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A Low-Glycemic Index Meal and Bedtime Snack Prevents Postprandial Hyperglycemia and Associated Rises in Inflammatory Markers, Providing Protection From Early but Not Late Nocturnal Hypoglycemia Following Evening Exercise in Type 1 Diabetes

Lookup NU author(s): Professor Mark Walker, Professor Mike TrenellORCiD, Professor Emma Stevenson, Professor James Shaw, Dr Daniel WestORCiD

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Abstract

OBJECTIVETo examine the influence of the glycemic index (GI) of foods consumed after evening exercise on postprandial glycemia, metabolic and inflammatory markers, and nocturnal glycemic control in type 1 diabetes.RESEARCH DESIGN AND METHODSOn two evenings (similar to 1700 h), 10 male patients (27 +/- 5 years of age, HbA(1c) 6.7 +/- 0.7% [49.9 +/- 8.1 mmol/mol]) were administered a 25% rapid-acting insulin dose with a carbohydrate bolus 60 min before 45 min of treadmill running. At 60 min postexercise, patients were administered a 50% rapid-acting insulin dose with one of two isoenergetic meals (1.0 g carbohdyrate/kg body mass [ BM]) matched for macronutrient content but of either low GI (LGI) or high GI (HGI). At 180 min postmeal, the LGI group ingested an LGI snack and the HGI group an HGI snack (0.4 g carbohdyrate/kg BM) before returning home (similar to 2300 h). Interval samples were analyzed for blood glucose and lactate; plasma glucagon, epinephrine, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha); and serum insulin, cortisol, nonesterified fatty acid, and w beta-hydroxybutyrate concentrations. Interstitial glucose was recorded for 20 h postlaboratory attendance through continuous glucose monitoring.RESULTSFollowing the postexercise meal, an HGI snack induced hyperglycemia in all patients (mean 6 SD glucose 13.5 +/- 3.3 mmol/L) and marked increases in TNF-a and IL-6, whereas relative euglycemia was maintained with an LGI snack (7.7 +/- 2.5 mmol/L, P < 0.001) without inflammatory cytokine elevation. Both meal types protected all patients from early hypoglycemia. Overnight glycemia was comparable, with a similar incidence of nocturnal hypoglycemia (n = 5 for both HGI and LGI).CONCLUSIONSConsuming LGI food with a reduced rapid-acting insulin dose following evening exercise prevents postprandial hyperglycemia and inflammation and provides hypoglycemia protection for similar to 8 h postexercise; however, the risk of late nocturnal hypoglycemia remains.

Publication metadata

Author(s): Campbell MD, Walker M, Trenell MI, Stevenson EJ, Turner D, Bracken RM, Shaw JA, West DJ

Publication type: Article

Publication status: Published

Journal: Diabetes Care

Year: 2014

Volume: 37

Issue: 7

Pages: 1845-1853

Print publication date: 01/07/2014

Online publication date: 01/05/2014

Acceptance date: 18/03/2014

ISSN (print): 0149-5992

ISSN (electronic): 1935-5548

Publisher: American Diabetes Association

URL: http://dx.doi.org/10.2337/dc14-0186

DOI: 10.2337/dc14-0186

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