1
|
Vertyshev AY, Akberdin IR, Kolpakov FA. Numerous Trigger-like Interactions of Kinases/Protein Phosphatases in Human Skeletal Muscles Can Underlie Transient Processes in Activation of Signaling Pathways during Exercise. Int J Mol Sci 2023; 24:11223. [PMID: 37446402 DOI: 10.3390/ijms241311223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
Optimizing physical training regimens to increase muscle aerobic capacity requires an understanding of the internal processes that occur during exercise that initiate subsequent adaptation. During exercise, muscle cells undergo a series of metabolic events that trigger downstream signaling pathways and induce the expression of many genes in working muscle fibers. There are a number of studies that show the dependence of changes in the activity of AMP-activated protein kinase (AMPK), one of the mediators of cellular signaling pathways, on the duration and intensity of single exercises. The activity of various AMPK isoforms can change in different directions, increasing for some isoforms and decreasing for others, depending on the intensity and duration of the load. This review summarizes research data on changes in the activity of AMPK, Ca2+/calmodulin-dependent protein kinase II (CaMKII), and other components of the signaling pathways in skeletal muscles during exercise. Based on these data, we hypothesize that the observed changes in AMPK activity may be largely related to metabolic and signaling transients rather than exercise intensity per se. Probably, the main events associated with these transients occur at the beginning of the exercise in a time window of about 1-10 min. We hypothesize that these transients may be partly due to putative trigger-like kinase/protein phosphatase interactions regulated by feedback loops. In addition, numerous dynamically changing factors, such as [Ca2+], metabolite concentration, and reactive oxygen and nitrogen species (RONS), can shift the switching thresholds and change the states of these triggers, thereby affecting the activity of kinases (in particular, AMPK and CaMKII) and phosphatases. The review considers the putative molecular mechanisms underlying trigger-like interactions. The proposed hypothesis allows for a reinterpretation of the experimental data available in the literature as well as the generation of ideas to optimize future training regimens.
Collapse
Affiliation(s)
| | - Ilya R Akberdin
- Department of Computational Biology, Scientific Center for Information Technologies and Artificial Intelligence, Sirius University of Science and Technology, 354340 Sochi, Russia
- Biosoft.Ru, Ltd., 630058 Novosibirsk, Russia
- Department of Natural Sciences, Novosibirsk State University, 630090 Novosibirsk, Russia
| | - Fedor A Kolpakov
- Department of Computational Biology, Scientific Center for Information Technologies and Artificial Intelligence, Sirius University of Science and Technology, 354340 Sochi, Russia
- Biosoft.Ru, Ltd., 630058 Novosibirsk, Russia
- Federal Research Center for Information and Computational Technologies, 630090 Novosibirsk, Russia
| |
Collapse
|
2
|
Armstrong M, Colberg SR, Sigal RJ. Where to Start? Physical Assessment, Readiness, and Exercise Recommendations for People With Type 1 or Type 2 Diabetes. Diabetes Spectr 2023; 36:105-113. [PMID: 37193205 PMCID: PMC10182968 DOI: 10.2337/dsi22-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Exercise plays an important role in the management of diabetes and is associated with many benefits such as decreased morbidity and mortality. For people exhibiting signs and symptoms of cardiovascular disease, pre-exercise medical clearance is warranted; however, requiring broad screening requirements can lead to unnecessary barriers to initiating an exercise program. Robust evidence supports the promotion of both aerobic and resistance training, with evidence emerging on the importance of reducing sedentary time. For people with type 1 diabetes, there are special considerations, including hypoglycemia risk and prevention, exercise timing (including prandial status), and differences in glycemic responses based on biological sex.
Collapse
Affiliation(s)
- Marni Armstrong
- Medicine Strategic Clinical Network, Alberta Health Services, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sheri R. Colberg
- Human Movement Sciences Department, Old Dominion University, Norfolk, VA
| | - Ronald J. Sigal
- Departments of Medicine, Cardiac Sciences, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
3
|
Sanchez-Rangel E, Deajon-Jackson J, Hwang JJ. Pathophysiology and management of hypoglycemia in diabetes. Ann N Y Acad Sci 2022; 1518:25-46. [PMID: 36202764 DOI: 10.1111/nyas.14904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In the century since the discovery of insulin, diabetes has changed from an early death sentence to a manageable chronic disease. This change in longevity and duration of diabetes coupled with significant advances in therapeutic options for patients has fundamentally changed the landscape of diabetes management, particularly in patients with type 1 diabetes mellitus. However, hypoglycemia remains a major barrier to achieving optimal glycemic control. Current understanding of the mechanisms of hypoglycemia has expanded to include not only counter-regulatory hormonal responses but also direct changes in brain glucose, fuel sensing, and utilization, as well as changes in neural networks that modulate behavior, mood, and cognition. Different strategies to prevent and treat hypoglycemia have been developed, including educational strategies, new insulin formulations, delivery devices, novel technologies, and pharmacologic targets. This review article will discuss current literature contributing to our understanding of the myriad of factors that lead to the development of clinically meaningful hypoglycemia and review established and novel therapies for the prevention and treatment of hypoglycemia.
Collapse
Affiliation(s)
- Elizabeth Sanchez-Rangel
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jelani Deajon-Jackson
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Janice Jin Hwang
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA.,Division of Endocrinology, Department of Internal Medicine, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
4
|
Larocque JC, Gardy S, Sammut M, McBey DP, Melling CWJ. Sexual dimorphism in response to repetitive bouts of acute aerobic exercise in rodents with type 1 diabetes mellitus. PLoS One 2022; 17:e0273701. [PMID: 36083870 PMCID: PMC9462568 DOI: 10.1371/journal.pone.0273701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/14/2022] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study was to examine sex-specific differences in the blood glucose (BG) response to recurrent aerobic exercise in type 1 diabetes rats. Specifically, we examined the role of peak estrogen (E2) concentrations during proestrus on BG response to prolonged repetitive aerobic exercise. To do so, nineteen Sprague-Dawley rats were assigned to four exercised groups: control female (CXF; n = 5), control male (CXM; n = 5), diabetic female (DXF, n = 5) and diabetic male (DXM, n = 4). Diabetes was induced in DX groups via subcutaneous multiple injections of low dose streptozotocin (20mg/day for 7 days). After four days of exercise, muscle and liver glycogen content, liver gluconeogenic enzyme content, muscle Beta oxidation activity and BG responses to exercise were compared. The final bout of exercise took place during proestrus when E2 concentrations were at their highest in the female rats. During days 1–3 DXM had significantly lower BG concentrations during exercise than DXF. While both T1DM and non-T1DM females demonstrated higher hepatic G6Pase expression and muscle beta oxidation activity levels on day 4 exercise, no differences in BG response between the male and female T1DM rats were evident. Further, no differences in liver and muscle glycogen content following day 4 of exercise were seen between the sexes. These results would suggest that heightened E2 levels during proestrus may not be an important factor governing glucose counter regulatory response to exercise in female T1DM rats. Rather, the pre-exercise blood glucose levels are likely to be a large determinant of the blood glucose response to exercise in both male and female rats.
Collapse
Affiliation(s)
| | - Silar Gardy
- School of Kinesiology, Western University, London, ON, Canada
| | - Mitchell Sammut
- School of Kinesiology, Western University, London, ON, Canada
| | - David P. McBey
- School of Kinesiology, Western University, London, ON, Canada
| | - C. W. James Melling
- School of Kinesiology, Western University, London, ON, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine, Western University, London, ON, Canada
- * E-mail:
| |
Collapse
|
5
|
McCarthy O, Schmidt S, Christensen MB, Bain SC, Nørgaard K, Bracken R. The endocrine pancreas during exercise in people with and without type 1 diabetes: Beyond the beta-cell. Front Endocrinol (Lausanne) 2022; 13:981723. [PMID: 36147573 PMCID: PMC9485437 DOI: 10.3389/fendo.2022.981723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Although important for digestion and metabolism in repose, the healthy endocrine pancreas also plays a key role in facilitating energy transduction around physical exercise. During exercise, decrements in pancreatic β-cell mediated insulin release opposed by increments in α-cell glucagon secretion stand chief among the hierarchy of glucose-counterregulatory responses to decreasing plasma glucose levels. As a control hub for several major glucose regulatory hormones, the endogenous pancreas is therefore essential in ensuring glucose homeostasis. Type 1 diabetes (T1D) is pathophysiological condition characterised by a destruction of pancreatic β-cells resulting in pronounced aberrations in glucose control. Yet beyond the beta-cell perhaps less considered is the impact of T1D on all other pancreatic endocrine cell responses during exercise and whether they differ to those observed in healthy man. For physicians, understanding how the endocrine pancreas responds to exercise in people with and without T1D may serve as a useful model from which to identify whether there are clinically relevant adaptations that need consideration for glycaemic management. From a physiological perspective, delineating differences or indeed similarities in such responses may help inform appropriate exercise test interpretation and subsequent program prescription. With more complex advances in automated insulin delivery (AID) systems and emerging data on exercise algorithms, a timely update is warranted in our understanding of the endogenous endocrine pancreatic responses to physical exercise in people with and without T1D. By placing our focus here, we may be able to offer a nexus of better understanding between the clinical and engineering importance of AIDs requirements during physical exercise.
