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Guidelines for Premeal Insulin Dose Reduction for Postprandial Exercise

In Guidelines for Premeal Insulin Dose Reduction for Postprandial Exercise of Different Intensities and Durations in Type 1 Diabetic Subjects Treated Intensively With a Basal-Bolus Insulin Regimen (Ultralente-Lispro), researchers from the Centre Hospitalier de l'université de Montrél validated an insulin dose reduction schedule for people with Type 1 diabetes designed to reduce the risk of exercise-induced hypoglycemia. While the patients in this study used Ultralente and Lispro (Humalog), the results of the study can be used as a point of departure for patients using other insulin regimens.

The study examined three different exercise intensities, referred to as a percentage of maximum aerobic capacity (V02max), and two durations. During the experiments, patients reduced their pre-meal Lispro insulin by varrying amounts to determine the optimum reduction to avoid hypoglycemia caused by exercise. The study showed clearly that postprandial exercise is always assocaited with an increased risk of hypoglycemia if premeal insulin is not reduced, especially when using Lispro insulin.

As a result of the experiments, the team created the following guidelines:

    % Dose reduction  

  Exercise intensity  
(% V02max)
30 min of
60 min of



From these results we see that you should reduce your pre-meal short acting insulin by 50 percent if you plan to exercise at half your maximum intensity for 30 minutes to reduce the risk of exercise induced hypoglycemia.

Since the participants in this study were adults using Ultralente and Lispro, if you are using another insulin regimen or are not an adult, you should consult your diabetes team for advice. Frequent blood glucose testing before, during, and after exercise can help you learn how much you need to reduce your insulin when you exercise.

Reference: Diabetes Care 24:625-630, 2001

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Last Updated: Thursday February 27, 2014 19:28:21
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