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Managing Blood Sugar During Exercise with Long-Acting Insulin

Engaging in regular physical activity is good for overall health. It helps with weight management, blood pressure, cardiovascular health, blood sugar, and more. Individuals with type 1 diabetes may find exercise helpful in improving insulin sensitivity and reducing the amount of insulin needed following activity. However, this can also be a challenge because they must carefully monitor their blood-glucose levels to ensure that they do not become too low or too high.

A recent study found that combining long-acting insulin (degludec) with the use of an insulin pump can be beneficial for managing glucose levels during and after exercise. Some individuals with T1D prefer to remove their insulin pump during exercise, and by administering degludec before starting exercise, they were able to remain in target range (70-180 mg/dL) for longer periods of time than when just using the insulin pump alone.

The study involved 24 physically active adults who participated in two phases of workouts that included five weeks of high- and moderate-intensity sessions. During one phase, they only used their insulin pump to control their basal insulin needs, and for the second, they used the insulin pump and the degludec. When using the insulin pump alone, they spent an average of 143 minutes (40% of the time) in target range, but when using the degludec, this time in range increased to 230 minutes (64% of the time).

The researchers found that “this was down to a significant 87-minute reduction in time spent in hyperglycemia, with no difference seen for hypoglycemia” as well. In addition, when using the hybrid insulin approach, blood sugar rose just 14.5 mg/dL after 30 minutes following exercise, compared to an 82.9 mg/dL increase using the insulin pump alone.

More than two-thirds of participants found the hybrid insulin regimen useful, and nearly half said they were somewhat or very likely to continue using this approach while exercising in the future. The researchers are looking at moving forward with a larger study to see if these results continue to be significant when more people are involved.

This study shows that there may be more than one effective option for improving glucose control during exercise for individuals with type 1 diabetes. They do not have to rely on the insulin pump alone, and some may find administering degludec beneficial when exercising without their insulin pump.

Diabetes Research Connection (DRC) is interested to see how this study plays out in the future and if more people can benefit from the hybrid insulin regimen while exercising. It is encouraging to see more options become available to help individuals better control their diabetes while improving their health and quality of life. DRC supports early-career scientists in pursuing novel research on type 1 diabetes by providing access to funding. The goal is to one day find a cure while also improving prevention, treatment, and management of the disease. Learn more by visiting http://diabetesresearchconnection.org.

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Understanding the Impact of GABA on Insulin Secretion and Regulation

In order to manage blood glucose levels, pancreatic beta cells release insulin in pulses. These bursts of insulin help the body to regulate and stabilize blood sugar. In individuals with type 1 diabetes, however, the pancreatic beta cells that normally secrete insulin are mistakenly destroyed by the body. This leaves the body unable to effectively regulate blood sugar on its own. Understanding the interaction between insulin-producing beta cells and other processes in the body may help researchers improve treatment and prevention options when it comes to diabetes.

A recent study examined the different roles gamma amino-butyric acid (GABA) plays in cell activity. In the brain, GABA is released from nerve cell vesicles each time a nerve impulse occurs. The GABA prepares cells for subsequent impulses by working as a calming agent. Researchers previously believed that this process worked in much the same way in the pancreas.

However, in the pancreas, GABA is evenly distributed throughout the beta cells rather than contained within small vesicles, and it is transported via the volume regulatory anion channel. This is the same channel that helps stabilize pressure inside and outside of cells so that they maintain their shape. Furthermore, research showed that GABA is released in a similar pattern and frequency as pulsatile in vivo insulin secretion. Just like in the brain, GABA plays an integral role in preparing and calming cells to make them more receptive to subsequent insulin pulses.

Scientists are interested in learning more about how GABA signaling can support the regulation of insulin secretion and potentially protect cells from autoimmune activity. This opens new doors for biomedical research that has the ability to impact diabetes care.

It is encouraging to see different types of researchers all coming together and learning from and building upon one another’s work in order to advance understanding, prevention, and treatment of various diseases, including diabetes.

Diabetes Research Connection stays abreast of the latest discoveries in the field and supports early career scientists in contributing to this body of work by providing critical funding for their projects. It is essential that scientists have the resources to pursue novel research in order to develop improved prevention, treatment, and management options for type 1 diabetes. Learn more and support current projects by visiting https://diabetesresearchconnection.org.

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Could Higher-Dose and Lower-Dose Insulin Glargine be Equally Effective in Managing Type 1 Diabetes?

In an effort to maintain greater blood-glucose stability throughout the day and minimize highs and lows, some individuals with type 1 diabetes use insulin glargine, which is a once-a-day, long-acting insulin. It is an analogue, or laboratory-created, insulin which has been modified to act more uniformly in managing glucose levels.

Insulin glargine comes in varying strengths, and a recent study found that there were no significant differences in safety or effectiveness between insulin glargine 100 U/mL and insulin glargine 300 U/mL when administered in children and adolescents. Data from 463 EDITION JUNIOR study participants between the ages of 6 and 17 were compared over 26 weeks. Of those participants, 233 were randomly assigned to insulin glargine 300 U/mL, and 228 were randomly assigned to insulin glargine 100 U/mL. Both groups continued to follow their normal routine for mealtime insulin but injected insulin glargine once per day.

Results showed that all participants experienced a reduction in HbA1c levels over the 26 weeks. However, there were fewer instances of severe hypoglycemia among participants using the insulin glargine 300 U/mL, though overall, results were comparable between groups. Both insulins were effective in achieving target study endpoints and did not demonstrate any unexpected safety concerns.

In comparing insulin glargine 100 U/mL and insulin glargine 300 U/mL, researchers may be able to use insulin glargine 300 U/mL as yet another treatment option for children and adolescents with type 1 diabetes. It is currently under review by the FDA, and researchers are evaluating data from a six-month safety follow-up.

