Type 1 Diabetes Mellitus and Exercise

  • David Maahs
  • Craig E. Taplin
  • Rosanna Fiallo-Scharer
Chapter
Part of the Contemporary Diabetes book series (CDI)

Abstract

Exercise is an important aspect of the care of persons with type 1 diabetes and presents different challenges than in type 2 diabetes. In this chapter, American Diabetes Association recommendations for exercise will be reviewed as well as pathophysiologic differences in type 1 diabetes including counterregulatory hormones with an emphasis on exercise-related hypoglycemia and exercise in youth with type 1 diabetes. The risks and benefits of exercise, practical considerations, and new technologies will also be discussed.

Keywords

Type 1 diabetes mellitus Exercise Hypoglycemia Counterregulatory hormones Self-monitoring blood glucose Insulin pump. 

References

  1. 1.
    Feudtner C. Bittersweet: Diabetes, Insulin and the Transformation of Illness. Chapel Hill: University of North Carolina Press. 2003.Google Scholar
  2. 2.
    Chase HP. Understanding Diabetes: A Handbook for People Who Are Living with Diabetes. 11th ed. 2006, Paros Press, Denvev, Co.Google Scholar
  3. 3.
    Saudek CD, Derr RL, Kalyani RR. Assessing glycemia in diabetes using self-monitoring blood glucose and hemoglobin A1c. JAMA 2006 April 12;295(14):1688–97.PubMedCrossRefGoogle Scholar
  4. 4.
    Hirsch IB. Insulin analogues. N Engl J Med 2005 January 13;352(2):174–83.PubMedCrossRefGoogle Scholar
  5. 5.
    The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993 September 30;329(14):977–86.Google Scholar
  6. 6.
    Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. J Pediatr 1994 August;125(2):177–88.Google Scholar
  7. 7.
    Nathan DM, Lachin J, Cleary P, Orchard T, Brillon DJ, Backlund JY, O'Leary DH, Genuth S. Intensive diabetes therapy and carotid intima-media thickness in type 1 diabetes mellitus. N Engl J Med 2003 June 5;348(23):2294–303.PubMedCrossRefGoogle Scholar
  8. 8.
    Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, Raskin P, Zinman B. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005 December 22;353(25):2643–53.PubMedCrossRefGoogle Scholar
  9. 9.
    Tamborlane WV. Fulfilling the promise of insulin pump therapy in childhood diabetes. Pediatr Diabetes 2006 August;7(Suppl. 4):4–10.PubMedCrossRefGoogle Scholar
  10. 10.
    Klonoff DC. Continuous glucose monitoring: roadmap for 21st century diabetes therapy. Diabetes Care 2005 May;28(5):1231–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Zinman B, Ruderman N, Campaigne BN, Devlin JT, Schneider SH. Physical activity/exercise and diabetes. Diabetes Care 2004 January;27(Suppl. 1):S58–62.Google Scholar
  12. 12.
    Gerstein HC, Bosch J, Pogue J, Taylor DW, Zinman B, Yusuf S. Rationale and design of a large study to evaluate the renal and cardiovascular effects of an ACE inhibitor and vitamin E in high- risk patients with diabetes. The MICRO-HOPE Study. Microalbuminuria, cardiovascular, and renal outcomes. Heart Outcomes Prevention Evaluation. Diabetes Care 1996;19(11):1225–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Wasserman DH, Zinman B. Exercise in individuals with IDDM. Diabetes Care 1994 August;17(8):924–37.PubMedGoogle Scholar
  14. 14.
    Camacho RC, Galassetti P, Davis SN, Wasserman DH. Glucoregulation during and after exercise in health and insulin-dependent diabetes. Exerc Sport Sci Rev 2005 January;33(1):17–23.PubMedGoogle Scholar
  15. 15.
    Jeanne H. Steppel, Edward S. Horton. Exercise for the patient with type 1 diabetes mellitus. In Diabetes mellitus: a fundamental and clinical text. 2006. p. 671–81.Google Scholar
  16. 16.
    Riddell MC, Iscoe KE. Physical activity, sport, and pediatric diabetes. Pediatr Diabetes 2006 February;7(1):60–70.PubMedCrossRefGoogle Scholar
  17. 17.
