The effect of cold exposure with shivering on glucose tolerance in healthy men

A.J. Sellers*, H. Pallubinsky, P. Rense, W. Bijnens, T. van de Weijer, E. Moonen-Kornips, P. Schrauwen, W.D. van Marken Lichtenbelt

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Muscle glycogen use and glucose uptake during cold exposure increases with shivering intensity. We hypothesized that cold exposure, with shivering, would subsequently increase glucose tolerance. Fifteen healthy men (age = 26 +/- 5 yr, body mass index = 23.9 +/- 2.5 kg.m(-2)) completed two experimental trials after an overnight fast. Cold exposure (10 degrees C) was applied during the first trial, via a water-perfused suit, to induce at least 1 h of shivering in each participant. For comparison, a thermoneutral (32 degrees C) condition was applied during the second trial, under identical conditions, for the same duration as determined during the cold exposure. After the thermal exposures, participants rested under a duvet for 90 min, which was followed by a 3-h oral glucose tolerance test. Skin temperature (means +/- SE) decreased at the end of the cold exposure compared with that before (26.9 +/- 0.3 vs. 33.7 +/- 0.1 degrees C, P < 0.001). Total energy expenditure during the 1 h of shivering was greater than that during the time-matched thermoneutral condition (619 +/- 23 vs. 309 +/- 7 kJ, P < 0.001). Cold exposure increased the areas under the glucose and insulin curves by 4.8% (P = 0.066) and 24% (P = 0.112), respectively. The Matsuda and insulin-glucose indices changed after cold exposure by 21% (P = 0.125) and 30% (P = 0.100), respectively. Cold exposure did not subsequently increase glucose tolerance. Instead, the Matsuda and insulin-glucose indices suggest insulin resistance post shivering.NEW & NOTEWORTHY This is the first study to examine the effect of cold-induced shivering on subsequent glucose tolerance determined under thermoneutral conditions. Plasma glucose and insulin concentrations increased during the oral glucose tolerance test post shivering. Additionally, insulin sensitivity indices suggest insulin resistance following cold exposure. These results provide evidence for an acute post-shivering response, whereby glucose metabolism has deteriorated, contrary to the results from earlier studies on cold acclimation.
Original languageEnglish
Pages (from-to)193-205
Number of pages13
JournalJournal of Applied Physiology
Issue number1
Publication statusPublished - 1 Jan 2021


  • brown adipose-tissue
  • cold-induced thermogenesis
  • fatty-acids
  • glucose metabolism
  • insulin sensitivity
  • intensity
  • metabolism
  • muscle glycogen
  • oral glucose tolerance test
  • plasma
  • prior exercise
  • responses
  • thermoregulation
  • whole-body

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