It is encouraging to see that more options are being explored to meet the needs of individuals living with type 1 diabetes in order to maintain target glucose levels with fewer fluctuations. Diabetes Research Connection (DRC) will continue to follow these types of studies to see how they impact the future of diabetes management and accessibility to care.

DRC provides critical funding for early career scientists pursuing novel, peer-reviewed research studies for type 1 diabetes. Projects aim to improve prevention and treatment of the disease, as well as enhance quality of life and eventually find a cure. To learn more about current studies and support these efforts, visit http://diabetesresearchconnection.org.

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Evaluating the Effect of Specific T Cells on Type 1 Diabetes Risk and Treatment

As researchers delve more deeply into trying to understand the origins of type 1 diabetes (T1D), they become increasingly aware that there is not a single disease pathogenesis, but rather multiple paths that vary from person to person. While they know that T1D results from the immune system attacking and destroying insulin-producing beta cells in the pancreas, there may be several different factors that contribute to this risk.

A recent study examined a variety of T cells, T cell receptors, antigens, and autoantibodies that may play a role in the development of T1D. One common factor they found was that individuals with an elevated level of islet autoantibodies in the peripheral blood are at increased risk of developing T1D within their lifetime. Researchers also know that in addition to risk genes, human leukocyte antigen (HLA) genes and the autoantibody glutamic acid decarboxylase (GAD) could vary from person to person and impact the effectiveness of targeted therapies. Children who possess two or more islet autoantibodies have around an “85% chance of developing T1D within 15 years and nearly a 100% lifetime risk for disease development.”

However, the mere presence of islet autoantibodies does not demonstrate disease state, because it could be years before clinical T1D presentation. In its early stage (stage 1), while the autoantibodies are present, beta cell function remains normal. As risk for T1D advances (stage 2), metabolic abnormalities develop. Finally, with T1D onset (stage 3), there is both a presence of autoantibodies and loss of beta cell function in regard to blood glucose. The staging paradigm was derived from data from the United States’ Diabetes AutoImmunity Study in the Young (DAISY), Finland’s Type 1 Diabetes Prediction and Prevention Study (DIPP), and Germany’s BABYDIAB studies.

Given the similarities of mouse models and human models when it comes to diabetes, mouse models are often used to study disease risk, evaluate pathogenesis, and assess potential treatment options. Researchers have found that specific antigens and T cells affect pancreatic islets differently. Understanding these antigen subsets could be critical in determining effective clinical therapeutics for prevention and treatment.

Thanks to the Network for Pancreatic Organ Donors (nPOD), more than 150 cases have been collected from organ donors with T1D since 2007, as well as more than 150 from non-diabetic donors and dozens of donors with autoantibodies but no clinical diabetes. These tissue donations have provided researchers with islets, cells, and data from multiple facets of the ody that contribute to T1D risk.

Understanding tissue specific T cells, antigens, and autoantibodies may help identify biomarkers of disease activity which could improve targeted therapeutic interventions. Eventually, this may help reduce risk of T1D by creating early intervention strategies.

While not involved with this study, Diabetes Research Connection (DRC) is focused on advancing understanding of T1D and improving prevention, diagnosis, and treatment options as well as progress toward a cure. Early career scientists receive critical funding to pursue novel, peer-reviewed research projects regarding multiple aspects of T1D. Learn more by visiting http://diabetesresearchconnection.org.

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Advanced Technology Could Bypass Finger Sticks for Glucose Monitoring

One of the annoying – but necessary – parts of managing type 1 diabetes in conducting multiple finger sticks every day to check blood sugar levels. This is one of the most accurate ways that people with diabetes can determine whether they need to inject themselves with insulin or not, especially around mealtimes and when being physically active. But advances in technology may have found a way to accurately monitor blood sugar levels without requiring finger sticks.

Dexcom is a company that is well known for its continuous glucose monitoring (CGM) systems, and they are set to launch a new model, the Dexcom G6, in June. Ahead of this release, one user got to try it out early and shared her experiences with the new system.

The G6 comes with a sensor that is placed under the skin and affixed with a transmitter that wirelessly relays information to a receiver. The receiver is often the person’s smartphone and is accessed using a corresponding app. There is an auto-applicator that makes inserting the sensor quick, easy, and painless. Once inserted, it is functional for 10 days before shutting off and needing to be replaced.

However, the sensor continuously monitors blood sugar levels so that individuals do not have to constantly check on their own using a glucometer. For this user, it took a few days for the G6 to begin accurately reading her glucose levels, so she did double-check initially with the glucometer. However, soon they began giving the same readings, and she could track her blood sugar using the app.

The system also gives alerts and alarms for when blood sugar becomes too high or dips too low. It can even alert to downward trends before blood sugar gets the chance to become dangerously low, allowing individuals to appropriately respond and keep levels more stable. In addition, the company has made the transmitter sleeker and more comfortable. It has a 28% lower profile than the current G5 model and affixes flush against the sensor.

Since the system has not been released to the public yet, the final cost is unknown. Plus, this will vary depending on an individual’s insurance coverage or if they are paying out of pocket. However, it provides many benefits in helping individuals with T1D in effectively managing their blood sugar in a more hands-free way and providing readings around the clock that can be viewed through the app or receiver. The benefits may outweigh the costs in the end for some.

The Diabetes Research Connection (DRC) is excited to see how technology is changing to better support the needs of individuals with type 1 diabetes and help them manage their condition. As research continues to advance, so do technology and treatment options. The DRC is committed to empowering early career scientists in pursuing novel research around type 1 diabetes and raises funds to support these efforts. To learn more about current projects and provide support, visit http://diabetesresearchconnection.org.

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