Exercise capacity in subjects with type 1 diabetes mellitus in eu- and hyperglycaemia

Stettler, Christoph; Jenni, Stefan; Allemann, Sabin; Steiner, R; Hoppeler, Hans; Trepp, Roman; Christ, Emanuel; Zwahlen, Marcel; Diem, Peter

doi:10.1002/dmrr.608

Cited by 38 publications

(31 citation statements)

References 41 publications

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“…Similar GLUox values (and the contribution to total energy yield) were also observed between the controls and diabetic patients during shorter aerobic exercises (≤ 1-h duration) [31,41]. Indeed, increased extracellular glucose availability, does not translate into increased intracellular GLUox [37,40]. At variance, T1DM patients exercising under high insulin infusion rates showed a slightly increased whole-body CHO oxidation rate [39].…”

Section: Discussionsupporting

confidence: 50%

“…The keystone of the algorithm is the estimate of the amount of CHO oxidized during the effort on the basis of heart rate (HR), taken as an index of exercise intensity [36]. The fuel oxidation rates during exercise were studied in T1DM patients mainly under constant insulin infusion rate and quite constant glycemia [14,[37][38][39][40]. Undoubtedly, these experimental protocols allow to carefully control several parameters that are likely to affect metabolism.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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Section: Discussionsupporting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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“…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]. Furthermore, Chokkalingam et al [36] observed that only patients exercising under high insulin infusion rates showed a slightly increased whole-body carbohydrates oxidation rate.…”

Section: Discussionmentioning

confidence: 97%

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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“…Conversely, little is known on the complementary impact of differing levels of blood glucose on fuel metabolism and exercise performance in these patients. Recently, we found the contribution of carbohydrate and lipid oxidation to overall energy consumption to be similar in euglycaemia and hyperglycaemia during exercise up to 40 min, but the study design did not allow a detailed quantification of substrate fluxes [8]. Even less is known on the effect of differing glycaemic levels on fuel metabolism during aerobic exercise of longer duration in patients with type 1 diabetes mellitus.…”

Section: Introductionmentioning

confidence: 99%

Fuel metabolism during exercise in euglycaemia and hyperglycaemia in patients with type 1 diabetes mellitus—a prospective single-blinded randomised crossover trial

et al. 2008

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Aims/hypothesis We assessed systemic and local muscle fuel metabolism during aerobic exercise in patients with type 1 diabetes at euglycaemia and hyperglycaemia with identical insulin levels. Methods This was a single-blinded randomised crossover study at a university diabetes unit in Switzerland. We studied seven physically active men with type 1 diabetes (mean±SEM age 33.5±2.4 years, diabetes duration 20.1±3.6 years, HbA 1c 6.7±0.2% and peak oxygen uptake [V :O 2peak ] 50.3±4.5 ml min). Men were studied twice while cycling for 120 min at 55 to 60% of V : O 2peak , with a blood glucose level randomly set either at 5 or 11 mmol/l and identical insulinaemia. The participants were blinded to the glycaemic level; allocation concealment was by opaque, sealed envelopes. Magnetic resonance spectroscopy was used to quantify intramyocellular glycogen and lipids before and after exercise. Indirect calorimetry and measurement of stable isotopes and counter-regulatory hormones complemented the assessment of local and systemic fuel metabolism. Results The contribution of lipid oxidation to overall energy metabolism was higher in euglycaemia than in hyperglycaemia (49.4±4.8 vs 30.6±4.2%; p<0.05). Carbohydrate oxidation accounted for 48.2±4.7 and 66.6±4.2% of total energy expenditure in euglycaemia and hyperglycaemia, respectively (p<0.05). The level of intramyocellular glycogen before exercise was higher in hyperglycaemia than in euglycaemia (3.4±0.3 vs 2.7±0.2 arbitrary units [AU]; p<0.05). Absolute glycogen consumption tended to be higher in hyperglycaemia than in euglycaemia (1.3±0.3 vs 0.9±0.1 AU). Cortisol and growth hormone increased more strongly in euglycaemia than in hyperglycaemia (levels at the end of exercise 634±52 vs 501±32 nmol/l and 15.5±4.5 vs 7.4±2.0 ng/ml, respectively; p<0.05). Conclusions/interpretation Substrate oxidation in type 1 diabetic patients performing aerobic exercise in euglycaemia is similar to that in healthy individuals revealing a shift towards lipid oxidation during exercise. In hyperglycaemia fuel metabolism in these patients is dominated by carbohydrate oxidation. Intramyocellular glycogen was not spared in hyperglycaemia.

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Exercise capacity in subjects with type 1 diabetes mellitus in eu- and hyperglycaemia

Abstract: In subjects with type 1 diabetes, exercise capacity is not influenced by hyperglycaemia. Comparable levels of lactate and similar respiratory exchange ratio suggest that an increase in extracellular glucose availability did not translate into increased intracellular glucose oxidation.

Cited by 38 publications

References 41 publications

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

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

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

Fuel metabolism during exercise in euglycaemia and hyperglycaemia in patients with type 1 diabetes mellitus—a prospective single-blinded randomised crossover trial

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