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Hall B, Żebrowska A, Sikora M, Siatkowski S, Robins A. The Effect of High-Intensity Interval Exercise on Short-Term Glycaemic Control, Serum Level of Key Mediator in Hypoxia and Pro-Inflammatory Cytokines in Patients with Type 1 Diabetes-An Exploratory Case Study. Nutrients 2023; 15:3749. [PMID: 37686781 PMCID: PMC10490106 DOI: 10.3390/nu15173749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Type 1 diabetes (T1D) is associated with hyperglycaemia-induced hypoxia and inflammation. This study assessed the effects of a single bout of high-intensity interval exercise (HIIE) on glycaemia (BG) and serum level of pro-inflammatory cytokines, and an essential mediator of adaptive response to hypoxia in T1D patients. The macronutrient intake was also evaluated. Nine patients suffering from T1D for about 12 years and nine healthy individuals (CG) were enrolled and completed one session of HIIE at the intensity of 120% lactate threshold with a duration of 4 × 5 min intermittent with 5 min rests after each bout of exercise. Capillary and venous blood were withdrawn at rest, immediately after and at 24 h post-HIIE for analysis of BG, hypoxia-inducible factor alpha (HIF-1α), tumour necrosis factor alpha (TNF-α) and vascular-endothelial growth factor (VEGF). Pre-exercise BG was significantly higher in the T1D patients compared to the CG (p = 0.043). HIIE led to a significant decline in T1D patients' BG (p = 0.027) and a tendency for a lower BG at 24 h post-HIIE vs. pre-HIIE. HIF-1α was significantly elevated in the T1D patients compared to CG and there was a trend for HIF-1α to decline, and for VEGF and TNF-α to increase in response to HIIE in the T1D group. Both groups consumed more and less than the recommended amounts of protein and fat, respectively. In the T1D group, a tendency for a higher digestible carbohydrate intake and more frequent hyperglycaemic episodes on the day after HIIE were observed. HIIE was effective in reducing T1D patients' glycaemia and improving short-term glycaemic control. HIIE has the potential to improve adaptive response to hypoxia by elevating the serum level of VEGF. Patients' diet and level of physical activity should be screened on a regular basis, and they should be educated on the glycaemic effects of digestible carbohydrates.
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Affiliation(s)
- Barbara Hall
- School of Physiological and Medical Sciences, Department of Physiology, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland; (A.Ż.); (M.S.)
| | - Aleksandra Żebrowska
- School of Physiological and Medical Sciences, Department of Physiology, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland; (A.Ż.); (M.S.)
| | - Marcin Sikora
- School of Physiological and Medical Sciences, Department of Physiology, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland; (A.Ż.); (M.S.)
| | - Szymon Siatkowski
- Institute of Healthy Living, The Jerzy Kukuczka Academy of Physical Education, Mikolowska Street 72a, 40-065 Katowice, Poland;
| | - Anna Robins
- School of Health and Society, University of Salford, Allerton Building, 43 Crescent, Salford M5 4WT, UK;
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Riddell MC, Shakeri D, Scott SN. A Brief Review on the Evolution of Technology in Exercise and Sport in Type 1 Diabetes: Past, Present, and Future. Diabetes Technol Ther 2022; 24:289-298. [PMID: 34809493 DOI: 10.1089/dia.2021.0427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
One hundred years ago, insulin was first used to successfully lower blood glucose levels in young people living with what was then called juvenile diabetes. While insulin was not a cure for diabetes, it allowed individuals to resume a near normal life and have some freedom to eat more liberally and gain the strength they needed to live a more active lifestyle. Since then, a number of therapeutic and technical advances have arisen to further improve the health and wellbeing of individuals living with type 1 diabetes, allowing many to participate in sport at the local, regional, national or international level of competition. This review and commentary highlights some of the key advances in diabetes management in sport over the last 100 years since the discovery of insulin.
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Affiliation(s)
- Michael C Riddell
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Canada
| | - Dorsa Shakeri
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Canada
| | - Sam N Scott
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland
- Team Novo Nordisk Professional Cycling Team, Atlanta, Georgia, USA
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3
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Medical Problems of the Athlete. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Trojian T, Colberg S, Harris G, Oh R, Dixit S, Gibson M, Corcoran M, Ramey L, Berg PV. American Medical Society for Sports Medicine Position Statement on the Care of the Athlete and Athletic Person With Diabetes. Clin J Sport Med 2022; 32:8-20. [PMID: 34930869 DOI: 10.1097/jsm.0000000000000906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
ABSTRACT The American Medical Society for Sports Medicine (AMSSM) developed this position statement to assist physicians and other health professionals in managing athletes and active people with diabetes. The AMSSM selected the author panel through an application process to identify members with clinical and academic expertise in the care of active patients with diabetes. This article reviews the current knowledge and gaps regarding the benefits and risks of various types of exercise and management issues for athletes and physically active people with diabetes, including nutrition and rehabilitation issues. Resistance exercises seem to be beneficial for patients with type 1 diabetes, and the new medications for patients with type 2 diabetes generally do not need adjustment with exercise. In preparing this statement, the authors conducted an evidence review and received open comment from the AMSSM Board of Directors before finalizing the recommendations.
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Cyranka K, Dudek D, Małecki MT, Klupa T. "Fighting spirit": specific personality traits as one of the key factors for sport championship in type 1 diabetes mellitus. Diabetol Int 2021; 12:317-323. [PMID: 33457163 PMCID: PMC7804577 DOI: 10.1007/s13340-020-00488-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/22/2020] [Indexed: 11/18/2022]
Abstract
There is ample evidence that sport is a protective factor against a number of health risks, across all ages, in the general population. An in-depth understanding of energy metabolism has reasonably entailed exercise as a cornerstone in the lifestyle of almost all subjects with type 1 diabetes mellitus (T1DM). Nevertheless, individuals with T1DM often fail in accomplishing exercise guidelines and they are often less active than their peer without diabetes. Two major obstacles are feared: management of blood glucose control and hypoglycemia. Nowadays, strategies, including glucose monitoring technology and insulin pump therapy, have significantly contributed to the participation in regular physical activity, and even in competitive sports, for T1DM people. The case report presents an analysis of specific personality traits and psychological parameters of 20 years old female Polish multiple champion in weightlifting with excellent T1DM control.
