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TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med...
Transcript of TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med...
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TYPE 1 DIABETES: Aerobic Exercise
Dr. Matthew D. Campbell
Ph.D, ACSM CEP, BSc (hons)
www.researchgate.net/profile/Matthew_Campbell6
@Campbell_MD
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Glucose
Inte
rstitia
l g
luco
se
(m
mo
l.l-1
)
2
3
4
5
6
7
8
9
141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24
Time (hours)
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Glucose
Inte
rstitia
l g
luco
se
(m
mo
l.l-1
)
2
3
4
5
6
7
8
9
141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24
Time (hours)
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Glucose
Inte
rstitia
l g
luco
se
(m
mo
l.l-1
)
2
3
4
5
6
7
8
9
141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24
Time (hours)
0
10
20
30
40
50
160
170
Se
rum
insu
lin (
pm
ol.l-1
)
Insulin
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Glucose
Inte
rstitia
l g
luco
se
(m
mo
l.l-1
)
2
3
4
5
6
7
8
9
141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24
Time (hours)
0
10
20
30
40
50
160
170
Se
rum
insu
lin (
pm
ol.l-1
)
Insulin
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Glucose
Inte
rstitia
l g
luco
se
(m
mo
l.l-1
)
2
3
4
5
6
7
8
9
141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24
Time (hours)
0
10
20
30
40
50
160
170
Se
rum
insu
lin (
pm
ol.l-1
)
Insulin
I’M HUNGRY
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Glucose
Inte
rstitia
l g
luco
se
(m
mo
l.l-1
)
2
3
4
5
6
7
8
9
141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24
Time (hours)
0
10
20
30
40
50
160
170
Se
rum
insu
lin (
pm
ol.l-1
)
Insulin
I’M HUNGRY
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Glucose
Inte
rstitia
l g
luco
se
(m
mo
l.l-1
)
2
3
4
5
6
7
8
9
141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24
Time (hours)
0
10
20
30
40
50
160
170
Se
rum
insu
lin (
pm
ol.l-1
)
Insulin
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Glucose
Inte
rstitia
l g
luco
se
(m
mo
l.l-1
)
2
3
4
5
6
7
8
9
141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24
Time (hours)
0
10
20
30
40
50
160
170
Se
rum
insu
lin (
pm
ol.l-1
)
Insulin
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Glucose
I’M HUNGRY
Inte
rstitia
l g
luco
se
(m
mo
l.l-1
)
2
3
4
5
6
7
8
9
141 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24
Time (hours)
0
10
20
30
40
50
160
170
Se
rum
insu
lin (
pm
ol.l-1
)
Insulin
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Inte
rstitia
l g
luco
se
(m
mo
l.l-1
)
2
5
8
11
14
17
20
23
14Rest 1 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24
Time (hours post-exercise)
Glucose concentrations
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Inte
rstitia
l g
luco
se
(m
mo
l.l-1
)
2
5
8
11
14
17
20
23
14Rest 1 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24
Time (hours post-exercise)
Glucose concentrations
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Glucose concentrations
Inte
rstitia
l g
luco
se
(m
mo
l.l-1
)
2
5
8
11
14
17
20
23
14Rest 1 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24
Time (hours post-exercise)
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Glucose concentrations
Inte
rstitia
l g
luco
se
(m
mo
l.l-1
