OBJECTIVE - This study investigated the effect of moderate exercise on the absorption of inhaled insulin via the AERx(R) insulin Diabetes Management System (iDMS). RESEARCH DESIGN AND METHODS - In this randomized, open-label, 4-period cross-over, glucose clamp study 23 non-smoking subjects with type 1 diabetes received a dose of 0.19 units/kg inhaled human insulin followed in random order by either 1) no exercise (NOEX), or 30 min exercise starting 2) 30 min after dosing (EX30), 3) 120 min after dosing (EX120), or 4) 240 min after dosing (EX240). RESULTS - Exercise changed the shape of the free plasma insulin curves, but compared to NOEX the AUC(ins) for the first 2 hours after start of exercise was unchanged for EX30 and EX240, while 15% decreased for EX120 (p<0.01). The overall insulin absorption during 6 and 10 hours after dosing was 13% decreased for EX30 (p<0.005); 11% decreased for EX120 (p<0.01); while unchanged for EX240. Exercise did not influence the maximum insulin concentration (C(max)), while the time to C(max) was 22 min earlier for EX30 (p=0.04). The AUC(GIR) for 2 hours after start of exercise increased by 58% for EX30, 45% for EX120, and 71% for EX240 (all p<0.02), compared to NOEX. CONCLUSION - Thirty minutes of moderate exercise led to unchanged or decreased absorption of inhaled insulin via AERx(R) iDMS, and faster C(max) for early exercise. Thus, patients using AERx(R) iDMS can adjust insulin dose as usually independent of time of exercise, but should be aware of faster effect if exercising early after dosing.
Diabetes Care, 2007, Vol 30, Issue 10, p. 2571-2576