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Can an overdose treatment make exercise safer for people with diabetes?

Betsy Seaquist, MD, an M Health Fairview diabetes expert, is researching a new approach to a common post-exercise problem.
Exercise is one of the best ways to manage diabetes, but the threat of hypoglycemia, or low blood sugar, may discourage some diabetics from working out, according to Endocrinologist Betsy Seaquist, MD. Seaquist is testing whether naloxone can help diabetics manage post-exercise hypoglycemia.
For people living with diabetes, the downsides of exercise can be significant.

A day after exercise, diabetics are prone to hypoglycemia. This crash in their blood sugar levels can cause shakiness, sweating, and — if unrecognized — a loss of consciousness. People who are aware of the symptoms can take action in time. But a person’s awareness of hypoglycemia symptoms is reduced after each episode, making it harder for them to get help quickly enough.

“It’s very disruptive,” said M Health Fairview Endocrinologist Betsy Seaquist, MD. “It discourages people from wanting to exercise, which is a key to controlling diabetes. If we could develop a way to ensure that people will always recognize their hypoglycemia, it would be really helpful.”

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Help from an unlikely source?

Seaquist is examining if naloxone — commonly known as Narcan® — can help patients with Type 1 diabetes maintain their awareness of hypoglycemia after exercising. While naloxone is used to counter the effects of an opioid overdose, there’s reason to believe it has further applications.

“We know from other studies that if you have naloxone present during hypoglycemia, people recognize their hypoglycemia the next day,” Seaquist said. “So we thought, will naloxone be effective before that, if it's given during exercise, to make people aware of their hypoglycemia the next day?”

A bike ride for research

Patients in her study have Type 1 diabetes and complete two rounds of a two-day trial. On the first day, patients are given either a naloxone or saline nasal spray before completing a 90-minute exercise session on a stationary bicycle. The other spray is given during the second round of the trial. Patients are monitored to ensure they’re exercising to maximum capacity during both rides.

On the second day of each round, patients are placed into hypoglycemia so Seaquist’s team can measure their body’s response to the lower blood sugar levels.

Reducing the burden of diabetes

If successful, the study may suggest that intranasal naloxone could be used during exercise to ensure the body’s response to hypoglycemia is not reduced as it usually is. 

For people with diabetes, it would mean being able to exercise without worrying about potentially dire side effects. For Seaquist, it would mean helping patients she’s worked with for so long.

“Hypoglycemia is very common for people with diabetes,” Seaquist said. “Think about how it could interfere with your work, or driving, or your family life and worrying about this all the time. It’s very exciting knowing I could help patients take away some of the burdens of the disease.”

A role model of academic medicine

"I can't adequately express my respect and gratitude for Dr. Seaquist. She is a giant in the field of diabetes," said M Health Fairview Chief Academic Officer Brad Benson, MD, noting that Seaquist has served as President of the American Diabetes Association and just received their inaugural Lois Javanovic Transformative Woman in Diabetes Award.

"In addition to directly caring for our patients, she mentors our learners, leads our subspecialty service Line, and has spent her career discovering a better future for everyone with diabetes,” Benson said. “She embodies what academic medicine is all about."