)
2
5
8
11
14
17
20
23
14Rest 1 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24
Time (hours post-exercise)
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13:00 14:00
Rest 0 5 15 30 60
Sample Point (minutes)
Scan J Med Sci Sports 2015: 25:216-222
DOI: 10.1111/sms.12193
Blo
od
glu
cose
(m
mo
l.l-1
)
-6
-5
-4
-3
-2
-1
0
1
2
Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic
responses in T1DM patients
M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN
![Page 18: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/18.jpg)
13:00 14:00
Sample Point (minutes)
Aerobic
Blo
od
glu
cose
(m
mo
l.l-1
)
-6
-5
-4
-3
-2
-1
0
1
2
Rest 0 5 15 30 60
Scan J Med Sci Sports 2015: 25:216-222
DOI: 10.1111/sms.12193
Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic
responses in T1DM patients
M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN
![Page 19: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/19.jpg)
13:00 14:00
Sample Point (minutes)
Aerobic
Blo
od
glu
cose
(m
mo
l.l-1
)
-6
-5
-4
-3
-2
-1
0
1
2
Rest 0 5 15 30 60
Scan J Med Sci Sports 2015: 25:216-222
DOI: 10.1111/sms.12193
Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic
responses in T1DM patients
M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN
![Page 20: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/20.jpg)
13:00 14:00
Sample Point (minutes)
Aerobic
Blo
od
glu
cose
(m
mo
l.l-1
)
-6
-5
-4
-3
-2
-1
0
1
2
Rest 0 5 15 30 60
Scan J Med Sci Sports 2015: 25:216-222
DOI: 10.1111/sms.12193
EAT CHO
Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic
responses in T1DM patients
M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN
![Page 21: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/21.jpg)
13:00 14:00
Sample Point (minutes)
Aerobic
Blo
od
glu
cose
(m
mo
l.l-1
)
-6
-5
-4
-3
-2
-1
0
1
2
Rest 0 5 15 30 60
Scan J Med Sci Sports 2015: 25:216-222
DOI: 10.1111/sms.12193
Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic
responses in T1DM patients
M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN
EAT CHO REDUCE IU
![Page 22: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/22.jpg)
Inte
rsti
tial
glu
cose
(m
mo
l.l-1
)
14:00 23:00 14:00
1 3 5 7 9 11 13 15 17 19 21 23
Time (hours post-exercise)
2
4
6
8
10
12
14
16
18Aerobic
Scan J Med Sci Sports 2015: 25:216-222
DOI: 10.1111/sms.12193
Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic
responses in T1DM patients
M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN
![Page 23: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/23.jpg)
Inte
rsti
tial
glu
cose
(m
mo
l.l-1
)
14:00 23:00 14:00
1 3 5 7 9 11 13 15 17 19 21 23
Time (hours post-exercise)
2
4
6
8
10
12
14
16
18Aerobic
Scan J Med Sci Sports 2015: 25:216-222
DOI: 10.1111/sms.12193
Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic
responses in T1DM patients
M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN
![Page 24: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/24.jpg)
Inte
rsti
tial
glu
cose
(m
mo
l.l-1
)
14:00 23:00 14:00
1 3 5 7 9 11 13 15 17 19 21 23
Time (hours post-exercise)
2
4
6
8
10
12
14
16
18Aerobic
Scan J Med Sci Sports 2015: 25:216-222
DOI: 10.1111/sms.12193
Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic
responses in T1DM patients
M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN
![Page 25: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/25.jpg)
