Hypoglycemia during prolonged exercise in normal men. Health-related quality of life and treatment satisfaction in the Sensor-Augmented Pump Therapy for A1C Reduction 3 (STAR 3) trial. Randomized Controlled Clinical Trial of Blood Glucose Awareness Training (BGAT III) in Switzerland and Germany An Integrated Multivariable Artificial Pancreas Control System Continuous glucose monitoring reveals delayed nocturnal hypoglycemia after intermittent high-intensity exercise in nontrained patients with type 1 diabetes. Glucose or intermittent high-intensity exercise in glargine/glulisine users with T1DM. Reduced Hypoglycemia and Increased Time in Target Using Closed-Loop Insulin Delivery During Nights With or Without Antecedent Afternoon Exercise in Type 1 Diabetes
Hypoglycemia ( blood glucose less than 45 mg per deciliter [ less than 2.5 mmol per liter ] ) occurred in seven of 19 healthy men who exercised to exhaustion on a cycle ergometer at 60 to 65 per cent of maximal aerobic power . The hypoglycemic subjects exercised for 15 to 70 minutes despite blood glucose levels of 25 to 48 mg per deciliter ( 1.4 to 2.7 mmol per liter ) , and their exhaustion time ( mean + /- S.E.M. , 142 + /- 15 minutes ) was not significantly different from that of the euglycemic group ( 165 + /- 11 ) . Plasma epinephrine was inversely related to blood glucose ( P less than 0.01 ) and was three times higher in the hypoglycemic subjects ( P less than 0.05 ) . Glucose ingestion ( 40 or 80 g per hour ) prevented the hypoglycemia and result ed in a smaller rise in plasma epinephrine but did not alter perceived exertion or consistently delay exhaustion . We conclude that hypoglycemia occurs in normal subjects during prolonged exercise and results in an exaggerated rise in plasma epinephrine . However , hypoglycemia fails to effect endurance , and its prevention does not consistently delay exhaustion OBJECTIVE This study assessed health-related quality of life ( HRQOL ) and treatment satisfaction in sensor-augmented pump therapy ( SAPT ) compared with optimal conventional therapy-multiple daily injection ( MDI ) therapy with self-monitoring of blood glucose (SMBG)-in  adults and children with type 1 diabetes and children 's caregivers . Patient acceptance of new therapies is essential to their adoption and effective use . RESEARCH DESIGN AND METHODS STAR 3 , a r and omized 12-month clinical trial , compared SAPT with MDI+SMBG in 485 adult and pediatric patients . Within- and between-treatment arm changes in generic HRQOL , diabetes-specific HRQOL ( fear of hypoglycemia ) , and treatment satisfaction were assessed ( significance criterion P<0.01 ) . RESULTS In adults , children , and caregivers , there were no significant between-arm changes in generic HRQOL : SF-36 Physical Component Summary and Mental Component Summary scores in adults and the PedsQL Physical Health Summary and Psychosocial Health Summary scores in children or caregivers . Diabetes-specific HRQOL ( Hypoglycemia Fear Survey Worry and Behavior subscale scores ) improved more in SAPT than in MDI adults . Hypoglycemia Behavior scores improved more in SAPT caregivers . Key treatment satisfaction measures ( Insulin Delivery System Rating Question naire measures of Convenience , Efficacy , and Overall Preference ) improved more in SAPT adults , children , and caregivers ( all P<0.001 ) ; all exceeded the criterion for minimal detectable difference . CONCLUSIONS In the first-ever large-scale study of SAPT compared with optimal conventional therapy , SAPT had significant advantages for hypoglycemia fear in adults and caregivers and for treatment satisfaction in adults , children , and caregivers Although both diabetes and the efficacy of medical management are international issues , psycho-educational interventions might be culturally bound . Blood Glucose Awareness Training ( BGAT ) is a psycho-educational program for patients with type 1 diabetes mellitus . It is focused on improving recognition and management of extreme blood glucose levels , and is the best documented American psycho-educational program for this