Michael Mueller-Korbsch, MedVienna Aerztezentrum, Austria
Title : Aerobe exercise in patients with typ 1 diabetes mellitus (DM1) guided with sensor augmented Continuous Subcutan Insulin Infusion (CSII) or Open Artificial Pancreas System (Open APS)
Managing diabetes during exercise requires individuals with type 1 diabetes mellitus (DM1) to balance their insulin dosing and food intake to maintain target glucose levels and avoiding hypoglycaemia always. Several factors such as glucose level at start, insulin dosing, fitness level and aerob or anaerob type of exercise can influence glycemic response.
The first and most important factor is to reduce the insulin dosage of the pump during aerobic exercise, because the body becomes more sensitive to insulin action. Glucose monitoring for insulin dosing is done exclusively with a real time continuous glucose monitoring (rtCGM) system, which measures tissue glucose. The starting value is ideal between 150-180 mg/dl. To achieve this, prandial insulin boluses can be reduced or basal insulin delivery with the pump can be stopped prior to exercise. During exercise, insulin dosing is reduced to a minimal insulin dose of around 0.2 IU per hour. After aerobic exercise, a lower basal rate is necessary depending on the patient's fitness level. Whereas during anaerobic exercise (e.g. weightlifting) the insulin avidity is significantly reduced due to ATP production. In this case, the usual pump settings should remain the same and additive insulin boluses may be needed according to rtCGM value and trend.
Since the sensor augmented insulin pump therapy requires a lot of work and eagerness of the patient, the therapy of DM1 is now moving forward to artificial pancreas systems. Those commercial systems currently available in Europe have limited success in maintaining target glucose levels while prolonged exercise. That is one of the reasons while patients prefer to do exercise with Open APS systems. Those are under further development due to their autobolus function. The only changes are the target ranges and the amount of insulin that may be delivered.
Michael Mueller-Korbsch has completed his medical study at the age of 26 years at the University Tuebingen/Germany. He received his internal medicine training at the Medical University of Ulm/ Germany, Department of Endocrinology and Gastroenterology.
He is senior physician at the 5th Medical Department of Endocrinology and Rheumatology Clinic Ottakring and MedVienna Aerztezentrum Vienna Austria
He has published 3 papers in reputed journals and has been presenting 4 posters at the annual ADA meeting 2015, 2019, 2020, 2021 and one practical guide Diabetes Manual Georg Thieme-Verlag, Stuttgart 2002 and 2010