    Tansey MJ, Tsalikian E, Beck RW, Mauras N, Buckingham BA, Weinzimer SA, Janz KF, Kollman C, Xing D, Ruedy KJ, Steffes MW, Borland TM, Singh RJ, Tamborlane WV. The effects of aerobic exercise on glucose and counterregulatory hormone concentrations in children with type 1 diabetes. Diabetes Care 2006 January;29(1):20–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Amiel SA, Tamborlane WV, Simonson DC, Sherwin RS. Defective glucose counterregulation after strict glycemic control of insulin-dependent diabetes mellitus. N Engl J Med 1987 May 28;316(22):1376–83.PubMedCrossRefGoogle Scholar
  19. 19.
    Galassetti P, Mann S, Tate D, Neill RA, Costa F, Wasserman DH, Davis SN. Effects of antecedent prolonged exercise on subsequent counterregulatory responses to hypoglycemia. Am J Physiol Endocrinol Metab 2001 June;280(6):E908–17.PubMedGoogle Scholar
  20. 20.
    Galassetti P, Tate D, Neill RA, Morrey S, Wasserman DH, Davis SN. Effect of antecedent hypoglycemia on counterregulatory responses to subsequent euglycemic exercise in type 1 diabetes. Diabetes 2003 July;52(7):1761–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Galassetti P, Neill AR, Tate D, Ertl AC, Wasserman DH, Davis SN. Sexual dimorphism in counterregulatory responses to hypoglycemia after antecedent exercise. J Clin Endocrinol Metab 2001 August;86(8):3516–24.PubMedCrossRefGoogle Scholar
  22. 22.
    Galassetti P, Tate D, Neill RA, Morrey S, Wasserman DH, Davis SN. Effect of sex on counterregulatory responses to exercise after antecedent hypoglycemia in type 1 diabetes. Am J Physiol Endocrinol Metab 2004 July;287(1):E16–24.PubMedCrossRefGoogle Scholar
  23. 23.
    Koivisto VA, Felig P. Effects of leg exercise on insulin absorption in diabetic patients. N Engl J Med 1978 January 12;298(2):79–83.PubMedCrossRefGoogle Scholar
  24. 24.
    Marliss EB, Vranic M. Intense exercise has unique effects on both insulin release and its roles in glucoregulation: implications for diabetes. Diabetes 2002 February;51(Suppl. 1):S271–83.PubMedCrossRefGoogle Scholar
  25. 25.
    Robertson K, Adolfsson P, Riddell MC, Scheiner G, Hanas R. Exercise in children and adolescents with diabetes. ISPAD Clinical Practice Consensus Guidelines 2006–07. Pediatr Diabetes 2008 February;9(1):65–77.PubMedCrossRefGoogle Scholar
  26. 26.
    Austin A, Warty V, Janosky J, Arslanian S. The relationship of physical fitness to lipid and lipoprotein(a) levels in adolescents with IDDM. Diabetes Care 1993 February;16(2):421–5.PubMedCrossRefGoogle Scholar
  27. 27.
    LaPorte RE, Dorman JS, Tajima N, Cruickshanks KJ, Orchard TJ, Cavender DE, Becker DJ, Drash AL. Pittsburgh Insulin-Dependent Diabetes Mellitus Morbidity and Mortality Study: physical activity and diabetic complications. Pediatrics 1986;78:1027–33.PubMedGoogle Scholar
  28. 28.
    Raile K, Kapellen T, Schweiger A, Hunkert F, Nietzschmann U, Dost A, Kiess W. Physical activity and competitive sports in children and adolescents with type 1 diabetes. Diabetes Care 1999 November;22(11):1904–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Tsalikian E, Mauras N, Beck RW, Tamborlane WV, Janz KF, Chase HP, Wysocki T, Weinzimer SA, Buckingham BA, Kollman C, Xing D, Ruedy KJ. Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus. J Pediatr 2005 October;147(4):528–34.PubMedCrossRefGoogle Scholar
  30. 30.
    Hansen PA, Nolte LA, Chen MM, Holloszy JO. Increased GKUT-4 translocation mediates enhanced insulin sensitivity of muscle glucose transport after exercise. J Appl Physiol 1998 Oct;85(4):1218–22.PubMedGoogle Scholar
  31. 31.
    Borghouts LB, Keizer HA. Exercise and insulin sensitivity: a review. Int J Sports Med 2000 January;21(1):1–12.PubMedCrossRefGoogle Scholar
  32. 32.
    Arslanian S, Nixon PA, Becker D, Drash AL. Impact of physical fitness and glycemic control on in vivo insulin action in adolescents with IDDM. Diabetes Care 1990 January;13(1):9–15.PubMedCrossRefGoogle Scholar
