BMJ Case Reports 2012; doi:10.1136/bcr.03.2011.3939
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)

Towards creating a superstimulus to normalise glucose metabolism in the prediabetic: a case-study in the feast-famine and activity-rest cycle

  1. Brian Caulfield2
  1. 1Institute of Sport and Health, University College Dublin, Dublin, Ireland
  2. 2UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
  1. Correspondence to Dr Louis, louiscrowe{at}


We live in a time of plenty. During evolution, periods of hunger and simultaneously high activity levels would combine giving a stimulus which is absent from modern lifestyles. This is potentially connected with abnormal glucose metabolism. It was hypothesised that simultaneous fasting and aggressive aerobic neuromuscular electrical stimulation (NMES) exercise, until metabolic exhaustion, may be an acceptable modern equivalent. A healthy subject fasted for 44 h (water allowed) during which he undertook three aerobic NMES sessions at >50%VO2max; heart rate >160 bpm. Metabolic gas analysis of a comparable session in the non-fasting state showed 100% carbohydrate substrate utilisation. With fasting the NMES exercise consumed mostly fat–up to 100% fat utilisation at 42 h. This clear shift away from using carbohydrate as a substrate and hypoglycaemia may indicate that carbohydrate stores are nearly depleted. The authors postulate that this may constitute a metabolic super stimulus mimicking the famine-activity periods of our ancestors.


  • Competing interests Our project is 90% funded by Enterprise Ireland, an Irish governmental agency. The remaining funding and NMES unit that delivered the treatment was supplied by BioMedical Rearch in whom the corresponding author has a minor holding.

  • Patient consent Not obtained.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article