Inte
rsti
tial
glu
cose
(m
mo
l.l-1
)
14:00 23:00 14:00
1 3 5 7 9 11 13 15 17 19 21 23
Time (hours post-exercise)
2
4
6
8
10
12
14
16
18Aerobic
Scan J Med Sci Sports 2015: 25:216-222
DOI: 10.1111/sms.12193
Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic
responses in T1DM patients
M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN
EAT CHO
![Page 26: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/26.jpg)
Inte
rsti
tial
glu
cose
(m
mo
l.l-1
)
14:00 23:00 14:00
1 3 5 7 9 11 13 15 17 19 21 23
Time (hours post-exercise)
2
4
6
8
10
12
14
16
18Aerobic
Scan J Med Sci Sports 2015: 25:216-222
DOI: 10.1111/sms.12193
Simulated games activity vs continuous running exercise: a novel comparison of the glycemic and metabolic
responses in T1DM patients
M.D.CAMPBELL, D.J.WEST, S.C.BAIN, M.I.C.KINGSLEY, P.FOLEY, L.KILDUFF, D.TURNER, B.GRAY, J.W.STEPHENS, R.M.BRACKEN
EAT CHO REDUCE IU
![Page 27: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/27.jpg)
CONSUME 1.g.Kg-1
OF CARBOHYDRATE
60 MINUTES
BEFORE EXERCISE
REDUCE RAPID-
ACTING INSULIN BY
~75%
CONSUME 1.g.Kg-1
OF LOW GI
CARBOHYDRATE 60
MINUTES AFTER
EXERCISE
REDUCE RAPID-
ACTING INSULIN BY
~50%
CONSUME 0.3.g.Kg-1
OF LOW GI
CARBOHYDRATE
BEFORE SLEEPING
OMIT PRANDIAL
INSULIN
ADMINISTRATION
1 2 3APPLY A ~20%
REDUCTION TO
TOTAL-DAILY
BASAL INSULIN
DOSE IN ADDITION
TO PRANDIAL
ADJUSTMENTS
4How to manage
aerobic exercise in
4 steps
![Page 28: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/28.jpg)
Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-
onset hypoglycemia in patients with type 1 diabetes
M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST
Blo
od
glu
cose
(m
mo
l.l-1
)
08:00 10:45
Rest 60 0 15 30 60
Sample Point (Minutes)
Diabetes Care 2013: 36:2217-2224
DOI: 10.2337/dc13-2467
2
4
6
8
10
12
14
16
18
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Blo
od
glu
cose
(m
mo
l.l-1
)
08:00 10:45
Rest 60 0 15 30 60
Sample Point (Minutes)
2
4
6
8
10
12
14
16
18
Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-
onset hypoglycemia in patients with type 1 diabetes
M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST
Diabetes Care 2013: 36:2217-2224
DOI: 10.2337/dc13-2467
![Page 30: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/30.jpg)
Blo
od
glu
cose
(m
mo
l.l-1
)
08:00 10:45
Rest 60 0 15 30 60
Sample Point (Minutes)
2
4
6
8
10
12
14
16
18
Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-
onset hypoglycemia in patients with type 1 diabetes
M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST
Diabetes Care 2013: 36:2217-2224
DOI: 10.2337/dc13-2467
![Page 31: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/31.jpg)
Blo
od
glu
cose
(m
mo
l.l-1
)
Rest 60 0 15 30 60 90 120 150 180 210 240
Sample Point (Minutes)
2
4
6
8
10
12
14
16
1808:00 10:45 13:45
100% Dose
75% Dose
50% Dose
Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-
onset hypoglycemia in patients with type 1 diabetes
M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST
Diabetes Care 2013: 36:2217-2224
DOI: 10.2337/dc13-2467
![Page 32: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/32.jpg)
Blo
od
glu
cose
(m
mo
l.l-1
)
08:00 10:45 13:45
Rest 60 0 15 30 60 90 120 150 180 210 240
Sample Point (Minutes)
2
4
6
8
10
12
14
16
18
*
** *
100% Dose
75% Dose
50% Dose
Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-
