Safer exercise advice for people with diabetes may prevent hypoglycaemia

People with type 1 diabetes may be able to avoid blood sugar dips at night after exercising in the evening by reducing their insulin dosage.

Dangerous falls in blood sugar levels, known as hypoglycaemia, can happen after exercise as the activity alters the body’s sensitivity to insulin and accelerates its effect.

Dr Dan West, a Senior Lecturer in Sport, Exercise and Rehabilitation, and his PhD student Matthew Campbell, who is now a Senior Research Associate in the department at Northumbria University, set out to test whether altering diet and insulin doses could help to prevent this potentially life-threatening problem.

Dr West said: “The fear of experiencing a dangerous blood sugar dip after exercise can prevent people with diabetes from exercising altogether – which has both physical and psychological implications.

“We have developed a strategy to manage insulin dosage in a way that prevents these falls in blood sugar so that people with diabetes can exercise safely.”

Anyone can experience hypoglycaemia, or hypo for short, but people with type 1 diabetes are particularly vulnerable. During a hypo blood sugar is used up too quickly, which means it can rapidly drop hours after exercising – particularly during the night when it is most dangerous.

The two-part study was carried out at the Royal Victoria Infirmary’s National Institute Health Research (NIHR) Clinical Research Facility in Newcastle in collaboration with Professors Mark Walker and James Shaw (who is currently funded by DRWF) and looked at the effects of adjusting slow-acting insulin levels in a group of 10 male participants with type 1 diabetes.

Blood sugar levels were monitored using a continuous glucose monitor which sits underneath the skin and has an alarm which is trigged if levels begin to fall dangerously.

In the first test, all participants took a normal slow-acting insulin dose and then completed a 45 minute exercise session at 6pm in the evening. Around 7-8 hours after the exercise, 90% of the patients experienced a blood sugar dip, all of which occurred whilst they were sleeping. 

During the second test, the insulin dose was reduced by 20% and participants took part in the same evening exercise session. This time, however, none of those taking part in the study suffered from drops in blood sugar.

Unexpectedly, the study also found that the 20% reduction of insulin not only prevented blood sugar from falling but also stopped blood sugar levels from rising too high. With this dose, levels remained within the ideal healthy range, and other important markers such as ketones (acid remaining when the body burns its own fat) and inflammatory cytokines (small proteins) were not affected. This was a particularly important finding as clinicians are often reluctant to change treatment regimens because of potentially exposing patients to these consequences.

Matthew said: “We are offering a pragmatic approach to a highly-relevant clinical issue, which is supported by robust scientific research.

“I have worked closely with those affected by diabetes and I’ve seen first-hand how this research could directly improve their lives. As researchers, it is important that the discoveries we make in the laboratory can be translated into clinical practice.”

Researchers at Northumbria University are exploring how to make exercise safer for people with diabetes

The researchers now intend to look at the education of people with diabetes who want to exercise and research the impact this could have on people’s lifestyles.

Dr West added: “I have close friends with type 1 diabetes and it is an incredibly difficult condition to live with. The whole team has worked very hard in carrying out this applied, practical research in a way which is accessible and relevant to people with diabetes. The result is research which has the potential to make a really positive change to the lives of those living with diabetes.”

For more information on Sport, Exercise and Rehabilitation courses at Northumbria University visit www.northumbria.ac.uk/exercise

Read the DRWF leaflet Exercise and diabetes

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