Collapse
Affiliation(s)
- Olivia McCarthy
- Applied Sport, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, United Kingdom
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
- *Correspondence: Olivia McCarthy,
| | - Signe Schmidt
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
| | | | | | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Richard Bracken
- Applied Sport, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, United Kingdom
| |
Collapse
|
6
|
Swain CTV, Drummond AE, Boing L, Milne RL, English DR, Brown KA, van Roekel EH, Dixon-Suen SC, Lynch MJ, Moore MM, Gaunt TR, Martin RM, Lewis SJ, Lynch BM. Linking Physical Activity to Breast Cancer via Sex Hormones, Part 1: The Effect of Physical Activity on Sex Steroid Hormones. Cancer Epidemiol Biomarkers Prev 2022; 31:16-27. [PMID: 34670800 PMCID: PMC7612605 DOI: 10.1158/1055-9965.epi-21-0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/13/2021] [Accepted: 10/07/2021] [Indexed: 11/23/2022] Open
Abstract
The effect of physical activity on breast cancer risk may be partly mediated by sex steroid hormones. This review synthesized and appraised the evidence for an effect of physical activity on sex steroid hormones. Systematic searches were performed using MEDLINE (Ovid), EMBASE (Ovid), and SPORTDiscus to identify experimental studies and prospective cohort studies that examined physical activity and estrogens, progestins, and/or androgens, as well as sex hormone binding globulin (SHBG) and glucocorticoids in pre- and postmenopausal women. Meta-analyses were performed to generate effect estimates. Risk of bias was assessed, and the GRADE system was used to appraise quality of the evidence. Twenty-eight randomized controlled trials (RCT), 81 nonrandomized interventions, and six observational studies were included. Estrogens, progesterone, and androgens mostly decreased, and SHBG increased, in response to physical activity. Effect sizes were small, and evidence quality was graded moderate or high for each outcome. Reductions in select sex steroid hormones following exercise supports the biological plausibility of the first part of the physical activity-sex hormone-breast cancer pathway. The confirmed effect of physical activity on decreasing circulating sex steroid hormones supports its causal role in preventing breast cancer.See related reviews by Lynch et al., p. 11 and Drummond et al., p. 28.
Collapse
Affiliation(s)
| | - Ann E Drummond
- Cancer Epidemiology Division, Cancer Council Victoria, Victoria, Australia
| | - Leonessa Boing
- Laboratory of Research in Leisure and Physical Activity, Santa Catarina State University, Florianópolis, Brazil
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kristy A Brown
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Eline H van Roekel
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Suzanne C Dixon-Suen
- Cancer Epidemiology Division, Cancer Council Victoria, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Michael J Lynch
- Nambour Heights Family Medical, Nambour, Queensland, Australia
| | - Melissa M Moore
- Medical Oncology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Tom R Gaunt
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Richard M Martin
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
| | - Sarah J Lewis
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Victoria, Australia.
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Shetty VB, Fournier PA, Paramalingam N, Soon W, Roby HC, Jones TW, Davis EA. Effect of Exercise Intensity on Exogenous Glucose Requirements to Maintain Stable Glycemia At High Insulin Levels in Type 1 Diabetes. J Clin Endocrinol Metab 2021; 106:e83-e93. [PMID: 33097945 DOI: 10.1210/clinem/dgaa768] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 01/17/2023]
Abstract
CONTEXT Under basal insulin levels, there is an inverted U relationship between exercise intensity and exogenous glucose requirements to maintain stable blood glucose levels in type 1 diabetes (T1D), with no glucose required for intense exercise (80% V̇O2 peak), implying that high-intensity exercise is not conducive to hypoglycemia. OBJECTIVE This work aimed to test the hypothesis that a similar inverted U relationship exists under hyperinsulinemic conditions, with high-intensity aerobic exercise not being conducive to hypoglycemia. METHODS Nine young adults with T1D (mean ± SD age, 22.6 ± 4.7 years; glycated hemoglobin, 61 ± 14 mmol/mol; body mass index, 24.0 ± 3.3 kg/m2, V̇O2 peak, 36.6 ± 8.0 mL·kg-1 min-1) underwent a hyperinsulinemic-euglycemic clamp to maintain stable glycemia (5-6 mmol·L-1), and exercised for 40 minutes at 4 intensities (35%, 50%, 65%, and 80% V̇O2peak) on separate days following a randomized counterbalanced study design. MAIN OUTCOME MEASURES Glucose infusion rates (GIR) and glucoregulatory hormones levels were measured. RESULTS The GIR (± SEM) to maintain euglycemia was 4.4 ± 0.4 mg·kg-1 min-1 prior to exercise, and increased significantly by 1.8 ± 0.4, 3.0 ± 0.4, 4.2 ± 0.7, and 3.5 ± 0.7 mg·kg-1 min-1 during exercise at 35%, 50%, 65%, and 80% V̇O2 peak, respectively, with no significant differences between the 2 highest exercise intensities (P > .05), despite differences in catecholamine levels (P < .05). During the 2-hour period after exercise at 65% and 80% V̇O2 peak, GIRs did not differ from those during exercise (P > .05). CONCLUSIONS Under hyperinsulinemic conditions, the exogenous glucose requirements to maintain stable glycemia during and after exercise increase with exercise intensity then plateau with exercise performed at above moderate intensity ( > 65% V̇O2 peak). High-intensity exercise confers no protection against hypoglycemia.
Collapse
Affiliation(s)
- Vinutha B Shetty
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Pediatrics within the Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Paul A Fournier
- School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Nirubasini Paramalingam
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Wayne Soon
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Heather C Roby
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Pediatrics within the Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Pediatrics within the Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
8
|
Francescato MP, Ajčević M, Accardo A. Carbohydrate Requirement for Exercise in Type 1 Diabetes: Effects of Insulin Concentration. J Diabetes Sci Technol 2020; 14:1116-1121. [PMID: 30767503 PMCID: PMC7645145 DOI: 10.1177/1932296819826962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- Maria Pia Francescato
- Department of Medicine, University of Udine, Udine, Italy
- Maria Pia Francescato, MD, Department of Medicine, University of Udine, p. le M. Kolbe 4, 33100 Udine, Italy.
| | - Miloš Ajčević
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Agostino Accardo
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| |
Collapse
|
9
|
Moser O, Mueller A, Eckstein ML, Ziko H, Aberer F, Treiber G, Unteregger C, Kojzar H, Mader JK, Sourij C, Pferschy P, Obermayer A, Tripolt N, Sourij H. Improved glycaemic variability and basal insulin dose reduction during a running competition in recreationally active adults with type 1 diabetes-A single-centre, prospective, controlled observational study. PLoS One 2020; 15:e0239091. [PMID: 32915897 PMCID: PMC7485886 DOI: 10.1371/journal.pone.0239091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/29/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION To investigate the glycaemic response, macronutrient intake and insulin management in people with type 1 diabetes (T1D) compared to healthy individuals around a running competition. MATERIAL AND METHODS This was a single-centre, prospective, controlled observational study performed in individuals with T1D and healthy people. 24 people (12 T1D) were included in this study (age: T1D 41±12 vs. healthy 38±6 years, females: 3 vs. 6, BMI: 25.53.0 vs. 22.9±2.8 kg/m2). Both groups received an intermittently scanned continuous glucose monitoring (isCGM; FreeStyle Libre 1, Abbott, USA) system to assess glycaemia 24 hours before, during and 24 hours after a running competition. During this period, participants recorded their food intake and insulin administration. Data were analysed via ANOVA and mixed model analyses with post-hoc testing (p≤0.05). RESULTS For overall glycaemic ranges in comparison of groups, significant differences were found for time in range (T1D 63±21% vs. healthy 89±13%, p = 0.001), time above range (TAR) 1 (T1D 21±15% vs. healthy 0±0%, p<0.001) and TAR 2 (T1D 8 [0-16%] vs. healthy 0±0%, p<0.001). When glycaemic variability was assessed, people with T1D had a higher glycaemic variability compared to healthy individuals (p<0.0001). Basal insulin dose was significantly reduced when compared against the regular pre-study basal insulin dose (pre-study 22±6 vs. pre-competition day 11±9 (-50±41%), p = 0.02; competition day 15±5 (-32± 1%)). CONCLUSION People with T1D have impaired glucose responses around a running competition compared to healthy individuals. However, basal insulin dose reductions were sufficient to prevent further dysglycaemia. CLINICAL TRIAL ID drks.de; DRKS00019886.
Collapse
Affiliation(s)
- Othmar Moser
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Alexander Mueller
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Exercise Physiology, Training & Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Max L. Eckstein
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Haris Ziko
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gerlies Treiber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christina Unteregger
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Kojzar
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Julia K. Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Caren Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Pferschy
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Anna Obermayer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Norbert Tripolt
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| |
Collapse
|
10
|
Gouldrup H, Ma T. Why are physical activity breaks more effective than a single session of isoenergetic exercise in reducing postprandial glucose? A systemic review and meta-analysis. J Sports Sci 2020; 39:212-218. [PMID: 32835621 DOI: 10.1080/02640414.2020.1812196] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Previous studies revealed that interrupting sitting time with short, frequent physical activity (PA) breaks were more effective than a single session of isoenergetic exercise in reducing postprandial glucose. However, in those studies, the expected glucose-lowering effects of single-session exercises were diminished or even eliminated by exercise-induced glucose counterregulation as evidenced by the higher glucose levels during or after exercise compared to uninterrupted sitting. This study was aimed to investigate whether glucose counterregulation is a potential explanation of PA breaks being more effective than a single session of isoenergetic exercise in reducing postprandial glucose. We meta-analysed the standardized mean differences (SMD) of glucose incremental area under the curve (iAUC). PA breaks were more effective than single-session exercise in reducing glucose iAUC (5 studies, SMD = -0.581; 95% confidence interval [CI], -0.777 to -0.385; P < 0.0001) when exercise-induced glucose counterregulation occurred. There was no significant difference in glucose iAUC between PA breaks and single-session exercises (2 studies, SMD = 0.302; 95% CI, -0.107 to 0.711; P = 0.451) when glucose counterregulation did not occur. We concluded that the exercise-induced glucose counterregulation was a potential explanation of PA breaks being more effective than a single session of isoenergetic exercise in reducing postprandial glucose responses. (PROSPERO ID: CRD42020175737).
