Exercise effects on postprandial glucose metabolism in type 1 diabetes: a triple-tracer approach

Abstract

To determine the effects of exercise on postprandial glucose metabolism and insulin action in type 1 diabetes (T1D), we applied the triple tracer technique to study 16 T1D subjects on insulin pump therapy before, during, and after 75 min of moderate-intensity exercise (50% V̇o2max) that started 120 min after a mixed meal containing 75 g of labeled glucose. Prandial insulin bolus was administered as per each subject's customary insulin/carbohydrate ratio adjusted for meal time meter glucose and the level of physical activity. Basal insulin infusion rates were not altered. There were no episodes of hypoglycemia during the study. Plasma dopamine and norepinephrine concentrations rose during exercise. During exercise, rates of endogenous glucose production rose rapidly to baseline levels despite high circulating insulin and glucose concentrations. Interestingly, plasma insulin concentrations increased during exercise despite no changes in insulin pump infusion rates, implying increased mobilization of insulin from subcutaneous depots. Glucagon concentrations rose before and during exercise. Therapeutic approaches for T1D management during exercise will need to account for its effects on glucose turnover, insulin mobilization, glucagon, and sympathetic response and possibly other blood-borne feedback and afferent reflex mechanisms to improve both hypoglycemia and hyperglycemia.

Keywords: exercise; insulin mobilization; postprandial glucose kinetics.

Fig. 1.

A: glucose (top), insulin (middle), and glucagon (bottom) concentrations obtained from time 0 to 360 min in type 1 diabetic (T1D) subjects. Shaded box between 120 and 195 min represents exercise period at 50% V̇o_2max. The inset in the middle shows the mean insulin pump infusion rates during the study. B: plasma dopamine (top), epinephrine (middle), and norepinephrine (bottom) concentrations obtained from time 0 to 360 min in T1D subjects. Shaded box between 120 and 195 min represents exercise period at 50% V̇o_2max.

Fig. 2.

A: [6-³H]glucose/[1-¹³C]glucose ratio (top) and [6,6-²H₂]glucose/endogenous glucose ratio (bottom) obtained from time 0 to 360 min in T1D subjects. Shaded box between 120 and 195 min represents exercise period at 50% V̇o_2max. B: individual tracer/tracee ratios during the study.

Fig. 3.

Rates of meal appearance (MR_a; A), endogenous glucose production (EGP; B), glucose disappearance (R_d; C), and glucose clearance (D) obtained from time 0 to 360 min in T1D subjects. Shaded box between 120 and 195 min represents exercise period at 50% V̇o_2max.

Fig. 4.

Glucose (top), insulin (middle), and glucagon (bottom) concentrations obtained from time 0 to 360 min in T1D subjects (solid line and ●) and healthy controls (dotted line and □). Shaded box between 120 and 195 min represents exercise period at 50% V̇o_2max. Inset in middle shows the mean insulin pump infusion rates during the study in T1D subjects.

Fig. 5.

MR_a (A), EGP (B), R_d (C), and glucose clearance (D) obtained from time 0 to 360 min in T1D subjects (●) and healthy controls (□). Shaded box between 120 and 195 min represents exercise period at 50% V̇o_2max.