Isomaltulose Improves Glycemia and Maintains Run Performance in Type 1 Diabetes
Abstract
PURPOSE: Individuals with type 1 diabetes mellitus (T1DM) are encouraged to reduce rapid-acting insulin and consume CHO to prevent hypoglycemia during or after exercise. However, research comparing the metabolic and performance effects of different CHO is limited. This study compared the alterations in metabolism and fuel oxidation in response to performance running after preexercise ingestion of isomaltulose or dextrose in T1DM. METHODS: After preliminary testing, on two occasions, seven T1DM individuals consumed 0.6 g·kg⁻¹ body mass of either dextrose (DEX; glycemic index = 96) or isomaltulose (ISO; glycemic index = 32), 2 h before a discontinuous incremental run to 80% V˙O2peak on a motorized treadmill followed by a 10-min all-out performance test on a nonmotorized treadmill. Blood glucose (BG), acid-base, and cardiorespiratory parameters were measured 2 h before, during, and after both run tests. Data (mean ± SEM) were analyzed using repeated-measures ANOVA. RESULTS: Preexercise BG area under the curve was lower under ISO in comparison with DEX (ISO = +4.0 ± 0.3 mmol·L⁻¹·h⁻¹ vs DEX = +7.0 ± 0.6 mmol·L⁻¹·h⁻¹, P < 0.01). Resting blood lactate concentrations and rate of CHO oxidation under ISO were greater than those elicited under DEX (P < 0.05). There were no metabolic or cardiorespiratory differences between conditions in response to submaximal exercise despite lower BG concentrations under ISO (P < 0.05). T1DM individuals completed the same distance at the same speed during the 10-min run test under both conditions (not significant). CONCLUSIONS: Consumption of isomaltulose alongside rapid-acting insulin reduction improves BG responses to exercise and produces a similar high-intensity run performance compared with dextrose in T1DM individuals.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In physically-active type-I diabetic patients, consumption of isomaltulose alongside rapid-acting insulin reduction improved blood glucose responses to exercise and produced a similar high-intensity run performance compared with dextrose.
“For instance, positive metabolic effects have been reported in physically-active type-I diabetic patients given that the consumption of isomaltulose alongside rapid-acting insulin reduction improved blood glucose responses to exercise and produced a similar high-intensity run performance compared with dextrose [49].”
From The 4R’s Framework of Nutritional Strategies for Post-Exercise Recovery: A Review with Emphasis on New Generation of Carbohydrates (2020) · cites this paper as [49]
Cites
Measurement of substrate oxidation during exercise by means of gas exchange measurements
Jeukendrup, A. E., & Wallis, G. A. (2005) · International Journal of Sports Medicine · doi:10.1055/s-2004-830512 · Cited by 799 · see citing works
A new validated endurance performance test
Jeukendrup, A. E., Saris, W. H. M., Brouns, F. J. P. H., & Kester, A. D. M. (1996) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199602000-00017 · Cited by 560 · see citing works
Borg, G. (1982) · International Journal of Sports Medicine · doi:10.1055/s-2008-1026080 · Cited by 487 · see citing works
Intense Exercise Has Unique Effects on Both Insulin Release and Its Roles in Glucoregulation
Marliss, E. B., & Vranic, M. (2002) · Diabetes · doi:10.2337/diabetes.51.2007.s271 · Cited by 390 · see citing works
RABASA-LHORET, R. P. R., Bourque, J., Ducros, F., & Chiasson, J. (2001) · Diabetes Care · doi:10.2337/diacare.24.4.625 · Cited by 299 · see citing works
Isomaltulose (Palatinose®): a review of biological and toxicological studies
