Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin

Eva Tsalikian; Larry Fox; Kathleen F. Janz; Darrell Wilson; H. Peter Chase; Rosanna Fiallo-Scharer; Laurel Messer; Barbara Tallant; Michael J. Tansey; Linda F. Larson; Julie Coffey; Tim Wysocki; Nelly Mauras; Larry A. Fox; Keisha Bird; Kim Englert; Bruce A. Buckingham; Darrell M. Wilson; Jennifer M. Block; Paula Clinton; Stuart A. Weinzimer; William V. Tamborlane; Elizabeth A. Doyle; Kristin Sikes; Roy W. Beck; Katrina J. Ruedy; Craig Kollman; Dongyuan Xing; Cynthia R. Stockdale; Michael W. Steffes; Jean M. Bucksa; Maren L. Nowicki; Carol A. Van Hale; Vicky Makky; Gilman D. Grave; Karen Teff; Karen K. Winer; Dorothy M. Becker; Patricia Cleary; Christopher M. Ryan; Neil H. White; Perrin C. White

doi:10.2337/dc06-0495

Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin

Eva Tsalikian, Larry Fox, Kathleen F. Janz, Darrell Wilson, H. Peter Chase, Rosanna Fiallo-Scharer, Laurel Messer, Barbara Tallant, Michael J. Tansey, Linda F. Larson, Julie Coffey, Tim Wysocki, Nelly Mauras, Larry A. Fox, Keisha Bird, Kim Englert, Bruce A. Buckingham, Darrell M. Wilson, Jennifer M. Block, Paula ClintonStuart A. Weinzimer, William V. Tamborlane, Elizabeth A. Doyle, Kristin Sikes, Roy W. Beck, Katrina J. Ruedy, Craig Kollman, Dongyuan Xing, Cynthia R. Stockdale, Michael W. Steffes, Jean M. Bucksa, Maren L. Nowicki, Carol A. Van Hale, Vicky Makky, Gilman D. Grave, Karen Teff, Karen K. Winer, Dorothy M. Becker, Patricia Cleary, Christopher M. Ryan, Neil H. White, Perrin C. White

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Abstract

OBJECTIVE - Strategies for preventing hypoglycemia during exercise in children with type 1 diabetes have not been well studied. The Diabetes Research in Children Network (DirecNet) Study Group conducted a study to determine whether stopping basal insulin could reduce the frequency of hypoglycemia occurring during exercise. RESEARCH DESIGN AND METHODS - Using a randomized crossover design, 49 children 8-17 years of age with type 1 diabetes on insulin pump therapy were studied during structured exercise sessions on 2 days. On day 1, basal insulin was stopped during exercise, and on day 2 it was continued. Each exercise session, performed from ∼4:00-5:00 P.M., consisted of four 15-min treadmill cycles at a target heart rate of 140 bpm (interspersed with three 5-min rest breaks over 75 min), followed by a 45-min observation period. Frequently sampled glucose concentrations (measured in the DirecNet Central Laboratory) were measured before, during, and after the exercise. RESULTS - Hypoglycemia (≤70 mg/dl) during exercise occurred less frequently when the basal insulin was discontinued than when it was continued (16 vs. 43%; P = 0.003). Hyperglycemia (increase from baseline of ≥20% to ≥200 mg/dl) 45 min after the completion of exercise was more frequent without basal insulin (27 vs. 4%; P = 0.002). There were no cases of abnormal blood ketone levels. CONCLUSIONS - Discontinuing basal insulin during exercise is an effective strategy for reducing hypoglycemia in children with type 1 diabetes, but the risk of hyperglycemia is increased.

Original language	English (US)
Pages (from-to)	2200-2204
Number of pages	5
Journal	Diabetes care
Volume	29
Issue number	10
DOIs	https://doi.org/10.2337/dc06-0495
State	Published - Oct 2006

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Advanced and Specialized Nursing

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Tsalikian, E., Fox, L., Janz, K. F., Wilson, D., Chase, H. P., Fiallo-Scharer, R., Messer, L., Tallant, B., Tansey, M. J., Larson, L. F., Coffey, J., Wysocki, T., Mauras, N., Fox, L. A., Bird, K., Englert, K., Buckingham, B. A., Wilson, D. M., Block, J. M., ... White, P. C. (2006). Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin. Diabetes care, 29(10), 2200-2204. https://doi.org/10.2337/dc06-0495