onset hypoglycemia in patients with type 1 diabetes
M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST
Diabetes Care 2013: 36:2217-2224
DOI: 10.2337/dc13-2467
![Page 33: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/33.jpg)
Blo
od
glu
cose
(m
mo
l.l-1
)
08:00 10:45 13:45
Rest 60 0 15 30 60 90 120 150 180 210 240
Sample Point (Minutes)
2
4
6
8
10
12
14
16
18
*
** *
100% Dose
75% Dose
50% Dose
Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-
onset hypoglycemia in patients with type 1 diabetes
M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST
Diabetes Care 2013: 36:2217-2224
DOI: 10.2337/dc13-2467
![Page 34: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/34.jpg)
Inte
rsti
tial
glu
cose
(m
mo
l.l-1
)
4 6 8 10 12 14 16 18 20 22 24
2
4
6
8
10
12
14
16
18
Time (hours post-exercise)
15:00 23:00 09:00
* 100% Dose
75% Dose
50% Dose
Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-
onset hypoglycemia in patients with type 1 diabetes
M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST
Diabetes Care 2013: 36:2217-2224
DOI: 10.2337/dc13-2467
![Page 35: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/35.jpg)
Inte
rsti
tial
glu
cose
(m
mo
l.l-1
)
4 6 8 10 12 14 16 18 20 22 24
2
4
6
8
10
12
14
16
18
Time (hours post-exercise)
15:00 23:00 09:00
* 100% Dose
75% Dose
50% Dose
Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-
onset hypoglycemia in patients with type 1 diabetes
M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST
Diabetes Care 2013: 36:2217-2224
DOI: 10.2337/dc13-2467
![Page 36: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/36.jpg)
Inte
rsti
tial
glu
cose
(m
mo
l.l-1
)
4 6 8 10 12 14 16 18 20 22 24
2
4
6
8
10
12
14
16
18
Time (hours post-exercise)
15:00 23:00 09:00
* 100% Dose
75% Dose
50% Dose
Large pre- and post-exercise rapid-acting insulin reduction preserve glycemia and prevent early- but not late-
onset hypoglycemia in patients with type 1 diabetes
M.D.CAMPBELL, M.WALKER, M.I.TRENELL, D.J.JAKOVLJEVIC, E.J.STEVENSON, R.M.BRACKEN, S.C.BAIN, D.J.WEST
Diabetes Care 2013: 36:2217-2224
DOI: 10.2337/dc13-2467
![Page 37: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/37.jpg)
Hypoglycaemia is preventable for <8 hours post-exercise
But at the cost of post-prandial hyperglycaemia
The risk of late-onset hypoglycaemia remains high
![Page 38: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/38.jpg)
What if CHO amount is increased?
What if CHO type is manipulated?
What if exercise is performed in the evening?
![Page 39: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/39.jpg)
Blo
od
glu
cose
(m
mo
l.l-1
)
17:00 19:45 22:45
Rest 60 0 15 30 60 90 120 150 180 210 240
Sample Point (Minutes)
Diabetes Care 2014: 37:1-9
DOI: 10.2337/dc14-0186
2
5
8
11
14
17
20
23
26
High GI
Low GI
A low-glycemic index meal and bedtime snack prevents postprandial hyperycemia and associated rises in inflammation,
providing protection from early but not late-nocturnal hypoglycemia after evening exercise in T1DM
M.D.CAMPBELL, M.WALKER, M.I.TRENELL, E.J.STEVENSON, D.TURNER, R.M.BRACKEN, J.A.SHAW, D.J.WEST
![Page 40: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/40.jpg)
Blo
od
glu
cose
(m
mo
l.l-1
)
17:00 19:45 22:45
Rest 60 0 15 30 60 90 120 150 180 210 240
Sample Point (Minutes)
2
5
8
11
14
17
20
23
26
High GI
Low GI
