Safe Completion of a Trail Running Ultramarathon by Four Men with Type 1 Diabetes

Abstract

In this brief report, we describe the feat of four men with type 1 diabetes mellitus (T1DM) who decided to take part in a mountain ultramarathon in Bieszczady, Poland on May 27, 2016. Before participating in the competition, they asked two diabetologists for a consultation and to assist in diabetic control during the marathon. The aim of the study was to assess the metabolic safety in people with T1DM during extreme physical exertion in a mountain ultramarathon. All subjects were treated with continuous subcutaneous insulin infusion. The marathon route was 82 km, and the sum of the climbs and descents was 3235 and 3055 m, respectively. Diabetologists controlled glucose levels using a glucometer, plasma lactate levels, and ketones in the capillary blood. In addition, they monitored the intake of carbohydrates and fluids. Clinical tests were performed at the three checkpoints (at 32, 49, and 66 km) during the race and after completing the race (at 82 km). This study shows that extreme physical exertion by a person with type 1 diabetes is possible. All subjects avoided severe hypoglycemia by significantly reducing their insulin dose and consuming additional carbohydrates. Such actions, despite the occurrence of hyperglycemia >250 mg/dL did not result in ketoacidosis. Safe participation in mountain ultramarathons by people with type 1 diabetes can be achieved if they undertake appropriate physical and diabetologic preparation.

Risk factors of hypoglycaemia in type 1 diabetes individuals during intensive sport exercise—Data from the SPORTGIVECHANCE event

“…It was shown in several studies that use of CGM and FGM reduces time spent in hypoglycaemia . Some published data, including the ones originating from extreme sporting events, support the use of insulin pumps and CGM to reduce the risk of hypoglycaemia related to exercise . However, these new glucose monitoring technologies are currently recommended as an additional tool rather than a replacement of SMBG…”

Defining Off-road Running: A Position Statement from the Ultra Sports Science Foundation

“…Hence the inclusion of all these physiological data is important in assessing research studies, especially if they deal with performance prediction or assessment and we recommend including them in the description of the study. Additionally, where a medical condition is present, this should also be clearly described, alongside its physiological determinants and outcomes [14,63]. A unified classification system (see ▶Fig.…”

“…However, this is not correct because each discipline has quite distinct characteristics in terms of distance, elevation change, terrain, environmental conditions, and "event culture" (e. g. individual race characteristics, competitiveness, and community involvement). There is also an abundance of different nomenclature and spelling used in scientific publications, such as: ultramarathon, ultra marathon, mountain ultra marathon, mountain ultramarathon, ultra-trail-marathon, ultra trail running, long distance trail running, and trail running ultramarathon [12][13][14][15][16][17]. As scientific interest in these activities grows, it becomes imperative to clarify the terms and develop a universal language for discussing these events to avoid research misinterpretation and miscommunication and apply it appropriately to the relevant running population.…”

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.…”