Extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin adjustments in individuals with type 1 diabetes

Abstract Aim To detail the extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin dose adjustments in individuals with type 1 diabetes (T1D) using multiple daily injections of insulins aspart (IAsp) and degludec (IDeg). Methods Sixteen individuals with T1D, completed a single-centred, randomised, four-period crossover trial consisting of 23-hour inpatient phases. Participants administered either a regular (100%) or reduced (50%) dose (100%; 5.1±2.4, 50%; 2.6±1.2 IU, p Results Inclusion of a 50% IAsp dose reduction strategy prior to evening exercise reduced the occurrence of in-exercise hypoglycemia (p=0.023). Mimicking this reductive strategy in the post-exercise period decreased risk of nocturnal hypoglycemia (p=0.045). Combining this strategy to reflect reductions either side of exercise resulted in higher glucose concentrations in the acute post-exercise (p=0.034), nocturnal, (p=0.001) and overall (p Conclusions These findings demonstrate the glycemic safety of peri-exercise bolus dose reduction strategies in minimising the prevalence of acute and nocturnal hypoglycemia following evening exercise in people with T1D on MDI. Use of newer background insulins with current bolus insulins demonstrates efficacy and advances current recommendations for safe performance of exercise. Clinical Trials Register DRKS00013509.