Collapse
Affiliation(s)
- Hannah Gouldrup
- Health Sciences Department, Franklin Pierce University , Rindge, NH, USA
| | - Tongyu Ma
- Health Sciences Department, Franklin Pierce University , Rindge, NH, USA
| |
Collapse
|
11
|
Jendle J, Adolfsson P. Continuous Glucose Monitoring Diving and Diabetes: An Update of the Swedish Recommendations. J Diabetes Sci Technol 2020; 14:170-173. [PMID: 30712367 PMCID: PMC7189164 DOI: 10.1177/1932296819826584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Divers travel to different countries to explore various diving sites worldwide. In 2005, the Divers Alert Network (DAN) published their guidelines for recreational diving and diabetes mellitus. However, although years have passed, there is still no consensus in the form of international guidelines on diabetes and diving. Large differences are noted with regard to the regulations in different countries. Furthermore, the diabetes technology has evolved rapidly and is not reflected in current international guidelines. This is potentially both a medical and an insurance problem for a diver with diabetes. We present a short summary of the recently updated Swedish recommendations for recreational divers with type 1 diabetes mellitus, focusing on the use of continuous glucose monitoring and continuous subcutaneous insulin infusion during such circumstances.
Collapse
Affiliation(s)
- Johan Jendle
- Faculty of Medical Sciences, Örebro
University, Örebro, Sweden
- Johan Jendle, MD, PhD, Faculty of Medical
Sciences, Campus USÖ, Örebro University, SE-70182 Örebro, Sweden.
| | - Peter Adolfsson
- Department of Pediatrics, Hospital of
Halland, Kungsbacka, Sweden
- Institute of Clinical Sciences,
Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
12
|
Acute Response to Endurance Exercise Stress: Focus on Catabolic/anabolic Interplay Between Cortisol, Testosterone, and Sex Hormone Binding Globulin in Professional Athletes. J Med Biochem 2019; 38:6-12. [PMID: 30820178 PMCID: PMC6298450 DOI: 10.2478/jomb-2018-0016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/21/2018] [Indexed: 11/21/2022] Open
Abstract
Background Endocrine system plays a major role in both permissive and regulatory activities in order to adequately respond to physical stress of exercise. But level and direction of activation depend on many factors and are not easily interpreted. Methods We tested a group of male professional athletes (21 water polo players and 15 wrestlers), together with 20 sedentary controls matched by age. All participants took a continuous progressive exercise stress test on a treadmill until exhaustion and plateau of oxygen consumption (VO2). Blood samples for cortisol, sex hormone binding globulin (SHBG) and testosterone were drawn in four time points: baseline (B), start of the test (S), point of maximal strain (MAX) and in the 3rd minute of recovery period (R). Results Cortisol levels significantly increased in both groups, but the response between S and MAX was more pronounced in controls (p=0.036). The athletes had significantly higher levels of cortisol in all points in test, except during R (p=0.118), when their cortisol levels gradually started to decline. Significant increase in total testosterone was in great deal a consequence of increase in SHBG level (p<0.01 for both). Consequently, calculated free testosterone significantly decreased during test (p=0.008), and the drop was more pronounced in athletes. This was in concordance with significant correlation between SHBG and cortisol level demonstrated in athletes, but not in controls. Conclusions It seems that high intensity endurance exercise favors catabolic response, but the level of response highly depends on a previous level of training.
Collapse
|
13
|
Shetty VB, Fournier PA, Davey RJ, Retterath AJ, Paramalingam N, Roby HC, Davis EA, Jones TW. The time lag prior to the rise in glucose requirements to maintain stable glycaemia during moderate exercise in a fasted insulinaemic state is of short duration and unaffected by the level at which glycaemia is maintained in Type 1 diabetes. Diabet Med 2018; 35:1404-1411. [PMID: 29939421 DOI: 10.1111/dme.13771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 11/28/2022]
Abstract
AIMS To determine the duration of the low hypoglycaemia risk period after the start of moderate-intensity exercise performed under basal insulinaemic conditions and whether this period is affected by the level at which glycaemia is maintained under these conditions. METHODS This was a prospective, randomized counterbalanced study. Eight participants with Type 1 diabetes (mean ± sd age 21.5 ± 4.0 years) underwent either a euglycaemic (5-6 mmol/l) or hyperglycaemic clamp (9-10 mmol/l) on separate days and were infused with insulin at basal rates and [6,6-2 H]glucose while cycling for 40 min at 50% maximum oxygen consumption rate. The main outcome measures were the glucose infusion rates required to maintain stable glycaemia and glucoregulatory hormone levels, and rates of glucose appearance and disappearance. RESULTS During the first 20 min of exercise, the glucose infusion rate did not increase significantly, irrespective of the level at which glycaemia was maintained, but increased acutely between 20 and 25 min under both conditions. Maintaining higher glycaemia resulted in higher glucose infusion rate during, but not early post-exercise. With the exception of epinephrine, the glucoregulatory hormone levels and rates of glucose appearance and disappearance were similar between conditions. CONCLUSION Irrespective of the levels at which glycaemia is maintained, there is a 20-min low exogenous glucose demand period during which the exogenous glucose requirements to maintain stable glycaemia do not increase during moderate exercise performed at basal insulin level.
Collapse
Affiliation(s)
- V B Shetty
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia
- Division of Paediatrics, Medical School, Perth, WA, Australia
- Telethon Kids Institute, Children's Diabetes Centre, University of Western Australia, Perth, WA, Australia
| | - P A Fournier
- School of Human Sciences, Perth, WA, Australia
- Telethon Kids Institute, Children's Diabetes Centre, University of Western Australia, Perth, WA, Australia
| | - R J Davey
- Telethon Kids Institute, Children's Diabetes Centre, University of Western Australia, Perth, WA, Australia
| | - A J Retterath
- Telethon Kids Institute, Children's Diabetes Centre, University of Western Australia, Perth, WA, Australia
| | - N Paramalingam
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia
- Telethon Kids Institute, Children's Diabetes Centre, University of Western Australia, Perth, WA, Australia
| | - H C Roby
- Telethon Kids Institute, Children's Diabetes Centre, University of Western Australia, Perth, WA, Australia
| | - E A Davis
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia
- Division of Paediatrics, Medical School, Perth, WA, Australia
- Telethon Kids Institute, Children's Diabetes Centre, University of Western Australia, Perth, WA, Australia
| | - T W Jones
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia
- Division of Paediatrics, Medical School, Perth, WA, Australia
- Telethon Kids Institute, Children's Diabetes Centre, University of Western Australia, Perth, WA, Australia
| |
Collapse
|
14
|
Oh SH, Mierau A, Thevis M, Thomas A, Schneider C, Ferrauti A. Effects of different exercise intensities in the morning on football performance components in the afternoon. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2018. [DOI: 10.1007/s12662-018-0520-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
15
|
Paramalingam N, Fournier PA, Davey RJ, Roby HC, Smith GJ, Shetty VB, Guelfi KJ, Davis EA, Jones TW. A 10-second sprint does not blunt hormonal counter-regulation to subsequent hypoglycaemia. Diabet Med 2017; 34:1440-1446. [PMID: 28586510 DOI: 10.1111/dme.13396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2017] [Indexed: 11/30/2022]
Abstract
AIM To investigate whether a 10-second (s) sprint impairs the counter-regulatory response to subsequent hypoglycaemia. METHODS Nine people (five male, four female) with Type 1 diabetes, aged 21.1 ± 4.5 years, performed a 10-s rest or a 10-s maximum-effort sprint in random order on different days, while subjected to an euinsulinaemic-euglycaemic clamp. This was followed by a hyperinsulinaemic-hypoglycaemic glucose clamp 2.5 h later to induce hypoglycaemia for 40 min. At timed intervals, the counter-regulatory hormonal responses to hypoglycaemia were measured. Blood pressure, heart rate and hypoglycaemic symptoms were also assessed. RESULTS During the hypoglycaemic clamp, epinephrine, norepinephrine, growth hormone and cortisol levels increased significantly from baseline, and their responses were similar after both rest and sprint conditions. In particular, plasma epinephrine rose eightfold, from 197 ± 103 pmol/l to 1582 ± 1118 pmol/l after the rest condition, and from 219 ± 119 pmol/l to 1900 ± 898 pmol/l after the sprint condition. CONCLUSION A 10-s sprint is unlikely to blunt the subsequent hormonal counter-regulation to hypoglycaemia in individuals with Type 1 diabetes.
