Andrzej Gawrecki

Smoking and other factors associated with short-term partial remission of Type 1 diabetes in adults.

Diabet. Med. 29, 464–469 (2012)

High-intensity Exercise in Men with Type 1 Diabetes and Mode of Insulin Therapy

The purpose of this study was to evaluate the impact of high intensity exercise on glucose levels and risk of metabolic decompensation in males with type 1 diabetes (T1D), depending on the method of insulin administration. The study comprised 29 males (aged 25.3±5.1 years; duration of diabetes 10.3±3.2 years) treated with continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injections (MDI). Treadmill exercise test was performed twice in each patient until subjective exhaustion as maximum according to the Borg scale. All the patients achieved ≥85% of the maximal heart rate. Distance during the test was 4 500±1 400 m and 4 473±1 559 m in the MDI and CSII groups, respectively, which was achieved in 31±8 min. During the test and in the 6 h after, no clinically significant episodes of hypoglycemia occurred. Mean glucose levels did not exceed 10 mmol/L in most patients. The risk of the composite endpoint (hypoglycemia<3.8 mmol/L, hyperglycemia≥16.6 mmol/L, ketones≥0.6 mmol/L, and lactate>2.2 mmol/L) was higher in patients treated with MDI than CSII (OR3.75, 95%CI:1.22-11.52, p=0.02). In conclusion, planned high intensity physical effort in men with well-controlled T1D is metabolically safe. CSII shows greater metabolic advantage over MDI during and after high intensity exercise in men with T1D.

Proposals for therapeutic decisions according to glucose trends in patients with type 1 diabetes

Nowadays, self-management of diabetes is more and more often based on continuous and flash glucose monitoring systems. In addition to measuring current glucose levels, both systems provide blood glucose levels from the past few hours in the form of a graph, as well as an indication of glucose trends via arrows. This information adds a new dimension to the self-management of diabetes, and should result in the modification of diabetes therapy. The paper presents proposals for modifications of treatment decisions based on glucose trends in patients with type 1 diabetes. By considering glucose trends, it is hoped that glycemic variability and numbers of hypoglycemia and hyperglycemia episodes will be reduced.