Taking a very small dose of glucagon — the hormone that’s used to raise blood glucose when it gets dangerously low — before exercising led to a reduced risk of hypoglycemia (low blood glucose) in adults with type 1 diabetes, according to a new study published in the journal Diabetes Care.
Many people with diabetes — especially type 1 diabetes — are familiar with glucagon as part of an emergency injection kit for severe hypoglycemia. In this format, glucagon may come as a prefilled syringe that is used when a person cannot safely take a food, beverage, or glucose tablet to raise blood glucose levels. But researchers have increasingly been interested in exploring glucagon as a preventive treatment for hypoglycemia, taken in a smaller dose than is used for emergency treatment of hypoglycemia. While it isn’t always possible to know when you’re at risk for hypoglycemia, one situation in which hypoglycemia is more likely for many people with diabetes is during or following exercise. You may be able to reduce your risk for hypoglycemia related to exercise by doing certain types of activities at certain times of the day, by using a continuous glucose monitoring (CGM) system, or by making sure your overall diabetes treatment strategy isn’t too aggressive.
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For the latest study, researchers recruited adults with type 1 diabetes to look at the effect of taking glucagon before moderate- to high-intensity aerobic exercise. A total of 45 participants completed the study, which included being randomly assigned to one of three different treatment arms. Treatment arm A consisted of taking 150 micrograms of glucagon immediately before exercise, plus reducing the basal insulin delivery rate on an insulin pump by 50% for the duration of exercise. Treatment arm B consisted of taking a placebo (inactive injection) instead of glucagon while also reducing basal insulin delivery, and treatment arm C consisted of taking glucagon without reducing basal insulin delivery. All participants went through an in-clinic training phase before completing their assigned treatment in their day-to-day lives, during a period that lasted 12 weeks. They were instructed to do exercise sessions lasting between 30 and 75 minutes in whatever setting they preferred.
Glucagon treatment linked to lower rate of exercise-related hypoglycemia
During the main real-world phase of the study, participants completed a total of 795 exercise sessions. The researchers found that based on participants’ glucose self-monitoring, level 1 hypoglycemia (below 70 mg/dl) was less common in both of the glucagon treatment arms. The rate of level 1 hypoglycemia during exercise sessions was 12% for arm A (glucagon plus basal insulin reduction) and 16% for arm C (glucagon without basal insulin reduction). For arm B (placebo injection plus basal insulin reduction), the rate of level 1 hypoglycemia was 39%. There were no significant differences between the treatment arms for other outcomes, including time spent below the target glucose range, time in range, or time above range during a 300-minute period starting with the glucagon or placebo injection.
The researchers also found that participants consumed less glucose during or following exercise when they took glucagon beforehand, but not by a statistically significant amount. The rate of reported adverse events was similar in each of the treatment arms, suggesting that taking glucagon before exercise didn’t carry an increased risk for unpleasant or dangerous side effects.
The researchers concluded that taking a mini-dose of glucagon before aerobic exercise, with or without reducing basal insulin delivery, may help adults with type 1 diabetes reduce the risk of exercise-associated hypoglycemia. Future studies may shed light on the optimal dose of glucagon to reduce the risk for hypoglycemia during exercise, while limiting any spike in glucose that could result from taking the hormone.
Want to learn more about hypoglycemia? Read “Understanding Hypoglycemia,” “What Is Hypoglycemia? Symptoms and Treatments,” and “Best Ways to Treat Low Blood Sugar.”
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