Collapse
Affiliation(s)
- N Paramalingam
- Telethon Kids Institute, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia
- Division of Paediatrics, within the Medical School, University of Western Australia, Perth, WA, Australia
- School of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - P A Fournier
- School of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - R J Davey
- Telethon Kids Institute, Perth, WA, Australia
- Division of Paediatrics, within the Medical School, University of Western Australia, Perth, WA, Australia
| | - H C Roby
- Telethon Kids Institute, Perth, WA, Australia
| | - G J Smith
- Telethon Kids Institute, Perth, WA, Australia
| | - V B Shetty
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia
- Division of Paediatrics, within the Medical School, University of Western Australia, Perth, WA, Australia
| | - K J Guelfi
- School of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - E A Davis
- Telethon Kids Institute, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia
- Division of Paediatrics, within the Medical School, University of Western Australia, Perth, WA, Australia
| | - T W Jones
- Telethon Kids Institute, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia
- Division of Paediatrics, within the Medical School, University of Western Australia, Perth, WA, Australia
| |
Collapse
|
16
|
Alginate-combined cholic acid increased insulin secretion of microencapsulated mouse cloned pancreatic β cells. Ther Deliv 2017; 8:833-842. [DOI: 10.4155/tde-2017-0042] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aim: A semisynthetic primary bile acid (PBA) has exerted hypoglycemic effects in Type 1 diabetic animals, which were hypothesized to be due to its anti-inflammatory and cellular glucose-regulatory effects. Thus, the research purpose aimed to examine antidiabetic effects of a PBA, in terms of cellular inflammation and survival and insulin release, in the context of supporting β-cell delivery and Type 1 diabetic treatment. Materials & methods: 10 formulations were prepared, five without PBA (control) and five with PBA (test). Formulations were used to microencapsulate pancreatic β cells and the microcapsules were examined for morphology, cell viability, insulin release and inflammation. Results & conclusion: PBA improved cell viability, insulin release and reduced inflammation in a formulation-dependent manner, which suggests potential use in cell delivery and diabetes treatment. [Formula: see text]
Collapse
|
17
|
Abraham MB, Davey RJ, Cooper MN, Paramalingam N, O'Grady MJ, Ly TT, Jones TW, Fournier PA, Davis EA. Reproducibility of the plasma glucose response to moderate-intensity exercise in adolescents with Type 1 diabetes. Diabet Med 2017; 34:1291-1295. [PMID: 28586529 DOI: 10.1111/dme.13395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2017] [Indexed: 11/28/2022]
Abstract
AIMS The aim of the study was to evaluate the reproducibility of the plasma glucose response to moderate-intensity exercise performed on different days under controlled conditions in adolescents with Type 1 diabetes. METHODS Eight adolescents with Type 1 diabetes on continuous subcutaneous insulin infusion completed two exercise sessions, each on two separate days, under basal insulin and fasting conditions. On each day, participants cycled twice for 30 min at 55% of their peak rate of oxygen consumption, with each exercise session separated by a 30-min rest. RESULTS Plasma insulin levels were similar between testing days and exercise sessions. The mean absolute drop in plasma glucose from the commencement to the end of exercise was 1.6 ± 0.5 mmol/l on day 1 and 1.9 ± 0.7 mmol/l on day 2 (P = 0.3). In response to the first exercise session, plasma glucose levels relative to baseline did not change significantly (0.2 ± 0.6 and -0.2 ± 0.5 mmol/l on days 1 and 2). By contrast, the change in plasma glucose during the second exercise session was -1.1 ± 0.7 and -1.3 ± 0.7mmol/l on days 1 and 2, respectively. The mean absolute intra-individual difference in the change in plasma glucose between testing days were 0.7 ± 0.5 [95% confidence interval (CI) 0.4-1.0] and 0.7 ± 0.4 (95% CI 0.4-1.0) mmol/l, at the end of the first and second exercise sessions respectively. CONCLUSIONS The plasma glucose response to moderate-intensity exercise under similar glycaemic and basal insulin conditions can be reproducible in adolescents with Type 1 diabetes.
Collapse
Affiliation(s)
- M B Abraham
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - R J Davey
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - M N Cooper
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - N Paramalingam
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - M J O'Grady
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Australia
| | - T T Ly
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - T W Jones
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - P A Fournier
- School of Sport Science, Exercise and Health, The University of Western Australia, Perth, Australia
| | - E A Davis
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| |
Collapse
|
18
|
Abstract
Use of artificial light resulted in relative independence from the natural light-dark (LD) cycle, allowing human subjects to shift the timing of food intake and work to convenient times. However, the increase in artificial light exposure parallels the increase in obesity prevalence. Light is the dominant Zeitgeber for the central circadian clock, which resides within the hypothalamic suprachiasmatic nucleus, and coordinates daily rhythm in feeding behaviour and metabolism. Eating during inappropriate light conditions may result in metabolic disease via changes in the biological clock. In this review, we describe the physiological role of light in the circadian timing system and explore the interaction between the circadian timing system and metabolism. Furthermore, we discuss the acute and chronic effects of artificial light exposure on food intake and energy metabolism in animals and human subjects. We propose that living in synchrony with the natural daily LD cycle promotes metabolic health and increased exposure to artificial light at inappropriate times of day has adverse effects on metabolism, feeding behaviour and body weight regulation. Reducing the negative side effects of the extensive use of artificial light in human subjects might be useful in the prevention of metabolic disease.
Collapse
|
19
|
Horton WB, Subauste JS. Care of the Athlete With Type 1 Diabetes Mellitus: A Clinical Review. Int J Endocrinol Metab 2016; 14:e36091. [PMID: 27679652 PMCID: PMC5035675 DOI: 10.5812/ijem.36091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/24/2016] [Accepted: 03/01/2016] [Indexed: 12/17/2022] Open
Abstract
CONTEXT Type 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 ACQUISITION PubMed 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. RESULTS The 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. CONCLUSIONS Managing 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).
Collapse
Affiliation(s)
- William B. Horton
- Department of Medicine, University of Mississippi Medical Center, Mississippi, United States
- Corresponding author: William B. Horton, Department of Medicine, University of Mississippi Medical Center, 2500 N State Street, Jackson, Mississippi 39216, United States. Tel: +1-6019845601, Fax: +1-6019846665, E-mail:
| | - Jose S. Subauste
- Department of Medicine, University of Mississippi Medical Center, Mississippi, United States
- Division of Endocrinology, University of Mississippi Medical Center, Mississippi, United States
- Department of Medicine, G.V. Montgomery VA Medical Center, Mississippi, Jackson, United States
| |
Collapse
|
20
|
Justice TD, Hammer GL, Davey RJ, Paramalingam N, Guelfi KJ, Lewis L, Davis EA, Jones TW, Fournier PA. Effect of antecedent moderate-intensity exercise on the glycemia-increasing effect of a 30-sec maximal sprint: a sex comparison. Physiol Rep 2015; 3:3/5/e12386. [PMID: 26019290 PMCID: PMC4463820 DOI: 10.14814/phy2.12386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This study investigated whether a prior bout of moderate-intensity exercise attenuates the glycemia-increasing effect of a maximal 30-sec sprint. A secondary aim was to determine whether the effect of antecedent exercise on the glucoregulatory response to sprinting is affected by sex. Participants (men n = 8; women n = 7) were tested on two occasions during which they either rested (CON) or cycled for 60-min at a moderate intensity of ~65% (EX) before performing a 30-sec maximal cycling effort 195 min later. In response to the sprint, blood glucose increased to a similar extent between EX and CON trials, peaking at 10 min of recovery, with no difference between sexes (P > 0.05). Blood glucose then declined at a faster rate in EX, and this was associated with a glucose rate of disappearance (Rd) that exceeded the glucose rate of appearance (Ra) earlier in EX compared with CON, although the overall glucose Ra and Rd profile was higher in men compared with women (P < 0.05). The response of growth hormone was attenuated during recovery from EX compared with CON (P < 0.05), with a lower absolute response in women compared with men (P < 0.05). The response of epinephrine and norepinephrine was also lower in women compared with men (P < 0.05) but similar between trials. In summary, a prior bout of moderate-intensity exercise does not affect the magnitude of the glycemia-increasing response to a 30-sec sprint; however, the subsequent decline in blood glucose is more rapid. This blood glucose response is similar between men and women, despite less pronounced changes in glucose Ra and Rd, and a lower response of plasma catecholamines and growth hormone to sprinting in women.
Collapse
Affiliation(s)
- Tara D Justice
- School of Sport Science, Exercise, and Health The University of Western Australia, Crawley, Western Australia, Australia
| | - Greta L Hammer
- School of Sport Science, Exercise, and Health The University of Western Australia, Crawley, Western Australia, Australia
| | - Raymond J Davey
- School of Sport Science, Exercise, and Health The University of Western Australia, Crawley, Western Australia, Australia Telethon Kids Institute The University of Western Australia, Crawley, Western Australia, Australia School of Paediatrics and Child Health The University of Western Australia, Perth, Western Australia, Australia
| | - Nirubasini Paramalingam
- Telethon Kids Institute The University of Western Australia, Crawley, Western Australia, Australia Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Western Australia, Australia
| | - Kym J Guelfi
- School of Sport Science, Exercise, and Health The University of Western Australia, Crawley, Western Australia, Australia
| | - Lynley Lewis
- Department of Medicine, Christchurch Heart Institute The University of Otago, Dunedin, New Zealand
| | - Elizabeth A Davis
- Telethon Kids Institute The University of Western Australia, Crawley, Western Australia, Australia School of Paediatrics and Child Health The University of Western Australia, Perth, Western Australia, Australia Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Western Australia, Australia
| | - Timothy W Jones
- Telethon Kids Institute The University of Western Australia, Crawley, Western Australia, Australia School of Paediatrics and Child Health The University of Western Australia, Perth, Western Australia, Australia Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Western Australia, Australia
| | - Paul A Fournier
- School of Sport Science, Exercise, and Health The University of Western Australia, Crawley, Western Australia, Australia
| |
Collapse
|
21
|
Abstract
While being physically active bestows many health benefits on individuals with type 1 diabetes, their overall blood glucose control is not enhanced without an effective balance of insulin dosing and food intake to maintain euglycemia before, during, and after exercise of all types. At present, a number of technological advances are already available to insulin users who desire to be physically active with optimal blood glucose control, although a number of limitations to those devices remain. In addition to continued improvements to existing technologies and introduction of new ones, finding ways to integrate all of the available data to optimize blood glucose control and performance during and following exercise will likely involve development of "smart" calculators, enhanced closed-loop systems that are able to use additional inputs and learn, and social aspects that allow devices to meet the needs of the users.