purpose . A r and omized controlled clinical trial of BGAT 's long-term benefits in a non-American setting has been lacking . One hundred and eleven adults with type 1 diabetes mellitus from Switzerl and and Germany participated . After a 6 months baseline assessment , subjects were r and omly assigned to receive either 2 months of BGAT ( n = 56 ) or a physician-guided self-help control intervention ( n = 55 ) . BGAT  improved recognition of low ( p = 0.008 ) , high ( p = .03 ) , and overall blood glucose ( p = 0.001 ) , and reduced frequency of severe hypoglycemia ( p = 0.04 ) , without compromising metabolic control .  BGAT reduced both the external locus of control ( p < 0.02 ) and fear of hypoglycemia ( p < 0.02 ) . BGAT was efficacious in reducing adverse clinical events and achieving clinical ly desirable goals in a European , as well as American setting Objective : The objective was to develop a closed-loop ( CL ) artificial pancreas ( AP ) control system that uses continuous measurements of glucose concentration and physiological variables , integrated with a hypoglycemia early alarm module to regulate glucose concentration and prevent hypoglycemia . Material s and Methods : Eleven open-loop ( OL ) and 9 CL experiments were performed . A multivariable adaptive artificial pancreas ( MAAP ) system was used for the first 6 CL experiments . An integrated multivariable adaptive artificial pancreas ( IMAAP ) system consisting of MAAP augmented with a hypoglycemia early alarm system was used during the last 3 CL experiments . Glucose values and physical activity information were measured and transferred to the controller every 10 minutes and insulin suggestions were entered to the pump manually . All experiments were design ed to be close to real-life conditions . Results : Severe hypoglycemic episodes were seen several times during the OL experiments . With the MAAP system , the occurrence of severe hypoglycemia was decreased significantly ( P < .01 ) . No hypoglycemia was seen with the IMAAP system . There was also a significant difference ( P < .01 ) between OL and CL experiments with regard to percentage of glucose concentration ( 54 % vs 58 % ) that remained within target range ( 70 - 180 mg/dl ) . Conclusions : Integration of an adaptive control and hypoglycemia early alarm system was able to keep glucose concentration values in target range in patients with type 1 diabetes . Postpr and ial hypoglycemia and exercise-induced hypoglycemia did not occur when this system was used . Physical activity information improved estimation of the blood glucose concentration and effectiveness of the control system OBJECTIVE Exercise is a cornerstone of diabetes therapy in type 1 diabetes mellitus ( DMT1 ) patients . The type of exercise is important in determining the propensity to hypoglycemia . We assessed , by continuous glucose monitoring ( CGM ) , the glucose profiles during and in the following 20h after a session of two different types of exercise . RESEARCH DESIGN AND METHODS Eight male volunteers with well-controlled DMT1 were studied . They underwent 30min of both intermittent high-intensity exercise ( IHE ) and moderate-intensity exercise ( MOD ) in r and om order . Expired air was recorded during exercise , while metabolic and hormonal determinations  were performed before and for 120 min after exercises . The CGM system and activity monitor were applied for the subsequent 20h . RESULTS Blood glucose level declined during both type of exercise . At 150 min following the start of exercise , plasma glucose content was slightly higher after IHE . No changes were observed in plasma insulin concentration . A significant increase of norepinephrine concentration was noticed during IHE . Between midnight and 6:00 a.m. the glucose levels were significantly lower after IHE than those observed after MOD ( area under the curve , 23.3 ± 3 vs. 16 ± 3 mg/dL/420 min [ P = 0.04 ] ; mean glycemia at 3 a.m. , 225 ± 31 vs. 147 ± 17 mg/dL [ P<0.05 ] ) . The number of hypoglycemic episodes after IHE was higher than that observed after MOD ( seven vs. two [ P<0.05 ] ) . CONCLUSIONS We demonstrate that ( 1 ) CGM is a useful approach in DMT1 patients who undergo an exercise program and ( 2 ) IHE is associated with delayed nocturnal hypoglycemia INTRODUCTION The effects of glargine/glulisine insulin regimen on exercise blood glucose ( BG ) and strategies to limit exercise-induced hypoglycemia are not well documented . Intermittent high-intensity exercise has been proposed to prevent hypoglycemia , but its effect in participants with type 1 diabetes using glargine/glulisine  is unknown . METHODS The study used a repeated- measures design with three r and omly ordered exercise conditions . Eleven participants completed 60 min of moderate-intensity exercise  at 50 % VO(2peak ) for all conditions . These conditions varied as follows : participants ingested 0 g of glucose preexercise ( 0 G + MOD ) , 30 g of glucose preexercise ( 30 G + MOD ) , or 0 g of glucose preexercise but performed brief high-intensity intervals interspersed every 2 min ( 0 G + MOD/INT ) during exercise . If BG fell < 4 mmol·L(-1 ) , a 20 % dextrose solution was started to maintain BG between 4 and 5 mmol·L(-1 ) . RESULTS Consuming 30 g of glucose before exercise ( 30 G + MOD ) result ed in a higher preexercise BG ( 11.7 ± 2.7 mmol·L(-1 ) ) compared with 0 g of glucose before exercise ( 0 G + MOD , 7.8 ± 4.0 , and 0 G + MOD/INT , 9.2 ± 3.5mmol·L(-1 ) ) , P < 0.05 . A dextrose infusion was required in 7/11 , 4/11 , and 1/11 participants for 0 G + MOD , 0 G + MOD/INT , 30 G + MOD conditions , respectively , P < 0.02 . The duration and the quantity of dextrose infused were greatest in the 0 G + MOD condition , moderate in the to 0 G + MOD/INT condition , and minimal in the 30 G + MOD condition , P < 0.01 . CONCLUSION Our results suggest that both moderate-intensity exercise with a 30-g preexercise glucose beverage or interspersed with intermittent high-intensity sprints may be safe strategies to prevent hypoglycemia in glargine/glulisine users OBJECTIVE Afternoon exercise increases the risk of  nocturnal hypoglycemia ( NH ) in subjects with type 1 diabetes . We hypothesized that automated feedback-controlled closed-loop ( CL ) insulin delivery would be superior to open-loop ( OL ) control in preventing NH and maintaining a higher proportion of blood glucose levels within the target blood glucose range on nights with and without antecedent afternoon exercise . RESEARCH DESIGN AND METHODS Subjects completed two 48-h inpatient study periods in r and om order :  usual OL control and CL control using a proportional-integrative-derivative plus insulin feedback algorithm . Each admission included a sedentary day and an exercise day , with a st and ardized protocol of 60 min of brisk treadmill walking to 65–70 % maximum heart rate at 3:00 p.m. RESULTS Among 12 subjects ( age 12–26 years , A1C 7.4 ± 0.6 % ) , antecedent exercise increased the frequency of NH ( reference blood glucose < 60 mg/dL ) during OL control from six to eight events . In contrast , there was only one NH event each on nights with and without antecedent exercise during CL control ( P = 0.04 vs. OL nights ) . Overnight , the percentage of glucose values in target range was increased with CL control ( P < 0.0001 ) . Insulin delivery was lower between 10:00 p.m. and 2:00 a.m. on nights after exercise on CL versus OL , P = 0.008 . CONCLUSIONS CL insulin delivery provides an effective means to reduce the risk of NH while increasing the percentage of time spent in target range , regardless of activity level in the mid-afternoon . These data suggest that CL control could be of benefit to patients with type 1 diabetes even if it is limited to the overnight period
For blood glucose there was little difference between groups at any time point .
Objective Type 1 diabetes mellitus rates are rising worldwide .
The health benefits of physical exercise in this condition are many , but more than 60 % do not participate , mainly from fear of hypoglycemia .
This systematic review explores the effects of physical exercise modes on blood glucose levels in adults for hypoglycemia prevention .