Published online August 31, 2005
PEDIATRICS Vol. 116 No. 3 September 2005, pp. e348-e355 (doi:10.1542/peds.2004-2428)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Admon, G.
Right arrow Articles by Phillip, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Admon, G.
Right arrow Articles by Phillip, M.
Related Collections
Right arrow Endocrinology

ELECTRONIC ARTICLE

Exercise With and Without an Insulin Pump Among Children and Adolescents With Type 1 Diabetes Mellitus

Gil Admon, MD, MHA*,{ddagger}, Yitzhak Weinstein, PhD§,||, Bareket Falk, PhD§, Naomi Weintrob, MD*,{ddagger}, Hadassa Benzaquen, CDE*, Ragina Ofan, BSN*, Gila Fayman, BSC*, Levana Zigel, BSC§, Naama Constantini, MD§ and Moshe Phillip, MD*,{ddagger}

* Institute for Endocrinology and Diabetes, National Center of Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
{ddagger} Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
§ Ribstein Center for Sport Medicine Sciences and Research, Wingate Institute, Netanya, Israel
|| Life Science Division, Ohalo College, Katzerin, Israel

Background. The use of insulin pumps is becoming a popular technique for insulin delivery among patients with type 1 diabetes mellitus (T1DM), but there is no consensus regarding the guidelines for proper pump use during exercise.

Objective. To investigate the physiologic responses and risk of hypoglycemia among children and adolescents with T1DM when exercising with the pump on (PO) (50% of the basal rate) or pump off (PF).

Methods. Ten subjects with T1DM (6 female subjects and 4 male subjects), 10 to 19 years of age, performed prolonged exercise (40–45 minutes) on a cycle ergometer ~2 hours after a standard breakfast and an insulin (Lispro) bolus. Complex carbohydrates (20 g) were provided before and after the exercise. Each patient exercised once with PO and once with PF, in a randomized, crossover (single-blind) manner. During exercise and 45 minutes of recovery, subjects were monitored for cardiorespiratory, metabolic, and hormonal responses. Blood glucose concentrations were recorded for 24 hours after exercise, with a continuous glucose monitoring system, to document late hypoglycemic events.

Results. During exercise, blood glucose concentrations decreased by 59 ± 58 mg/dL (mean ± SD: 29 ± 24%) with PF and by 74 ± 51 mg/dL (35.5 ± 18%) with PO (not significant). No significant differences were found in cortisol, growth hormone, or noradrenaline levels between PO and PF. There were no differences in cardiorespiratory parameters, blood lactate concentrations, or free fatty acids concentrations between pump modes. Hypoglycemic events during exercise were asymptomatic and occurred for 2 subjects with PO and 2 with PF. Nine subjects had late hypoglycemia after PO, compared with 6 after PF (not significant).

Conclusions. We found no advantage for subjects with either PO or PF during exercise, and we noted that late hypoglycemia was more common than hypoglycemia during exercise. However, PO was associated with a trend of increased risk for late hypoglycemia. We recommend that the pump be removed or turned off during prolonged exercise and that blood glucose concentrations be monitored for several hours after exercise, regardless of the pump mode.

Key Words: type 1 diabetes mellitus • children and adolescents • insulin pump • exercise • hypoglycemia • maximal oxygen consumption rate • VO2max

Abbreviations: CGMS, continuous glucose monitoring system • CSII, continuous subcutaneous insulin infusion • FFA, free fatty acid • GH, growth hormone • HR, heart rate • NA, noradrenaline • PF, pump off • PO, pump on • RER, respiratory exchange ratio • RPE, rate of perceived exertion • DM, diabetes mellitus • T1DM, type 1 diabetes mellitus • VO2max, maximal oxygen consumption rate • VE, expired ventilation

Accepted Mar 14, 2005.




This article has been cited by other articles:


Home page
 Diabetes CareHome page
S. Shalitin and M. Phillip
Hypoglycemia in Type 1 Diabetes: A still unresolved problem in the era of insulin analogs and pump therapy
Diabetes Care, February 1, 2008; 31(Supplement_2): S121 - S124.
[Abstract] [Full Text] [PDF]

Home page
 Diabetes CareHome page
M. Phillip, T. Battelino, H. Rodriguez, T. Danne, F. Kaufman, and for the Consensus forum participants
Use of Insulin Pump Therapy in the Pediatric Age-Group: Consensus statement from the European Society for Paediatric Endocrinology, the Lawson Wilkins Pediatric Endocrine Society, and the International Society for Pediatric and Adolescent Diabetes, endorsed by the American Diabetes Association and the European Association for the Study of Diabetes
Diabetes Care, June 1, 2007; 30(6): 1653 - 1662.
[Full Text] [PDF]