Abstract
International charities and health care organizations advocate regular physical activity for health benefit in people with type 1 diabetes. Clinical expert and international diabetes organizations’ position statements support the management of good glycemia during acute physical exercise by adjusting exogenous insulin and/or carbohydrate intake. Yet research has detailed, and patients frequently report, variable blood glucose responses following both the same physical exercise session and insulin to carbohydrate alteration. One important source of this variability is insulin delivery to the circulation. With modern insulin analogs, it is important to understand how different insulins, their delivery methods, and inherent physiological factors, influence the reproducibility of insulin absorption from the injection site into circulation. Furthermore, contrary to the adaptive pancreatic response to exercise in the person without diabetes, the physiological and metabolic shifts with exercise may increase circulating insulin concentrations that may contribute to exercise-related hyperinsulinemia and consequent hypoglycemia. Thus, a furthered understanding of factors underpinning insulin delivery may offer more confidence for healthcare professionals and patients when looking to improve management of glycemia around exercise.
Highlights
People with type 1 diabetes (T1D) are required to administer exogenous insulin via multiple daily insulin (MDI) regimen or automated pump therapy
Insulin absorption rate into circulation is influenced by different factors both at rest and during exercise
Compared to the same individual at rest, the exercise-induced increased appearance of insulin in the blood leads to a greater reduction in blood glucose
Summary
People with type 1 diabetes (T1D) are required to administer exogenous insulin via multiple daily insulin (MDI) regimen or automated pump therapy. For both delivery methods, insulin is administered into adipose tissue that lies beneath the dermal layers of the skin and above the musculoskeletal compartment. Insulin is administered into adipose tissue that lies beneath the dermal layers of the skin and above the musculoskeletal compartment Upon entering this subcutaneous layer, the injected insulin forms a depot, where it is at its highest concentration in the interstitium. Insulin molecules must dissociate into smaller monomer units to move across the capillary endothelium and enter the circulation.
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