Glycemic Control and Muscle Damage in 3 Athletes With Type 1 Diabetes During a Successful Performance in a Relay Ultramarathon: A Case Report

Belli, Taísa; Macedo, Denise Vaz de; Scariot, Pedro Paulo Menezes; Araújo, Gustavo Gomes de; Reis, Ivan Gustavo Masselli dos; Lazarim, Fernanda Lorenzi; Nunes, Lázaro Alessandro Soares; Brenzikofer, René; Gobatto, Cláudio Alexandre

doi:10.1016/j.wem.2017.04.005

Cited by 11 publications

(15 citation statements)

References 34 publications

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“… Elevation profile throughout the “Brazil 135 Ultramarathon” route with the four session test locations. Reprinted and adapted minimally from Belli et al (2017b) , Copyright (2017), with permission from Elsevier. …”

Section: Methodsmentioning

confidence: 99%

Mountain Ultramarathon Induces Early Increases of Muscle Damage, Inflammation, and Risk for Acute Renal Injury

et al. 2018

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Purpose: This study aimed to investigate changes in muscle damage during the course of a 217-km mountain ultramarathon (MUM). In an integrative perspective, inflammatory response and renal function were also studied.Methods: Six male ultra-runners were tested four times: pre-race, at 84 km, at 177 km, and immediately after the race. Blood samples were analyzed for serum muscle enzymes, acute-phase protein, cortisol, and renal function biomarkers.Results: Serum creatine kinase (CK), lactate dehydrogenase (LDH), and aspartate aminotransferase (AST) increased significantly throughout the race (P < 0.001, P < 0.001; P = 0.002, respectively), and effect size (ES) denoted a large magnitude of muscle damage. These enzymes increased from pre-race (132 ± 18, 371 ± 66, and 28 ± 3 U/L, respectively) to 84 km (30, 1.8, and 3.9-fold, respectively); further increased from 84 to 177 km (4.6, 2.9, and 6.1-fold, respectively), followed by a stable phase until the finish line. Regarding the inflammatory response, significant differences were found for C-reactive protein (CRP) (P < 0.001) and cortisol (P < 0.001). CRP increased from pre-race (0.9 ± 0.3 mg/L) to 177 km (243-fold), cortisol increased from pre-race (257 ± 30 mmol/L) to the 84 km (2.9-fold), and both remained augmented until the finish line. Significant changes were observed for creatinine (P = 0.03), urea (P = 0.001), and glomerular filtration rate (GFR) (P < 0.001), and ES confirmed a moderate magnitude of changes in renal function biomarkers. Creatinine and urea increased, and GFR decreased from pre-race (1.00 ± 0.03 mg/dL, 33 ± 6 mg/dL, and 89 ± 5 ml/min/1.73 m2, respectively) to 84 km (1.3, 3.5, and 0.7-fold, respectively), followed by a plateau phase until the finish line.Conclusion: This study shows evidence that muscle damage biomarkers presented early peak levels and they were followed by a plateau phase during the last segment of a 217-km MUM. The acute-phase response had a similar change of muscle damage. In addition, our data showed that our volunteers meet the risk criteria for acute kidney injury from 84 km until they finished the race, without demonstrating any clinical symptomatology.

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Section: Methodsmentioning

confidence: 99%

Mountain Ultramarathon Induces Early Increases of Muscle Damage, Inflammation, and Risk for Acute Renal Injury

et al. 2018

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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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“… (4.9% vs 3±8%, respectively). Whilst there are only limited data concerning the glycaemic profiles of exercising athletes with Type 1 diabetes, in the literature that is available hyperglycaemia is commonplace because of a tendency to adjust carbohydrate and insulin amounts in an effort to avoid hypoglycaemia .…”

Section: Discussionmentioning

confidence: 99%

“…The overall duration of hyperglycaemia (blood glucose >10 mmol/l) was comparable to that observed in 11 individuals consuming <50 g of carbohydrate per day studied by Leow et al [14] (4.9% vs 3AE8%, respectively). Whilst there are only limited data concerning the glycaemic profiles of exercising athletes with Type 1 diabetes, in the literature that is available hyperglycaemia is commonplace because of a tendency to adjust carbohydrate and insulin amounts in an effort to avoid hypoglycaemia [7,11,12].…”

Section: Discussionmentioning

confidence: 99%

“…Despite efforts to reduce blood glucose variability through anticipatory insulin reductions and carbohydrate consumption, glycaemic control during exercise remains complex and unpredictable. Numerous variables must be considered, including exercise intensity, type, duration, time of day, circulating insulin, insulin absorption and carbohydrate intake, among a host of others . Difficulties in pre‐empting and accounting for these factors in real time, can lead to prolonged and significant hyperglycaemia, hypoglycaemia, or both .…”

Section: Introductionmentioning

confidence: 99%

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Glycaemic stability of a cyclist with Type 1 diabetes: 4011 km in 20 days on a ketogenic diet

2019

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Background Maintaining glycaemic control during exercise presents a significant challenge for people living with Type 1 diabetes. Significant glycaemic variability has been observed in athletes with Type 1 diabetes in competitive contexts. While very‐low‐carbohydrate ketogenic diets have been shown to minimize glycaemic excursions, no published data have examined if this translates to exercise. Case report We report the case of a 37‐year‐old man with Type 1 diabetes who successfully undertook a 4011 km cycle across Australia over 20 consecutive days whilst consuming a very‐low‐carbohydrate ketogenic diet. Continuous glucose monitoring data capture was 98.4% for the ride duration and showed remarkable glycaemic stability, with a standard deviation of 2.1 mmol/l (average interstitial glucose 6.1 mmol/l) and 80.4% of time spent within a range of 3.9–10 mmol/l. Interstitial glucose was <3 mmol/l for 2.1% of this time, with only a single episode of symptomatic hypoglycaemia prompting brief interruption of exercise for carbohydrate administration. Conclusion This case demonstrates the viability of a very‐low‐carbohydrate ketogenic diet in an individual with Type 1 diabetes undertaking exercise. While the effect of a very‐low‐carbohydrate ketogenic diet is yet to be examined more broadly in athletes with Type 1 diabetes, the glycaemic stability observed suggests that fat adaptation may attenuate glycaemic swings and reduce reliance on carbohydrate consumption during exercise for maintaining euglycaemia.

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Glycemic Control and Muscle Damage in 3 Athletes With Type 1 Diabetes During a Successful Performance in a Relay Ultramarathon: A Case Report

Cited by 11 publications

References 34 publications

Mountain Ultramarathon Induces Early Increases of Muscle Damage, Inflammation, and Risk for Acute Renal Injury

Mountain Ultramarathon Induces Early Increases of Muscle Damage, Inflammation, and Risk for Acute Renal Injury

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

Glycaemic stability of a cyclist with Type 1 diabetes: 4011 km in 20 days on a ketogenic diet

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