Introduction: In Type 1 Diabetes Mellitus (T1DM) physical activity helps to maintain better metabolic control, enhancing patients quality of life (Riddell et al., 2013). However, the risk of hypoglicemia during or after physical activity represents one of the most important factors limiting voluntary exercise in T1DM (Dubé et al., 2006). To prevent hypoglicemia it is suggested to ingest greater quantities of charbohydrates (CHO), even after reducing the dose of insuline. (Grimm blabla). To achieve better glycemic balance a specific algorithm has been recently proposed. ECRES estimates the glucose supplement for individualized patients and situations, in order to maintain safe blood glucose levels (Francescato et al., 2011). Aim of the present study was to compare free CHO consumption during a marathon 24x1 hour (Telethon 2013), with ECRES estimated glucose supplement. Methods: Telethon 24x1 hour is an annual event to collect fundings for research on rare diseases. During this event a team composed by people with T1DM participated, each member running for 1 hour. From the 24 participants, we could not include in our analysis 5 people, 1 because of a positive peptide C and 4 because of unreliable recorded heart rate. At the end 19 patients were included (8 females, 10 with multiple daily insuline injections, 36±10 yrs, 68±11 kg, 7.47±0.85 HbA1c). Medical assistance was continuously provided during the whole event. It have been recorded information about their usual therapies, any specific adjustment, blood glucose before, in the middle, and at the end of their run, and heart rate during the run. ECRES algorithm was adjusted on patient’s specific case and glycemia was estimated and compared with real results. ECRES estimation was considered “good” if final glycemia was between 70 and 180 mg/dL (3.9 – 10 mM). Results: Patients run on average 10.4±2.8 km in about 1 h each, showing an average heart rate of 157±21 bpm. Glycemia at the start of the fraction was in the range 4.5-20.6 mmol/L; in 8/19 cases glycemia was > 10 mmol/L while no one was < 3.9 mmol/L. Average glycemia at 30 min amounted to 9.1±4.5 mmol/L; three patients incurred in a moderate fall of glycemia (between 3.3 and 3.9 mmol/L at 30 min), quickly and stably compensated consuming a few sugar drops. Glycemia further decreased significantly (p<0.01) to 7.4±3.1 mmol/L at the end of the runs. One patient incurred in a more severe hyoglycemia at about 40 min (2 mmol/L) that was difficult to be compensated by the end of the race. In three cases, glycemia increased by the end of the patient’s run. The amount of carbohydrates estimated by the ECRES algorithm would allow 63% of patients to conclude their 1-h run with glycemia in the optimal range. Discussion Present investigation showed that patients let free to choose the best countermeasure to prevent an excessive fall of glycemia for 1-h run frequently induce an inappropriate high glycemia before the start of the physical activity. The ECRES algorithm, although specifically designed to estimate the carbohydrates required by a T1DM patient for aerobic exercises, would have suggested appropriate amounts of carbohydrates also for the more challenging physical activity performed by patients on the occasion of the 24 x 1-h Telethon Marathon. This result supports the view that the ECRES algorithm can indeed become a useful tool for T1DM patients to help them in keeping more constant glycemic levels on exercise occasions. Bibliography Dubé MC, Valois P, Prud’homme D, Weisnagel SJ, Lavoie C (2006). Diabetes Res Clin Pract, 72(1): 20-26. Francescato MP, Geat M, Accardo A, Blokar M, Cattin L, Noacco C (2011). Med Sci Sports Exerc, 43(1): 2-11. Grimm JJ, Ybarra J, Berne´ C, Muchnick S, Golay A (2004). Diabetes Metab,30(5):465–70. Riddell MC, Miadovnik L, Simms M, Li B, Zisser H (2013). Diabetes Technol Ther, 15(1): S96-106.

Comparison between real and estimated carbohydrate supplements in type 1 diabetic patients during 1-h runs

FRANCESCATO, Maria Pia
2014-01-01

Abstract

Introduction: In Type 1 Diabetes Mellitus (T1DM) physical activity helps to maintain better metabolic control, enhancing patients quality of life (Riddell et al., 2013). However, the risk of hypoglicemia during or after physical activity represents one of the most important factors limiting voluntary exercise in T1DM (Dubé et al., 2006). To prevent hypoglicemia it is suggested to ingest greater quantities of charbohydrates (CHO), even after reducing the dose of insuline. (Grimm blabla). To achieve better glycemic balance a specific algorithm has been recently proposed. ECRES estimates the glucose supplement for individualized patients and situations, in order to maintain safe blood glucose levels (Francescato et al., 2011). Aim of the present study was to compare free CHO consumption during a marathon 24x1 hour (Telethon 2013), with ECRES estimated glucose supplement. Methods: Telethon 24x1 hour is an annual event to collect fundings for research on rare diseases. During this event a team composed by people with T1DM participated, each member running for 1 hour. From the 24 participants, we could not include in our analysis 5 people, 1 because of a positive peptide C and 4 because of unreliable recorded heart rate. At the end 19 patients were included (8 females, 10 with multiple daily insuline injections, 36±10 yrs, 68±11 kg, 7.47±0.85 HbA1c). Medical assistance was continuously provided during the whole event. It have been recorded information about their usual therapies, any specific adjustment, blood glucose before, in the middle, and at the end of their run, and heart rate during the run. ECRES algorithm was adjusted on patient’s specific case and glycemia was estimated and compared with real results. ECRES estimation was considered “good” if final glycemia was between 70 and 180 mg/dL (3.9 – 10 mM). Results: Patients run on average 10.4±2.8 km in about 1 h each, showing an average heart rate of 157±21 bpm. Glycemia at the start of the fraction was in the range 4.5-20.6 mmol/L; in 8/19 cases glycemia was > 10 mmol/L while no one was < 3.9 mmol/L. Average glycemia at 30 min amounted to 9.1±4.5 mmol/L; three patients incurred in a moderate fall of glycemia (between 3.3 and 3.9 mmol/L at 30 min), quickly and stably compensated consuming a few sugar drops. Glycemia further decreased significantly (p<0.01) to 7.4±3.1 mmol/L at the end of the runs. One patient incurred in a more severe hyoglycemia at about 40 min (2 mmol/L) that was difficult to be compensated by the end of the race. In three cases, glycemia increased by the end of the patient’s run. The amount of carbohydrates estimated by the ECRES algorithm would allow 63% of patients to conclude their 1-h run with glycemia in the optimal range. Discussion Present investigation showed that patients let free to choose the best countermeasure to prevent an excessive fall of glycemia for 1-h run frequently induce an inappropriate high glycemia before the start of the physical activity. The ECRES algorithm, although specifically designed to estimate the carbohydrates required by a T1DM patient for aerobic exercises, would have suggested appropriate amounts of carbohydrates also for the more challenging physical activity performed by patients on the occasion of the 24 x 1-h Telethon Marathon. This result supports the view that the ECRES algorithm can indeed become a useful tool for T1DM patients to help them in keeping more constant glycemic levels on exercise occasions. Bibliography Dubé MC, Valois P, Prud’homme D, Weisnagel SJ, Lavoie C (2006). Diabetes Res Clin Pract, 72(1): 20-26. Francescato MP, Geat M, Accardo A, Blokar M, Cattin L, Noacco C (2011). Med Sci Sports Exerc, 43(1): 2-11. Grimm JJ, Ybarra J, Berne´ C, Muchnick S, Golay A (2004). Diabetes Metab,30(5):465–70. Riddell MC, Miadovnik L, Simms M, Li B, Zisser H (2013). Diabetes Technol Ther, 15(1): S96-106.
2014
9789462284777
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11390/979350
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