  33. 33.
    Perseghin G, Lattuada G, Danna M, Sereni LP, Maffi P, De Cobelli F, Battezzati A, Secchi A, Del Maschio A, Luzi L. Insulin resistance, intramyocellular lipid content and plasma adiponectin in patients with type 1 diabetes. Am J Physiol Endocrinol Metab 2003; 258(6):E1174–81.Google Scholar
  34. 34.
    Williams KV, Erbey JR, Becker D, Arslanian S, Orchard TJ. Can clinical factors estimate insulin resistance in type 1 diabetes? Diabetes 2000 April;49(4):626–32.PubMedCrossRefGoogle Scholar
  35. 35.
    Ekstrand AV, Groop PH, Gronhagen-Riska C. Insulin resistance precedes microalbuminuria in patients with insulin-dependent diabetes mellitus. Nephrol Dial Transplant 1998 December;13(12):3079–83.PubMedCrossRefGoogle Scholar
  36. 36.
    Greenbaum CJ. Insulin resistance in type 1 diabetes. Diabetes Metab Res Rev 2002 May;18(3):192–200.PubMedCrossRefGoogle Scholar
  37. 37.
    Nijs HG, Radder JK, Frolich M, Krans HM. The course and determinants of insulin action in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1989 January;32(1):20–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Reinehr T, Holl RW, Roth CL, Wiesel T, Stachow R, Wabitsch M, Andler W. Insulin resistance in children and adolescents with type 1 diabetes mellitus: relation to obesity. Pediatr Diabetes 2005 March;6(1):5–12.PubMedCrossRefGoogle Scholar
  39. 39.
    Schauer IE, Bergman B, Snell-Bergeon J, Maahs DM, Kretowski A, Eckel RH, Rewers MJ. Insulin sensitivity and free fatty acid suppression differ in person with type 1 diabetes compared to non-diabetic controls: the CACTI Study. Abstract 1300-P 68th Scientific Sessions ADA, 2008.Google Scholar
  40. 40.
    Nadeau KJ, West N, Sorenson E, Vehik K, Maahs DM, Zeitler PS, Liese A, Draznin B, Mayer-Davis EJ, Hamman RF, Dabelea D. Reduced insulin sensitivity in youth with type 1 and type 2 diabetes. Abstract 1804-P 68th Scientific Sessions ADA, 2008.Google Scholar
  41. 14.
    Nadeau KJ, Sorenson E, Brown M, Zeitler PS, Draznin B, Reusch J, Regensteiner JG. Exercise function is abnormal in adolescents with type 1 and type 2 diabetes. Oral Presentation 327-OR 68th Scientific Sessions ADA, 2008.Google Scholar
  42. 42.
    Libby P, Nathan DM, Abraham K, Brunzell JD, Fradkin JE, Haffner SM, Hsueh W, Rewers M, Roberts BT, Savage PJ, Skarlatos S, Wassef M, Rabadan-Diehl C. Report of the National Heart, Lung, and Blood Institute-National Institute of Diabetes and Digestive and Kidney Diseases Working Group on Cardiovascular Complications of Type 1 Diabetes Mellitus. Circulation 2005 June 28;111(25):3489–93.PubMedCrossRefGoogle Scholar
  43. 43.
    Epidemiology of severe hypoglycemia in the diabetes control and complications trial. The DCCT Research Group. Am J Med 1991 April;90(4):450–9.Google Scholar
  44. 44.
    Chase HP, Dixon B, Pearson J, Fiallo-Scharer R, Walravens P, Klingensmith G, Rewers M, Garg SK. Reduced hypoglycemic episodes and improved glycemic control in children with type 1 diabetes using insulin glargine and neutral protamine Hagedorn insulin. J Pediatr 2003 December;143(6):737–40.PubMedCrossRefGoogle Scholar
  45. 45.
    MacDonald MJ. Postexercise late-onset hypoglycemia in insulin-dependent diabetic patients. Diabetes Care 1987 September;10(5):584–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Davis EA, Keating B, Byrne GC, Russell M, Jones TW. Hypoglycemia: incidence and clinical predictors in a large population- based sample of children and adolescents with IDDM. Diabetes Care 1997 January;20(1):22–5.PubMedCrossRefGoogle Scholar
  47. 47.
