Ultraendurance Athletes With Type 1 Diabetes: Leadville 100 Experience

Khodaee, Morteza; Riederer, Mark; VanBaak, Karin; Hill, John C.

doi:10.1016/j.wem.2014.10.002

Cited by 12 publications

(12 citation statements)

References 12 publications

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“…minimum guidelines. Indeed, within the current research literature base there exist several examples of extreme exercise completion in people with T1D, including half marathons (21.1 km 2 ), marathons (42.2 km [3][4][5][6] ), ultramarathons (~133 km 7 ), mountain ultramarathons (82 km 8 ), relay ultramarathons (65-84.5 km per athlete over 3 days 9 ), multiday marathon walks (42 km each day for 5 days 10 ), Ironman events (3.8 km swim, 180 km cycle, 42.2 km run 11 ), Ultraman (3-day, multistage ultraendurance triathlons: 10 km swim, 144.8 km bike (day 1), 275.4 km bike (day 2), and 84.4 km run (day 3) 12 ), ultramarathon (161 km cycle and 161 km run 13 ), multiday cycling events (15-day, 2300 km cycling 14 ) and crosscountry ski events (75 km over 7+ hours 15 ). However, in such extreme exercises, frequent blood glucose monitoring is advised to minimize dysglycemia and assure safe participation.…”

Section: Metabolismmentioning

confidence: 99%

Glycemic responses to strenuous training in male professional cyclists with type 1 diabetes: a prospective observational study

McCarthy

Eckstein

Scott

et al. 2020

BMJ Open Diab Res Care

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IntroductionThis prospective observational study sought to establish the glycemic, physiological and dietary demands of strenuous exercise training as part of a 9-day performance camp in a professional cycling team with type 1 diabetes (T1D).Research design and methodsSixteen male professional cyclists with T1D on multiple daily injections (age: 27±4 years; duration of T1D: 11±5 years; body mass index: 22±2 kg/m2; glycated hemoglobin: 7%±1% (50±6 mmol/mol); maximum rate of oxygen consumption: 73±4 mL/kg/min) performed road cycle sessions (50%–90% of the anaerobic threshold, duration 1–6 hours) over 9 consecutive days. Glycemic (Dexcom G6), nutrition and physiological data were collected throughout. Glycemic data were stratified into predefined glycemic ranges and mapped alongside exercise physiology and nutritional parameters, as well as split into daytime and night-time phases for comparative analysis. Data were assessed by means of analysis of variance and paired t-tests. A p value of ≤0.05 (two-tailed) was statistically significant.ResultsHigher levels of antecedent hypoglycemia in the nocturnal hours were associated with greater time spent in next-day hypoglycemia overall (p=0.003) and during exercise (p=0.019). Occurrence of nocturnal hypoglycemia was associated with over three times the risk of next-day hypoglycemia (p<0.001) and a twofold risk of low glucose during cycling (p<0.001). Moreover, there was trend for a greater amount of time spent in mild hypoglycemia during the night compared with daytime hours (p=0.080).ConclusionThe higher prevalence of nocturnal hypoglycemia was associated with an increased risk of next-day hypoglycemia, which extended to cycle training sessions. These data highlight the potential need for additional prebed carbohydrates and/or insulin dose reduction strategies around exercise training in professional cyclists with T1D.Trial registration numberDRKS00019923.

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Section: Metabolismmentioning

confidence: 99%

Glycemic responses to strenuous training in male professional cyclists with type 1 diabetes: a prospective observational study

McCarthy

Eckstein

Scott

et al. 2020

BMJ Open Diab Res Care

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“…Recent studies have also explored the effects of endurance ( 45 ) and ultra-endurance ( 82 ) athletic competition on T1DM athletes, and results suggest individualized adaptation of therapy during training and competition is most effective. Future studies could examine these topics further and help create effective management strategies for these scenarios.…”

Section: Resultsmentioning

confidence: 99%

Care of the Athlete With Type 1 Diabetes Mellitus: A Clinical Review

Horton

Subauste

2016

Int J Endocrinol Metab

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ContextType 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 AcquisitionPubMed 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.ResultsThe 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.ConclusionsManaging 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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“…It is important to acknowledge that a substantial number of people with T1D wish to greatly exceed the minimum activity guidelines, which means that some of the available studies provide limited use to these individuals and their healthcare providers. Within the literature, there are numerous examples of people with T1D undertaking impressive feats of endurance, lasting hours or even days, including ultramarathons, Ironman competitions, hiking over multiple days and long-distance cross-country skiing [113][114][115][116][117][118][119][120][121][122][123][124][125][126][127]. Such extreme feats of endurance would not be possible without close glucose monitoring and adjustment to food intake.…”

Section: Prolonged Endurance Exercise: Balancing Energy Requirements With Glycemic Controlmentioning

confidence: 99%

Carbohydrate Intake in the Context of Exercise in People with Type 1 Diabetes

et al. 2019

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Although the benefits of regular exercise on cardiovascular risk factors are well established for people with type 1 diabetes (T1D), glycemic control remains a challenge during exercise. Carbohydrate consumption to fuel the exercise bout and/or for hypoglycemia prevention is an important cornerstone to maintain performance and avoid hypoglycemia. The main strategies pertinent to carbohydrate supplementation in the context of exercise cover three aspects: the amount of carbohydrates ingested (i.e., quantity in relation to demands to fuel exercise and avoid hypoglycemia), the timing of the intake (before, during and after the exercise, as well as circadian factors), and the quality of the carbohydrates (encompassing differing carbohydrate types, as well as the context within a meal and the associated macronutrients). The aim of this review is to comprehensively summarize the literature on carbohydrate intake in the context of exercise in people with T1D.

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Ultraendurance Athletes With Type 1 Diabetes: Leadville 100 Experience

Cited by 12 publications

References 12 publications

Glycemic responses to strenuous training in male professional cyclists with type 1 diabetes: a prospective observational study

Glycemic responses to strenuous training in male professional cyclists with type 1 diabetes: a prospective observational study

Care of the Athlete With Type 1 Diabetes Mellitus: A Clinical Review

Carbohydrate Intake in the Context of Exercise in People with Type 1 Diabetes

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