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Affiliation(s)
- Katarzyna Cyranka
- Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Dominika Dudek
- Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Maciej T Małecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
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Jabbour G, Bragazzi NL. Continuous Blood Glucose Monitoring Increases Vigorous Physical Activity Levels and Is Associated With Reduced Hypoglycemia Avoidance Behavior In Youth With Type 1 Diabetes. Front Endocrinol (Lausanne) 2021; 12:722123. [PMID: 34557162 PMCID: PMC8454404 DOI: 10.3389/fendo.2021.722123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/20/2021] [Indexed: 12/30/2022] Open
Abstract
The primary goal of this study was to explore physical activity (PA) levels, hypoglycemia fear scores and hypoglycemia episodes according to insulin administration and blood glucose monitoring methods in youth with type 1 diabetes (T1D). A self-administered questionnaire was completed by 28 children and 33 adolescents with T1D, and their PA was assessed. Hypoglycemia episodes, fear of hypoglycemia scores, insulin therapy (pump vs. injection) and blood glucose monitoring (continuous blood glucose monitors [CGMs] vs. blood glucose meters) methods are reported in the present work. There were no significant differences in the number of hypoglycemic episodes, child hypoglycemia fear survey behavior or total scores, or any components of the PA profile between youth using injections and those using a pump. However, these variables differed significantly when compared according to blood glucose monitoring method (CGMs vs. blood glucose meters): 41.2 vs. 81.8, p<0.01; 1.03 ± 0.05 vs. 2.6 ± 0.63, p<0.01; 1.09 ± 0.43 vs. 2.94 ± 0.22, p<0.01; and 222 ± 18 vs. 49 ± 11, p<0.01 (for total time in vigorous PA in minutes per week), respectively. CGM use correlated significantly with VPA levels (β=0.6; p=0.04). Higher VPA levels were associated with higher child hypoglycemia fear survey behavior scores (β=0.52; p=0.04). The latter correlates negatively with the number of episodes of hypoglycemia in the past 12 months in all category groups. The type of insulin injection was not associated with more activity in youth with T1D. In contrast, CGM use may be associated with increased vigorous PA among T1D youth. Those with higher hypoglycemia fear survey behavior scores engaged in more VPA and had fewer hypoglycemia episodes. Although CGM use ensures continuous monitoring of glycemia during exercise, increasing hypoglycemia avoidance behavior is still a necessary part of exercise management strategies in active youth with T1D.
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Affiliation(s)
- Georges Jabbour
- Department of Physical Education, College of Education, Qatar University, Doha, Qatar
- *Correspondence: Georges Jabbour, ,
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
- Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy
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Müller-Korbsch M, Frühwald L, Heer M, Fangmeyer-Binder M, Reinhart-Mikocki D, Fasching P. Assessment of the "Second Day" Exercise Effect on Glycemic Control, Insulin Requirements, and CHO Intake in Type 1 Diabetes Adults. J Diabetes Sci Technol 2021; 15:127-133. [PMID: 31583900 PMCID: PMC7783009 DOI: 10.1177/1932296819879419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Glucose control during consecutive days of aerobic exercise has not been well studied. We assessed glycemia, insulin requirements, and carbohydrate (CHO) needs during two consecutive days of prolonged cycling in type 1 diabetes (T1D) adults using sensor-augmented insulin pump therapy. METHODS Twenty adults with well-controlled T1D and six healthy adults (for comparison) were enrolled. Assessments were made during two consecutive days of cycling activities (30 miles per day). On day 1 (D1), basal rates were reduced 50% and CHO intake was guided by real-time continuous glucose monitoring (rtCGM) data to maintain a target range (70-180 mg/dL). On day 2 (D2), basal insulin infusion was stopped for the first hour of biking and resumed at a minimal rate during biking. Carbohydrate intake one hour before, during, and ten minutes after biking was recorded. Times within/below target range, glycemic variability, and mean glucose were calculated from rtCGM data. RESULTS Among 17 T1D participants who completed the study, mean glucose levels at the start of cycling were slightly lower on D2 vs D1: 138 ± 16 mg/dL and 122 ± 16, respectively, P = NS. Type 1 diabetes participants achieved near-normal glucose levels at the end of both cycling events; however, the reduction in glucose was most notable at one hour into the event on D2 vs D1. Carbohydrate intake was notably lower during D2 vs D1 with no difference in time <54 mg/dL (both P = NS). CONCLUSIONS Type 1 diabetes individuals using rtCGM-augmented insulin pump therapy can safely engage in consecutive days of prolonged aerobic exercise by significantly reducing insulin dosages with no increase in CHO intake.
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Affiliation(s)
- Michael Müller-Korbsch
- MedVienna Ärztezentrum, Austria
- Michael Müller-Korbsch, MD, MedVienna Ärztezentrum, Sensengasse 3, Vienna 1090, Austria.
| | - Lisa Frühwald
- 5th Medizinische Abteilung für Endokrinologie und Rheumatologie, Wilhelminenspital Austria, Vienna, Austria
| | - Michael Heer
- University of Applied Sciences Technikum Wien, Vienna, Austria
| | - Maria Fangmeyer-Binder
- 5th Medizinische Abteilung für Endokrinologie und Rheumatologie, Wilhelminenspital Austria, Vienna, Austria
| | - David Reinhart-Mikocki
- 5th Medizinische Abteilung für Endokrinologie und Rheumatologie, Wilhelminenspital Austria, Vienna, Austria
| | - Peter Fasching
- 5th Medizinische Abteilung für Endokrinologie und Rheumatologie, Wilhelminenspital Austria, Vienna, Austria
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Buckley JP, Riddell M, Mellor D, Bracken RM, Ross MK, LaGerche A, Poirier P. Acute glycaemic management before, during and after exercise for cardiac rehabilitation participants with diabetes mellitus: a joint statement of the British and Canadian Associations of Cardiovascular Prevention and Rehabilitation, the International Council for Cardiovascular Prevention and Rehabilitation and the British Association of Sport and Exercise Sciences. Br J Sports Med 2020; 55:bjsports-2020-102446. [PMID: 33361136 DOI: 10.1136/bjsports-2020-102446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 12/12/2022]
Abstract
Type 1 (T1) and type 2 (T2) diabetes mellitus (DM) are significant precursors and comorbidities to cardiovascular disease and prevalence of both types is still rising globally. Currently,~25% of participants (and rising) attending cardiac rehabilitation in Europe, North America and Australia have been reported to have DM (>90% have T2DM). While there is some debate over whether improving glycaemic control in those with heart disease can independently improve future cardiovascular health-related outcomes, for the individual patient whose blood glucose is well controlled, it can aid the exercise programme in being more efficacious. Good glycaemic management not only helps to mitigate the risk of acute glycaemic events during exercising, it also aids in achieving the requisite physiological and psycho-social aims of the exercise component of cardiac rehabilitation (CR). These benefits are strongly associated with effective behaviour change, including increased enjoyment, adherence and self-efficacy. It is known that CR participants with DM have lower uptake and adherence rates compared with those without DM. This expert statement provides CR practitioners with nine recommendations aimed to aid in the participant's improved blood glucose control before, during and after exercise so as to prevent the risk of glycaemic events that could mitigate their beneficial participation.
