4. Discussion
hypoglycemia, hyperglycemia, T1D, normoglycemia, hypoglycemic
HYPOGLYCEMIA, HYPERGLYCEMIA, REBOUND HYPERGLYCEMIA, NOCTURNAL HYPOGLYCEMIA
Lately, overcoming the problem of hypoglycemia and maintaining normoglycemia during exercise in T1D seems quite attainable, not only due to recently available technological tools such as continuous/flash glucose monitoring systems, insulin pumps, and closed loop systems, but also specifically developed protocols regarding insulin dose adjustments and carbohydrate intake in order to prevent hypoglycemia [Our results demonstrated similar advantages of resistance and aerobic training regarding rebound hyperglycemia and maintenance of glycemic stability over a 24 h post-exercise period. This could be explained by the study design implementing a protocol including low-GI meals 60 min prior to and after each type of exercise with the administration of reduced boluses by 25% and 50% of calculated bolus, respectively. In a previously published study investigating the impact of low- versus high-GI food on post-treadmill exercise glucose levels, the low-GI meal better prevented post-exercise hyperglycemia compared to the high-GI meal. However, both the high- and low-GI meals protected all patients from early hypoglycemia, but the risk of nocturnal hypoglycemia remained [Furthermore, all our participants were treated with multiple daily injections (MDI) using ultra-long-acting insulin, with no adjustments of basal insulin doses as recommended in previous studies [Several studies demonstrated that performing aerobic exercise in the afternoon or evening increases the risk of hypoglycemic episodes, especially nocturnal ones [IsCGM has been proven to be clinically valuable, reducing the risks of hypoglycemia, hyperglycemia, and glycemic variability (GV) and improving patient quality of life for a wide range of patient populations and clinical indications [As was expected, the GH response to both types of exercise were similar, with a significant increase immediately after the cessation, followed by a decrease in the recovery phase. The increase of GH levels facilitated by all types of exercise is well-documented [In our study, a decrease in cortisol concentrations during both types of training was observed, whereas previous studies reported the opposite effect, with higher cortisol levels during training [Lactate levels were significantly increased following resistance training, while they remained completely unaffected after the aerobic session. This finding confirms a significant anaerobic component to RE reported in other studies [The limitation of the current study is the small sample size. On the other hand, randomization to the cross-over design and detailed study protocol controlling both insulin doses and carbohydrate intake (low GI), add to the study’s strength. Moreover, measuring cortisol, GH, and lactate levels helped in the interpretation of glycemia levels after the aerobic and anaerobic exercise, suggesting that the higher lactate levels seen after resistance training potentially attenuate the decline in blood glucose levels, especially in the early post-exercise period, via stimulation of gluconeogenesis.