Diabetes Care 2014: 37:1-9
DOI: 10.2337/dc14-0186
A low-glycemic index meal and bedtime snack prevents postprandial hyperycemia and associated rises in inflammation,
providing protection from early but not late-nocturnal hypoglycemia after evening exercise in T1DM
M.D.CAMPBELL, M.WALKER, M.I.TRENELL, E.J.STEVENSON, D.TURNER, R.M.BRACKEN, J.A.SHAW, D.J.WEST
![Page 41: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/41.jpg)
Blo
od
glu
cose
(m
mo
l.l-1
)
17:00 19:45 22:45
Rest 60 0 15 30 60 90 120 150 180 210 240
Sample Point (Minutes)
2
5
8
11
14
17
20
23
26
*
*
**
*
High GI
Low GI
Diabetes Care 2014: 37:1-9
DOI: 10.2337/dc14-0186
A low-glycemic index meal and bedtime snack prevents postprandial hyperycemia and associated rises in inflammation,
providing protection from early but not late-nocturnal hypoglycemia after evening exercise in T1DM
M.D.CAMPBELL, M.WALKER, M.I.TRENELL, E.J.STEVENSON, D.TURNER, R.M.BRACKEN, J.A.SHAW, D.J.WEST
![Page 42: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/42.jpg)
Inte
rsti
tial
glu
cose
(m
mo
l.l-1
)
4 6 8 10 12 14 16 18 20 22 24
Time (hours post-exercise)
23:45 07:45 18:00
2
5
8
11
14
17
20
23
26
High GI
Low GI
Diabetes Care 2014: 37:1-9
DOI: 10.2337/dc14-0186
A low-glycemic index meal and bedtime snack prevents postprandial hyperycemia and associated rises in inflammation,
providing protection from early but not late-nocturnal hypoglycemia after evening exercise in T1DM
M.D.CAMPBELL, M.WALKER, M.I.TRENELL, E.J.STEVENSON, D.TURNER, R.M.BRACKEN, J.A.SHAW, D.J.WEST
![Page 43: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/43.jpg)
Inte
rsti
tial
glu
cose
(m
mo
l.l-1
)
4 6 8 10 12 14 16 18 20 22 24
Time (hours post-exercise)
23:45 07:45 18:00
2
5
8
11
14
17
20
23
26 *
High GI
Low GI
Diabetes Care 2014: 37:1-9
DOI: 10.2337/dc14-0186
A low-glycemic index meal and bedtime snack prevents postprandial hyperycemia and associated rises in inflammation,
providing protection from early but not late-nocturnal hypoglycemia after evening exercise in T1DM
M.D.CAMPBELL, M.WALKER, M.I.TRENELL, E.J.STEVENSON, D.TURNER, R.M.BRACKEN, J.A.SHAW, D.J.WEST
![Page 44: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/44.jpg)
Inte
rsti
tial
glu
cose
(m
mo
l.l-1
)
4 6 8 10 12 14 16 18 20 22 24
Time (hours post-exercise)
23:45 07:45 18:00
2
5
8
11
14
17
20
23
26 *
High GI
Low GI
A low-glycemic index meal and bedtime snack prevents postprandial hyperycemia and associated rises in inflammation,
providing protection from early but not late-nocturnal hypoglycemia after evening exercise in T1DM
M.D.CAMPBELL, M.WALKER, M.I.TRENELL, E.J.STEVENSON, D.TURNER, R.M.BRACKEN, J.A.SHAW, D.J.WEST
Diabetes Care 2014: 37:1-9
DOI: 10.2337/dc14-0186
![Page 45: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/45.jpg)
Hypoglycaemia is preventable for <8 hours post-exercise
And post-prandial hyperglycaemia can be minimised
Late-onset hypoglycaemia occurs irrespective of CHO amount or type
![Page 46: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/46.jpg)
What else can you try to avoid
late-onset hypoglycaemia?
![Page 47: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/47.jpg)
Does long-acting (basal) insulin play a role in late-onset hypoglycaemia?
Does manipulating long-acting (basal) insulin cause hyperglycaemia?
Does this comprehensive strategy carry wider clinical implications?