Collapse
Affiliation(s)
- Sheri R Colberg
- Human Movement Sciences Department, Old Dominion University, Norfolk, VA, USA
| | - Remmert Laan
- William Sansum Diabetes Center, Santa Barbara, CA, USA
| | - Eyal Dassau
- Department of Chemical Engineering, University of California, Santa Barbara, CA, USA
| | - David Kerr
- William Sansum Diabetes Center, Santa Barbara, CA, USA
| |
Collapse
|
22
|
Davey RJ, Paramalingam N, Retterath AJ, Lim EM, Davis EA, Jones TW, Fournier PA. Antecedent hypoglycaemia does not diminish the glycaemia-increasing effect and glucoregulatory responses of a 10 s sprint in people with type 1 diabetes. Diabetologia 2014; 57:1111-8. [PMID: 24632737 DOI: 10.1007/s00125-014-3218-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 02/26/2014] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS A 10 s sprint has been reported to provide a means to prevent acute post-exercise hypoglycaemia in young adults with type 1 diabetes because of its glycaemia-raising effect, but it is unclear whether this effect is impaired by antecedent hypoglycaemia. The purpose of this study was to investigate whether antecedent hypoglycaemia impairs the glycaemia-raising effect of a 10 s sprint in individuals with type 1 diabetes. METHODS Eight individuals underwent a hyperinsulinaemic-hypoglycaemic or hyperinsulinaemic-euglycaemic clamp on two separate mornings. Thereafter, the participants underwent a basal insulin-euglycaemic clamp before performing a 10 s sprint on a cycle ergometer. The levels of blood glucose and glucoregulatory hormones and rates of glucose appearance (Ra) and disappearance (Rd) were compared between conditions. RESULTS During the morning clamps, blood glucose levels were significantly different between conditions of hypoglycaemia (2.8 ± 0.1 mmol/l) and euglycaemia (5.4 ± 0.2 mmol/l; p < 0.001). Mean glycaemia prior to sprinting was similar (5.6 ± 0.4 and 5.5 ± 0.3 mmol/l for hypoglycaemic and euglycaemic conditions, respectively; p = 0.83). In response to the afternoon sprint, the pattern of increase in blood glucose levels did not differ between conditions, reaching similar maximal levels 45 min after exercise (6.5 ± 0.4 and 6.6 ± 0.3 mmol/l, respectively; p = 0.43). The early post-exercise patterns in glucose Ra and Rd and increases in plasma adrenaline (epinephrine), growth hormone and cortisol levels did not differ between conditions. CONCLUSIONS/INTERPRETATION Hypoglycaemia in the morning does not diminish the glycaemia-raising effect of an afternoon 10 s sprint in young adults with type 1 diabetes, suggesting that sprinting is a useful strategy for opposing hypoglycaemia, regardless of prior hypoglycaemia.
Collapse
Affiliation(s)
- Raymond J Davey
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, 100 Roberts Road, Subiaco, Perth, WA, 6008, Australia,
| | | | | | | | | | | | | |
Collapse
|
23
|
Garg SK, Brazg RL, Bailey TS, Buckingham BA, Slover RH, Klonoff DC, Shin J, Welsh JB, Kaufman FR. Hypoglycemia begets hypoglycemia: the order effect in the ASPIRE in-clinic study. Diabetes Technol Ther 2014; 16:125-30. [PMID: 24405492 DOI: 10.1089/dia.2013.0219] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The ASPIRE in-clinic study established that automatic suspension of insulin with the threshold suspend (TS) feature reduces the duration of induced hypoglycemia. The study's crossover design allowed the effects of antecedent hypoglycemia to be studied. SUBJECTS AND METHODS The study enrolled 50 subjects who exercised until plasma glucose (YSI glucose and lactate analyzer; YSI, Inc., Yellow Springs, OH) reached ≤85 mg/dL. Hypoglycemia was evaluated after the YSI value reached <70 mg/dL. In TS experiments, insulin was stopped for 2 h once a sensor glucose (SG) value of ≤70 mg/dL was detected; in control experiments, basal insulin delivery continued. Subjects were randomly assigned to Group A (TS in Period 1; control in Period 2) or Group B (control in Period 1; TS in Period 2). Experiments were separated by 3-10 days. RESULTS Hypoglycemia was 63.7 min shorter in Period 1 TS experiments (no preceding control experiment) than in Period 2 TS experiments (one or more preceding control experiment(s)) (P<0.01). The number of experiments prior to a successful TS experiment was lower for Period 1 than for Period 2 (0.36 ± 0.64 vs. 1.57 ± 0.84; P<0.001), as was the cumulative duration of antecedent hypoglycemia (16.6 min vs. 204.6 min; P<0.001). The between-groups difference in hypoglycemia duration was not attributable to differences in SG rates of change, the duration of exercise, or area under the curve of <70 mg/dL × min in the 2 days before the successful experiment (all P>0.3). CONCLUSIONS The TS feature's ability to mitigate hypoglycemia was decreased by an episode or episodes of prolonged antecedent hypoglycemia, suggesting hypoglycemia begets hypoglycemia. The effect of antecedent hypoglycemia should be taken into consideration in the design of future experiments assessing strategies to reduce hypoglycemia.
Collapse
|
24
|
Oosthuyse T, Badenhorst M, Avidon I. Bone resorption is suppressed immediately after the third and fourth days of multiday cycling but persistently increased following overnight recovery. Appl Physiol Nutr Metab 2014; 39:64-73. [DOI: 10.1139/apnm-2013-0105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Tanja Oosthuyse
- Exercise Laboratory, School of Physiology, University of the Witwatersrand, Medical School, Johannesburg, South Africa
| | - Margaret Badenhorst
- Exercise Laboratory, School of Physiology, University of the Witwatersrand, Medical School, Johannesburg, South Africa
| | - Ingrid Avidon
- Exercise Laboratory, School of Physiology, University of the Witwatersrand, Medical School, Johannesburg, South Africa
| |
Collapse
|
25
|
Abstract
Physical exercise is firmly incorporated in the management of type 1 diabetes (T1DM), due to multiple recognized beneficial health effects (cardiovascular disease prevention being preeminent). When glycemic values are not excessively low or high at the time of exercise, few absolute contraindications exist; practical guidelines regarding amount, type, and duration of age-appropriate exercise are regularly updated by entities such as the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes. Practical implementation of exercise regimens, however, may at times be problematic. In the poorly controlled patient, specific structural changes may occur within skeletal muscle fiber, which is considered by some to be a disease-specific myopathy. Further, even in well-controlled patients, several homeostatic mechanisms regulating carbohydrate metabolism often become impaired, causing hypo- or hyperglycemia during and/or after exercise. Some altered responses may be related to inappropriate exogenous insulin administration, but are often also partly caused by the "metabolic memory" of prior glycemic events. In this context, prior hyperglycemia correlates with increased inflammatory and oxidative stress responses, possibly modulating key exercise-associated cardio-protective pathways. Similarly, prior hypoglycemia correlates with impaired glucose counterregulation, resulting in greater likelihood of further hypoglycemia to develop. Additional exercise responses that may be altered in T1DM include growth factor release, which may be especially important in children and adolescents. These multiple alterations in the exercise response should not discourage physical activity in patients with T1DM, but rather should stimulate the quest for the identification of the exercise formats that maximize beneficial health effects.
Collapse
Affiliation(s)
- Pietro Galassetti
- Department of Pediatrics, University of California Irvine, Irvine, California, USA.
| | | |
Collapse
|
26
|
Davey RJ, Howe W, Paramalingam N, Ferreira LD, Davis EA, Fournier PA, Jones TW. The effect of midday moderate-intensity exercise on postexercise hypoglycemia risk in individuals with type 1 diabetes. J Clin Endocrinol Metab 2013; 98:2908-14. [PMID: 23780373 DOI: 10.1210/jc.2013-1169] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
CONTEXT Exercise increases the risk of hypoglycemia in type 1 diabetes. OBJECTIVE Recently we reported a biphasic increase in glucose requirements to maintain euglycemia after late-afternoon exercise, suggesting a unique pattern of delayed risk for nocturnal hypoglycemia. This study examined whether this pattern of glucose requirements occurs if exercise is performed earlier in the day. DESIGN, PARTICIPANTS, AND INTERVENTION Ten adolescents with type 1 diabetes underwent a hyperinsulinemic euglycemic glucose clamp on 2 different occasions during which they either rested or performed 45 minutes of moderate-intensity exercise at midday. Glucose was infused to maintain euglycemia for 17 hours after exercise. MAIN OUTCOME MEASURES The glucose infusion rate (GIR) to maintain euglycemia, glucose rates of appearance and disappearance, and levels of counterregulatory hormones were compared between conditions. RESULTS GIRs to maintain euglycemia were not significantly different between groups at baseline (9.8 ± 1.4 and 9.5 ± 1.6 g/h before the exercise and rest conditions, respectively) and did not change in the rest condition throughout the study. In contrast, GIR increased more than 3-fold during exercise (from 9.8 ± 1.4 to 30.6 ± 4.7 g/h), fell within the first hour of recovery, but remained elevated until 11 hours after exercise before returning to baseline levels. CONCLUSIONS The pattern of glucose requirements to maintain euglycemia in response to moderate-intensity exercise performed at midday suggests that the risk of exercise-mediated hypoglycemia increases during and for several hours after moderate-intensity exercise, with no evidence of a biphasic pattern of postexercise risk of hypoglycemia.
