Whole-body glucose oxidation rate during prolonged exercise in type 1 diabetic patients under usual life conditions

Geat, Mario; Stel, Giuliana; Poser, Stefano; Driussi, Caterina; Stenner, Elisabetta; Francescato, Maria Pia

doi:10.1016/j.metabol.2013.01.004

Cited by 6 publications

(3 citation statements)

References 77 publications

(80 reference statements)

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“…A time-dependent decrease in the CHOox during the 3-hr exercise was observed in our T1DM patients, even though they were administered fruit fudge to avoid an excessive fall of glycemia. Indeed, the carbohydrate oxidation rate and its time-dependent decrease were very similar to those observed in healthy people [ 43 , 44 ]. Present results confirm that an elevated extracellular glucose availability accompanied by a high insulin level, a frequent condition in T1DM patients, does not necessarily translate into a different behavior of CHOox as compared to healthy people [ 44 , 45 ].…”

Section: Discussionsupporting

confidence: 70%

Prolonged Exercise in Type 1 Diabetes: Performance of a Customizable Algorithm to Estimate the Carbohydrate Supplements to Minimize Glycemic Imbalances

Francescato

Stel

Stenner³

et al. 2015

PLoS ONE

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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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Section: Discussionsupporting

confidence: 70%

Prolonged Exercise in Type 1 Diabetes: Performance of a Customizable Algorithm to Estimate the Carbohydrate Supplements to Minimize Glycemic Imbalances

Francescato

Stel

Stenner³

et al. 2015

PLoS ONE

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“…This extra amount of carbohydrates might be considered a caloric load that will be oxidized in mitochondria, resulting in a potential higher production of free radicals and thus constituting a confounding variable in the experimental setup of the present work. Nevertheless, an experimentation similar to the present one [33] showed that the whole-body carbohydrates oxidation rate was not significantly different between patients with type 1 DM receiving appropriate amounts of fruit fudge (to avoid an excessive fall of glycemia) and the control group, who was not given carbohydrates during the exercise. In addition, it was reported by others that increased extracellular glucose availability does not necessarily translate into increased intracellular glucose oxidation during exercise [34], [35].…”

Section: Discussionsupporting

confidence: 61%

Oxidative Stress in Patients with Type 1 Diabetes Mellitus: Is It Affected by a Single Bout of Prolonged Exercise?

et al. 2014

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Presently, no clear-cut guidelines are available to suggest the more appropriate physical activity for patients with type 1 diabetes mellitus due to paucity of experimental data obtained under patients' usual life conditions. Accordingly, we explored the oxidative stress levels associated with a prolonged moderate intensity, but fatiguing, exercise performed under usual therapy in patients with type 1 diabetes mellitus and matched healthy controls. Eight patients (4 men, 4 women; 49±11 years; Body Mass Index 25.0±3.2 kg·m− 2; HbA1c 57±10 mmol·mol−1) and 14 controls (8 men, 6 women; 47±11 years; Body Mass Index 24.3±3.3 kg·m− 2) performed a 3-h walk at 30% of their heart rate reserve. Venous blood samples were obtained before and at the end of the exercise for clinical chemistry analysis and antioxidant capacity. Capillary blood samples were taken at the start and thereafter every 30 min to determine lipid peroxidation. Patients showed higher oxidative stress values as compared to controls (95.9±9.7 vs. 74.1±12.2 mg·L−1 H2O2; p<0.001). In both groups, oxidative stress remained constant throughout the exercise (p = NS), while oxidative defence increased significantly at the end of exercise (p<0.02) from 1.16±0.13 to 1.19±0.10 mmol·L−1 Trolox in patients and from 1.09±0.21 to 1.22±0.14 mmol·L−1 Trolox in controls, without any significant difference between the two groups. Oxidative stress was positively correlated to HbA1c (p<0.005) and negatively related with uric acid (p<0.005). In conclusion, we were the first to evaluate the oxidative stress in patients with type 1 diabetes exercising under their usual life conditions (i.e. usual therapy and diet). Specifically, we found that the oxidative stress was not exacerbated due to a single bout of prolonged moderate intensity aerobic exercise, a condition simulating several outdoor leisure time physical activities. Oxidative defence increased in both patients and controls, suggesting beneficial effects of prolonged aerobic fatiguing exercise.

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“…29,36 Moreover, despite patients showed higher insulin and blood glucose levels, their carbohydrate oxidation rates were not significantly different compared to healthy controls even during incremental 37 or prolonged exercise. 38 Linear relationships have been proposed to estimate the glucose oxidation rate during exercise (specifically for “active” and “sedentary” subjects) based on the percentage theoretical maximal heart rate. 37 Data on healthy people and T1D patients were pooled together 39 as well as those of both genders, which effects are still under debate.…”

Section: Insulin Concentrations and Exercisementioning

confidence: 99%

Carbohydrate Requirement for Exercise in Type 1 Diabetes: Effects of Insulin Concentration

Francescato

Ajčević

Accardo

2019

J Diabetes Sci Technol

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Physical activity is a keystone of a healthy lifestyle as well as of management of patients with type 1 diabetes. The risk of exercise-induced hypoglycemia, however, is a great challenge for these patients. The glycemic response to exercise depends upon several factors concerning the patient him/herself (eg, therapy, glycemic control, training level) and the characteristics of the exercise performed. Only in-depth knowledge of these factors will allow to develop individualized strategies minimizing the risk of hypoglycemia. The main factors affecting the exercise-induced hypoglycemia in patients with T1D have been analyzed, including the effects of insulin concentration. A model is discussed, which has the potential to become the basis for providing patients with individualized suggestions to keep constant glucose levels on each exercise occasion.

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Whole-body glucose oxidation rate during prolonged exercise in type 1 diabetic patients under usual life conditions

Cited by 6 publications

References 77 publications

Prolonged Exercise in Type 1 Diabetes: Performance of a Customizable Algorithm to Estimate the Carbohydrate Supplements to Minimize Glycemic Imbalances

Prolonged Exercise in Type 1 Diabetes: Performance of a Customizable Algorithm to Estimate the Carbohydrate Supplements to Minimize Glycemic Imbalances

Oxidative Stress in Patients with Type 1 Diabetes Mellitus: Is It Affected by a Single Bout of Prolonged Exercise?

Carbohydrate Requirement for Exercise in Type 1 Diabetes: Effects of Insulin Concentration

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