{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T11:24:20Z","timestamp":1790421860686,"version":"4.1.0"},"reference-count":22,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,21]],"date-time":"2021-11-21T00:00:00Z","timestamp":1637452800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health, Czech Republic","award":["00064203"],"award-info":[{"award-number":["00064203"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>The glycemic response to ingested glucose for the treatment of hypoglycemia following exercise in type 1 diabetes patients has never been studied. Therefore, we aimed to characterize glucose dynamics during a standardized bout of hypoglycemia-inducing exercise and the subsequent hypoglycemia treatment with the oral ingestion of glucose. Ten male patients with type 1 diabetes performed a standardized bout of cycling exercise using an electrically braked ergometer at a target heart rate (THR) of 50% of the individual heart rate reserve, determined using the Karvonen equation. Exercise was terminated when hypoglycemia was reached, followed by immediate hypoglycemia treatment with the oral ingestion of 20 g of glucose. Arterialized blood glucose (ABG) levels were monitored at 5 min intervals during exercise and for 60 min during recovery. During exercise, ABG decreased at a mean rate of 0.11 \u00b1 0.03 mmol\/L\u00b7min\u22121 (minimum: 0.07, maximum: 0.17 mmol\/L\u00b7min\u22121). During recovery, ABG increased at a mean rate of 0.13 \u00b1 0.05 mmol\/L\u00b7min\u22121 (minimum: 0.06, maximum: 0.19 mmol\/L\u00b7min\u22121). Moreover, 20 g of glucose maintained recovery from hypoglycemia throughout the 60 min postexercise observation window.<\/jats:p>","DOI":"10.3390\/nu13114165","type":"journal-article","created":{"date-parts":[[2021,11,21]],"date-time":"2021-11-21T21:00:50Z","timestamp":1637528450000},"page":"4165","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Characterization of Individualized Glycemic Excursions during a Standardized Bout of Hypoglycemia-Inducing Exercise and Subsequent Hypoglycemia Treatment\u2014A Pilot Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2465-7333","authenticated-orcid":false,"given":"Jan","family":"Bro\u017e","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Second Medical Faculty, Charles University, 150 00 Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew D.","family":"Campbell","sequence":"additional","affiliation":[{"name":"School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Urbanov\u00e1","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Third Faculty of Medicine, University Hospital Kr\u00e1lovsk\u00e9 Vinohrady, 106 00 Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1864-6964","authenticated-orcid":false,"given":"Marisa A.","family":"Nunes","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Second Medical Faculty, Charles University, 150 00 Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludmila","family":"Brunerov\u00e1","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Third Faculty of Medicine, University Hospital Kr\u00e1lovsk\u00e9 Vinohrady, 106 00 Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2901-0646","authenticated-orcid":false,"given":"Dario","family":"Raheli\u0107","sequence":"additional","affiliation":[{"name":"Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 100 00 Zagreb, Croatia"},{"name":"School of Medicine, University of Zagreb, 100 00 Zagreb, Croatia"},{"name":"Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 310 00 Osijek, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denisa","family":"Jan\u00ed\u010dkov\u00e1 \u017d\u010f\u00e1rsk\u00e1","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Second Medical Faculty, Charles University, 150 00 Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7174-4451","authenticated-orcid":false,"given":"Arian","family":"Taniwall","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Second Medical Faculty, Charles University, 150 00 Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Brabec","sequence":"additional","affiliation":[{"name":"Institute of Computer Science, Academy of Science of the Czech Republic, 110 00 Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vojt\u011bch","family":"Berka","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Second Medical Faculty, Charles University, 150 00 Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juraj","family":"Michalec","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Second Medical Faculty, Charles University, 150 00 Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Pol\u00e1k","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology, Third Faculty of Medicine, Charles University, 106 00 Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/S2213-8587(17)30169-9","article-title":"Exercise and physical activity in type 1 diabetes","volume":"5","author":"Campbell","year":"2017","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.2337\/dc08-0720","article-title":"Barriers to physical activity among patients with type 1 diabetes","volume":"31","author":"Brazeau","year":"2008","journal-title":"Diabetes Care"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Scott, S., Kempf, P., Bally, L., and Stettler, C. (2019). Carbohydrate Intake in the Context of Exercise in People with Type 1 Diabetes. Nutrients, 11.","DOI":"10.3390\/nu11123017"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1586\/eem.10.78","article-title":"Exercise-related hypoglycemia in diabetes mellitus","volume":"6","author":"Younk","year":"2011","journal-title":"Expert Rev. Endocrinol. Metab."