EXERCISE-INDUCED HYPOGLYCEMIA IN IDDM PATIENTS TREATED WITH A SHORT-ACTING INSULIN ANALOG

In order to examine the effect of short-acting insulin analogue on the exercise-induced hypoglycaemia in insulin-dependent diabetes mellitus (IDDM) patients we compared the glycaemic response of 40 min cycle er gometer exercise performed either shortly (40 min) or later (180 min) after a breakfast meal and subcutaneous injection of either short-acti ng insulin analogue [Lys(B28) Pro(B29)] or soluble human insulin (Humu lin Regular) in ten IDDM patients with long duration of the disease. B oth preparations had been used 1 month before respective studies. Chan ges in blood glucose, insulin and counterregulatory hormones were assa yed. As compared to human insulin, after the analogue injection the pe ak insulin concentration came earlier, was 56% higher (p < 0.05) and d isappeared faster, and the postprandial blood glucose response was low er (p < 0.05). In the analogue-treated patients the exercise-induced h ypoglycaemia was 2.2-fold greater (p < 0.01) during the early exercise , but 46% less (p < 0.05) during late exercise as compared to the trea tment with human insulin. Serum insulin or analogue concentration at t he beginning of the exercise correlated closely with the fall in blood glucose during exercise (r = 0.74, p < 0.01; r = 0.73, p < 0.02, resp ectively). In the analogue-treated patients, fasting serum glucagon an d adrenalin concentrations were higher than during human insulin thera py (p < 0.05) and remained so throughout the study. As compared to sol uble human insulin, a much faster absorption of insulin analogue: 1) r educes post-prandial hyperglycaemia, 2) can either augment or reduce e xercise-induced hypoglycaemia depending on the time interval between i nsulin injection and the time of exercise. Since exercise is usually n ot performed until 2-3 h after a meal, short-acting insulin analogue m ay be more feasible than soluble human insulin for active IDDM patient s.