    McMahon SK, Ferreira LD, Ratnam N, Davey RJ, Youngs LM, Davis EA, Fournier PA, Jones TW. Glucose requirements to maintain euglycemia after moderate-intensity afternoon exercise in adolescents with type 1 diabetes are increased in a biphasic manner. J Clin Endocrinol Metab. 2007 March;92(3):963–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Banarer S, Cryer PE. Sleep-related hypoglycemia-associated autonomic failure in type 1 diabetes: reduced awakening from sleep during hypoglycemia. Diabetes 2003 May;52(5):1195–203.PubMedCrossRefGoogle Scholar
  49. 49.
    Cryer PE. Diverse causes of hypoglycemia-associated autonomic failure in diabetes. N Engl J Med 2004 May 27;350(22):2272–9.PubMedCrossRefGoogle Scholar
  50. 50.
    Cryer PE. Mechanisms of hypoglycemia-associated autonomic failure and its component syndromes in diabetes. Diabetes 2005 December;54(12):3592–601.PubMedCrossRefGoogle Scholar
  51. 51.
    Tsalikian E, Kollman C, Tamborlane WB, Beck RW, Fiallo-Scharer R, Fox L, Janz KF, Ruedy KJ, Wilson D, Xing D, Weinzimer SA. Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin. Diabetes Care 2006 October;29(10):2200–4.PubMedCrossRefGoogle Scholar
  52. 52.
    Strong WB, Malina RM, Blimkie CJ, Daniels SR, Dishman RK, Gutin B, Hergenroeder AC, Must A, Nixon PA, Pivarnik JM, Rowland T, Trost S, Trudeau F. Evidence based physical activity for school-age youth. J Pediatr 2005 June;146(6):732–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Silverstein J, Klingensmith G, Copeland K, Plotnick L, Kaufman F, Laffel L, Deeb L, Grey M, Anderson B, Holzmeister LA, Clark N. Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. Diabetes Care 2005 January;28(1):186–212.PubMedCrossRefGoogle Scholar
  54. 54.
    Wolfsdorf JI. Children with diabetes benefit from exercise. Arch Dis Child 2005 December;90(12):1215–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Internet Communication 2007. Accessed January 1, 2007. http://www.diabetes.org
  56. 56.
    Guelfi KJ, Jones TW, Fournier PA. Intermittent high-intensity exercise does not increase the risk of early postexercise hypoglycemia in individuals with type 1 diabetes. Diabetes Care 2005 February;28(2):416–8.PubMedCrossRefGoogle Scholar
  57. 57.
    Guelfi KJ, Jones TW, Fournier PA. The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes. Diabetes Care 2005 June;28(6):1289–94.PubMedCrossRefGoogle Scholar
  58. 58.
    Bussau VA, Ferreira LD, Jones TW, Fournier PA. The 10-s maximal sprint: a novel approach to counter an exercise-mediated fall in glycemia in individuals with type 1 diabetes. Diabetes Care 2006 March;29(3):601–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Riddell M, Iscoe K. Physical activity, sport, and pedaitric diabetes. Pediatr Diabetes 2006;7:60–70.PubMedCrossRefGoogle Scholar
  60. 60.
    Chase HP, Dixon B, Pearson J, Fiallo-Scharer R, Walravens P, Klingensmith G, Rewers M, Garg SK. Reduced hypoglycemic episodes and improved glycemic control in children with type 1 diabetes using insulin glargine and neutral protamine Hagedorn insulin. J Pediatr 2003 December;143(6):737–40.PubMedCrossRefGoogle Scholar
  61. 61.
    Admon G, Weinstein Y, Falk B, Weintrob N, Benzaquen H, Ofan R, Fayman G, Zigel L, Constantini N, Phillip M. Exercise with and without an insulin pump among children and adolescents with type 1 diabetes mellitus. Pediatrics 2005 September;116(3):e348–55.PubMedCrossRefGoogle Scholar
  62. 62.
    Hovorka R. Continuous glucose monitoring and closed-loop systems. Diabet Med 2006 January;23(1):1–12.PubMedCrossRefGoogle Scholar
  63. 63.
    Shalitin S, Phillip M. Closing the loop: combining insulin pumps and glucose sensors in children with type 1 diabetes mellitus. Pediatr Diabetes 2006 August;7(Suppl. 4):45–9.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • David Maahs
    • 1
  • Craig E. Taplin
    • 1
  • Rosanna Fiallo-Scharer
    • 1
  1. 1.Division of EndocrinologyDepartment of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado DenverAuroraUSA

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