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Affiliation(s)
- John P Buckley
- Shrewsbury Centre for Active Living, University of Chester Faculty of Medicine and Life Sciences, Chester, Cheshire West and Chester, UK
- Institute of Sport Exercise and Health, University College London, London, UK
| | - Michael Riddell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- LMC Healthcare, Diabetes and Endocrinology, Toronto, Ontario, Canada
| | - Duane Mellor
- Aston Medical School, Aston University, Birmingham, West Midlands, UK
- Sport and Exercise Science, Swansea University College of Engineering, Swansea, Wales, UK
| | - Richard M Bracken
- Sport and Exercise Science, Swansea University College of Engineering, Swansea, Wales, UK
| | - Marie-Kristelle Ross
- Hotel-Dieu de Levis, Laval University Faculty of Medicine, Quebec city, Quebec, Canada
| | - Andre LaGerche
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Paul Poirier
- Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec, Canada
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Baur DA, Saunders MJ. Carbohydrate supplementation: a critical review of recent innovations. Eur J Appl Physiol 2020; 121:23-66. [PMID: 33106933 DOI: 10.1007/s00421-020-04534-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/12/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE To critically examine the research on novel supplements and strategies designed to enhance carbohydrate delivery and/or availability. METHODS Narrative review. RESULTS Available data would suggest that there are varying levels of effectiveness based on the supplement/supplementation strategy in question and mechanism of action. Novel carbohydrate supplements including multiple transportable carbohydrate (MTC), modified carbohydrate (MC), and hydrogels (HGEL) have been generally effective at modifying gastric emptying and/or intestinal absorption. Moreover, these effects often correlate with altered fuel utilization patterns and/or glycogen storage. Nevertheless, performance effects differ widely based on supplement and study design. MTC consistently enhances performance, but the magnitude of the effect is yet to be fully elucidated. MC and HGEL seem unlikely to be beneficial when compared to supplementation strategies that align with current sport nutrition recommendations. Combining carbohydrate with other ergogenic substances may, in some cases, result in additive or synergistic effects on metabolism and/or performance; however, data are often lacking and results vary based on the quantity, timing, and inter-individual responses to different treatments. Altering dietary carbohydrate intake likely influences absorption, oxidation, and and/or storage of acutely ingested carbohydrate, but how this affects the ergogenicity of carbohydrate is still mostly unknown. CONCLUSIONS In conclusion, novel carbohydrate supplements and strategies alter carbohydrate delivery through various mechanisms. However, more research is needed to determine if/when interventions are ergogenic based on different contexts, populations, and applications.
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Affiliation(s)
- Daniel A Baur
- Department of Physical Education, Virginia Military Institute, 208 Cormack Hall, Lexington, VA, 24450, USA.
| | - Michael J Saunders
- Department of Kinesiology, James Madison University, Harrisonburg, VA, 22801, USA
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Riddell MC, Scott SN, Fournier PA, Colberg SR, Gallen IW, Moser O, Stettler C, Yardley JE, Zaharieva DP, Adolfsson P, Bracken RM. The competitive athlete with type 1 diabetes. Diabetologia 2020; 63:1475-1490. [PMID: 32533229 PMCID: PMC7351823 DOI: 10.1007/s00125-020-05183-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022]
Abstract
Regular exercise is important for health, fitness and longevity in people living with type 1 diabetes, and many individuals seek to train and compete while living with the condition. Muscle, liver and glycogen metabolism can be normal in athletes with diabetes with good overall glucose management, and exercise performance can be facilitated by modifications to insulin dose and nutrition. However, maintaining normal glucose levels during training, travel and competition can be a major challenge for athletes living with type 1 diabetes. Some athletes have low-to-moderate levels of carbohydrate intake during training and rest days but tend to benefit, from both a glucose and performance perspective, from high rates of carbohydrate feeding during long-distance events. This review highlights the unique metabolic responses to various types of exercise in athletes living with type 1 diabetes. Graphical abstract.
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Affiliation(s)
- Michael C Riddell
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity & Chronic Disease Unit, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
- LMC Diabetes & Endocrinology, Toronto, ON, Canada.
| | - Sam N Scott
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland
- Team Novo Nordisk Professional Cycling Team, Atlanta, GA, USA
| | - Paul A Fournier
- School of Human Sciences, Division Sport Science, Exercise and Health, University of Western Australia, Crawley, WA, Australia
| | - Sheri R Colberg
- Human Movement Sciences Department, Old Dominion University, Norfolk, VA, USA
| | - Ian W Gallen
- Royal Berkshire NHS Foundation Trust Centre for Diabetes and Endocrinology, Royal Berkshire Hospital, Reading, UK
| | - Othmar Moser
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jane E Yardley
- Augustana Faculty, University of Alberta, Edmonton, AB, Canada
- Alberta Diabetes Institute, Edmonton, AB, Canada
- Women's and Children's Health Research Institute, Edmonton, AB, Canada
| | - Dessi P Zaharieva
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter Adolfsson
- Department of Pediatrics, The Hospital of Halland, Kungsbacka, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Richard M Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, A111 Engineering East, Fabian Way, Crymlyn Burrows, Swansea, SA1 8EN, UK.
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11
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Cockcroft EJ, Narendran P, Andrews RC. Exercise‐induced hypoglycaemia in type 1 diabetes. Exp Physiol 2020; 105:590-599. [DOI: 10.1113/ep088219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/26/2019] [Indexed: 12/30/2022]
Affiliation(s)
| | - P. Narendran
- Department of DiabetesUniversity Hospitals Birmingham NHS Foundation Trust Birmingham UK
- Institute of Immunology and ImmunotherapyUniversity of Birmingham Birmingham UK
| | - R. C. Andrews
- University of Exeter Medical School Exeter UK
- Department of DiabetesTaunton and Somerset NHS Foundation Trust Taunton UK
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12
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Medical Problems of the Athlete. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_58-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Athletes of various skill levels commonly use many different types of medications, often at rates higher than the general population. Common medication classes used in athletes include analgesics such as nonsteroidal anti-inflammatory drugs and acetaminophen, inhalers for asthma and exercise-induced bronchoconstriction, antihypertensives, antibiotics, and insulin. Prescribers must be aware of the unique considerations for each of these medications when using them in patients participating in physical activity. The safety, efficacy, impact on athletic performance, and regulatory restrictions of the most common medications used in athletes are discussed in this article.
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Affiliation(s)
- Benjamin Ferry
- Trident/MUSC Family Medicine Residency Program, Department of Family Medicine, Medical University of South Carolina, 9228 Medical Plaza Drive, Charleston, SC 29406, USA
| | - Alexei DeCastro
- Department of Family Medicine, Medical University of South Carolina, College of Medicine, 9228 Medical Plaza Drive, Charleston, SC 29406, USA
| | - Scott Bragg
- Department of Family Medicine, College of Medicine, College of Pharmacy, Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina, 280 Calhoun Street MSC 140, Charleston, SC 29425, USA.
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Pre-Exercise Blood Glucose Levels Determine the Amount of Orally Administered Carbohydrates during Physical Exercise in Individuals with Type 1 Diabetes-A Randomized Cross-Over Trial. Nutrients 2019; 11:nu11061287. [PMID: 31174360 PMCID: PMC6627914 DOI: 10.3390/nu11061287] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 12/21/2022] Open
Abstract
The aim of the study was to assess the amount of orally administered carbohydrates needed to maintain euglycemia during moderate-intensity exercise in individuals with type 1 diabetes. Nine participants with type 1 diabetes (four women, age 32.1 ± 9.0 years, BMI 25.5 ± 3.9 kg/m2, HbA1c 55 ± 7 mmol/mol (7.2 ± 0.6%)) on insulin Degludec were randomized to cycle for 55 min at moderate intensity (63 ± 7% VO2peak) for five consecutive days on either 75% or 100% of their regular basal insulin dose. The impact of pre-exercise blood glucose concentration on the carbohydrate requirement was analyzed by one-way ANOVA stratified for pre-exercise blood glucose quartiles. The effect of the basal insulin dose on the amount of orally administered carbohydrates was evaluated by Wilcoxon matched-pairs signed-rank test. The amount of orally administered carbohydrates during the continuous exercise sessions was similar for both trial arms (75% or 100% basal insulin) with median [IQR] of 36 g (9–62 g) and 36 g (9–66 g) (p = 0.78). The amount of orally administered carbohydrates was determined by pre-exercise blood glucose concentration for both trial arms (p = 0.03). Our study elucidated the importance of pre-exercise glucose concentration related orally administered carbohydrates to maintain euglycemia during exercise in individuals with type 1 diabetes.
