Exercise effects on postprandial glucose metabolism in type 1 diabetes: A triple-tracer approach

Ashwini Mallad, Ling Hinshaw, Michele Schiavon, Chiara Dalla Man, Vikash Dadlani, Rita Basu, Ravi Lingineni, Claudio Cobelli, Matthew L. Johnson, Rickey Carter, Yogish C. Kudva, Ananda Basu

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


To determine the effects of exercise on postprandial glucose metabolism and insulin action in type 1 diabetes (T1D), we applied the triple tracer technique to study 16 T1D subjects on insulin pump therapy before, during, and after 75 min of moderate-intensity exercise (50% VO2max) that started 120 min after a mixed meal containing 75 g of labeled glucose. Prandial insulin bolus was administered as per each subject’s customary insulin/carbohydrate ratio adjusted for meal time meter glucose and the level of physical activity. Basal insulin infusion rates were not altered. There were no episodes of hypoglycemia during the study. Plasma dopamine and norepinephrine concentrations rose during exercise. During exercise, rates of endogenous glucose production rose rapidly to baseline levels despite high circulating insulin and glucose concentrations. Interestingly, plasma insulin concentrations increased during exercise despite no changes in insulin pump infusion rates, implying increased mobilization of insulin from subcutaneous depots. Glucagon concentrations rose before and during exercise. Therapeutic approaches for T1D management during exercise will need to account for its effects on glucose turnover, insulin mobilization, glucagon, and sympathetic response and possibly other blood-borne feedback and afferent reflex mechanisms to improve both hypoglycemia and hyperglycemia.

Original languageEnglish (US)
Pages (from-to)E1106-E1115
JournalAmerican Journal of Physiology - Endocrinology and Metabolism
Issue number12
StatePublished - Jun 15 2015


  • Exercise
  • Insulin mobilization
  • Postprandial glucose kinetics

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Physiology
  • Physiology (medical)


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