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Effect of differing antecedent hypoglycemia on counterregulatory responses to exercise in type 1 diabetes.
Am J Physiol Endocrinol Metab. 2006 Jun; 290(6):E1109-17.AJ

Abstract

Hypoglycemia frequently occurs during or after exercise in intensively treated patients with type 1 diabetes mellitus (T1DM), but the underlying mechanisms are not clear. In both diabetic and nondiabetic subjects, moderate hypoglycemia blunts counterregulatory responses to subsequent exercise, but it is unknown whether milder levels of hypoglycemia can exert similar effects in a dose-dependent fashion. This study was designed to test the hypothesis that prior hypoglycemia of differing depths induces acute counterregulatory failure of proportionally greater magnitude during subsequent exercise in T1DM. Twenty-two T1DM patients (11 males/11 females, HbA1c 8.0 +/- 0.3%) were studied during 90 min of euglycemic cycling exercise after two 2-h periods of previous day euglycemia or hypoglycemia of 3.9, 3.3, or 2.8 mmol/l (HYPO-3.9, HYPO-3.3, HYPO-2.8, respectively). Patients' counterregulatory responses (circulating levels of neuroendocrine hormones, intermediary metabolites, substrate flux, tracer-determined glucose kinetics, and cardiovascular measurements) were assessed during exercise. Identical euglycemia and basal insulin levels were successfully maintained during all exercise studies, regardless of blood glucose levels during the previous day. After day 1 euglycemia, patients displayed normal counterregulatory responses to exercise. Conversely, when identical exercise was performed after day 1 hypoglycemia of increasing depth, a progressively greater blunting of glucagon, catecholamine, cortisol, endogenous glucose production, and lipolytic responses to exercise was observed. This was paralleled by a graduated increase in the amount of exogenous glucose needed to maintain euglycemia during exercise. Our results demonstrate that acute counterregulatory failure during prolonged, moderate-intensity exercise may be induced in a dose-dependent fashion by differing depths of antecedent hypoglycemia starting at only 3.9 mmol/l in patients with T1DM.

Authors+Show Affiliations

Galassetti P
Division of Diabetes, Endocrinology & Metabolism, Vanderbilt Univ. School of Medicine, Nashville, TN 37232-6303, USA.
Tate D
No affiliation info available
Neill RA
No affiliation info available
Richardson A
No affiliation info available
Leu SY
No affiliation info available
Davis SN
No affiliation info available

MeSH

AdultBlood GlucoseDiabetes Mellitus, Type 1EpinephrineExerciseFatty Acids, NonesterifiedFemaleGlucose Clamp TechniqueHormonesHumansHypoglycemiaInsulinLactic AcidMaleTime Factors

Pub Type(s)

Clinical Trial
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

16403779

Citation

Galassetti, Pietro, et al. "Effect of Differing Antecedent Hypoglycemia On Counterregulatory Responses to Exercise in Type 1 Diabetes." American Journal of Physiology. Endocrinology and Metabolism, vol. 290, no. 6, 2006, pp. E1109-17.
Galassetti P, Tate D, Neill RA, et al. Effect of differing antecedent hypoglycemia on counterregulatory responses to exercise in type 1 diabetes. Am J Physiol Endocrinol Metab. 2006;290(6):E1109-17.
Galassetti, P., Tate, D., Neill, R. A., Richardson, A., Leu, S. Y., & Davis, S. N. (2006). Effect of differing antecedent hypoglycemia on counterregulatory responses to exercise in type 1 diabetes. American Journal of Physiology. Endocrinology and Metabolism, 290(6), E1109-17.
Galassetti P, et al. Effect of Differing Antecedent Hypoglycemia On Counterregulatory Responses to Exercise in Type 1 Diabetes. Am J Physiol Endocrinol Metab. 2006;290(6):E1109-17. PubMed PMID: 16403779.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of differing antecedent hypoglycemia on counterregulatory responses to exercise in type 1 diabetes. AU - Galassetti,Pietro, AU - Tate,Donna, AU - Neill,Ray A, AU - Richardson,Antoinette, AU - Leu,Szu-Yun, AU - Davis,Stephen N, Y1 - 2006/01/10/ PY - 2006/1/13/pubmed PY - 2006/7/14/medline PY - 2006/1/13/entrez SP - E1109 EP - 17 JF - American journal of physiology. Endocrinology and metabolism JO - Am J Physiol Endocrinol Metab VL - 290 IS - 6 N2 - Hypoglycemia frequently occurs during or after exercise in intensively treated patients with type 1 diabetes mellitus (T1DM), but the underlying mechanisms are not clear. In both diabetic and nondiabetic subjects, moderate hypoglycemia blunts counterregulatory responses to subsequent exercise, but it is unknown whether milder levels of hypoglycemia can exert similar effects in a dose-dependent fashion. This study was designed to test the hypothesis that prior hypoglycemia of differing depths induces acute counterregulatory failure of proportionally greater magnitude during subsequent exercise in T1DM. Twenty-two T1DM patients (11 males/11 females, HbA1c 8.0 +/- 0.3%) were studied during 90 min of euglycemic cycling exercise after two 2-h periods of previous day euglycemia or hypoglycemia of 3.9, 3.3, or 2.8 mmol/l (HYPO-3.9, HYPO-3.3, HYPO-2.8, respectively). Patients' counterregulatory responses (circulating levels of neuroendocrine hormones, intermediary metabolites, substrate flux, tracer-determined glucose kinetics, and cardiovascular measurements) were assessed during exercise. Identical euglycemia and basal insulin levels were successfully maintained during all exercise studies, regardless of blood glucose levels during the previous day. After day 1 euglycemia, patients displayed normal counterregulatory responses to exercise. Conversely, when identical exercise was performed after day 1 hypoglycemia of increasing depth, a progressively greater blunting of glucagon, catecholamine, cortisol, endogenous glucose production, and lipolytic responses to exercise was observed. This was paralleled by a graduated increase in the amount of exogenous glucose needed to maintain euglycemia during exercise. Our results demonstrate that acute counterregulatory failure during prolonged, moderate-intensity exercise may be induced in a dose-dependent fashion by differing depths of antecedent hypoglycemia starting at only 3.9 mmol/l in patients with T1DM. SN - 0193-1849 UR - https://www.unboundmedicine.com/medline/citation/16403779/Effect_of_differing_antecedent_hypoglycemia_on_counterregulatory_responses_to_exercise_in_type_1_diabetes_ DB - PRIME DP - Unbound Medicine ER -