The Effect of Exercise on the Absorption of Inhaled Human Insulin via the AERx Insulin Diabetes Management System in People With Type 1 Diabetes

  1. Astrid H. Petersen, PHD123,
  2. Gerd Köhler, MD1,
  3. Stefan Korsatko, MD1,
  4. Andrea Wutte, MSC1,
  5. Manfred Wonisch, MD, PHD1,
  6. Ole K. Jeppesen, MSC3,
  7. Thomas Sparre, MD, PHD3,
  8. Per Clauson, MD, PHD3,
  9. Torben Laursen, MD, PHD2,
  10. Per Wollmer, MD, PHD4 and
  11. Thomas R. Pieber, MD1
  1. 1Department of Internal Medicine, Medical University Graz, Graz, Austria
  2. 2Department of Pharmacology, University of Aarhus, Aarhus, Denmark
  3. 3Global Development, Novo Nordisk, Bagsvaerd, Denmark
  4. 4Department of Clinical Research, Lund University, Malmö, Sweden
  1. Address correspondence and reprint requests to Astrid Heide Petersen, Novo Nordisk A/S, Novo Allé, DK-2880 Bagsvaerd, Denmark. E-mail: ashp{at}novonordisk.com

Abstract

OBJECTIVE—This study investigated the effect of moderate exercise on the absorption of inhaled insulin via the AERx insulin diabetes management system (iDMS).

RESEARCH DESIGN AND METHODS—In this randomized, open-label, four-period, crossover, glucose clamp study 23 nonsmoking subjects with type 1 diabetes received a dose of 0.19 units/kg inhaled human insulin followed in random order by either 1) no exercise (NOEX group) or 30 min exercise starting, 2) 30 min after dosing (EX30), 3) 120 min after dosing (EX120), or 4) 240 min after dosing (EX240).

RESULTS—Exercise changed the shape of the free plasma insulin curves, but compared with the NOEX group the area under the curve for free plasma insulin (AUCins) for the first 2 h after the start of exercise was unchanged for EX30 and EX240, while it was 15% decreased for EX120 (P < 0.01). The overall insulin absorption during 6 and 10 h after dosing was 13% decreased for EX30 (P < 0.005), 11% decreased for EX120 (P < 0.01), and unchanged for EX240. Exercise did not influence the maximum insulin concentration (Cmax), while the time to Cmax was 22 min earlier for EX30 (P = 0.04). The AUC for the glucose infusion rate (AUCGIR) for 2 h after the start of exercise increased by 58% for EX30, 45% for EX120, and 71% for EX240 (all P < 0.02) compared with the NOEX group.

CONCLUSIONS—Thirty minutes of moderate exercise led to unchanged or decreased absorption of inhaled insulin via AERx iDMS and faster Cmax for early exercise. Thus, patients using AERx iDMS can adjust insulin dose as usual independent of time of exercise, but they should be aware of the faster effect if exercising early after dosing.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 9 July 2007. DOI: 10.2337/dc06-2589.

    At the time of study, A.H.P. was affiliated with the Medical University Graz, Graz, Austria.

    A.H.P., P.C., O.K.J., and T.S. are employed by and hold stock in Novo Nordisk. T.L., P.W., and T.R.P. have served on an advisory panel for, have received honoraria from, and have received grant/research support from Novo Nordisk.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted June 20, 2007.
    • Received January 9, 2007.
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  1. Published online before print July 9, 2007, doi: 10.2337/dc06-2589 Diabetes Care October 2007 vol. 30 no. 10 2571-2576
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