Collapse
Affiliation(s)
- Raymond J Davey
- Telethon Institute for Child Health Research, Centre for Child Health Research, School of Sport Science, Exercise, and Health, The University of Western Australia, Crawley, Western Australia 6009, Australia.
| | | | | | | | | | | | | |
Collapse
|
27
|
Sartorio A, Agosti F, Patrizi A, Tringali G, Marazzi N, Giunta M, Muller EE, Rigamonti AE. GH responses to two consecutive bouts of respiratory muscle endurance training in healthy adults. J Endocrinol Invest 2013; 36:255-60. [PMID: 22842679 DOI: 10.3275/8523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Repetition of voluntary exercise bouts and of different pharmacological GH-releasing stimuli at 2-h intervals is associated with a complete abolishment of GH responsiveness. By contrast, a different pattern is observed after repeated neuromuscular electrostimulation, which is characterized by preservation of GH responsiveness. Aim of the study was to evaluate GH responses to repeated bouts of respiratory muscle endurance training (RMET) by mean of a specific commercially available device (Spiro Tiger®). Eight healthy men underwent an incremental progressive RMET protocol of 11 daily sessions. Blood samplings for GH, cortisol and lactate (LA) determinations were collected during the 12th session, which was composed of two consecutive bouts of RMET (of identical intensity and duration: 1 min at a respiration rate of 28 acts/min, 5 min at 32 acts/min, 5 min at 34 acts/min, 4 min at 36 acts/min) at a 2 h interval. Baseline GH levels (mean: 0.9±0.4 ng/ml) significantly (p<0.01) increased after the first bout of RMET (peak: 15.7±4.0 ng/ml). The administration of the second bout of RMET resulted in a significantly lower (p<0.05) GH increase (peak: 3.9±0.8 ng/ml) in comparison with the first one. Baseline LA levels (mean: 1.2±0.1 mmol/l) significantly increased (p<0.001) after the first bout of RMET (peak: 2.3±0.2 mmol/l). The administration of the second RMET bout resulted in a comparable LA increase (from a basal value of 1.2±0.1 mmol/l up to a peak of 2.0±0.1 mmol/l, p<0.001). The first bout of RMET caused a significant increase of cortisol levels (p<0.01), starting from a basal mean value of 142.9±9.4 ng/ml up to a peak of 188.8±10.3 ng/ml. By contrast, the second bout of RMET did not induce any significant change of cortisol levels (basal: 149.1±9.0 ng/ml, peak: 168.5±5.1 ng/ml). In conclusion, a single bout of RMET is capable of stimulating GH and cortisol secretions and LA production. When a second bout is repeated after 2 h, there is a blunting of GH and cortisol responses with a preservation of LA release. Further studies are needed to schedule long-term RMET protocols capable of persistently stimulating GH-IGF-I release and to maximally enhance the ergogenic and metabolic benefits of this intervention either in normal subjects (e.g. athletes) or patients with an impairment of motor capabilities requested to perform normal daily activities (i.e. severely obese and elderly people).
Collapse
Affiliation(s)
- A Sartorio
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-endocrinological Research, Milan and Verbania, Italy
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Adolfsson P, Nilsson S, Albertsson-Wikland K, Lindblad B. Hormonal response during physical exercise of different intensities in adolescents with type 1 diabetes and healthy controls. Pediatr Diabetes 2012; 13:587-96. [PMID: 23173876 DOI: 10.1111/j.1399-5448.2012.00889.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 05/13/2012] [Accepted: 05/15/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Physical activity is a critical component in the care of diabetes. Although it offers health benefits it presents challenges. OBJECTIVE To investigate differences between adolescent boys and girls with type 1 diabetes and healthy controls in terms of maximal work capacity (VO(2) max) and hormonal response to physical exercise of different intensities. SUBJECTS Twelve individuals (six boys and six girls; age 14-19 yr, pubertal stage 4-5) with type 1 diabetes (duration, 6.3 ± 4.4 yr; hemoglobin A1c, 63 ± 10 mmol/mol) were compared with 12 healthy controls matched for age, sex, pubertal stage, body mass index standard deviation score, and amount of regular physical activity. METHODS During consecutive days, three different workloads; maximal, endurance, and interval, were performed on an Ergometer cycle. During the tests, levels of lactate, glucose, insulin, and regulatory hormones [glucagon, cortisol, growth hormone (GH), adrenaline, and noradrenaline] were measured in blood. Subcutaneous glucose was measured continuously. RESULTS VO(2) max did not differ between the groups, diabetes 49.8 ± 9.9 vs. control 50.7 ± 12.0 mL/min/kg. Hormonal responses did not differ between the groups except for mean peak GH level during the interval test, diabetes 63.2 ± 27.0 vs. control 33.8 ± 20.9 mU/L, p < 0.05. CONCLUSIONS Physical capacity and hormonal regulation of blood glucose in connection with physical exercise of different intensities did not differ between adolescents with diabetes and healthy controls. Thus, adolescents with type 1 diabetes can participate in physical activity on the same terms as healthy peers.
Collapse
Affiliation(s)
- Peter Adolfsson
- Department of Pediatrics, Göteborg Pediatric Growth Research Center, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
| | | | | | | |
Collapse
|
29
|
Fahey AJ, Paramalingam N, Davey RJ, Davis EA, Jones TW, Fournier PA. The effect of a short sprint on postexercise whole-body glucose production and utilization rates in individuals with type 1 diabetes mellitus. J Clin Endocrinol Metab 2012; 97:4193-200. [PMID: 22962428 DOI: 10.1210/jc.2012-1604] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Recently we showed that a 10-sec maximal sprint effort performed before or after moderate intensity exercise can prevent early hypoglycemia during recovery in individuals with type 1 diabetes mellitus (T1DM). However, the mechanisms underlying this protective effect of sprinting are still unknown. OBJECTIVE The objective of the study was to test the hypothesis that short duration sprinting increases blood glucose levels via a disproportionate increase in glucose rate of appearance (Ra) relative to glucose rate of disappearance (Rd). SUBJECTS AND EXPERIMENTAL DESIGN: Eight T1DM participants were subjected to a euglycemic-euinsulinemic clamp and, together with nondiabetic participants, were infused with [6,6-(2)H]glucose before sprinting for 10 sec and allowed to recover for 2 h. RESULTS In response to sprinting, blood glucose levels increased by 1.2 ± 0.2 mmol/liter (P < 0.05) within 30 min of recovery in T1DM participants and remained stable afterward, whereas glycemia rose by only 0.40 ± 0.05 mmol/liter in the nondiabetic group. During recovery, glucose Ra did not change in both groups (P > 0.05), but glucose Rd in the nondiabetic and diabetic participants fell rapidly after exercise before returning within 30 min to preexercise levels. After sprinting, the levels of plasma epinephrine, norepinephrine, and GH rose transiently in both experimental groups (P < 0.05). CONCLUSION A sprint as short as 10 sec can increase plasma glucose levels in nondiabetic and T1DM individuals, with this rise resulting from a transient decline in glucose Rd rather than from a disproportionate rise in glucose Ra relative to glucose Rd as reported with intense aerobic exercise.
Collapse
Affiliation(s)
- A J Fahey
- School of Exercise Science and Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | | | | | | | | | | |
Collapse
|
30
|
Chu L, Hamilton J, Riddell MC. Clinical management of the physically active patient with type 1 diabetes. PHYSICIAN SPORTSMED 2011; 39:64-77. [PMID: 21673486 DOI: 10.3810/psm.2011.05.1896] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The prevalence and incidence of type 1 diabetes continues to increase worldwide. Most patients with type 1 diabetes are young at the time of diagnosis and wish to continue leading a physically active life. Although regular exercise, insulin therapy, and proper nutrition are the cornerstone of treatment, there are considerable challenges in managing the active individual with type 1 diabetes. The current recommendation for diabetes management is intensive glycemic control for all patients when possible to help prevent secondary complications. Both insulin pump therapy and multiple daily injections are beneficial treatment options to lower average glucose levels; however, without continuous glucose monitoring, these treatment options typically increase the risk of hypoglycemia. In active patients with type 1 diabetes, the challenges of maintaining good glycemia are complicated by the inability to regulate insulin concentrations during and after exercise. Physiological and psychosocial factors during growth and maturation also provide additional challenges. This article highlights challenges and key strategies for diabetes management in the active individual with type 1 diabetes, including the application of the most recent diabetes technologies.
Collapse
Affiliation(s)
- Lisa Chu
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | | | | |
Collapse
|
31
|
Does careful glycemic control improve aerobic capacity in subjects with type 1 diabetes? Exerc Sport Sci Rev 2011; 38:161-7. [PMID: 20871232 DOI: 10.1097/jes.0b013e3181f4501e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Existing evidence shows that some, but not all, individuals with type 1 diabetes are capable of the same aerobic capacity as matched nondiabetic subjects. Poor glycemic control impairs pulmonary, cardiac, and vascular responses to exercise. This review examines how careful glycemic control affects these responses and may independently improve aerobic capacity.