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Moser O, Eckstein ML, Mueller A, Birnbaumer P, Aberer F, Koehler G, Sourij C, Kojzar H, Holler P, Simi H, Pferschy P, Dietz P, Bracken RM, Hofmann P, Sourij H. Impact of physical exercise on sensor performance of the FreeStyle Libre intermittently viewed continuous glucose monitoring system in people with Type 1 diabetes: a randomized crossover trial. Diabet Med 2019; 36:606-611. [PMID: 30677187 DOI: 10.1111/dme.13909] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2018] [Indexed: 01/10/2023]
Abstract
AIMS To evaluate the sensor performance of the FreeStyle Libre intermittently viewed continuous glucose monitoring system using reference blood glucose levels during moderate-intensity exercise while on either full or reduced basal insulin dose in people with Type 1 diabetes. METHODS Ten participants with Type 1 diabetes [four women, mean ± sd age 31.4 ± 9.0 years, BMI 25.5±3.8 kg/m2 , HbA1c 55±7 mmol/mol (7.2±0.6%)] exercised on a cycle ergometer for 55 min at a moderate intensity for 5 consecutive days at the clinical research facility, while receiving either their usual or a 75% basal insulin dose. After a 4-week washout period, participants performed the second exercise period having switched to the alternative basal insulin dose. During exercise, reference capillary blood glucose values were analysed using the fully enzymatic-amperometric method and compared with the interstitial glucose values obtained. Intermittently viewed continuous glucose monitoring accuracy was analysed according to median (interquartile range) absolute relative difference, and Clarke error grid and Bland-Altman analysis for overall glucose levels during exercise, stratified by glycaemic range and basal insulin dosing scheme (P<0.05). RESULTS A total of 845 glucose values were available during exercise to evaluate intermittently viewed continuous glucose monitoring sensor performance. The median (interquartile range) absolute relative difference between the reference values and those obtained by the sensor across the glycaemic range overall was 22 (13.9-29.7)%, and was 36.3 (24.2-45.2)% during hypoglycaemia, 22.8 (14.6-30.6)% during euglycaemia and 15.4 (9-21)% during hyperglycaemia. Usual basal insulin dose was associated with a worse sensor performance during exercise compared with the reduced (75%) basal insulin dose [median (interquartile range) absolute relative difference: 23.7 (17.2-30.7)% vs 20.5 (12-28.1)%; P<0.001). CONCLUSIONS The intermittently viewed continuous glucose monitoring sensor showed diminished accuracy during exercise. Absolute glucose readings derived from the sensor should be used cautiously and need confirmation by additional finger-prick blood glucose measurements.
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Affiliation(s)
- O Moser
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - M L Eckstein
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - A Mueller
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, Medical University of Graz, Graz, Austria
- Sport Science Laboratory, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - P Birnbaumer
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, Medical University of Graz, Graz, Austria
| | - F Aberer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - G Koehler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - C Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - H Kojzar
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - P Holler
- Sport Science Laboratory, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - H Simi
- Sport Science Laboratory, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - P Pferschy
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - P Dietz
- Department of Physical Activity and Public Health, Institute of Sports Science, Medical University of Graz, Graz, Austria
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the University of Mainz, Mainz, Germany
| | - R M Bracken
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - P Hofmann
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, Medical University of Graz, Graz, Austria
| | - H Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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16
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Moser O, Eckstein ML, Mueller A, Birnbaumer P, Aberer F, Koehler G, Sourij C, Kojzar H, Holler P, Simi H, Pferschy P, Dietz P, Bracken RM, Hofmann P, Sourij H. Reduction in insulin degludec dosing for multiple exercise sessions improves time spent in euglycaemia in people with type 1 diabetes: A randomized crossover trial. Diabetes Obes Metab 2019; 21:349-356. [PMID: 30221457 PMCID: PMC6587463 DOI: 10.1111/dom.13534] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/30/2018] [Accepted: 09/11/2018] [Indexed: 12/29/2022]
Abstract
AIMS To compare the time spent in specified glycaemic ranges in people with type 1 diabetes (T1D) during 5 consecutive days of moderate-intensity exercise while on either 100% or 75% of their usual insulin degludec (IDeg) dose. MATERIALS AND METHODS Nine participants with T1D (four women, mean age 32.1 ± 9.0 years, body mass index 25.5 ± 3.8 kg/m2 , glycated haemoglobin 55 ± 7 mmol/mol (7.2% ± 0.6%) on IDeg were enrolled in the trial. Three days before the first exercise period, participants were randomized to either 100% or 75% of their usual IDeg dose. Participants exercised on a cycle ergometer for 55 minutes at a moderate intensity for 5 consecutive days. After a 4-week wash-out period, participants performed the last exercise period for 5 consecutive days with the alternate IDeg dose. Time spent in specified glycaemic ranges, area under the curve and numbers of hypoglycaemic events were compared for the 5 days on each treatment allocation using a paired Students' t test, Wilcoxon matched-pairs signed-rank test and two-way ANOVA. RESULTS Time spent in euglycaemia over 5 days was greater for the 75% IDeg dose versus the 100% IDeg dose (4008 ± 938 minutes vs. 3566 ± 856 minutes; P = 0.04). Numbers of hypoglycaemic events (P = 0.91) and time spent in hypoglycaemia (P = 0.07) or hyperglycaemia (P = 0.38) was similar for both dosing schemes. CONCLUSIONS A 25% reduction in usual IDeg dose around regular exercise led to more time spent in euglycaemia, with small effects on time spent in hypo- and hyperglycaemia.