Lina, B. A. R., Jonker, D., & Kozianowski, G. (2002) · Food and Chemical Toxicology · doi:10.1016/s0278-6915(02)00105-9 · Cited by 293 · see citing works
Fatty acid oxidation is directly regulated by carbohydrate metabolism during exercise
Coyle, E. F., Jeukendrup, A. E., Wagenmakers, A. J. M., & Saris, W. H. M. (1997) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1997.273.2.e268 · Cited by 292 · see citing works
Metabolic Regulation: A Human Perspective
Frayn, K. N. (1996) · Cited by 276 · see citing works
Impact of Exercise on Overnight Glycemic Control in Children with Type 1 Diabetes Mellitus
The Diabetes Research In Children, N. (2005) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2005.04.065 · Cited by 264 · see citing works
Gilbertson, H., Brand-Miller, J. C., Thorburn, A. W., Evans, S., Chondros, P., & Werther, G. A. (2001) · Diabetes Care · doi:10.2337/diacare.24.7.1137 · Cited by 251 · see citing works
Rasmussen, B. B., Holmbäck, U. C., Volpi, E., Morio, B., Paddon‐Jones, D., & Wolfe, R. R. (2002) · Journal of Clinical Investigation · doi:10.1172/jci15715 · Cited by 223 · see citing works
Postexercise Late-Onset Hypoglycemia in Insulin-Dependent Diabetic Patients
MacDonald, M. J. (1987) · Diabetes Care · doi:10.2337/diacare.10.5.584 · Cited by 221 · see citing works
Guelfi, K. J., Jones, T. W., & Fournier, P. A. (2005) · Diabetes Care · doi:10.2337/diacare.28.6.1289 · Cited by 221 · see citing works
Carbohydrate ingestion can completely suppress endogenous glucose production during exercise
Jeukendrup, A. E., Wagenmakers, A. J. M., Stegen, J. H. C. H., Gijsen, A. P., Brouns, F., & Saris, W. H. M. (1999) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1999.276.4.e672 · Cited by 219 · see citing works
Bussau, V. A., Ferreira, L. D., Jones, T. W., & Fournier, P. A. (2006) · Diabetes Care · doi:10.2337/diacare.29.03.06.dc05-1764 · Cited by 162 · see citing works
A Direct Comparison of Insulin Aspart and Insulin Lispro in Patients With Type 1 Diabetes
Plank, J., Wutte, A., Brunner, G. A., Siebenhofer, A., Semlitsch, B., Sommer, R., Hirschberger, S., & Pieber, T. R. (2002) · Diabetes Care · doi:10.2337/diacare.25.11.2053 · Cited by 158 · see citing works
Physical activity, sport, and pediatric diabetes
Riddell, M. C., & Iscoe, K. E. (2006) · Pediatric Diabetes · doi:10.1111/j.1399-543x.2006.00146.x · Cited by 157 · see citing works
Regulation of plasma fatty acid oxidation during low- and high-intensity exercise
Sidossis, L. S., Gastaldelli, A., Klein, S., & Wolfe, R. R. (1997) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1997.272.6.e1065 · Cited by 150 · see citing works
Iscoe, K. E., & Riddell, M. C. (2011) · Diabetic Medicine · doi:10.1111/j.1464-5491.2011.03274.x · Cited by 136 · see citing works
Exercise and Glycemic Control in Diabetes: Benefits, Challenges, and Adjustments to Pharmacotherapy
Gulve, E. A. (2008) · Physical Therapy · doi:10.2522/ptj.20080114 · Cited by 120 · see citing works
Comparison of insulin aspart and lispro: pharmacokinetic and metabolic effects.
Homko, C., Deluzio, A., Jimenez, C. C., Kolaczynski, J., & Boden, G. (2003) · Diabetes Care · doi:10.2337/diacare.26.7.2027 · Cited by 118 · see citing works
Nansel, T. R., Gellar, L., & McGill, A. E. (2008) · Diabetes Care · doi:10.2337/dc07-1879 · Cited by 96 · see citing works
Digestion and metabolism of sugars
Southgate, D. A. T. (1995) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/62.1.203s · Cited by 92 · see citing works
Jenni, S., Oetliker, C., Allemann, S., Ith, M., Tappy, L., Wuerth, S., Egger, A., Boesch, C., Schneiter, P., Diem, P., et al. (2008) · Diabetologia · doi:10.1007/s00125-008-1045-5 · Cited by 88 · see citing works
