Effects of long-duration medium-intensity exercise in glucose regulation and modeling

HERNÁN DE BATTISTA; JOSEP VEHÍ; NICOLÁS ROSALES; FABRICIO GARELLI

Berlin

Conferencia; 12th International Conference on Advanced Technologies & Treatments for Diabetes; 2019

Kenes

Background and Aims: Physical activity is an importantcomponent in diabetes care. Although it presents many healthbenefits, it also presents an important challenge in glycemiccontrol. The hormonal response to maintain homeostasis duringphysical activity changes the patient?s glucose dynamics, thus,affecting the performance of closed-loop controllers. One of themost common interventions among patients during exercise isbasal insulin reduction or suspension in order to avoid possiblehypoglycemia during or after physical activity. When consideringlong periods of physical activity, the total suspension of insulincan lead to hypoinsulinemia.Method: Low levels of insulin in plasma does not allow themuscle to use the glucose properly. A rebound after exercise,leading to hyperglycemia, could be product of the hypoinsulinemiaand the endogenous production of glucose. Nowadays,few mathematical models were proposed for specific conditionsthat cannot cover the multiple glycemic responses during exercisein clinical trials. Here it is proposed to modify the DallaManmodel in order to deploy the effects in endogenousglucose production, changes in insulin sensitivity and glucoseutilization.Results: Simulations with the new added dynamics duringexercise showed a true potential in representing glucose excursionprofiles presented in clinical data. The analysis of the effectcaused by the endogenous glucose production and hypoinsulinemia,i.e. the post-exercise glucose rebound, allows determiningand setting a minimum insulin constraint for closed-loopglucose controllers.Conclusion: An exercise model representing the effects oflong-term exercise of medium intensity is proposed which maybe used to tune and improve glucose control algorithms.