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Affiliation(s)
- Othmar Moser
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - Max L Eckstein
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - Alexander Mueller
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
- Sport Science Laboratory, Institute of Health and Tourism Management, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - Philipp Birnbaumer
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Felix Aberer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gerd Koehler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Kojzar
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Holler
- Sport Science Laboratory, Institute of Health and Tourism Management, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - Helmut Simi
- Sport Science Laboratory, Institute of Health and Tourism Management, FH Joanneum University of Applied Science, Bad Gleichenberg, Austria
| | - Peter Pferschy
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Pavel Dietz
- Department of Physical Activity and Public Health, Institute of Sports Science, University of Graz, Graz, Austria
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the University of Mainz, Mainz, Germany
| | - Richard M Bracken
- Diabetes Research Group, Medical School, Swansea University, Swansea, UK
- Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), College of Engineering, Swansea University, Swansea, UK
| | - Peter Hofmann
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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17
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Zaharieva DP, Riddell MC. Insulin Management Strategies for Exercise in Diabetes. Can J Diabetes 2018; 41:507-516. [PMID: 28942788 DOI: 10.1016/j.jcjd.2017.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/16/2017] [Accepted: 07/31/2017] [Indexed: 11/19/2022]
Abstract
There is no question that regular exercise can be beneficial and lead to improvements in overall cardiovascular health. However, for patients with diabetes, exercise can also lead to challenges in maintaining blood glucose balance, particularly if patients are prescribed insulin or certain oral hypoglycemic agents. Hypoglycemia is the most common adverse event associated with exercise and insulin therapy, and the fear of hypoglycemia is also the greatest barrier to exercise for many patients. With the appropriate insulin dose adjustments and, in some cases, carbohydrate supplementation, blood glucose levels can be better managed during exercise and in recovery. In general, insulin strategies that help facilitate weight loss with regular exercise and recommendations around exercise adjustments to prevent hypoglycemia and hyperglycemia are often not discussed with patients because the recommendations can be complex and may differ from one individual to the next. This is a review of the current published literature on insulin dose adjustments and starting-point strategies for patients with diabetes in preparation for safe exercise.
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Affiliation(s)
- Dessi P Zaharieva
- School of Kinesiology & Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity & Chronic Disease Unit, York University, Toronto, Ontario, Canada
| | - Michael C Riddell
- School of Kinesiology & Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity & Chronic Disease Unit, York University, Toronto, Ontario, Canada; LMC Diabetes & Endocrinology, Toronto, Ontario, Canada.
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18
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Codella R, Terruzzi I, Luzi L. Why should people with type 1 diabetes exercise regularly? Acta Diabetol 2017; 54:615-630. [PMID: 28289908 DOI: 10.1007/s00592-017-0978-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 02/27/2017] [Indexed: 01/09/2023]
Abstract
Plethoric evidence reminds of the protective effects of exercise against a number of health risks, across all ages, in the general population. The benefits of exercise for individuals with type 2 diabetes are indisputable. An in-depth understanding of energy metabolism has reasonably entailed exercise as a cornerstone in the lifestyle of almost all subjects with type 1 diabetes. Nevertheless, individuals with type 1 diabetes often fail in accomplishing exercise guidelines and they are less active than their peer without diabetes. Two major obstacles are feared by people with type 1 diabetes who wish to exercise regularly: management of blood glucose control and hypoglycemia. Nowadays, strategies, including glucose monitoring technology and insulin pump therapy, have significantly contributed to the participation in regular physical activity, and even in competitive sports, for people with type 1 diabetes. Novel modalities of training, like different intensity, interspersed exercise, are as well promising. The beneficial potential of exercise in type 1 diabetes is multi-faceted, and it has to be fully exploited because it goes beyond the insulin-mimetic action, possibly through immunomodulation.
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Affiliation(s)
- Roberto Codella
- Department of Biomedical Sciences for Health, University of Milan, Via F.lli Cervi 93, Segrate, 20090, Milan, Italy.
| | - Ileana Terruzzi
- Diabetes Research Institute, Metabolism, Nutrigenomics and Cellular Differentiation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, University of Milan, Via F.lli Cervi 93, Segrate, 20090, Milan, Italy
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Belli T, de Macedo DV, Scariot PPM, de Araújo GG, Dos Reis IGM, Lazarim FL, Nunes LAS, Brenzikofer R, Gobatto CA. Glycemic Control and Muscle Damage in 3 Athletes With Type 1 Diabetes During a Successful Performance in a Relay Ultramarathon: A Case Report. Wilderness Environ Med 2017. [PMID: 28629959 DOI: 10.1016/j.wem.2017.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Ultramarathon races are fairly demanding and impose substantial physiological stress on healthy athletes. These competitions may thus be considerably more challenging for individuals with diabetes. This case study aims to describe glycemic control, muscle damage, inflammation, and renal function in 3 athletes with type 1 diabetes during a successful performance in a relay ultramarathon. The team completed the race in 29 hours and 28 minutes, earning third place. The total distance covered by each athlete was 68.7, 84.5, and 65.1 km. Most blood glucose levels showed that athletes were in a zone where it was safe to exercise (90-250 mg/dL or 5.0-13.9 mmol/L). Creatine kinase, lactate dehydrogenase, and aspartate aminotransferase serum levels increased 1.2- to 50.7-fold prerace to postrace, and were higher than the reference ranges for all the athletes postrace. Blood leukocytes, neutrophils, and serum C-reactive protein (CRP) increased 1.6- to 52-fold prerace to postrace and were higher than the reference ranges for 2 athletes after the race. Serum creatinine increased 1.2-fold prerace to postrace for all the athletes but did not meet the risk criteria for acute kidney injury. In conclusion, our main findings show evidence of satisfactory glycemic control in athletes with type 1 diabetes during a relay ultramarathon. Moreover, elevation of muscle damage and inflammatory biomarkers occurred without affecting renal function and challenging the maintenance of blood glucose among athletes. These findings are novel and provide an initial understanding of the physiological responses in athletes with type 1 diabetes during ultramarathon races.
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Affiliation(s)
- Taisa Belli
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, SP, Brazil (Dr Belli, Mr Scariot, Drs dos Reis and Gobatto)
| | - Denise V de Macedo
- Laboratory of Exercise Biochemistry (LABEX), Biochemistry Department, Biology Institute, University of Campinas, Campinas, SP, Brazil (Drs de Macedo, Lazarim, and Nunes)
| | - Pedro P M Scariot
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, SP, Brazil (Dr Belli, Mr Scariot, Drs dos Reis and Gobatto)
| | - Gustavo G de Araújo
- Sports Science Research Group - Federal University of Alagoas (UFAL), Maceio AL, Brazil (Dr de Araújo)
| | - Ivan G M Dos Reis
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, SP, Brazil (Dr Belli, Mr Scariot, Drs dos Reis and Gobatto)
| | - Fernanda L Lazarim
- Laboratory of Exercise Biochemistry (LABEX), Biochemistry Department, Biology Institute, University of Campinas, Campinas, SP, Brazil (Drs de Macedo, Lazarim, and Nunes)
| | - Lázaro A S Nunes
- Laboratory of Exercise Biochemistry (LABEX), Biochemistry Department, Biology Institute, University of Campinas, Campinas, SP, Brazil (Drs de Macedo, Lazarim, and Nunes)
| | - René Brenzikofer
- Laboratory of Instrumentation for Biomechanics (LIB), Faculty of Physical Education, University of Campinas, Campinas, SP, Brazil (Dr Brenzikofer)
| | - Claudio A Gobatto
- Laboratory of Applied Sport Physiology (LAFAE), School of Applied Sciences, University of Campinas, Limeira, SP, Brazil (Dr Belli, Mr Scariot, Drs dos Reis and Gobatto).
