OBJECTIVE -This study investigated the effect of moderate exercise on the absorption of inhaled insulin via the AERx insulin diabetes management system (iDMS). RESEARCH DESIGN AND METHODS -In this randomized , open-label, four-period, crossover, glucose clamp study 23 nonsmoking 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 group) or 30 min exercise starting, 2) 30 min after dosing (EX30), 3) 120 min

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... fter dosing (EX120), or 4) 240 min after dosing (EX240). RESULTS -Exercise changed the shape of the free plasma insulin curves, but compared with the NOEX group the area under the curve for free plasma insulin (AUC ins ) for the first 2 h after the start of exercise was unchanged for EX30 and EX240, while it was 15% decreased for EX120 (P Ͻ 0.01). The overall insulin absorption during 6 and 10 h after dosing was 13% decreased for EX30 (P Ͻ 0.005), 11% decreased for EX120 (P Ͻ 0.01), and 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 ϭ 0.04). The AUC for the glucose infusion rate (AUC GIR ) for 2 h after the start of exercise increased by 58% for EX30, 45% for EX120, and 71% for EX240 (all P Ͻ 0.02) compared with the NOEX group. CONCLUSIONS -Thirty minutes of moderate exercise led to unchanged or decreased absorption of inhaled insulin via AERx iDMS and faster C max for early exercise. Thus, patients using AERx iDMS can adjust insulin dose as usual independent of time of exercise, but they should be aware of the faster effect if exercising early after dosing.