Exercise in diabetic man: glucose turnover and free insulin responses after glycemic normalization with intravenous insulin

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Abstract
The metabolic response to moderate exercise in postabsorptive insulin-dependent diabetics receiving insulin by constant intravenous infusion was compared with that of normal controls. The diabetics were infused with insulin overnight and were normoglycemic (89 ± 6 mg/dL, controls: 90 ± 6 mg/dL). With exercise, glycemia remained constant in both groups. In the diabetic subjects, glucose production was 166 ± 11 mg/min at rest, increased to 230 ± 27 mg/min with exercise (p < 0.05), and returned to base line during recovery. Glucose disappearance changed in a synchronous and parallel fashion. In the normal controls, insulin concentration was 0.44 ± 0.03 ng/mL at rest and decreased significantly with exercise (p < 0.01) while in the diabetic free insulin was fourfold higher (1.70 ± 0.32) and did not change with exercise. Lactate increased similarly (twofold) with exercise in both groups. In summary, (i) complete normalization of glycemia, glucose turnover, and the lactate response to postabsorptive exercise can be achieved by the intravenous infusion of insulin adjusted to obtain normoglycemia before the onset of exercise; (ii) this response was obtained with an associated elevation in circulating free insulin which probably reflects the peripheral intravenous route rather than the physiologic (portal) site of insulin administration.