Физические нагрузки и гипогликемия при СД1

[die_arztin]

Вроде бы избито, однако откопала все в том же Davidson's Diabetes Mellitus вот такой пассаж:
For patients on injection (в противовес пациентам с помпами - Н.Ф.), the more time between insulin administration and exercise, the less a repository of subcutaneous insulin is present for enhanced absorption. Thus exercising before breakfast (and before the morning injection of insulin) is an effective way to minimize exercise-induced hypoglycemia.
То есть рассуждает автор вроде бы логично. Но мне эта рекомендация, тем не менее, представляется сомнительной. По крайней мере, мне кажется, не стоит рекомендовать такое ВСЕМ пациентам, получающим инъекции инсулина. В частности, мне это представляется неприемлемым для пациентов, получающих инсулин средней длительности действия (лантус, скажем, еще куда ни шло). Поскольку моя задача - отредактировать перевод этой славной книги так, чтобы не навредить пациентам наших потенциальнеых читателей, пока я ограничилась вот такой интерпретацией:
Чем больше времени проходит между инъекцией инсулина и началом упражнений, тем меньше риск усиленного всасывания инсулина из места инъекции. Следовательно, риск гипогликемии ниже всего, если больной делает утреннюю гимнастику до завтрака (и, соответственно, до инъекции инсулина).
Но, возможно, я неправа, а ошибиться не хотелось бы...

[Melnichenko]

Тут вроде бы следует как-то оговорить, что все рекомендации даются для лиц с хорошей компенсаций- а то начнут с утренней зарей бороться гимнастикой ... Наверно, это раньше в тексте было.
Между прочим вот такого прямого указания на то, что так уж сильно от утренней гимнастики ( а что еще делать с утра? ) усилиться всасывание из подкожного слоя живота ( а куда сейчас короткий-то вводят) я не встречала...Более того, большиство людей ходят в фитнес во второй половине дня, да и в саду не с утра копают.. Так что не знаю, по- моему. это уж совсем высший пилотаж.. И жизнь осложняет.Впрочем, пойду посмотрю..

[Melnichenko]

Нарыла ажник 15 ссылок

Вот, группа товарищей примерно такого же мнения, как и мы с Вами...Francescato MP, Geat M, Fusi S, Stupar G, Noacco C, Cattin L.
Department of Biomedical Sciences and Technology, University of Udine, Udine, Italy.

The lack in control of insulin release combined with an inadequate carbohydrate (CHO) ingestion accounts for the occurrence of frequent metabolic unbalances during exercise in type 1 diabetic patients. The aim of the study was to quantify, in these patients, the CHO requirement to prevent hypoglycemia during moderate exercise performed at different time intervals after morning subcutaneous insulin injection. Twelve type 1 diabetic patients and 12 well-matched healthy subjects cycled 4 times for 1 hour at a constant workload. The rate of glucose oxidation was calculated continuously by indirect calorimetry throughout the exercise, while blood parameters were assessed periodically and orally given CHO were checked. CHO needed by the patients to prevent hypoglycemia decreased as the time elapsed from insulin administration increased, amounting to 0.63 +/- 0.30, 0.44 +/- 0.32, 0.28 +/- 0.24, and 0.14 +/- 0.18 g/kg after 1, 2.5, 4, and 5.5 hours, respectively. Total glucose requirement during moderate exercise (sum of alimentary and extracellular source) was correlated (r = 0.739, P <.001) to plasma insulin concentration, but not with fitness level. Time elapsed from last insulin dose is not a factor influencing the risk of hypoglycemia during exercise when a proportional, appropriate amount of CHO is ingested.

[die_arztin]

Прочтя продолжение, могут и с утренней зарей побороться:
Some authorities suggest avoiding exercise if glucose levels are high (e.g., >250 mg/dl) or if ketosis is present.88 Although the principles behind this recommendation are sound (as discussed earlier), often this is not necessary for several reasons. Patients’ responses to exercise are variable and depend on, among other things, the intensity and duration of the exercise, as well as the timing of the previous insulin injection. This approach has been vindicated by a study in which only 5 of 74 episodes of exercise in patients with type 1 diabetes begun with blood glucose concentrations exceeding 300 mg/dl resulted in increased levels at the conclusion of the exercise.

[Melnichenko]

А до этого вопроса и мы сами могли бы додуматься....

Glycemic response during exercise after administration of insulin lispro compared with that after administration of regular human insulin.
Yamakita T, Ishii T, Yamagami K, Yamamoto T, Miyamoto M, Hosoi M, Yoshioka K, Sato T, Onishi S, Tanaka S, Fujii S.
Department of Internal Medicine, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, Japan.

To examine the glycemic response during exercise after administration of short-acting insulin lispro, we compared changes in plasma glucose concentrations during exercise performed by patients with diabetes after the administration of either insulin lispro or regular human insulin. Seven patients with diabetes (two with type 1 and five with type 2) participated in this study. Each of the insulin-depleted subjects received the same number of units of either insulin lispro or regular human insulin, delivered subcutaneously to the abdomen. The next day, each subject received a similar injection of the solution not previously administered. After each injection, the subjects were fed a standard meal of approximately 9 kcal/kg body weight. One hour after eating the test meal, the subjects performed 30 min of cycle ergometer exercise at 50% maximal oxygen uptake. Plasma glucose, insulin, glucagon, growth hormone (GH), and catecholamine concentrations were then measured at specific intervals. Insulin concentrations were higher and peaked earlier after administration of insulin lispro than after administration of regular human insulin. The length of time, needed to reach minimum plasma glucose concentration after exercise was begun, was significantly shorter after administration of insulin lispro, and the percentage of plasma glucose decrease induced by exercise relative to the peak concentration was significantly greater. No differences were found in the concentration changes of counterregulatory hormones between the insulin lispro data and the regular human insulin data. Compared with regular human insulin, insulin lispro induces a more rapid and greater decrease in plasma glucose concentration during exercise because of its faster absorption.