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Petruzelkova L, Pickova K, Sumnik Z, Soupal J, Obermannova B. Effectiveness of SmartGuard Technology in the Prevention of Nocturnal Hypoglycemia After Prolonged Physical Activity. Diabetes Technol Ther 2017; 19:299-304. [PMID: 28520532 DOI: 10.1089/dia.2016.0459] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The prevention of postexercise nocturnal hypoglycemia after prolonged physical activity using sensor-augmented pump (SAP) therapy with predictive low-glucose management (PLGM) has not been well studied. We conducted a study at a pediatric diabetes camp to determine whether a SAP with PLGM reduces the frequency of nocturnal hypoglycemia after prolonged physical activity more effectively than a SAP with a carbohydrate intake algorithm. METHODS During a 1-week sport camp, 20 children (aged 10-13 years) with type 1 diabetes (T1D) managed by SAP therapy either with (n = 7) or without PLGM (n = 13) were studied. The hypoglycemia management strategy and the continuous glucose monitoring (CGM)/PLGM settings were standardized. The incidence, severity, and duration of hypoglycemia and carbohydrate intake were documented and compared. RESULTS The PLGM system was activated on 78% of all nights (once per night on average). No difference was found between the SAP and PLGM groups in the mean overnight glucose curve or mean morning glucose (7.8 ± 2 mmol/L vs. 7.4 ± 3 mmol/L). There was no difference in the frequency and severity of hypoglycemia. However, the SAP group consumed significantly more carbohydrates to prevent and treat hypoglycemia than those in the PLGM group; the values were 10 ± 2 and 1 ± 2 gS (P < 0.0001) in the SAP and PLGM groups, respectively. Moreover, the SAP group spent a significantly longer time in hypoglycemia (64 ± 2 min vs. 38 ± 2 min, P < 0.05). We observed a difference in the time distribution of nocturnal hypoglycemia (10 to 12 p.m. in the PLGM group and 3 to 7 a.m. in the SAP group, P < 0.05). CONCLUSION With PLGM system, euglycemia after prolonged physical activity was largely maintained with a minimal carbohydrate intake.
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Affiliation(s)
- Lenka Petruzelkova
- 1 Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague , Czech Republic
| | - Klara Pickova
- 1 Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague , Czech Republic
| | - Zdenek Sumnik
- 1 Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague , Czech Republic
| | - Jan Soupal
- 2 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University in Prague , Czech Republic
| | - Barbora Obermannova
- 1 Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague , Czech Republic
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21
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Short-Acting Insulin Reduction Strategies for Continuous Cycle Ergometer Exercises in Patients with Type 1 Diabetes Mellitus. Asian J Sports Med 2017. [DOI: 10.5812/asjsm.42160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Medical Problems of the Athlete. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Strategies used by Patients with Type 1 Diabetes to Avoid Hypoglycemia in a 24×1-Hour Marathon: Comparison with the Amounts of Carbohydrates Estimated by a Customizable Algorithm. Can J Diabetes 2016; 41:184-189. [PMID: 27939876 DOI: 10.1016/j.jcjd.2016.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/05/2016] [Accepted: 09/21/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The preferred countermeasure to avoid exercise-related hypoglycemia was investigated in a group of patients with type 1 diabetes participating in a stressful event, a 24×1-hour relay marathon. The carbohydrates actually consumed were compared to those estimated for each patient by applying a customizable algorithm, Exercise Carbohydrates Requirement Estimating Software (ECRES), based on patient's usual therapy and diet and on the exercise characteristics. METHODS Glycemia was tested at the start, middle and end of the races. Usual therapies and diets and the adopted countermeasures were recorded in detail. RESULTS We studied 19 patients who walked/ran 10.4±2.8 km with a heart rate of 167±11 beats per minute. Of the 19 patients, 7 patients reduced the administered insulin (premeal bolus or basal infusion rate). Glycemia fell by the end of the races (p=0.006; median -1.8 mmol⋅L-1; interquartile range -0.4 mmol⋅L-1 to -5.3 mmol⋅L-1), despite 9 patients being hyperglycemic at the start. Of the patients, 14 concluded the race with glycemia on target, and 4 patients were hyperglycemic. Amounts of carbohydrates actually consumed (median 30 g; interquartile range 0 g to 71 g) were not significantly different from those estimated by ECRES (median 38 g; interquartile range 24 g to 68 g), the 2 quantities being significantly related (R=0.64; p=0.003). ECRES estimated lower carbohydrate levels (-13 g) than the amounts actually consumed by the 4 patients who concluded their exercises with hyperglycemia. CONCLUSIONS Patients preferred to consume extra carbohydrates to avoid the possible exercise-induced hypoglycemia. ECRES would provide satisfactory estimates of the carbohydrate requirements, even for a stressful condition, and almost equal to the quantities consumed following medical advice.
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Accuracy of Continuous Glucose Monitoring (CGM) during Continuous and High-Intensity Interval Exercise in Patients with Type 1 Diabetes Mellitus. Nutrients 2016; 8:nu8080489. [PMID: 27517956 PMCID: PMC4997402 DOI: 10.3390/nu8080489] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 01/25/2023] Open
Abstract
Continuous exercise (CON) and high-intensity interval exercise (HIIE) can be safely performed with type 1 diabetes mellitus (T1DM). Additionally, continuous glucose monitoring (CGM) systems may serve as a tool to reduce the risk of exercise-induced hypoglycemia. It is unclear if CGM is accurate during CON and HIIE at different mean workloads. Seven T1DM patients performed CON and HIIE at 5% below (L) and above (M) the first lactate turn point (LTP1), and 5% below the second lactate turn point (LTP2) (H) on a cycle ergometer. Glucose was measured via CGM and in capillary blood (BG). Differences were found in comparison of CGM vs. BG in three out of the six tests (p < 0.05). In CON, bias and levels of agreement for L, M, and H were found at: 0.85 (−3.44, 5.15) mmol·L−1, −0.45 (−3.95, 3.05) mmol·L−1, −0.31 (−8.83, 8.20) mmol·L−1 and at 1.17 (−2.06, 4.40) mmol·L−1, 0.11 (−5.79, 6.01) mmol·L−1, 1.48 (−2.60, 5.57) mmol·L−1 in HIIE for the same intensities. Clinically-acceptable results (except for CON H) were found. CGM estimated BG to be clinically acceptable, except for CON H. Additionally, using CGM may increase avoidance of exercise-induced hypoglycemia, but usual BG control should be performed during intense exercise.