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2217","DOI":"10.2337\/dc12-2467","article-title":"Large Pre-and Postexercise Rapid-Acting Insulin Reductions Preserves Glycemia and Prevents Early-but Not Late-Onset Hypoglycemia in Patients with Type 1 Diabetes","volume":"36","author":"Campbell","year":"2013","journal-title":"Diabetes Care."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e000085","DOI":"10.1136\/bmjdrc-2015-000085","article-title":"Insulin therapy and dietary adjustments to normalize glycaemia and prevent nocturnal hypoglycaemia after evening exercise in type 1 diabetes: A randomized controlled trial","volume":"12","author":"Campbell","year":"2015","journal-title":"BMJ Open Diabetes Res. Care"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Campbell, M.D., Walker, M., Trenell, M.I., Luzio, S.C., Dunseath, G., Tuner, D., Bracken, R.M., Bain, S.C., Russell, M., and Stevenson, E.J. (2014). Metabolic implications when employing heavy pre- and post-exercise rapid-acting insulin reduction to prevent hypoglycaemia in type 1 diabetes patients: A randomised clinical trial. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0097143"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.2337\/dc14-0186","article-title":"A low glycemic index meal and bedtime snack prevents postprandial hyperglycemia and associated rises in inflammatory markers, providing protection from early but not late nocturnal hypoglycemia following evening exercise in type 1 diabetes patients","volume":"37","author":"Campbell","year":"2014","journal-title":"Diabetes Care."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2599","DOI":"10.1007\/s00421-015-3251-4","article-title":"Evaluation of glucose control when a new strategy of increased carbohydrate supply is implemented during prolonged physical exercise in type 1 diabetes","volume":"115","author":"Adolfsson","year":"2015","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Standards of Care (2021). Glycemic Targets: Standards of Medical Care in Diabetes\u20142021 American Diabetes Association. Diabetes Care, 44, S73\u2013S84.","DOI":"10.2337\/dc21-S006"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1007\/s00259-002-0772-y","article-title":"Use of arterialised venous instead of arterial blood for measurement of myocardial glucose metabolism during euglycaemic-hyperinsulinaemic clamping","volume":"29","author":"Klein","year":"2002","journal-title":"Eur. J. Nucl. Med. Mol. Imaging."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/S0001-2998(82)80003-2","article-title":"Scintigraphic evaluation of gastric emptying","volume":"12","author":"Malmud","year":"1982","journal-title":"Semin Nucl. Med."},{"key":"ref_13","first-page":"307","article-title":"The effects of training on heart rate: A longitudinal study","volume":"35","author":"Karvonen","year":"1957","journal-title":"Ann. Mcd. Exp. Bid. Fenn."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1046\/j.1464-5491.2001.00620.x","article-title":"Symptoms of hypoglycaemia in people with diabetes","volume":"18","author":"McAulay","year":"2001","journal-title":"Diabet. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1111\/dme.13070","article-title":"Association of aerobic fitness level with exercise-induced hypoglycaemia in Type 1 diabetes","volume":"33","author":"Haidar","year":"2016","journal-title":"Diabet. Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Wood, S.N. (2017). Generalized Additive Models: An Introduction with R, Chapman & Hall\/CRC. [2nd ed.].","DOI":"10.1201\/9781315370279"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1214\/ss\/1038425655","article-title":"Flexible smoothing with B-splines and penalties","volume":"11","author":"Eilers","year":"1996","journal-title":"Stat. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1007\/s40279-015-0302-2","article-title":"Quantifying the acute changes in glucose with exercise in type 1 diabetes: A systematic review and meta-analysis","volume":"45","author":"Kumareswaran","year":"2015","journal-title":"Sports Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"575","DOI":"10.2337\/diacare.19.6.575","article-title":"Glycemic responses to exercise in IDDM after simple and complex carbohydrate supplementation","volume":"19","author":"Soo","year":"1996","journal-title":"Diabetes Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1001\/archinte.1990.00390150083016","article-title":"The search for an optimized treatment of hypoglycemia. Carbohydrates in tablets, solutin, or gel for the correction of insulin reactions","volume":"150","author":"Slama","year":"1990","journal-title":"Arch. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1152\/jappl.1974.37.5.679","article-title":"Factors limiting gastric emptying during rest and exercise","volume":"7","author":"Costill","year":"1974","journal-title":"Appl. Physiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1152\/jappl.1967.23.3.331","article-title":"Gastric emptying intestinal absorption during prolonged severe exercise","volume":"23","author":"Fordtran","year":"1967","journal-title":"J. Appl. 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