(VP041) EFFECT OF TWO POST-EXERCISE STRATEGIES FOLLOWING A LATE AFTERNOON EXERCISE SESSION ON THE RISK OF NOCTURNAL HYPOGLYCEMIA IN ADULTS AND ADOLESCENTS LIVING WITH TYPE 1 DIABETES

Background: For people living with type 1 diabetes (pwT1D), the risk of hypoglycemia is not only increased during exercise, but for several hours following exercise. When exercise is performed late in the afternoon, it can lead to nocturnal hypoglycemia (NH). During nighttime, the awakening response, as well as hypoglycemia detection are frequently altered, leaving pwDT1 in a vulnerable position. Although post-exercise mitigation strategies exist to limit this risk, limited evidence-based data are available. Our objective was to compare two post-exercise strategies to reduce the risk of NH.

METHODS AND RESULTS: Twenty-three pwT1D treated with an insulin pump (16 adults, 7 adolescents; HbA1c = 7.4 ± 1.0%) were included. Participants performed two 60min continuous moderate intensity exercise sessions (at 60% of VO2peak) on a cycle ergometer. Exercise was performed 4h post-meal. After the exercise session, one of the following strategies was applied in a random order: 1/ 20% insulin basal rate reduction for 10h, associated with a 20% diner bolus reduction (BRR), 2/ 45g carbohydrate (CHO) snack, immediately post-exercise with a 50% reduction of insulin bolus reduction, and a 30g CHO bedtime snack without bolus (SNACK). Interstitial glucose levels were measured with a continuous glucose monitor (CGM (Dexcom G5 – G6)) from start of intervention to the next day.

Results: CGM data were analyzed from midnight to 6:00am. NH occurred in two participants with SNACK, and three participants with BRR, one of which experienced NH on both nights. The difference in blood glucose levels from midnight to 6:00 am was greater with SNACK (-2.5 ± 6.3 mmol/L, SNACK vs. 0.9 ± 3.7 mmol/L, BRR, p=0.029). No differences in the time spent below (>3.9 mmol/L), within (3.9 – 10.0 mmol/L) or above (>10.0 mmol/L) range were found between SNACK and BRR.

Conclusion: These findings suggest that both strategies are safe and effective to limit the risk of post-exercise nocturnal hypoglycemia, offering more options to people living with type 1 diabetes.