Health complications among people with Type 1 diabetes (T1D) could be reduced by manipulating insulin doses during mealtimes and following exercise, extensive research has found.

This year marks the 100th anniversary of insulin’s discovery – the first life-saving treatment for people with diabetes and one of history’s greatest medical breakthroughs. Since then, there has been transformational developments in how to treat and manage the disease.

During National Diabetes Week (June 14-20) this week, the University of Sunderland is celebrating past scientific and personal achievements, as well as advancements yet to come. Our research is changing the way this disease is managed and transforming the lives of people living with it.

Diabetes is characterised by elevated blood sugar (glucose) levels, which contribute to complications including kidney, foot, eye, heart and stroke disease. There are two main types: in T1D the body stops producing insulin while in type 2 diabetes (T2D), insulin is still produced but is less effective due to resistance of the body to its action, termed insulin resistance (IR). Overweight T1D individuals can also develop IR, displaying both insulin deficiency and resistance, a group defined as having double diabetes (DD). People with DD are more prone to diabetes complications, for reasons that are still being investigated.

A major component of diabetes care is exercise and diet. However, self-managing T1D around exercise and diet can be extremely challenging.

The University of Sunderland has a portfolio of internationally-renowned research in diabetes, exercise and diet which is helping people with T1D exercise safely and improve diabetes management around mealtimes.

Dr Matthew Campbell, Principal Investigator in Human Metabolism in the University’s Faculty of Health Sciences and Wellbeing, explains: “Managing blood sugar levels around exercise and diet can be very challenging for people with T1D. For example, the type, intensity, duration and timing of exercise all influence blood sugar responses and this is further complicated by trying to manage diet and insulin levels. For example, our research shows that high-intensity intermittent exercise (like football, rugby, or hockey) can result in a sharp increase in blood sugar levels during and immediately after exercise, but lower-intensity long-duration exercise (such as jogging or walking) can result in a drop in blood sugar levels.

“We have also shown that irrespective of the type of exercise performed, people with T1D are at risk of developing extremely low blood sugar levels (called hypoglycaemia, and commonly referred to as hypo’s) later in the day, and particularly at night. This increased risk of developing late-onset nocturnal hypo’s can be fatal and is a major barrier to exercise for a substantial proportion of people.

“Our work has informed NICE guidelines with clinical recommendations around safe exercise management. Many people with T1D often see a ‘yoyo’ pattern in blood sugars with exercise. This is caused by a mismatch between the sugar lowering effects of exercise and difficulties in estimating the right amount of carbohydrate to maintain sugar levels. We suggest adjusting the doses of insulin administered before and after exercise as well as focusing on eating slow-releasing carbohydrates “

As well as exercise, adjusting insulin doses around mealtimes is just as important in stabilising glucose levels. Historically, guidance focused almost soley on adjusting insulin doses based on the carbohydrate content of food – a single macronutrient. However, people eat mixed-macronutrient meals containing both fat and protein, which also influence insulin requirements and blood sugar levels.

Dr Campbell says: “Trying to calculate the insulin requirements for commonly consumed foods rich in carbohydrate, protein and fat and ‘guest-imating’ adequate amounts of insulin to administer to manage sugar levels after eating is very difficult and very easy to get wrong. Many people with T1D often struggle with managing sugar levels around mealtimes and this is a major contributor to the risk of developing diabetes complications.

“The fat in a meal can cause a delayed, steady increase in sugar levels for many hours after a meal, and often this moderate increase in sugar can go unchecked. In order to better manage glucose levels, extra insulin is needed to cover the insulin requirements of fat. However, we have shown that increasing the insulin dose administered with the meal can increase the risk of dangerous hypo’s. Instead, we have shown that simply administered the extra amount of insulin three-hours after a meal (i.e. splitting the dose) is effective at completely normalising  sugar levels for the whole of the meal period without the risk of developing hypo’s.”

He added: “This method was also seen to reduce biomarkers associated with inflammation and vascular damage, which have previously been shown to increase after eating fat-rich foods. Taken together, our new insulin dose splitting strategy is comprehensive and safe, not only does it help you improve your diabetes management – but also lowers your risk of developing some of the complications you would associate with eating foods rich in fat.

“We are currently working to help refine the current guidelines for healthcare professionals supporting people with T1D.”

These studies are just part of a number of cross-faulty projects looking at ways to improve the quality of life for people with diabetes, being led by the University of Sunderland, and unveiled during National Diabetes Week.

National Charity Diabetes UK is funding up to £100k for a study into whether breaking up prolonged sitting time with short frequent bouts of light-intensity walking can improve glucose levels and reduce risk factors associated with T1D complications. Sunderland is working in collaboration with the University of Cambridge and University of Leeds on the 18-month project.

National Diabetes Week this year is all about creating awareness of the condition and encouraging people to share their experiences of living with diabetes. Many other groups and organizations take part in diabetes week, hosting a wide variety of informative and fundraising events.

To read more about Dr Campbell’s work, published in Nutrition, Metabolism and Cardiovascular Diseases, go to: https://www.nmcd-journal.com/article/S0939-4753(21)00244-1/fulltext

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