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25
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Horton WB, Subauste JS. Care of the Athlete With Type 1 Diabetes Mellitus: A Clinical Review. Int J Endocrinol Metab 2016; 14:e36091. [PMID: 27679652 PMCID: PMC5035675 DOI: 10.5812/ijem.36091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/24/2016] [Accepted: 03/01/2016] [Indexed: 12/17/2022] Open
Abstract
CONTEXT Type 1 diabetes mellitus (T1DM) results from a highly specific immune-mediated destruction of pancreatic β cells, resulting in chronic hyperglycemia. For many years, one of the mainstays of therapy for patients with T1DM has been exercise balanced with appropriate medications and medical nutrition. Compared to healthy peers, athletes with T1DM experience nearly all the same health-related benefits from exercise. Despite these benefits, effective management of the T1DM athlete is a constant challenge due to various concerns such as the increased risk of hypoglycemia. This review seeks to summarize the available literature and aid clinicians in clinical decision-making for this patient population. EVIDENCE ACQUISITION PubMed searches were conducted for "type 1 diabetes mellitus AND athlete" along with "type 1 diabetes mellitus AND exercise" from database inception through November 2015. All articles identified by this search were reviewed if the article text was available in English and related to management of athletes with type 1 diabetes mellitus. Subsequent reference searches of retrieved articles yielded additional literature included in this review. RESULTS The majority of current literature available exists as recommendations, review articles, or proposed societal guidelines, with less prospective or higher-order treatment studies available. The available literature is presented objectively with an attempt to describe clinically relevant trends and findings in the management of athletes living with T1DM. CONCLUSIONS Managing T1DM in the context of exercise or athletic competition is a challenging but important skill for athletes living with this disease. A proper understanding of the hormonal milieu during exercise, special nutritional needs, glycemic control, necessary insulin dosing adjustments, and prevention/management strategies for exercise-related complications can lead to successful care plans for these patients. Individualized management strategies should be created with close cooperation between the T1DM athlete and their healthcare team (including a physician and dietitian).
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Affiliation(s)
- William B. Horton
- Department of Medicine, University of Mississippi Medical Center, Mississippi, United States
- Corresponding author: William B. Horton, Department of Medicine, University of Mississippi Medical Center, 2500 N State Street, Jackson, Mississippi 39216, United States. Tel: +1-6019845601, Fax: +1-6019846665, E-mail:
| | - Jose S. Subauste
- Department of Medicine, University of Mississippi Medical Center, Mississippi, United States
- Division of Endocrinology, University of Mississippi Medical Center, Mississippi, United States
- Department of Medicine, G.V. Montgomery VA Medical Center, Mississippi, Jackson, United States
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26
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Gargallo-Fernández M, Escalada San Martín J, Gómez-Peralta F, Rozas Moreno P, Marco Martínez A, Botella-Serrano M, Tejera Pérez C, López Fernández J. [Clinical recommendations for sport practice in diabetic patients (RECORD Guide). Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN)]. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2015; 62:e73-93. [PMID: 25840764 DOI: 10.1016/j.endonu.2015.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 02/09/2015] [Accepted: 02/16/2015] [Indexed: 02/07/2023]
Abstract
UNLABELLED Sporting activity is becoming a common practice in patients with diabetes mellitus (DM). This situation requires both a preliminary medical assessment and a wide range of changes in treatment which have scarcely been addressed in medical literature. OBJECTIVE To prepare a clinical guideline on the medical approach to patients with diabetes who practice sport regularly. METHODS An expert panel from the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN) reviewed the most relevant literature in each of the sections. Based both on this review and on data from the experience of a number of athletes with DM, a number of recommendations were agreed within each section. Finally, the Working Group and representatives of the SEEN jointly discussed all these recommendations. CONCLUSION The guideline provides recommendations ranging from medical assessment before patients with DM start to practice sport to actions during and after physical activity. Recommendations are also given on aspects such as the impact of sport on blood glucose control, training schemes, or special risk situations.
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Affiliation(s)
| | | | | | - Pedro Rozas Moreno
- Servicio de Endocrinología y Nutrición, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Amparo Marco Martínez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Toledo, Toledo, España; Servicio de Endocrinología y Nutrición, Hospital Universitario Quirón, Madrid, España
| | - Marta Botella-Serrano
- Servicio de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Madrid, España
| | - Cristina Tejera Pérez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario Ferrol, Ferrol, La Coruña, España
| | - Judith López Fernández
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Canarias, Tenerife, España
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Abstract
While being physically active bestows many health benefits on individuals with type 1 diabetes, their overall blood glucose control is not enhanced without an effective balance of insulin dosing and food intake to maintain euglycemia before, during, and after exercise of all types. At present, a number of technological advances are already available to insulin users who desire to be physically active with optimal blood glucose control, although a number of limitations to those devices remain. In addition to continued improvements to existing technologies and introduction of new ones, finding ways to integrate all of the available data to optimize blood glucose control and performance during and following exercise will likely involve development of "smart" calculators, enhanced closed-loop systems that are able to use additional inputs and learn, and social aspects that allow devices to meet the needs of the users.
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Affiliation(s)
- Sheri R Colberg
- Human Movement Sciences Department, Old Dominion University, Norfolk, VA, USA
| | - Remmert Laan
- William Sansum Diabetes Center, Santa Barbara, CA, USA
| | - Eyal Dassau
- Department of Chemical Engineering, University of California, Santa Barbara, CA, USA
| | - David Kerr
- William Sansum Diabetes Center, Santa Barbara, CA, USA
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Prolonged exercise in type 1 diabetes: performance of a customizable algorithm to estimate the carbohydrate supplements to minimize glycemic imbalances. PLoS One 2015; 10:e0125220. [PMID: 25918842 PMCID: PMC4412669 DOI: 10.1371/journal.pone.0125220] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/22/2015] [Indexed: 01/11/2023] Open
Abstract
Physical activity in patients with type 1 diabetes (T1DM) is hindered because of the high risk of glycemic imbalances. A recently proposed algorithm (named Ecres) estimates well enough the supplemental carbohydrates for exercises lasting one hour, but its performance for prolonged exercise requires validation. Nine T1DM patients (5M/4F; 35–65 years; HbA1c 54±13 mmol·mol-1) performed, under free-life conditions, a 3-h walk at 30% heart rate reserve while insulin concentrations, whole-body carbohydrate oxidation rates (determined by indirect calorimetry) and supplemental carbohydrates (93% sucrose), together with glycemia, were measured every 30 min. Data were subsequently compared with the corresponding values estimated by the algorithm. No significant difference was found between the estimated insulin concentrations and the laboratory-measured values (p = NS). Carbohydrates oxidation rate decreased significantly with time (from 0.84±0.31 to 0.53±0.24 g·min-1, respectively; p<0.001), being estimated well enough by the algorithm (p = NS). Estimated carbohydrates requirements were practically equal to the corresponding measured values (p = NS), the difference between the two quantities amounting to –1.0±6.1 g, independent of the elapsed exercise time (time effect, p = NS). Results confirm that Ecres provides a satisfactory estimate of the carbohydrates required to avoid glycemic imbalances during moderate intensity aerobic physical activity, opening the prospect of an intriguing method that could liberate patients from the fear of exercise-induced hypoglycemia.
