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- Title
Risk of Exercise Induced Hypoglycemia in Patients with Diabetes Mellitus Type 2 (DM2) on Intensified Insulin Therapy (ICT): Comparison of NPH-Insulin versus Glargine as Basal Insulin Supplement.
- Authors
Reuter, Thomas; Topuz, Mendaha; Riese, Brigitte; Wiedenmann, Bertram; Ploeckinger, Ursula
- Abstract
Insulin glargine is a long-acting insulin analoge with a duration of action of up to 24 hours. Therefore adjustment of the insulin dose to physical activity may be difficult. Thus we compared the risk of hypoglycemia in patients on ICT with insulin glargine vs NPH-insulin as basal insulin supplement during a treadmill-exercise test. 123 patients (female 37) with DM2 were evaluated. All patients (PT) were on ICT and had either NPH or Glargine (GLA) as basal insulin supplement. All data are median (25./75. percentile). HbA1c: 7.5% (6.9/7.9) and 7.3% (6.8/7.9), p = 0.16; age: 63 (57/69) and 61 (55/64) years, p = 0.001. Bodymass index: 31.5 (28.5/34.8) and 30.9 (27.2/34.5), p = 0.02; NPH vs GLA; respectively. Blood glucose (BG) and capillary lactate concentration (LAC) were measured at 10 min intervals during a 30 min exercise test (EXT) on a treadmill at 60% of maximal oxygen consumption (VO2max) indicated by a LAC ≥ 2.0 mmol/l. The results of a pre-test determining the workload at 60% VO[sub 2]max were used at the beginning of the EXT. During both EXT velocity and inclination were adjusted according to LAC. 126 PT completed the EXT, 62 PT with NPH and 58 with GLA. The BG (mg/dl) at the beginning (BGbeg), minimal BG (BGmin) and the BG decline (BGdec) were comparable in both groups [BGbeg 138 (113/146) vs 129 (113/141), p = 0.35, BGmin 87 (72/105) vs 78 (71/103), p = 0.29, BGdec 40 (27/56) vs 45 (25/53), p=ns, NPH and GLA, respectively). LAC (mmol/L) at beginning and maximal LAC were not significantly different in both groups [LAC (0min): 1.40 (1.19/1.75) vs 1.49 (1.12/1.83), p = n.s. and LAC (max) 1.92 (1.60/2.25) vs 2.0 (1.64/2.40), p=ns, NPH and GLA, respectively]. Maximal LAC was reached at a rate of 4.1 (3.0/5.3) km/h vs 4.6 (4.0/5.5) km/h and with an inclination of 1.5 (1.5/2.5) % vs 2.5 (1.5/4.0) %, NPH vs GLA, respectively. The incidence of hypglycemia (HG) was 2.5%. Three episodes of mild HG (BG < 60 mg%, with symptoms) occurred in the GLA-group, none in the NPH-group (p=0,2). Mild symptoms of HG with BG > 60 mg/dl, but < 90 mg/dl, were recorded 9 times with NPH and 17 times with GLA (p=0,27). The physical workload to achieve LAC > 2 mmol/l was low in the study population with marked metabolic syndrome. The risk of HG during physical activity is low in PT with DM2 on ICT independent of the insulin used.
- Subjects
EXERCISE physiology; HYPOGLYCEMIA; PEOPLE with diabetes; INSULIN therapy; BLOOD sugar; METABOLIC syndrome
- Publication
Diabetes, 2007, Vol 56, pA280
- ISSN
0012-1797
- Publication type
Article