Physical Activity to Prevent and Treat Hyperglycemia from a Mistimed Bolus Insulin Dose

Summary

People living with type 1 diabetes (PwT1D) are recommended to administer insulin 10-15 minutes before meal consumption (pre-bolus), to account for the delay in the glucose lowering action associated with subcutaneously administered insulin. Due to the demands of day-to-day life, pre-bolusing is not always possible or may be forgotten. With continuous glucose monitors (CGMs), PwT1D may be alerted to this missed insulin dose by a CGM alert, including rapidly rising glucose (change \>2.5mmol/L/15min) or hyperglycemia (\>10.0 mmol/L), and deliver a mistimed (post-prandial) dose in response to CGM alert. This study was designed to determine the effect of combining a post-prandial/mistimed insulin dose with 15 minutes of brisk walking. It is expected that walking will help to minimize or prevent hyperglycemia after a mistimed bolus insulin dose, as well as blunt the rise in glucose following a mistimed insulin dose.

Eligibility

Inclusion Criteria:

* Adults aged 18-24 years
* Type 1 diabetes diagnostic for at least two years
* Estimated glycated hemoglobin or glucose management indicator obtained from the past 30 days of CGM data of \< 9.9%
* Use a Dexcom G7 CGM in routine care

Exclusion Criteria:

* Changes in insulin management strategy within the past 2 months
* Diagnosis of gastroparesis
* Having a condition that could render exercise harmful
* Intolerance to gluten and lactose
* Having significant renal disease (e.g., eGRF \< 30 ml/min)
* Inability to provide informed consent due to cognitive deficit
* Currently taking other medications (other than insulin) that may alter glucose metabolism (e.g., non-insulin antihyperglycemic drugs such as sglt2-inhibitors, corticosteroids), unless dosages thereof have been stable for more than three months
* For women, being pregnant or breastfeeding

Conditions2

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