West, D. J., Stephens, J. W., Bain, S. C., Kilduff, L. P., Luzio, S. D., Still, R., & Bracken, R. M. (2010) · Journal of Sports Sciences · doi:10.1080/02640414.2010.531753 · Cited by 75 · see citing works
Self-citationExercise in the Management of Type 1 Diabetes Mellitus
Steppel, J. H., & Horton, E. S. (2003) · Reviews in Endocrine and Metabolic Disorders · doi:10.1023/a:1027302112655 · Cited by 57 · see citing works
Glucose Response to Intense Aerobic Exercise in Type 1 Diabetes
Mauvais‐Jarvis, F., Sobngwi, E., Porcher, R., Garnier, J. P., Vexiau, P., Duvallet, A. L., & Gautier, J. (2003) · Diabetes Care · doi:10.2337/diacare.26.4.1316 · Cited by 56 · see citing works
West, D. J., Morton, R. D., Bain, S. C., Stephens, J. W., & Bracken, R. M. (2010) · Journal of Sports Sciences · doi:10.1080/02640411003734093 · Cited by 49 · see citing works
Self-citationPerrone, C., Laitano, O., & Meyer, F. (2005) · Diabetes Care · doi:10.2337/diacare.28.10.2537 · Cited by 46 · see citing works
Isomaltulose Improves Postexercise Glycemia by Reducing CHO Oxidation in T1DM
West, D. J., MORTON, R. D., Stephens, J. W., Bain, S. C., Kilduff, L. P., Luzio, S. D., Still, R., & Bracken, R. M. (2010) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181eb6147 · Cited by 37 · see citing works
Self-citationCampaigne, B. N., Wallberg‐Henriksson, H., & GUNNARSSON, R. (1987) · Diabetes Care · doi:10.2337/diacare.10.6.716 · Cited by 36 · see citing works
Grimm, J. (2005) · doi:10.1002/0470022086.ch2 · Cited by 33 · see citing works
Oral glucose ingestion increases endurance capacity in normal and diabetic (type I) humans
Ramires, P. R., Forjaz, C. L. M., Strunz, C. M. C., Silva, M. E. R., Diament, J., Nicolau, W., Liberman, B., & Negrão, C. E. (1997) · Journal of Applied Physiology · doi:10.1152/jappl.1997.83.2.608 · Cited by 29 · see citing works
Guidelines on the current best practice for the management of type 1 diabetes, sport and exercise
Perry, E., & GALLEN, I. W. (2009) · Practical Diabetes · doi:10.1002/pdi.1351 · Cited by 26 · see citing works
The Effects of Low– and High–Glycemic Index Meals on Time Trial Performance
Moore, L. J. S., Midgley, A. W., Thomas, G., Thurlow, S., & McNaughton, L. R. (2009) · International Journal of Sports Physiology and Performance · doi:10.1123/ijspp.4.3.331 · Cited by 26 · see citing works
CLINICAL PRACTICE QUESTION Exercise in Type 1 diabetes
GALLEN, I. W. (2003) · Diabetic Medicine · doi:10.1034/j.1600-6143..s1.002.x · Cited by 13 · see citing works
Effect of Glycemic Index Meals on Recovery and Subsequent Endurance Capacity
Wong, S. H., Chen, Y. J., Fung, W. M., & Morris, J. G. (2009) · International Journal of Sports Medicine · doi:10.1055/s-0029-1237710 · Cited by 12 · see citing works
Davies, M. J. (2003) · Diabetic Medicine · doi:10.1046/j.1464-5491.2003.00011.x · Cited by 4 · see citing works
Flagged first, then by citations
1 of the 39 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Exercise management in type 1 diabetes: a consensus statement
Riddell, M. C., Gallen, I. W., Smart, C. E., Taplin, C. E., Adolfsson, P., Lumb, A. N., Kowalski, A., Rabasa-Lhoret, R., McCrimmon, R. J., Hume, C., et al. (2017) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(17)30014-1 · Cited by 903 · see citing works
Bonilla, D. A., Pérez-Idárraga, A., Odriozola-Martínez, A., & Kreider, R. B. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18010103 · Cited by 77 · see citing works
“For instance, positive metabolic effects have been reported in physically-active type-I diabetic patients given that the consumption of isomaltulose alongside rapid-acting insulin reduction improved blood glucose responses to exercise and produced a similar high-intensity run performance compared with dextrose [49].”
