1. Introduction
T1DM, hypoglycemia, hypoglycemic, Diabetes, diabetes
REBOUND HYPERGLYCEMIA, TYPE 1 DIABETES MELLITUS, HYPOGLYCEMIA, HYPERGLYCEMIA, DIABETES, CARDIOVASCULAR COMPLICATIONS, DIABETES
(1) Background: The increased risk of developing hypoglycemia and worsening of glycemic stability during exercise is a major cause of concern for patients with type 1 diabetes mellitus (T1DM). (2) Aim: This pilot study aimed to assess glycemic stability and hypoglycemic episodes during and after aerobic versus resistance exercises using a flash glucose monitoring system in patients with T1DM. (3) Participants and Methods: We conducted a randomized crossover prospective study including 14 adult patients with T1DM. Patients were randomized according to the type of exercise (aerobic vs. resistance) with a recovery period of three days between a change of groups. Glucose stability and hypoglycemic episodes were evaluated during and 24 h after the exercise. Growth hormone (GH), cortisol, and lactate levels were determined at rest, 0, 30, and 60 min post-exercise period. (4) Results: The median age of patients was 53 years, with a median HbA1c of 7.1% and a duration of diabetes of 30 years. During both training sessions, there was a drop in glucose levels immediately after the exercise (0′), followed by an increase at 30′ and 60′, although the difference was not statistically significant. However, glucose levels significantly decreased from 60′ to 24 h in the post-exercise period (Patients with T1DM and uncontrolled glucose levels can develop cardiovascular complications, while glucose-lowering treatment strategies can prevent or postpone their appearance. In those patients, exercise is advised for reducing the risk of several chronic conditions [Although exercise is advocated by the American Diabetes Association (ADA) as a means of treatment for people with diabetes, around 63% of individuals with T1DM are inactive [Additionally, aerobic exercise improves the quantity and function of insulin receptors on skeletal muscles and fat and increases the overall number of cellular glucose transporters, which leads to increased glucose uptake and a corresponding faster decrease of blood glucose during the activity [During resistance training, insulin and glucagon cease to be the key energy regulation source, leading to increased lactate production due to non-oxygen-dependent glucose decomposition (anaerobic metabolism). Catecholamine levels increase in response to anaerobic changes push glucose production and release from the liver, causing blood glucose levels to rise and thus minimizing the risk of blood glucose drop during exercise. Nevertheless, hypoglycemia may develop for an extended period after exercise [Better maintenance of glucose stability is associated with resistance exercise compared to aerobic exercise, although it can induce rebound hyperglycemia, probably due to increased secretion of counter-regulatory hormones [Defining the optimal type and time of exercise is extremely difficult, even in healthy individuals. Patients with T1DM, besides individual preferences for different exercise types, need to consider the additional factor during physical activity, which is the maintenance of target glucose levels, although utilizing technology tools such as intermittent or continuous glucose monitoring, insulin pumps, and closed loop systems significantly improved the management of T1DM. Therefore, a better understanding of the impact of aerobic exercise, resistance training, or HIIT on glycemic variability, hypoglycemia, hyperglycemia, and energy expenditure is important for creating optimal strategies for better management of diabetes and a positive impact on HbA1c.The aim of this study was to assess glycemic levels and hormonal changes after acute aerobic versus resistance training using intermittent continuous glucose monitoring in patients with T1DM.