![Page 48: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/48.jpg)
Blo
od
glu
cose
(m
mo
l.l-1
)
17:00 19:45 22:45
Rest 60 0 15 30 60 90 120 150 180 210 240
Sample Point (Minutes)
BMJ Open Diabetes Research and Care 2015: 3;:e000085
DOI: 10.1136/bmjdrc-2015-000085
2
5
8
11
14
17
20
23
26
80% Basal Dose
100% Basal Dose
Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening
exercise in type 1 diabetes: a randomized controlled trial
M.D.CAMPBELL, M.WALKER, R.M.BRACKEN, D.TURNER, E.J.STEVENSON, J.T.GONZALEZ, J.A.SHAW, D.J.WEST
![Page 49: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/49.jpg)
Inte
rsti
tial
glu
cose
(m
mo
l.l-1
)
Time (hours post-exercise)
23:45 07:45 18:00
2
4
6
8
10
12
14
16
18
4 6 8 10 12 14 16 18 20 22 24
*
80% Basal Dose
100% Basal Dose
BMJ Open Diabetes Research and Care 2015: 3;:e000085
DOI: 10.1136/bmjdrc-2015-000085
Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening
exercise in type 1 diabetes: a randomized controlled trial
M.D.CAMPBELL, M.WALKER, R.M.BRACKEN, D.TURNER, E.J.STEVENSON, J.T.GONZALEZ, J.A.SHAW, D.J.WEST
![Page 50: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/50.jpg)
Inte
rsti
tial
glu
cose
(m
mo
l.l-1
)
Time (hours post-exercise)
23:45 07:45 18:00
2
4
6
8
10
12
14
16
18
4 6 8 10 12 14 16 18 20 22 24
*
80% Basal Dose
100% Basal Dose
BMJ Open Diabetes Research and Care 2015: 3;:e000085
DOI: 10.1136/bmjdrc-2015-000085
Insulin therapy and dietary adjustments to normalize glycemia and prevent nocturnal hypoglycemia after evening
exercise in type 1 diabetes: a randomized controlled trial
M.D.CAMPBELL, M.WALKER, R.M.BRACKEN, D.TURNER, E.J.STEVENSON, J.T.GONZALEZ, J.A.SHAW, D.J.WEST
![Page 51: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/51.jpg)
Adjusting basal-bolus insulin & CHO prevent early & late hypoglycaemia
Metabolic, hormonal, and inflammatory biomarkers unaffected
Strategy is easily tailored to the individual person
![Page 52: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/52.jpg)
CONSUME 1.g.Kg-1
OF CARBOHYDRATE
60 MINUTES
BEFORE EXERCISE
REDUCE RAPID-
ACTING INSULIN BY
~75%
CONSUME 1.g.Kg-1
OF LOW GI
CARBOHYDRATE 60
MINUTES AFTER
EXERCISE
REDUCE RAPID-
ACTING INSULIN BY
~50%
CONSUME 0.3.g.Kg-1
OF LOW GI
CARBOHYDRATE
BEFORE SLEEPING
OMIT PRANDIAL
INSULIN
ADMINISTRATION
1 2 3APPLY A ~20%
REDUCTION TO
TOTAL-DAILY
BASAL INSULIN
DOSE IN ADDITION
TO PRANDIAL
ADJUSTMENTS
4How to manage
aerobic exercise in
4 steps
![Page 53: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/53.jpg)
CONSUME 1.g.Kg-1
OF CARBOHYDRATE
60 MINUTES
BEFORE EXERCISE
REDUCE RAPID-
ACTING INSULIN BY
~75%
CONSUME 1.g.Kg-1
OF LOW GI
CARBOHYDRATE 60
MINUTES AFTER
EXERCISE
REDUCE RAPID-
ACTING INSULIN BY
~50%
CONSUME 0.3.g.Kg-1
OF LOW GI
CARBOHYDRATE
BEFORE SLEEPING