BackgroundChetty, T., Shetty, V., Fournier, P. A., Adolfsson, P., Jones, T. W., & Davis, E. A. (2019) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00326 · Cited by 69 · see citing works
Sokołowska, E., Sadowska, A. J., Sawicka, D., Kotulska-Bąblińska, I., & Car, H. (2021) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2021.1895057 · Cited by 61 · see citing works
Low Glycemic Index Prototype Isomaltulose—Update of Clinical Trials
Maresch, C. C., Petry, S. F., Theis, S., Bosy-Westphal, A., & Linn, T. (2017) · Nutrients · doi:10.3390/nu9040381 · Cited by 53 · see citing works
Oosthuyse, T., Carstens, M., & Millen, A. M. E. (2015) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2014-0178 · Cited by 37 · see citing works
Carbohydrate Intake in the Context of Exercise in People with Type 1 Diabetes
Scott, S. N., Kempf, P., Bally, L., & Stettler, C. (2019) · Nutrients · doi:10.3390/nu11123017 · Cited by 39 · see citing works
Potential Sugar Reduction in Cookies Formulated with Sucrose Alternatives
Kweon, M., Slade, L., & Levine, H. (2016) · Cereal Chemistry · doi:10.1094/cchem-01-16-0016-r · Cited by 28 · see citing works
Lee, E. J., Moon, Y., & Kweon, M. (2020) · LWT · doi:10.1016/j.lwt.2020.109565 · Cited by 25 · see citing works
Carbohydrate supplementation: A critical review of recent innovations
Baur, D. A., & Saunders, M. J. (2021) · European Journal of Applied Physiology · doi:10.1007/s00421-020-04534-y · Cited by 22 · see citing works
Kweon, M., Slade, L., & Levine, H. (2016) · Cereal Chemistry · doi:10.1094/cchem-02-16-0032-r · Cited by 22 · see citing works
Barea-Alvarez, M., Benito, M. T., Olano, A., Jimeno, M. L., & Moreno, F. J. (2014) · Journal of Agricultural and Food Chemistry · doi:10.1021/jf5033735 · Cited by 21 · see citing works
Kweon, M., Slade, L., & Levine, H. (2016) · Cereal Chemistry · doi:10.1094/cchem-03-16-0056-r · Cited by 14 · see citing works
Nutrition and Exercise Performance in Adults With Type 1 Diabetes
Colberg, S. R. (2020) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2020.05.014 · Cited by 12 · see citing works
Bally, L., Kempf, P., Züger, T., Speck, C., Pasi, N., Ciller, C., Feller, K., Loher, H., Rosset, R., Wilhelm, M., et al. (2017) · Nutrients · doi:10.3390/nu9020164 · Cited by 12 · see citing works
A Nutritional Approach to Optimizing Pump Therapy in Type 1 Diabetes Mellitus
Gitsi, E., Livadas, S., Angelopoulos, N., Paparodis, R. D., Raftopoulou, M., & Argyrakopoulou, G. (2023) · Nutrients · doi:10.3390/nu15234897 · Cited by 10 · see citing works
Eckstein, M. L., Aberer, F., Dobler, F. J. R., Aziz, F., Heise, T., Sourij, H., & Moser, O. (2022) · Metabolites · doi:10.3390/metabo12111017 · Cited by 8 · see citing works
Kosinski, C., Herzig, D., Laesser, C. I., Nakas, C. T., Melmer, A., Vogt, A. P., Vogt, B., Laimer, M. W., Bally, L., & Stettler, C. (2020) · Diabetes Care · doi:10.2337/dc19-2250 · Cited by 10 · see citing works
Nutritional Management of Athletes with Type 1 Diabetes: A Narrative Review
Cavallo, M., Fano, M. D., Barana, L., Dozzani, I., Bianchini, E., Pellegrino, M., Cisternino, L., Migliarelli, S., Giulietti, C., Pippi, R., et al. (2024) · Nutrients · doi:10.3390/nu16060907 · Cited by 6 · see citing works
Notbohm, H. L., Feuerbacher, J. F., Papendorf, F., Friese, N., Jacobs, M. W., Predel, H., Zacher, J., Bloch, W., & Schumann, M. (2021) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-021-00439-z · Cited by 8 · see citing works
Takada, S., Otsuka, J., Okamoto, Y., Watanabe, D., Aoki, M., Fujii, N., Kenny, G. P., Enoki, Y., Maejima, D., & Amano, T. (2022) · European Journal of Applied Physiology · doi:10.1007/s00421-022-05044-9 · Cited by 5 · see citing works