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Campbell MD, Gonzalez JT, Rumbold PLS, Walker M, Shaw JA, Stevenson EJ, West DJ. Comparison of appetite responses to high- and low-glycemic index postexercise meals under matched insulinemia and fiber in type 1 diabetes. Am J Clin Nutr 2015; 101:478-86. [PMID: 25733632 DOI: 10.3945/ajcn.114.097162] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients with type 1 diabetes face heightened risk of hypoglycemia after exercise. Subsequent overfeeding, as a preventative measure against hypoglycemia, negates the energy deficit after exercise. Patients are also required to reduce the insulin dose administered with postexercise foods to further combat hypoglycemia. However, the insulin dose is dictated solely by the carbohydrate content, even though postprandial glycemia is vastly influenced by glycemic index (GI). With a need to control the postexercise energy balance, appetite responses after meals differing in GI are of particular interest. OBJECTIVES We assessed the appetite response to low-glycemic index (LGI) and high-glycemic index (HGI) postexercise meals in type 1 diabetes patients. This assessment also offered us the opportunity to evaluate the influence of GI on appetite responses independently of insulinemia, which confounds findings in individuals without diabetes. DESIGN Ten physically active men with type 1 diabetes completed 2 trials in a randomized crossover design. After 45 min of treadmill exercise at 70% of the peak oxygen uptake, participants consumed an LGI (GI ∼37) or HGI (GI ∼92) meal with a matched macronutrient composition, negligible fiber content, and standardized insulin-dose administration. The postprandial appetite response was determined for 180 min postmeal. During this time, circulating glucose, insulin, glucagon, and glucagon-like peptide-1 (GLP-1) concentrations and subjective appetite ratings were determined. RESULTS The HGI meal produced an ∼60% greater postprandial glucose area under the curve (AUC) than did the LGI meal (P = 0.008). Insulin, glucagon, and GLP-1 did not significantly differ between trials (P > 0.05). The fullness AUC was ∼25% greater after the HGI meal than after the LGI meal (P < 0.001), whereas hunger sensations were ∼9% lower after the HGI meal than after the LGI meal (P = 0.001). CONCLUSION Under conditions of matched insulinemia and fiber, an HGI postexercise meal suppresses feelings of hunger and augments postprandial fullness sensations more so than an otherwise equivalent LGI meal in type 1 diabetes patients.
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Affiliation(s)
- Matthew D Campbell
- From the Department of Sport, Exercise and Rehabilitation (MDC, JTG, PLSR, DJW, and EJS) and the Brain, Performance and Nutrition Research Centre (JTG and EJS), Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom, and the Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom (MW and JAS)
| | - Javier T Gonzalez
- From the Department of Sport, Exercise and Rehabilitation (MDC, JTG, PLSR, DJW, and EJS) and the Brain, Performance and Nutrition Research Centre (JTG and EJS), Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom, and the Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom (MW and JAS)
| | - Penny L S Rumbold
- From the Department of Sport, Exercise and Rehabilitation (MDC, JTG, PLSR, DJW, and EJS) and the Brain, Performance and Nutrition Research Centre (JTG and EJS), Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom, and the Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom (MW and JAS)
| | - Mark Walker
- From the Department of Sport, Exercise and Rehabilitation (MDC, JTG, PLSR, DJW, and EJS) and the Brain, Performance and Nutrition Research Centre (JTG and EJS), Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom, and the Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom (MW and JAS)
| | - James A Shaw
- From the Department of Sport, Exercise and Rehabilitation (MDC, JTG, PLSR, DJW, and EJS) and the Brain, Performance and Nutrition Research Centre (JTG and EJS), Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom, and the Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom (MW and JAS)
| | - Emma J Stevenson
- From the Department of Sport, Exercise and Rehabilitation (MDC, JTG, PLSR, DJW, and EJS) and the Brain, Performance and Nutrition Research Centre (JTG and EJS), Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom, and the Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom (MW and JAS)
| | - Daniel J West
- From the Department of Sport, Exercise and Rehabilitation (MDC, JTG, PLSR, DJW, and EJS) and the Brain, Performance and Nutrition Research Centre (JTG and EJS), Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom, and the Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom (MW and JAS)
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Abstract
IN BRIEF Fear of hypoglycemia is one of the main barriers to physical activity for individuals with type 1 diabetes. Recent studies indicate that anaerobic forms of exercise (i.e., resistance exercise/weight lifting, sprints, and high-intensity intervals) can attenuate exercise-related declines in blood glucose both during and after exercise in young, healthy adults with type 1 diabetes. These responses might vary based on age, sex, and fitness level and in the general safety of relying on them to prevent hypoglycemia.
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Affiliation(s)
- Jane E. Yardley
- Department of Social Sciences, University of Alberta, Augustana Campus, Camrose, AB, Canada
- Manitoba Institute of Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ronald J. Sigal
- Faculties of Medicine and Kinesiology, University of Calgary, Calgary, AB, Canada
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Medical Problems of the Athlete. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_58-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dietary strategies for adult type 1 diabetes in light of outcome evidence. Eur J Clin Nutr 2014; 69:285-90. [DOI: 10.1038/ejcn.2014.214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 08/21/2014] [Accepted: 09/02/2014] [Indexed: 12/18/2022]
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Booth R, Hadley J, Holt RIG. Managing insulin and carbohydrate needs for an endurance cyclist. PRACTICAL DIABETES 2013. [DOI: 10.1002/pdi.1798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Position statement: hypoglycemia management in patients with diabetes mellitus. Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. ACTA ACUST UNITED AC 2013; 60:517.e1-517.e18. [PMID: 23916172 DOI: 10.1016/j.endonu.2013.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 04/16/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To provide practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus. PARTICIPANTS Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. METHODS Recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation system to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (PubMed). Papers in English and Spanish with publication date before 15 February 2013 were included. For recommendations about drugs only those approved by the European Medicines Agency were included. After formulation of recommendations, they were discussed by the Working Group. CONCLUSIONS The document provides evidence-based practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus.
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Geat M, Stel G, Poser S, Driussi C, Stenner E, Francescato MP. Whole-body glucose oxidation rate during prolonged exercise in type 1 diabetic patients under usual life conditions. Metabolism 2013; 62:836-44. [PMID: 23375550 DOI: 10.1016/j.metabol.2013.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 12/27/2012] [Accepted: 01/01/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Fuel oxidation during exercise was studied in type 1 insulin-dependent (T1DM) patients mainly under quite constant insulin and glycemia; these protocols, however, likely do not reflect patients' usual metabolic conditions. The glucose oxidation rate (GLUox) in T1DM patients under usual life conditions was thus investigated during prolonged exercise (3-h) and its behavior was described mathematically. MATERIALS/METHODS Whole-body GLUox was determined in eight T1DM patients (4/8 M; aged 35-59 years) and eight well-matched healthy subjects. Venous blood was drawn prior to and every 30 min until the end of exercise; glycemia, insulin, cortisol, and growth hormone concentrations were determined. Oxygen consumption, carbon dioxide production, and ventilation were measured at rest and thereafter every 30 min of the exercise. To prevent hypoglycemia, patients were given fruit fudge (93% sucrose) prior to / during exercise. RESULTS Insulin concentration and glycemia were significantly higher in patients across the entire exercise period (group effect, p<0.001 for both). GLUox decreased significantly with increasing exercise duration (time effect, p<0.001), but no significant difference was detected between the two groups (group effect, p=NS). GLUox, expressed as the percentage of the starting value, was described by an exponential function showing a time constant of 90 min (n=96; mean corrected R(2)=0.666). CONCLUSIONS GLUox in T1DM patients was not significantly different from the rate observed in the control subjects. The function describing the time course of GLUox may be useful to correct an estimated GLUox for the duration of exercise and help T1DM patients avoiding exercise-induced glycemic imbalances.
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Affiliation(s)
- Mario Geat
- Department of Medical and Biological Sciences, University of Udine, 33100-Udine, Italy
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