Tsalikian, E, Fox, L, Janz, KF, Wilson, D, Chase, HP, Fiallo-Scharer, R, Messer, L, Tallant, B, Tansey, MJ, Larson, LF, Coffey, J, Wysocki, T, Mauras, N, Fox, LA, Bird, K, Englert, K, Buckingham, BA, Wilson, DM, Block, JM, Clinton, P, Weinzimer, SA, Tamborlane, WV, Doyle, EA, Sikes, K, Beck, RW, Ruedy, KJ, Kollman, C, Xing, D, Stockdale, CR, Steffes, MW, Bucksa, JM, Nowicki, ML, Van Hale, CA, Makky, V, Grave, GD, Teff, K, Winer, KK, Becker, DM, Cleary, P, Ryan, CM, White, NH & White, PC 2006, 'Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin', Diabetes care, vol. 29, no. 10, pp. 2200-2204. https://doi.org/10.2337/dc06-0495

@article{9fa000865016450494b757ab4685f4d8,

title = "Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin",

abstract = "OBJECTIVE - Strategies for preventing hypoglycemia during exercise in children with type 1 diabetes have not been well studied. The Diabetes Research in Children Network (DirecNet) Study Group conducted a study to determine whether stopping basal insulin could reduce the frequency of hypoglycemia occurring during exercise. RESEARCH DESIGN AND METHODS - Using a randomized crossover design, 49 children 8-17 years of age with type 1 diabetes on insulin pump therapy were studied during structured exercise sessions on 2 days. On day 1, basal insulin was stopped during exercise, and on day 2 it was continued. Each exercise session, performed from ∼4:00-5:00 P.M., consisted of four 15-min treadmill cycles at a target heart rate of 140 bpm (interspersed with three 5-min rest breaks over 75 min), followed by a 45-min observation period. Frequently sampled glucose concentrations (measured in the DirecNet Central Laboratory) were measured before, during, and after the exercise. RESULTS - Hypoglycemia (≤70 mg/dl) during exercise occurred less frequently when the basal insulin was discontinued than when it was continued (16 vs. 43%; P = 0.003). Hyperglycemia (increase from baseline of ≥20% to ≥200 mg/dl) 45 min after the completion of exercise was more frequent without basal insulin (27 vs. 4%; P = 0.002). There were no cases of abnormal blood ketone levels. CONCLUSIONS - Discontinuing basal insulin during exercise is an effective strategy for reducing hypoglycemia in children with type 1 diabetes, but the risk of hyperglycemia is increased.",

author = "Eva Tsalikian and Larry Fox and Janz, {Kathleen F.} and Darrell Wilson and Chase, {H. Peter} and Rosanna Fiallo-Scharer and Laurel Messer and Barbara Tallant and Tansey, {Michael J.} and Larson, {Linda F.} and Julie Coffey and Tim Wysocki and Nelly Mauras and Fox, {Larry A.} and Keisha Bird and Kim Englert and Buckingham, {Bruce A.} and Wilson, {Darrell M.} and Block, {Jennifer M.} and Paula Clinton and Weinzimer, {Stuart A.} and Tamborlane, {William V.} and Doyle, {Elizabeth A.} and Kristin Sikes and Beck, {Roy W.} and Ruedy, {Katrina J.} and Craig Kollman and Dongyuan Xing and Stockdale, {Cynthia R.} and Steffes, {Michael W.} and Bucksa, {Jean M.} and Nowicki, {Maren L.} and {Van Hale}, {Carol A.} and Vicky Makky and Grave, {Gilman D.} and Karen Teff and Winer, {Karen K.} and Becker, {Dorothy M.} and Patricia Cleary and Ryan, {Christopher M.} and White, {Neil H.} and White, {Perrin C.}",

year = "2006",

month = oct,

doi = "10.2337/dc06-0495",

language = "English (US)",

volume = "29",

pages = "2200--2204",

journal = "Diabetes care",

issn = "0149-5992",

publisher = "American Diabetes Association Inc.",

number = "10",

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TY - JOUR

T1 - Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin

AU - Tsalikian, Eva

AU - Fox, Larry

AU - Janz, Kathleen F.

