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Acute, same-day effects of antecedent exercise on counterregulatory responses to subsequent hypoglycemia in type 1 diabetes mellitus.
Am J Physiol Endocrinol Metab. 2006 Jun; 290(6):E1331-8.AJ

Abstract

Exercise-induced hypoglycemia can occur within hours after exercise in type 1 diabetes mellitus (T1DM) patients. This study tested the hypothesis that an acute exercise bout causes (within hours) blunted autonomic and metabolic responses to subsequent hypoglycemia in patients with T1DM. Twelve T1DM patients (3 W/9 M) were studied during a single-step, 2-h hyperinsulinemic (572 +/- 4 pmol/l) hypoglycemic (2.8 +/- 0.1 mmol/l) clamp 2 h after either a hyperinsulinemic euglycemic (AM EUG) or hypoglycemic clamp (AM HYPO) or after sitting in a chair with basal insulin infusion (AM CON) or 90 min of moderate-intensity exercise (50% Vo(2 max), AM EX). Both AM HYPO and AM EX significantly blunted epinephrine responses and muscle sympathetic nerve activity responses to subsequent hypoglycemia compared with both control groups. Endogenous glucose production was significantly lower and the exogenous glucose infusion rate needed to maintain the hypoglycemic level was significantly greater during subsequent hypoglycemia in AM EX vs. CON. Rate of glucose disposal (Rd) was significantly reduced following AM HYPO. In summary, within 2.5 h, both moderate-intensity AM EX and AM HYPO blunted key autonomic counterregulatory responses. Despite this, glucose Rd was reduced during afternoon hypoglycemia following morning hypoglycemia, indicating posthypoglycemic insulin resistance. After morning exercise, endogenous glucose production was blunted, but glucose Rd was maintained during afternoon hypoglycemia, thereby indicating reduced metabolic defenses against hypoglycemia. These data suggest that exercise-induced counterregulatory failure can occur very rapidly, increasing the risk for hypoglycemia in T1DM within hours.

Authors+Show Affiliations

Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA. darleen.sandoval@uc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

16449302

Citation

Sandoval, Darleen A., et al. "Acute, Same-day Effects of Antecedent Exercise On Counterregulatory Responses to Subsequent Hypoglycemia in Type 1 Diabetes Mellitus." American Journal of Physiology. Endocrinology and Metabolism, vol. 290, no. 6, 2006, pp. E1331-8.
Sandoval DA, Guy DL, Richardson MA, et al. Acute, same-day effects of antecedent exercise on counterregulatory responses to subsequent hypoglycemia in type 1 diabetes mellitus. Am J Physiol Endocrinol Metab. 2006;290(6):E1331-8.
Sandoval, D. A., Guy, D. L., Richardson, M. A., Ertl, A. C., & Davis, S. N. (2006). Acute, same-day effects of antecedent exercise on counterregulatory responses to subsequent hypoglycemia in type 1 diabetes mellitus. American Journal of Physiology. Endocrinology and Metabolism, 290(6), E1331-8.
Sandoval DA, et al. Acute, Same-day Effects of Antecedent Exercise On Counterregulatory Responses to Subsequent Hypoglycemia in Type 1 Diabetes Mellitus. Am J Physiol Endocrinol Metab. 2006;290(6):E1331-8. PubMed PMID: 16449302.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute, same-day effects of antecedent exercise on counterregulatory responses to subsequent hypoglycemia in type 1 diabetes mellitus. AU - Sandoval,Darleen A, AU - Guy,Deanna L Aftab, AU - Richardson,M Antoinette, AU - Ertl,Andrew C, AU - Davis,Stephen N, Y1 - 2006/01/31/ PY - 2006/2/2/pubmed PY - 2006/7/14/medline PY - 2006/2/2/entrez SP - E1331 EP - 8 JF - American journal of physiology. Endocrinology and metabolism JO - Am J Physiol Endocrinol Metab VL - 290 IS - 6 N2 - Exercise-induced hypoglycemia can occur within hours after exercise in type 1 diabetes mellitus (T1DM) patients. This study tested the hypothesis that an acute exercise bout causes (within hours) blunted autonomic and metabolic responses to subsequent hypoglycemia in patients with T1DM. Twelve T1DM patients (3 W/9 M) were studied during a single-step, 2-h hyperinsulinemic (572 +/- 4 pmol/l) hypoglycemic (2.8 +/- 0.1 mmol/l) clamp 2 h after either a hyperinsulinemic euglycemic (AM EUG) or hypoglycemic clamp (AM HYPO) or after sitting in a chair with basal insulin infusion (AM CON) or 90 min of moderate-intensity exercise (50% Vo(2 max), AM EX). Both AM HYPO and AM EX significantly blunted epinephrine responses and muscle sympathetic nerve activity responses to subsequent hypoglycemia compared with both control groups. Endogenous glucose production was significantly lower and the exogenous glucose infusion rate needed to maintain the hypoglycemic level was significantly greater during subsequent hypoglycemia in AM EX vs. CON. Rate of glucose disposal (Rd) was significantly reduced following AM HYPO. In summary, within 2.5 h, both moderate-intensity AM EX and AM HYPO blunted key autonomic counterregulatory responses. Despite this, glucose Rd was reduced during afternoon hypoglycemia following morning hypoglycemia, indicating posthypoglycemic insulin resistance. After morning exercise, endogenous glucose production was blunted, but glucose Rd was maintained during afternoon hypoglycemia, thereby indicating reduced metabolic defenses against hypoglycemia. These data suggest that exercise-induced counterregulatory failure can occur very rapidly, increasing the risk for hypoglycemia in T1DM within hours. SN - 0193-1849 UR - https://www.unboundmedicine.com/medline/citation/16449302/Acute_same_day_effects_of_antecedent_exercise_on_counterregulatory_responses_to_subsequent_hypoglycemia_in_type_1_diabetes_mellitus_ DB - PRIME DP - Unbound Medicine ER -