tresiba and exercise

Paul Coker here, from 1BloodyDrop.com. Today, I’m at Swansea University and I’m here with Dr. Othmar Moser.  Dr. Moser is a researcher in diabetes and sports, he has Type 1 Diabetes himself and he’s something of a sports star.  Today, we’re going to be talking about some ground-breaking research that Dr. Moser has been doing about the use of a particular type of insulin called Degludec. Before we get there, I would like Dr. Moser to introduce himself.

 Welcome. Thank you for joining us. Dr. Moser, please tell us a little bit about your sporting background and your diagnosis with diabetes, and how that led you to do all of this wonderful research.

Dr Othmar Moser

Thank you for the opportunity to talk a little bit about myself and also about the research we are doing here in Swansea University. As you said, I got diagnosed with diabetes around 10 years ago. Before this time, at the triathlon, I had a very nice life travelling around the world and did a whole lot of competition and then I got diagnosed with type one diabetes which completely changed everything for me at that situation. I think the funny part was that I was already working in an institute in the field of type one diabetes. And afterwards, it was clear for me after finishing my BSc in sports and physiology that I want to stay in the field that I want to do research that I want to improve the quality of life in people with Type 1  Diabetes.  So I had the opportunity to do a doctors degree in medical sciences and out of that and my background I had the opportunity to perform research as a combination of doing physical exercise performing sports and testing new insulins new technologies around the exercise.

My primary aim was at this stage and it still I would say is still aim of my research to try to increase the quality of life in people with Type 1 Diabetes.

Paul Coker

I understand that you’ve just released some new research about the use of a particular type of insulin called Degludec which I think most of us would know as Tresiba.

Dr Othmar Moser – Consensus

Yeah, so this study came at us out of the blue, so the funny part was a recent consensus statement published in Lancet.  When you are exercising regularly, and you are running on insulin Degludec you should not reduce the insulin because this might end up in glycaemic disturbances. I was reading this review with interest and I was wondering, where does this opinion assumption come from?  So there were no data in the background existing on that.  We knew already because we performed a previous research using the insulin Degludec that it’s extremely stable. Which is good for the patient, this means low numbers of hypoglycemic episodes less glycemic reliability, so really good insulin.

Exercise Protocol – Phase 1

But for us it was of interest how can we use this type of insulin around regular exercise?  So what we did we ask a couple of participants to exercise for five days every day in the evening. The first round with a full dose of insulin Degludec with the normal dose of the basal insulin then a few weeks break between and afterwards doing the same again but reduce the insulin by 25%.

Reducing Insulin Degludec by 25% when Exercising Increased The Amount of Time That Blood Glucose was in Range

We had the idea that we see lower numbers of hypoglycemic episodes less time spent in hypoglycaemia when you reduce the insulin. Interestingly, what we found out in this crossover design was that the time spent in euglycemia, so this means full blood glucose levels between around 4mmol/l & 10mmol/l (72mg/dl – 180 mg/dl) went up when you reduce the insulin.

This could mean for future research for us what we want to do is show when you’re exercising regularly you should reduce your basal insulin also when you are using insulin Degludec because this could mean over longer time that your HbA1c, your long time glycemic control goes down, so this means you have an improved glycaemic control.

This could be something we could try to find with this insulin reduction in the future.

Paul Coker – How Many Times a Week do I need to Exercise to Benefit?

Does that mean that if I was using Degludec and I was exercising, and I reduce my dose, does that mean I need to be exercising every single day or five days out of seven?

Dr Moser – Exercising on Alternate Days May be Enough

I think such a reduction of 25% in insulin Degludec is needed for example when you’re exercising one day doing one day off exercising the next day, so we offer one day break in between. It would make sense to reduce the insulin Degludec dose. However, in this study the people are really exercising every day in a row over five days, without any break in between. It’s now difficult to say that immediately it means that everyone should reduce insulin Degludec when you are exercising. For example, three times a week, however, it might be or we could assume for example when you are exercising three times a week that you reduce your insulin Degludec dose by around 5% up to 10%. This would make sense this could be a conclusion out of it we could draw from our results.

However, it as I said the 25% reduction is working quite well when you’re really let me say four up to five times exercise a week for 30 to 60 minutes.

Paul Coker – Does this only Apply to Aerobic Exercise?

In your research you were looking at moderate intensity aerobic exercise. Do we have any clues as to what might happen if people doing High Intensity anaerobic exercise, would we expect to see similar results?

Dr Moser – Different Types of Exercise cause Different Glycemic Responses

So for this specific insulin we do not know yet. What we are expecting or what we know is when you are exercising with a very high intensity that during exercise the drop in the blood glucose concentration is less or even the glucose concentration goes slightly up.

Dr Moser – Exercise Leads to Lower Insulin Requirements for 24-28 Hours Afterwards

However, over a longer period for example, the following 24 hours up to 48 hours after exercise we saw that you have a higher number of hypoglycemic episodes during that time. This is what we saw also when using insulin Degludec in comparison of High Intensity Interval Training and continuous exercise that when you do in HIIT (High Intensity Interval Training) exercise that for the next 24 hours you have higher rates of hypoglycemic episodes.

What could that mean for insulin Degludec, it could mean when you’re exercising with higher intensity over a longer period, or before HIIT that you would even need to reduce the insulin a little bit more. However, this is just an assumption from my side and we did not investigate yet.

Dr Othmar Moser – The Research Provides a General Recommendation

What we have tried to do with our research is find a general recommendation which you can use as a starting point. However, it’s a good recommendation for example, clinicians can give afterwards that say okay try to start with a 25% reduction and after three days re-evaluate and see if you need to reduce a little bit more, or if you need to reduce a little bit less.

It’s a first recommendation you can give at the end of the day it’s an individual recommendation you have to find for yourself.

Paul Coker – Where Is the Research Published?

I think that is a brilliant way of putting it so thank you Dr. Moser. So, which journal was it published in most recently?

It was published in Diabetes, Obesity & Metabolism.   You can also read the abstract using PubMed

And it just remains for me to congratulate you on such a fantastic piece of research and also to congratulate you, because I understand that next week you’re going to be presenting this paper at the Fifth EASD conference in Berlin. Which is just incredible to congratulations.

Thank you very much.