

BackgroundTherapy must be adapted for people with type 1 diabetes to avoid exercise-induced hypoglycemia caused by increased exercise-related glucose uptake into muscles. Therefore, to avoid hypoglycemia, the preexercise short-acting insulin dose must be reduced for safety reasons. We report a case...

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Published in: Journal of Medical Case Reports
ISSN: 1752-1947
Published: 2017
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa36814
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Abstract: BackgroundTherapy must be adapted for people with type 1 diabetes to avoid exercise-induced hypoglycemia caused by increased exercise-related glucose uptake into muscles. Therefore, to avoid hypoglycemia, the preexercise short-acting insulin dose must be reduced for safety reasons. We report a case of a man with long-lasting type 1 diabetes in whom no blood glucose decrease during different types of exercise with varying exercise intensities and modes was found, despite physiological hormone responses.Case presentationA Caucasian man diagnosed with type 1 diabetes for 24 years performed three different continuous high-intensity interval cycle ergometer exercises as part of a clinical trial (ClinicalTrials.gov identifier NCT02075567). Intensities for both modes of exercises were set at 5% below and 5% above the first lactate turn point and 5% below the second lactate turn point. Short-acting insulin doses were reduced by 25%, 50%, and 75%, respectively. Measurements taken included blood glucose, blood lactate, gas exchange, heart rate, adrenaline, noradrenaline, cortisol, glucagon, and insulin-like growth factor-1. Unexpectedly, no significant blood glucose decreases were observed during all exercise sessions (start versus end, 12.97 ± 2.12 versus 12.61 ± 2.66 mmol L−1, p = 0.259). All hormones showed the expected response, dependent on the different intensities and modes of exercises.ConclusionsPeople with type 1 diabetes typically experience a decrease in blood glucose levels, particularly during low- and moderate-intensity exercises. In our patient, we clearly found no decline in blood glucose, despite a normal hormone response and no history of any insulin insensitivity. This report indicates that there might be patients for whom the recommended preexercise therapy adaptation to avoid exercise-induced hypoglycemia needs to be questioned because this could increase the risk of severe hyperglycemia and ketosis.
Keywords: Type 1 diabetes, Exercise, Blood glucose, Hormones
College: Faculty of Science and Engineering
Issue: 1

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