Risk of exercise-induced hypoglycaemia in patients with type 2 diabetes on intensive insulin therapy: Comparison of insulin glargine with NPH insulin as basal insulin supplement

Abstract

Aim Hypoglycaemia is the most common adverse event associated with intensive conventional insulin therapy (ICT). This study compared the risk of exercise-related hypoglycaemia in type 2 diabetes patients receiving either basal insulin glargine or NPH insulin. Methods In a prospective trial, 122 ICT patients (glargine n = 60, NPH n = 62) had a standardized treadmill test, monitored by capillary lactate concentration. Blood glucose (BG) profiles were performed the day before, during and the day after the exercise test, with the patients on a strict carbohydrate-defined diet. All patients had been on a stable ICT scheme for at least three months and had an HbA1c below 7.5%. Results BG at the beginning of the exercise test, BG decline and lowest BG during the test were comparable between the two groups. The episodes of mild hypoglycaemia (BG < 3.3 mmol/l) and amounts of additional carbohydrate intake due to mild symptoms of hypoglycaemia (BG 3.3–5.0 mmol/l) were not significantly different. No episodes of hypoglycaemia occurred during several hours after the exercise. Conclusions Moderate physical activity can be recommended for well-controlled type 2 diabetes patients receiving ICT, independently of glargine or NPH as basal insulin and without risk of exercise-induced hypoglycaemia.