OMIT PRANDIAL
INSULIN
ADMINISTRATION
1 2 3APPLY A ~20%
REDUCTION TO
TOTAL-DAILY
BASAL INSULIN
DOSE IN ADDITION
TO PRANDIAL
ADJUSTMENTS
4
![Page 54: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/54.jpg)
CONSUME 1.g.Kg-1
OF CARBOHYDRATE
60 MINUTES
BEFORE EXERCISE
REDUCE RAPID-
ACTING INSULIN BY
~75%
CONSUME 1.g.Kg-1
OF LOW GI
CARBOHYDRATE 60
MINUTES AFTER
EXERCISE
REDUCE RAPID-
ACTING INSULIN BY
~50%
CONSUME 0.3.g.Kg-1
OF LOW GI
CARBOHYDRATE
BEFORE SLEEPING
OMIT PRANDIAL
INSULIN
ADMINISTRATION
1 2 3APPLY A ~20%
REDUCTION TO
TOTAL-DAILY
BASAL INSULIN
DOSE IN ADDITION
TO PRANDIAL
ADJUSTMENTS
4
![Page 55: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/55.jpg)
CONSUME 1.g.Kg-1
OF CARBOHYDRATE
60 MINUTES
BEFORE EXERCISE
REDUCE RAPID-
ACTING INSULIN BY
~75%
CONSUME 1.g.Kg-1
OF LOW GI
CARBOHYDRATE 60
MINUTES AFTER
EXERCISE
REDUCE RAPID-
ACTING INSULIN BY
~50%
CONSUME 0.3.g.Kg-1
OF LOW GI
CARBOHYDRATE
BEFORE SLEEPING
OMIT PRANDIAL
INSULIN
ADMINISTRATION
1 2 3APPLY A ~20%
REDUCTION TO
TOTAL-DAILY
BASAL INSULIN
DOSE IN ADDITION
TO PRANDIAL
ADJUSTMENTS
4
![Page 56: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/56.jpg)
CONSUME 1.g.Kg-1
OF CARBOHYDRATE
60 MINUTES
BEFORE EXERCISE
REDUCE RAPID-
ACTING INSULIN BY
~75%
CONSUME 1.g.Kg-1
OF LOW GI
CARBOHYDRATE 60
MINUTES AFTER
EXERCISE
REDUCE RAPID-
ACTING INSULIN BY
~50%
CONSUME 0.3.g.Kg-1
OF LOW GI
CARBOHYDRATE
BEFORE SLEEPING
OMIT PRANDIAL
INSULIN
ADMINISTRATION
1 2 3APPLY A ~20%
REDUCTION TO
TOTAL-DAILY
BASAL INSULIN
DOSE IN ADDITION
TO PRANDIAL
ADJUSTMENTS
4
![Page 57: TYPE 1 DIABETES. Matthew Camp… · 13:00 14:00 Rest 0 5 15 30 60 Sample Point (minutes) Scan J Med Sci Sports 2015: 25:216-222 DOI: 10.1111/sms.12193 mmol.l](https://reader034.fdocuments.us/reader034/viewer/2022050411/5f880fd9ccaff6731623d9fc/html5/thumbnails/57.jpg)
Does this work outside the lab?
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Inte
rstitia
l g
luco
se
(m
mo
l.l-1
)
Glucose concentrations
2
5
8
11
14
17
20
23
14Rest 1 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24
Time (hours post-exercise)
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Inte
rstitia
l g
luco
se
(m
mo
l.l-1
)
Glucose concentrations
2
5
8
11
14
17
20
23
14Rest 1 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 21 22 2312 24
Time (hours post-exercise)
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CONSUME 1.g.Kg-1
OF CARBOHYDRATE
60 MINUTES
BEFORE EXERCISE
REDUCE RAPID-
ACTING INSULIN BY
~75%
CONSUME 1.g.Kg-1
OF LOW GI
CARBOHYDRATE 60
MINUTES AFTER
EXERCISE
REDUCE RAPID-
ACTING INSULIN BY
~50%
CONSUME 0.3.g.Kg-1
OF LOW GI
CARBOHYDRATE
BEFORE SLEEPING
OMIT PRANDIAL
INSULIN
ADMINISTRATION
1 2 3APPLY A ~20%
REDUCTION TO
TOTAL-DAILY
BASAL INSULIN
DOSE IN ADDITION
TO PRANDIAL
ADJUSTMENTS
4