AU - Wilson, Darrell

AU - Chase, H. Peter

AU - Fiallo-Scharer, Rosanna

AU - Messer, Laurel

AU - Tallant, Barbara

AU - Tansey, Michael J.

AU - Larson, Linda F.

AU - Coffey, Julie

AU - Wysocki, Tim

AU - Mauras, Nelly

AU - Fox, Larry A.

AU - Bird, Keisha

AU - Englert, Kim

AU - Buckingham, Bruce A.

AU - Wilson, Darrell M.

AU - Block, Jennifer M.

AU - Clinton, Paula

AU - Weinzimer, Stuart A.

AU - Tamborlane, William V.

AU - Doyle, Elizabeth A.

AU - Sikes, Kristin

AU - Beck, Roy W.

AU - Ruedy, Katrina J.

AU - Kollman, Craig

AU - Xing, Dongyuan

AU - Stockdale, Cynthia R.

AU - Steffes, Michael W.

AU - Bucksa, Jean M.

AU - Nowicki, Maren L.

AU - Van Hale, Carol A.

AU - Makky, Vicky

AU - Grave, Gilman D.

AU - Teff, Karen

AU - Winer, Karen K.

AU - Becker, Dorothy M.

AU - Cleary, Patricia

AU - Ryan, Christopher M.

AU - White, Neil H.

AU - White, Perrin C.

PY - 2006/10

Y1 - 2006/10

N2 - OBJECTIVE - Strategies for preventing hypoglycemia during exercise in children with type 1 diabetes have not been well studied. The Diabetes Research in Children Network (DirecNet) Study Group conducted a study to determine whether stopping basal insulin could reduce the frequency of hypoglycemia occurring during exercise. RESEARCH DESIGN AND METHODS - Using a randomized crossover design, 49 children 8-17 years of age with type 1 diabetes on insulin pump therapy were studied during structured exercise sessions on 2 days. On day 1, basal insulin was stopped during exercise, and on day 2 it was continued. Each exercise session, performed from ∼4:00-5:00 P.M., consisted of four 15-min treadmill cycles at a target heart rate of 140 bpm (interspersed with three 5-min rest breaks over 75 min), followed by a 45-min observation period. Frequently sampled glucose concentrations (measured in the DirecNet Central Laboratory) were measured before, during, and after the exercise. RESULTS - Hypoglycemia (≤70 mg/dl) during exercise occurred less frequently when the basal insulin was discontinued than when it was continued (16 vs. 43%; P = 0.003). Hyperglycemia (increase from baseline of ≥20% to ≥200 mg/dl) 45 min after the completion of exercise was more frequent without basal insulin (27 vs. 4%; P = 0.002). There were no cases of abnormal blood ketone levels. CONCLUSIONS - Discontinuing basal insulin during exercise is an effective strategy for reducing hypoglycemia in children with type 1 diabetes, but the risk of hyperglycemia is increased.

AB - OBJECTIVE - Strategies for preventing hypoglycemia during exercise in children with type 1 diabetes have not been well studied. The Diabetes Research in Children Network (DirecNet) Study Group conducted a study to determine whether stopping basal insulin could reduce the frequency of hypoglycemia occurring during exercise. RESEARCH DESIGN AND METHODS - Using a randomized crossover design, 49 children 8-17 years of age with type 1 diabetes on insulin pump therapy were studied during structured exercise sessions on 2 days. On day 1, basal insulin was stopped during exercise, and on day 2 it was continued. Each exercise session, performed from ∼4:00-5:00 P.M., consisted of four 15-min treadmill cycles at a target heart rate of 140 bpm (interspersed with three 5-min rest breaks over 75 min), followed by a 45-min observation period. Frequently sampled glucose concentrations (measured in the DirecNet Central Laboratory) were measured before, during, and after the exercise. RESULTS - Hypoglycemia (≤70 mg/dl) during exercise occurred less frequently when the basal insulin was discontinued than when it was continued (16 vs. 43%; P = 0.003). Hyperglycemia (increase from baseline of ≥20% to ≥200 mg/dl) 45 min after the completion of exercise was more frequent without basal insulin (27 vs. 4%; P = 0.002). There were no cases of abnormal blood ketone levels. CONCLUSIONS - Discontinuing basal insulin during exercise is an effective strategy for reducing hypoglycemia in children with type 1 diabetes, but the risk of hyperglycemia is increased.

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JO - Diabetes care

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Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin

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