Collapse
|
32
|
SCHAAL KARINE, VAN LOAN MARTAD, CASAZZA GRETCHENA. Reduced Catecholamine Response to Exercise in Amenorrheic Athletes. Med Sci Sports Exerc 2011; 43:34-43. [DOI: 10.1249/mss.0b013e3181e91ece] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
33
|
Borer KT, Wuorinen EC, Lukos JR, Denver JW, Porges SW, Burant CF. Two bouts of exercise before meals, but not after meals, lower fasting blood glucose. Med Sci Sports Exerc 2009; 41:1606-14. [PMID: 19568199 DOI: 10.1249/mss.0b013e31819dfe14] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Reduced counterregulatory responses to a next-day hypoglycemic challenge and hypoglycemia result from two spaced episodes of moderate-intensity exercise and have been characterized as exercise-associated autonomic failure. We hypothesized that this phenomenon is caused by postabsorptive state at the time of exercise rather than by autonomic failure. METHODS Participants were nine healthy postmenopausal women in a crossover study. Two hours of treadmill exercise at 43% of maximal effort were performed twice a day, separated by 5 h, either 1 h before (Before-Meals trial) or 1 h after a meal (After-Meals trial). Plasma insulin, counterregulatory hormones (glucagon, growth hormone, cortisol), and metabolites (glucose, free fatty acids, ketones) were measured to evaluate the effects of nutritional timing. Analyses of HR and vagal tone were measured to assess autonomic function. RESULTS Before-Meals exercise, but not After-Meals exercise, reduced postabsorptive plasma glucose by 20.2% during a 16-h period, without a change in counterregulatory response, and elicited postexercise ketosis. A 49% increase in insulin-glucagon ratio during meals, a 1 mM decline in glucagon glycemic threshold, and a reduced vagal tone during exercise were associated with Before-Meals but not with After-Meals trials. CONCLUSIONS These results demonstrate that exercise performed in postabsorptive, but not in postprandial state, lowers glucoregulatory set point and glucagon glycemic threshold and is accompanied by reduced vagal tone, counterregulatory responses, and glucagon glycemic threshold and by increased insulin-glucagon ratio. Reduced counterregulatory response, altered neuroendocrine function, and sustained lowering of blood glucose are most likely the consequences of reduced carbohydrate availability during exercise.
Collapse
Affiliation(s)
- Katarina T Borer
- School of Kinesiology, University of Michigan, Ann Arbor, MI 49109-2214, USA.
| | | | | | | | | | | |
Collapse
|
34
|
Bergeron MF. Youth sports in the heat: recovery and scheduling considerations for tournament play. Sports Med 2009; 39:513-22. [PMID: 19530749 DOI: 10.2165/00007256-200939070-00001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
One of the biggest challenges facing numerous young athletes is attempting to perform safely and effectively in the heat. An even greater performance challenge and risk for incurring exertional heat injury is encountered when a young athlete has to compete multiple times on the same day, with only a short rest period between rounds of play, during a hot-weather tournament. Within the scope of the rules, tournament directors frequently provide athletes with only the minimum allowable time between same-day matches or games. Notably, prior same-day exercise has been shown to increase cardiovascular and thermal strain and perception of effort in subsequent activity bouts, and the extent of earlier exercise-heat exposure can affect performance and competition outcome. Incurred water and other nutrient deficits are often too great to offset during short recovery periods between competition bouts, and the athletes are sometimes 'forced' to compete again not sufficiently replenished. Providing longer rest periods between matches and games can significantly improve athlete safety and performance, by enhancing recovery and minimizing the 'carryover' effects from previous competition-related physical activity and heat exposure that can negatively affect performance and safety. Governing bodies of youth sports need to address this issue and provide more specific, appropriate and evidence-based guidelines for minimum rest periods between same-day contests for all levels of tournament play in the heat. Youth athletes are capable of tolerating the heat and performing reasonably well and safely in a range of hot environments if they prepare well, manage hydration sufficiently, and are provided the opportunity to recover adequately between contests.
Collapse
Affiliation(s)
- Michael F Bergeron
- National Institute for Athletic Health and Performance and Center for Youth Sports and Health, Sanford USD Medical Center, Sioux Falls, South Dakota, USA.
| |
Collapse
|
35
|
|
36
|
Rosa JS, Galassetti PR. Altered molecular adaptation to exercise in children with type 1 diabetes: beyond hypoglycemia. Pediatr Diabetes 2009; 10:213-26. [PMID: 18828794 DOI: 10.1111/j.1399-5448.2008.00452.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jaime S Rosa
- Department of Pediatrics, Institute for Clinical Translational Science, University of California, Irvine, Orange, CA 92868, USA
| | | |
Collapse
|
37
|
Abstract
Leukocytosis contributes to exercise-induced immune modulation, which is a mechanism of cardiovascular protection. However, this process is poorly defined in children. We therefore measured leukocytes in 45 healthy, 18 overweight, 16 type 1 diabetic, and 8 asthmatic children at pre, end-, and 30-min postexercise (30-min intermittent or 6-min continuous). In all groups, total leukocytes, neutrophils, lymphocytes, and monocytes increased at end-exercise, but returned to baseline by 30-min postexercise, including neutrophils, previously reported to remain elevated for at least some exercise formats. This highly preserved pattern indicates the importance of the adaptive response to physical stress across multiple health conditions.
Collapse
|
38
|
Stokes KA, Tyler C, Gilbert KL. The growth hormone response to repeated bouts of sprint exercise with and without suppression of lipolysis in men. J Appl Physiol (1985) 2008; 104:724-8. [PMID: 18187617 DOI: 10.1152/japplphysiol.00534.2007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A single 30-s sprint is a potent physiological stimulus for growth hormone (GH) release. However, repeated bouts of sprinting attenuate the GH response, possibly due to negative feedback via elevated systemic free fatty acids (FFA). The aim of the study was to use nicotinic acid (NA) to suppress lipolysis to investigate whether serum FFA can modulate the GH response to exercise. Seven nonobese, healthy men performed two trials, consisting of two maximal 30-s cycle ergometer sprints separated by 4 h of recovery. In one trial (NA), participants ingested NA (1 g 60 min before, and 0.5 g 60 and 180 min after sprint 1); the other was a control (Con) trial. Serum FFA was not significantly different between trials before sprint 1 but was significantly lower in the NA trial immediately before sprint 2 [NA vs. Con: mean (SD); 0.08 (0.05) vs. 0.75 (0.34) mmol/l, P < 0.05]. Peak and integrated GH were significantly greater following sprint 2 compared with sprint 1 in the NA trial [peak GH: 23.3 (7.0) vs. 7.7 (11.9) microg/l, P < 0.05; integrated GH: 1,076 (350) vs. 316 (527) microg.l(-1).60 min(-1), P < 0.05] and compared with sprint 2 in the Con trial [peak GH: 23.3 (7.0) vs. 5.2 (2.3) microg/l, P < 0.05; integrated GH: 1,076 (350) vs. 206 (118) microg.l(-1).60 min(-1), P < 0.05]. In conclusion, suppressing lipolysis resulted in a significantly greater GH response to the second of two sprints, suggesting a potential role for serum FFA in negative feedback control of the GH response to repeated exercise.
Collapse
Affiliation(s)
- Keith A Stokes
- Sport and Exercise Science, School for Health, University of Bath, Bath, UK.
| | | | | |
Collapse
|
39
|
Iscoe KE, Corcoran M, Riddell MC. High Rates of Nocturnal Hypoglycemia in a Unique Sports Camp for Athletes with Type 1 Diabetes: Lessons Learned from Continuous Glucose Monitoring Systems. Can J Diabetes 2008. [DOI: 10.1016/s1499-2671(08)23008-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
40
|
Abstract
The Diabetes Control and Complications Trial demonstrated that tight control of diabetes management greatly reduces the risk of microvascular complications of diabetes. Unfortunately, tight control of blood glucose can also result in hypoglycemia, especially in patients with type 1 diabetes mellitus (T1DM). It is now widely recognized that antecedent hypoglycemia can blunt neuroendocrine, autonomic nervous system (ANS), and metabolic counterregulatory responses to subsequent hypoglycemia. Thus, blunted counterregulatory defenses against falling plasma glucose levels are a major risk factor for hypoglycemia in people with diabetes. This risk is also complicated by a difference in responses between males and females. Because of the qualitative similarity of neuroendocrine, ANS, and metabolic responses to hypoglycemia and exercise, we developed studies to determine whether neuroendocrine and ANS counterregulatory dysfunction play a role in the pathogenesis of exercise-related hypoglycemia in T1DM. Results from these studies have shown that neuroendocrine (catecholamine and glucagon), ANS (muscle sympathetic nerve activity), and metabolic (lipolysis and glucose kinetics) responses are blunted during exercise after antecedent hypoglycemia, and that there is a sexual dimorphism in responses. Similarly, antecedent episodes of exercise can blunt counterregulatory responses during subsequent hypoglycemia, thereby creating reciprocal feed-forward vicious cycles that increase the risk of hypoglycemia during either stress.
Collapse
Affiliation(s)
- Vanessa Jones Briscoe
- Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University Medical Center, 715 Preston Research Building, Nashville, TN 37232-6303, USA
| | | | | |
Collapse
|
41
|
de Graaf‐Roelfsema E, Keizer H, van Breda E, Wijnberg I, van der Kolk J. Hormonal responses to acute exercise, training and overtraining a review with emphasis on the horse. Vet Q 2007; 29:82-101. [DOI: 10.1080/01652176.2007.9695232] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
|
42
|
Abstract
Type I diabetes mellitus patients who tightly control blood glucose levels toward normal have increased frequency of hypoglycemia, a major barrier to physical activity. This article presents the hypothesis that dysfunctional autonomic regulation of metabolism after recent bouts of exercise or hypoglycemia contributes to exercise-induced hypoglycemia in these patients.
