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Can Fasting Glucose Levels Or Post-breakfast Glucose Fluctuations Predict The Occurrence Of Nocturnal Asymptomatic Hypoglycemia In Type 1 Diabetic Patients Receiving Basal-bolus Insulin Therapy With Long-acting Insulin?

Abstract To investigate whether the occurrence of nocturnal asymptomatic hypoglycemia may be predicted based on fasting glucose levels and post-breakfast glucose fluctuations. The study subjects comprised type 1 diabetic patients who underwent CGM assessments and received basal-bolus insulin therapy with long-acting insulin. The subjects were evaluated for I) fasting glucose levels and II) the range of post-breakfast glucose elevation (from fasting glucose levels to postprandial 1- and 2-hour glucose levels). The patients were divided into those with asymptomatic hypoglycemia during nighttime and those without for comparison. Optimal cut-off values were also determined for relevant parameters that could predict nighttime hypoglycemia by using ROC analysis. Results 64 patients (mean HbA1c 8.7 ± 1.8%) were available for analysis. Nocturnal asymptomatic hypoglycemia occurred in 23 patients (35.9%). Fasting glucose levels (I) were significantly lower in those with hypoglycemia than those without (118 ± 35 mg/dL vs. 179 ± 65 mg/dL; P < 0.001). The range of post-breakfast glucose elevation (II) was significantly greater in those with hypoglycemia than in those without (postprandial 1- Continue reading >>

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  1. Stump86

    Why does Exercise increase Blood Glucose?

    Exercise is great for lowering glucose because glucose is a rapidly metabolized form of energy, and when you exercise your body needs energy quickly. More often than not exercise will lower glucose, but there are certain circumstances under which blood glucose (BG) can actually increase from exercise.
    Blood glucose can rise most commonly if your BG is too high when you start exercising or if you exercise very strenuously. Both of these rises are caused by the same reason, a deficit in necessary insulin to fund the activity.
    BG Too High:
    BG being too high always means that there is not enough insulin available to bring the BG down to where it should be. Whether T1 or T2, insufficient effective insulin can cause highs and exacerbate highs during exercise.
    When you exercise muscles need energy and the quickest form of energy is glucose. Muscles will increase their sensitivity temporarily during exercise so that the same amount of insulin can bring more glucose into muscle cells so that they can work. However, if there is insufficient insulin the muscles will not be able to receive enough glucose from the blood, even if there is more than enough glucose in the blood. As a result, the muscles send a signal that they need more energy, which the body responds to by releasing more glucose. However, since there is still not enough insulin, BG rises and the muscles continue to send the signal for more energy. This is why if your BG is high before exercising, exercise can drive your BG up rather than down, the reason is that there is not enough insulin.
    Exercise Strenuously:
    The same reasons as above are the reasons why very strenuous exercise causes an increase rather than a decrease in BG. During strenuous exercise the muscles send a signal for more energy, which the body responds to by releasing more glucose. Without sufficient insulin, very hard exercise and sometimes even novel exercise will cause a rise in BG.
    At rest, the body uses about 60% of its energy as fat and 40% as glucose. The harder you work, the less fat is used and the more glucose is used until you reach a state of anaerobic activity (weight lifting, fast sprinting) which uses 100% glucose. It is counterintuitive, but the harder you exercise the more insulin your body needs to deal with the increased amount of glucose being released for energy. Often by exercising at a less strenuous pace, can cause BG to decrease with exercise again.

  2. NicoleAnn

    Great Job Shaun.....

  3. MarkM

    Originally Posted by Stump86
    ... The harder you work, the less fat is used and the more glucose is used until you reach a state of anaerobic activity (weight lifting, fast sprinting) which uses 100% glucose. It is counterintuitive, but the harder you exercise the more insulin your body needs to deal with the increased amount of glucose being released for energy. Often by exercising at a less strenuous pace, can cause BG to decrease with exercise again. I am not so sure about this ....
    Let me explain ...
    When exercise becomes anaerobic, glucose burns without the benefit of oxygen. And up to 17 times more of it is required. Because such large amunts of glucose are not available from the bloodstream and via the insulin transport mechanism, it is taken directly from the glycogen stored in the muscle. Insulin is not needed for this. Insulin is used for the glucose to get into muscle cells so that it can be stored as glycogen. But it is not needed when glycogen derived glucose is burned in the muscle.
    The hormone Glucagon is required for glycogen to be turned into glucose, and it is secreted into the bloodstream when adrenalin levels go up. Glucose made in this way from muscle glycogen can not get into the bloodstream and is burned by the muscle in which it was stored. But Glycogen stored in the liver is converted to glucose at the same time (because of the glucagon surging through the veins), and this glucose goes directly into the bloodstream. This is why anaerobic exercise causes blood glucose to go up.
    Insulin requirements don't really come into it. Having said that, if insulin levels are low blood glucose is likely to rise sharply after anaerobic exercise. Lots of glucose is produced by the liver via gluconeogenesis so that glycogen stores can be rebuilt. And insulin is required for this.
    As far as the pattern of energy usage is concerned, glucose is the primary source during the first 15-20 minutes of aerobic exercise. Initially, 70% of energy comes from carbohydrates. But it turns around after 20 minutes, after which fat becomes the primary source of energy. After you have been exercising for a while, 70% of the energy used comes from fat. But if the exercise becomes anaerobic, glycogen reserves (which are essentially glucose) will be drawn on. And the muscles will use as much glucose as they need.

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