Glycemic control during consecutive days with prolonged walking exercise in individuals with type 1 diabetes mellitus

Abstract

Running title: prolonged physical activity in type 1 diabetes Word count abstract: 239Word count main text: 3182 Tables: 1 Figures: 4 Trial number: NTR4061, www.trialregister.nl ABSTRACT Aims: Despite its general benefits for health, exercise complicates the maintenance of stable blood glucose concentrations in individuals with type 1 diabetes. The aim of the current study was to examine changes in food intake, insulin administration, and 24-h glycemic control in response to consecutive days with prolonged walking exercise (~8 h daily) in individuals with type 1 diabetes. Methods:Ten individuals with type 1 diabetes participating in the worlds' largest walking event were recruited for this observational study. Simultaneous measurements of 24-h glycemic control (continuous glucose monitoring), insulin administration and food intake were performed during a non-walking day (control) and during three subsequent days with prolonged walking exercise (daily distance 40 or 50 km). Results:Despite an increase in daily energy (31±18%; p<0.01) and carbohydrate (82±71g; p<0.01) intake during walking days, subjects lowered their insulin administration by 26±16% relative to the control day (p<0.01). Average 24-h blood glucose concentrations, the prevalence of hyperglycemia (blood glucose >10 mmol/L) and hypoglycemia (blood glucose <3.9 mmol/L) did not differ between the control day and walking days (p>0.05 for all variables). The prolonged walking exercise was associated with a modest increase in glycemic variability compared with the control day (p<0.05). Conclusion:Prolonged walking exercise allows for profound reductions in daily insulin administration in persons with type 1 diabetes, despite large increments in energy and carbohydrate intake. When taking such adjustments into account, prolonged moderate-intensity exercise does not necessarily impair 24-h glycemic control.

Physical activity and hippocampal volume in middle-aged patients with type 1 diabetes

“…PA is associated with improved glycemic regulation in adults with and without diabetes, ages 40-60 years, 9 possibly via improving insulin sensitivity. 10 Poor insulin sensitivity has been shown to be related to hippocampal atrophy 11 and dementia 12 in people with and without diabetes.…”

The competitive athlete with type 1 diabetes

“…The remainder described following either a low-carbohydrate diet (17% of participants;~40-99 g/day) or a very-low-carbohydrate diet (13% of participants), with a meal plan of carbohydrate intake of <40 g/day (S. R. Colberg, unpublished data). (b) Carbohydrate intake rates during endurance training and competition events: Data are from select studies and were analysed by R. M. Bracken [31,43,[72][73][74][75][76]. The x-axis provides information on exercise duration (h:min) and also profiles the exercise distance and mode used in each of the published studies.…”

Advances in Exercise, Physical Activity, and Diabetes

“…Prolonged multiday exercise is possible in individuals with T1D but often requires additional planning for the increased activity. Quite often, in order to avoid hypoglycemic episodes, individuals consume too many supplemental carbohydrates or are too aggressive with insulin reductions, resulting in hyperglycemia (17,18) or increased glycemic variability (19). Automatic functions such as the SmartGuard technology using PLGM or APS may reduce the burden of planning for such types of activity and aid in preventing hypoglycemic episodes during exercise and in recovery periods.…”