It appears that mini-dose glucagon (MDG) can prevent exercise-induced hypoglycemia in people with type 1 diabetes. What’s more, results from the T1D Exchange Clinic Network, collected by the Jaeb Center of Health Research, show that glucagon may result in less subsequent hyperglycemia, as compared to ingestion of carbohydrates, which has traditionally been used to counter the blood sugar effects of aerobic exercise.
The news brings a welcome alternative to the type 1 diabetes community, in which exercise is particularly difficult, due to the risk of exercise-induced hypoglycemia and the complexity one has to manage to prevent it. Still, regular physical activity and structured exercise are associated with lower HbA1c levels and reduced prevalence of diabetes complications, such as retinopathy—not to mention the sense of wellness upon being fit.
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For the study, 15 physically active adult individuals with type 1 diabetes—who were on continuous subcutaneous insulin infusion or “pump” therapy—engaged in four 45-minute morning exercise sessions, each with a different intervention. After fasting overnight, participants walked briskly on a treadmill after having had their basal insulin reduced by half, ingested 40 g oral glucose tablets, received 150µg subcutaneous MDG (G-Pen Mini, provided by Xeris Pharmaceuticals), or had no intervention.
Results showed that during exercise and its early recovery, participants’ plasma glucose increased slightly with MDG. Blood sugar increased more with glucose tablets and decreased with control or insulin reduction. Insulin levels did not differ among sessions, while blood glucagon increased with MDG administration.
Six of the participants experienced hypoglycemia (plasma glucose <70 mg/dL) during control sessions; five subjects during insulin reduction, and none with glucose tablets or MDG. Five of the participants experienced hyperglycemia (plasma glucose ≥250 mg/dL) with glucose tablets and one with MDG.
Overall, the T1D Exchange Mini-Dose Glucagon Exercise Study Group concluded that glucagon is a good alternative to the ingestion of carbohydrates to prevent exercise induced hypoglycemia, in part because MDG produced less episodes of subsequent hyperglycemia, post intervention. Glucagon also won favor because it can be administered at the time of exercise and avoids additional caloric intake, at odds with body weight goals. While the study’s authors admit there may be other better alternatives not tested in this study, still they hope that MDG will help motivate individuals to exercise more and better achieve their ideal body weight.
Results were published in the journal Diabetes Care here.