Collapse
|
43
|
Colberg SR. The impact of exercise on insulin action in type 2 diabetes mellitus: Relationship to prevention and control. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s1557-0843(06)80018-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
44
|
Galassetti P, Larson J, Iwanaga K, Salsberg SL, Eliakim A, Pontello A. Effect of a high-fat meal on the growth hormone response to exercise in children. J Pediatr Endocrinol Metab 2006; 19:777-86. [PMID: 16886585 DOI: 10.1515/jpem.2006.19.6.777] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Exercise-induced growth hormone (GH) secretion may significantly modulate growth and development in children. Altered physiological GH responses, therefore, may reduce the beneficial effects of exercise. High-fat food ingestion before exercise blunts the GH response in adults, but it is unknown whether this occurs in children. We therefore performed standard exercise tests, following a high-fat meal or placebo, in 12 children, age 11-15 (6 M, 6 F). GH, insulin-like growth factor-I, glucose, insulin, glucagon, cortisol, epinephrine and interleukin-6 samples were drawn at baseline, end-exercise, and 30 and 60 min post-exercise. While GH was similar at baseline in all experiments, the exercise-induced GH peak was lower after the high-fat meal (6.7 +/- 1.6 ng/l vs 11.8 +/- 2.4 ng/l, p <0.02). Other exercise responses were not affected by prior fat ingestion. A high-fat meal before exercise, therefore (a common event in Western societies), may reduce the growth factor response to exercise in children, with potential implications for growth and development.
Collapse
Affiliation(s)
- Pietro Galassetti
- General Clinical Research Center and Department of Pediatrics, University of California Irvine School of Medicine, USA.
| | | | | | | | | | | |
Collapse
|
45
|
M'Kaouar H, Péronnet F, Massicotte D, Lavoie C. Gender difference in the metabolic response to prolonged exercise with [13C]glucose ingestion. Eur J Appl Physiol 2004; 92:462-9. [PMID: 15138838 DOI: 10.1007/s00421-004-1122-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2003] [Indexed: 11/25/2022]
Abstract
The metabolic response to a 120-min cycling exercise with ingestion of [(13)C]glucose (3 g kg(-1)) was compared in women in the follicular phase of the cycle [ n=6; maximum rate of oxygen uptake (VO(2max)) 44.7 (2.6) ml kg(-1) min(-1)] and in men [ n=6; VO(2max) 54.2 (4.3) ml kg(-1) min(-1)] working at the same relative workload (approximately 65% VO(2max): 107 and 179 W in women and men, respectively). We hypothesized that the contribution of endogenous substrate oxidations (indirect respiratory calorimetry corrected for protein oxidation) to the energy yield will be similar in men and women, but that women will rely more than men on exogenous glucose oxidation. Over the exercise period, the respective contributions of protein, lipid and carbohydrate oxidation to the energy yield, were similar in men [3.7 (0.9), 21.7 (2.9) and 74.6 (3.5)%] and women [3.4 (0.8), 21.5 (2.2), 75.1 (2.5)%]. The rate of exogenous glucose oxidation was approximately 45% lower in women than men (0.5 and 0.6 g min(-1) vs 0.7 and 0.9 g min(-1), between min 40 and 80, and min 80 and 120, respectively). However, when the approximately 39% difference in absolute workload and energy expenditure was taken into account, the contribution of exogenous glucose oxidation to the energy yield was similar in men and women: 22.5 vs 24.2% between min 40 and 80, and 25.7 and 28.5% between min 80 and 120, respectively. These data indicate that when fed glucose, the respective contributions of the oxidation of the various substrates to the energy yield during prolonged exercise at the same % VO(2max) are similar in men and in women in the follicular phase of the cycle.
Collapse
Affiliation(s)
- Hanèn M'Kaouar
- Département de kinésiologie, Université de Montréal, CP 6128 Centre Ville, H3C 3J7, Montreal, Quebec, Canada
| | | | | | | |
Collapse
|
46
|
Sandoval DA, Galassetti P, Tate D, Neill A, Davis SN. Leptin responses to antecedent exercise and hypoglycemia in healthy and type 1 diabetes mellitus men and women. J Diabetes Complications 2003; 17:301-6. [PMID: 14583173 DOI: 10.1016/s1056-8727(02)00243-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
These studies examined the effects of hypoglycemia or exercise on leptin levels in 47 (23 women, 24 men) healthy (age 26+/-2 years, body mass index 23+/-0.5 kg.m(-2)) and type 1 diabetes mellitus (T1DM) subjects (age 29+/-2 years, body mass index 27+/-2 kg.m(-2)). In Study 1, healthy and T1DM subjects were exposed to morning and afternoon 120-min hyperinsulinemic hypoglycemic ( approximately 50 mg/dl) or euglycemic ( approximately 90 mg/dl) clamps. In Study 2, healthy subjects were studied during morning and afternoon 90-min exercise bouts at 50% VO(2max). In Study 1, basal levels of leptin were significantly greater in T1DM vs. the healthy subjects (13.8+/-3 vs. 5.4+/-1 ng/dl; P<.05). However, during the last 30 min of morning hypoglycemia, plasma leptin levels significantly decreased from 5.4+/-1 to 4.0+/-1 ng/dl (P<.05) and remained low during afternoon hypoglycemia (4.3+/-1 ng/dl) in healthy but not T1DM subjects. In Study 2, plasma leptin levels did not significantly change during exercise the bout in healthy men, but significantly decreased 3 h after morning exercise, and continued to decrease during afternoon exercise in healthy women (P<.0001). Thus, plasma leptin levels decrease in response to hypoglycemia in healthy but not T1DM subjects. However, T1DM patients do have increased basal leptin levels compared to healthy man. Lastly, there is a marked sexual dimorphism in plasma leptin responses to repeated episodes of exercise.
Collapse
Affiliation(s)
- Darleen A Sandoval
- Department of Medicine, Vanderbilt University School of Medicine and Nashville Veterans Affairs Medical Center, Nashville, TN 37232, USA.
| | | | | | | | | |
Collapse
|
47
|
Wideman L, Weltman JY, Hartman ML, Veldhuis JD, Weltman A. Growth hormone release during acute and chronic aerobic and resistance exercise: recent findings. Sports Med 2003; 32:987-1004. [PMID: 12457419 DOI: 10.2165/00007256-200232150-00003] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Exercise is a potent physiological stimulus for growth hormone (GH) secretion, and both aerobic and resistance exercise result in significant, acute increases in GH secretion. Contrary to previous suggestions that exercise-induced GH release requires that a "threshold" intensity be attained, recent research from our laboratory has shown that regardless of age or gender, there is a linear relationship between the magnitude of the acute increase in GH release and exercise intensity. The magnitude of GH release is greater in young women than in young men and is reduced by 4-7-fold in older individuals compared with younger individuals. Following the increase in GH secretion associated with a bout of aerobic exercise, GH release transiently decreases. As a result, 24-hour integrated GH concentrations are not usually elevated by a single bout of exercise. However, repeated bouts of aerobic exercise within a 24-hour period result in increased 24-hour integrated GH concentrations. Because the GH response to acute resistance exercise is dependent on the work-rest interval and the load and frequency of the resistance exercise used, the ability to equate intensity across different resistance exercise protocols is desirable. This has proved to be a difficult task. Problems with maintaining patent intravenous catheters have resulted in a lack of studies investigating alterations in acute and 24-hour GH pulsatile secretion in response to resistance exercise. However, research using varied resistance protocols and sampling techniques has reported acute increases in GH release similar to those observed with aerobic exercise. In young women, chronic aerobic training at an intensity greater than the lactate threshold resulted in a 2-fold increase in 24-hour GH release. The time line of adaptation and the mechanism(s) by which this training effect occurs are still elusive. Unfortunately, there are few studies investigating the effects of chronic resistance training on 24-hour GH release. The decrease in GH secretion observed in individuals who are older or have obesity is associated with many deleterious health effects, although a cause and effect relationship has not been established. While exercise interventions may not restore GH secretion to levels observed in young, healthy individuals, exercise is a robust stimulus of GH secretion. The combination of exercise and administration of oral GH secretagogues may result in greater GH secretion than exercise alone in individuals who are older or have obesity. Whether such interventions would result in favourable clinical outcomes remains to be established.
Collapse
Affiliation(s)
- Laurie Wideman
- Department of Exercise and Sport Science, University of North Carolina-Greensboro, Rm. 237E Health and Human Performance Building, Greensboro, NC 27410, USA.
| | | | | | | | | |
Collapse
|
48
|
Ronsen O, Lea T, Bahr R, Pedersen BK. Enhanced plasma IL-6 and IL-1ra responses to repeated vs. single bouts of prolonged cycling in elite athletes. J Appl Physiol (1985) 2002; 92:2547-53. [PMID: 12015372 DOI: 10.1152/japplphysiol.01263.2001] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The impact of repeated bouts of exercise on plasma levels of interleukin (IL)-6 and IL-1 receptor antagonist (IL-1ra) was examined. Nine well-trained men participated in four different 24-h trials: Long [two bouts of exercise, at 0800-0915 and afternoon exercise (Ex-A), separated by 6 h]; Short (two bouts, at 1100-1215 and Ex-A, separated by 3 h); One (single bout performed at the same Ex-A as second bout in prior trials); and Rest (no exercise). All exercise bouts were performed on a cycle ergometer at 75% of maximal O(2) uptake and lasted 75 min. Peak IL-6 observed at the end of Ex-A was significantly higher in Short (8.8 +/- 1.3 pg/ml) than One (5.2 +/- 0.7 pg/ml) but not compared with Long (5.9 +/- 1.2 pg/ml). Peak IL-1ra observed 1 h postexercise was significantly higher in Short (1,774 +/- 373 pg/ml) than One (302 +/- 53 pg/ml) but not compared with Long (1,276 +/- 451 pg/ml). We conclude that, when a second bout of endurance exercise is performed after only 3 h of recovery, IL-6 and IL-1ra responses are elevated. This may be linked to muscle glycogen depletion.
Collapse
Affiliation(s)
- Ola Ronsen
- Norwegian Olympic Sports Center, Norway.
| | | | | | | |
Collapse
|