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Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin
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, Diabetes Research in Children Network (DirecNet) Study Group
Diabetes Care 2006 Oct;29(10):2200-2204
clinical trial
4/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

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 to 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 about 4:00 to 5:00 pm, 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 versus 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 versus 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.
Copyright American Diabetes Association. Reprinted with permission from The American Diabetes Association.

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