Eckstein, M. L., Aziz, F., Aberer, F., Böckel, S., Zimmer, R. T., Erlmann, M. P., Sourij, H., & Moser, O. (2022) · Diabetic Medicine · doi:10.1111/dme.14981 · Cited by 5 · see citing works
Ivandić, M., Berković, M. C., Ormanac, K., Sabo, D., Kolarić, T. O., Kuna, L., Mihaljević, V., Canecki-Varžić, S., Smolić, M., & Bilić-Čurčić, I. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20064966 · Cited by 4 · see citing works
Thomakos, P., Vazeou, A., Sakkas, D., Panagopoulos, G., Anifantakis, K., Smyrnaki, P., Arvanitaki, T., Kyrlaki, E., Kefalogiannis, N., Mamoulakis, D., et al. (2018) · QJM · doi:10.1093/qjmed/hcy136 · Cited by 4 · see citing works
Innovative low-glycaemic carbohydrates: an update
Sentko, A. (2013) · Nutrafoods · doi:10.1007/s13749-013-0062-2 · Cited by 4 · see citing works
The role of alternative sugars on endurance capacity in balb/c mice
Kim, S., Jo, K., Kim, N., Hong, K., & Suh, H. J. (2020) · Journal of Food Biochemistry · doi:10.1111/jfbc.13409 · Cited by 3 · see citing works
McCarthy, O. M., Christensen, M. B., Tawfik, S., Kristensen, K. B., Hartmann, B., Holst, J. J., Schmidt, S., Nørgaard, K., & Bracken, R. M. (2024) · Nutrients · doi:10.3390/nu16234098 · Cited by 3 · see citing works
Self-citationValorization of biomass to palatinose
Hussain, N., Farooq, N., & Bilal, M. (2023) · Elsevier eBooks · doi:10.1016/b978-0-12-822887-6.00013-9 · Cited by 1 · see citing works
Ang, M. (2016) · SpringerBriefs in systems biology · doi:10.1007/978-3-319-27898-8_2 · Cited by 1 · see citing works
Pre-exercise Insulin and Carbohydrate Strategies in the Exercising T1DM Individual
Bracken, R. M., West, D. J., & Bain, S. C. (2012) · Springer eBooks · doi:10.1007/978-0-85729-754-9_3
Self-citationSafety of isomaltulose syrup (dried) as a novel food pursuant to Regulation (EU) 2015/2283
EFSA Panel on Nutrition, N. F. A. F. A. (., Turck, D., Bohn, T., Castenmiller, J. J. M., Henauw, S. D., Hirsch‐Ernst, K. I., Maciuk, A., Mangelsdorf, I., McArdle, H. J., Naska, A., et al. (2024) · EFSA Journal · doi:10.2903/j.efsa.2024.8491
Schmidt, K. R., Johansen, R. F., Riis, S., Larsen, M. S., Støvring, H., Wallis, G. A., ROWLANDS, D. S., Gormsen, L. C., & Søndergaard, E. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.70958
- Authors
- BRACKEN, R. M., PAGE, R., GRAY, B., KILDUFF, L. P., WEST, D. J., STEPHENS, J. W., & BAIN, S. C.
- Affiliations
- Swansea University (GB)
- Northumbria University (GB)
- ORCID
- Venue
- Medicine & Science in Sports & Exercise
- Published
- 2012-05
- Volume
- 44
- Issue
- 5
- Pages
- 800-808
- ISSN
- 0195-9131 (ISSN-L)
- OpenAlex
- W2007266392
- Cited by
- 32
- References
- 39
- Citations by year
- 2026: 1 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 2 · 2020: 6 · 2019: 2 · 2018: 1 · 2017: 3 · 2016: 4 · 2015: 1 · 2014: 1 · 2013: 1 · 2012: 1
- FWCI
- 0.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medicine & Science in Sports & Exercise (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Keywords
- isomaltulose, type 1 diabetes, glycemic index, D-glucose, blood glucose, exercise performance, running, fuel oxidation, blood lactate, hypoglycemia prevention, acid-base balance
- MeSH terms
- Adult, Analysis of Variance, Blood Glucose, Chromatography, High Pressure Liquid, Diabetes Mellitus, Type 1, Exercise Test, Female, Glucose, Humans, Hydrogen-Ion Concentration, Insulin, Isomaltose, Lactates, Male, Oxygen Consumption, Running, Area Under Curve, Glycemic Index
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
