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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

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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
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URI: https://cronfa.swan.ac.uk/Record/cronfa36814
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2017-11-17T11:15:12.7252416</datestamp><bib-version>v2</bib-version><id>36814</id><entry>2017-11-17</entry><title>Atypical blood glucose response to continuous and interval exercise in a person with type 1 diabetes: a case report</title><swanseaauthors><author><sid>f5da81cd18adfdedb2ccb845bddc12f7</sid><ORCID>0000-0002-6986-6449</ORCID><firstname>Richard</firstname><surname>Bracken</surname><name>Richard Bracken</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2017-11-17</date><deptcode>STSC</deptcode><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 &#xB1; 2.12 versus 12.61 &#xB1; 2.66 mmol L&#x2212;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.</abstract><type>Journal Article</type><journal>Journal of Medical Case Reports</journal><volume>11</volume><journalNumber>1</journalNumber><publisher/><issnElectronic>1752-1947</issnElectronic><keywords>Type 1 diabetes, Exercise, Blood glucose, Hormones</keywords><publishedDay>31</publishedDay><publishedMonth>12</publishedMonth><publishedYear>2017</publishedYear><publishedDate>2017-12-31</publishedDate><doi>10.1186/s13256-017-1355-7</doi><url/><notes/><college>COLLEGE NANME</college><department>Sport and Exercise Sciences</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>STSC</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2017-11-17T11:15:12.7252416</lastEdited><Created>2017-11-17T11:12:43.4316310</Created><path><level id="1">Faculty of Science and Engineering</level><level id="2">School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Sport and Exercise Sciences</level></path><authors><author><firstname>Othmar</firstname><surname>Moser</surname><order>1</order></author><author><firstname>Gerhard</firstname><surname>Tschakert</surname><order>2</order></author><author><firstname>Alexander</firstname><surname>Mueller</surname><order>3</order></author><author><firstname>Werner</firstname><surname>Groeschl</surname><order>4</order></author><author><firstname>Thomas R.</firstname><surname>Pieber</surname><order>5</order></author><author><firstname>Gerd</firstname><surname>Koehler</surname><order>6</order></author><author><firstname>Max L.</firstname><surname>Eckstein</surname><order>7</order></author><author><firstname>Richard</firstname><surname>Bracken</surname><orcid>0000-0002-6986-6449</orcid><order>8</order></author><author><firstname>Peter</firstname><surname>Hofmann</surname><order>9</order></author></authors><documents><document><filename>0036814-17112017111458.pdf</filename><originalFilename>moser2017.pdf</originalFilename><uploaded>2017-11-17T11:14:58.3570000</uploaded><type>Output</type><contentLength>488701</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><embargoDate>2017-11-17T00:00:00.0000000</embargoDate><copyrightCorrect>false</copyrightCorrect><language>eng</language></document></documents><OutputDurs/></rfc1807>
spelling 2017-11-17T11:15:12.7252416 v2 36814 2017-11-17 Atypical blood glucose response to continuous and interval exercise in a person with type 1 diabetes: a case report f5da81cd18adfdedb2ccb845bddc12f7 0000-0002-6986-6449 Richard Bracken Richard Bracken true false 2017-11-17 STSC 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. Journal Article Journal of Medical Case Reports 11 1 1752-1947 Type 1 diabetes, Exercise, Blood glucose, Hormones 31 12 2017 2017-12-31 10.1186/s13256-017-1355-7 COLLEGE NANME Sport and Exercise Sciences COLLEGE CODE STSC Swansea University 2017-11-17T11:15:12.7252416 2017-11-17T11:12:43.4316310 Faculty of Science and Engineering School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Sport and Exercise Sciences Othmar Moser 1 Gerhard Tschakert 2 Alexander Mueller 3 Werner Groeschl 4 Thomas R. Pieber 5 Gerd Koehler 6 Max L. Eckstein 7 Richard Bracken 0000-0002-6986-6449 8 Peter Hofmann 9 0036814-17112017111458.pdf moser2017.pdf 2017-11-17T11:14:58.3570000 Output 488701 application/pdf Version of Record true 2017-11-17T00:00:00.0000000 false eng
title Atypical blood glucose response to continuous and interval exercise in a person with type 1 diabetes: a case report
spellingShingle Atypical blood glucose response to continuous and interval exercise in a person with type 1 diabetes: a case report
Richard Bracken
title_short Atypical blood glucose response to continuous and interval exercise in a person with type 1 diabetes: a case report
title_full Atypical blood glucose response to continuous and interval exercise in a person with type 1 diabetes: a case report
title_fullStr Atypical blood glucose response to continuous and interval exercise in a person with type 1 diabetes: a case report
title_full_unstemmed Atypical blood glucose response to continuous and interval exercise in a person with type 1 diabetes: a case report
title_sort Atypical blood glucose response to continuous and interval exercise in a person with type 1 diabetes: a case report
author_id_str_mv f5da81cd18adfdedb2ccb845bddc12f7
author_id_fullname_str_mv f5da81cd18adfdedb2ccb845bddc12f7_***_Richard Bracken
author Richard Bracken
author2 Othmar Moser
Gerhard Tschakert
Alexander Mueller
Werner Groeschl
Thomas R. Pieber
Gerd Koehler
Max L. Eckstein
Richard Bracken
Peter Hofmann
format Journal article
container_title Journal of Medical Case Reports
container_volume 11
container_issue 1
publishDate 2017
institution Swansea University
issn 1752-1947
doi_str_mv 10.1186/s13256-017-1355-7
college_str Faculty of Science and Engineering
hierarchytype
hierarchy_top_id facultyofscienceandengineering
hierarchy_top_title Faculty of Science and Engineering
hierarchy_parent_id facultyofscienceandengineering
hierarchy_parent_title Faculty of Science and Engineering
department_str School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Sport and Exercise Sciences{{{_:::_}}}Faculty of Science and Engineering{{{_:::_}}}School of Aerospace, Civil, Electrical, General and Mechanical Engineering - Sport and Exercise Sciences
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description 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.
published_date 2017-12-31T03:46:10Z
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