Carbohydrate Management in Athletes with Type 1 Diabetes in a 10 km Run Competition

Abstract

The aim of this study was to identify the real consumption of CHO during a 10 km competitive run, to compare data with the recommended quantities according to current guidelines, and to analyse the clinical events associated with these different amounts. Protocol 1: observational study including 31 athletes with T1D and 127 athletes without diabetes, comparing data taken from dietary records of CHO intake on the competition day. Protocol 2: single-blind randomized trial in 18 athletes with T1D, testing a pre-exercise CHO supplement of 0.7 g CHO·kg^− 1 (n=10) or 0.35 g CHO·kg^− 1 (n=8). The results showed that T1D athletes consumed a lower quantity of CHO than athletes without diabetes at their usual breakfast and during the meal taken<1 h after the competition, but no differences were found in the supplement taken before the competition. In the randomized study, athletes consuming the higher dose of CHO (0.7 g CHO·kg^− 1) showed increased glycemic levels, comparing with the lower dose (0.35 g CHO·kg^− 1). In conclusion, athletes with T1D seem to increase CHO intake prior to the competition consuming similar amounts to those athletes without diabetes, but consuming smaller quantities of CHO than the recommended amounts. This appears to induce a more stable glycemic response, in comparison with supplements with high-CHO content.

Key words

diabetes - running - carbohydrate

• References

• 1 American College of Sports Medicine and American Diabetes Association joint position statement. Diabetes Mellitus and Exercise. Med Sci Sports Exerc 2010; 42: 2282-2303
• 2 Arkinstal MJ, Bruce CR, Clarck SA, Rickards CA, Burke LM, Hawley JA. Regulation of fuel metabolism by preexercise muscle glycogen content and exercise intensity. J Appl Physiol 2004; 97: 2275-2283
• 3 Bajpeyi S, Tanner CJ, Slentz CA, Duscha MD, McCartney JS, Hickner RC, Kraus WE, Houmard JA. Effect of exercise intensity and volumen on persistence of insulin sensitivity during training cessation. J Appl Physiol 2009; 106: 1079-1085
• 4 Baker LB, Jeukendrup AE. Optimal composition of fluid-replacement beverage. Compr Physiol 2014; 575-620 DOI: 10.1002/cphy.c130014.
• 5 Brazeau AS, Rabasa-Lhoret R, Strychar I, Mirescu H. Barriers to physical activity among patients with type 1 diabetes. Diabetes Care 2008; 31: 2108-2109
• 6 Colberg SR. Exercise and Diabetes. American Diabetes Association; Alexandria: 2013
• 7 Dubé MC, Weisnagel J, Prud’Homme D, Lavoie C. Exercise and newer insulins: how much glucose supplement to avoid Hypoglycemia?. Med Sci Sports Exerc 2005; 37: 1276-1282
• 8 Francescato MP, Carrato S. Management of exercise-induced glycemic imbalances in type 1 diabetes. CurrDiab Rev 2011; 7: 253-263
• 9 Gallen IW, Hume C, Lumb A. Fuelling the athlete with type 1 diabetes. Diabetes Obes Metab 2011; 13: 130-136
• 10 Grim JJ, Ybarra J, Berne C, Muchnick S, Golay A. A new table for prevention of hypoglycaemia during physical activity in type 1 diabetic patient. Diabetes Care 2004; 30: 465-470
• 11 Harriss DJ, Atkinson G. Ethical standards in sports and exercise science research: 2014 update. Int J Sports Med 2013; 34: 1025-1028
• 12 Jenni S, Oetliker C, Allemann S, Ith M, Tappy L, Wuerth S, Egger A, Boesch C, Schneiter PH, Diem P, Christ E, Stettler C. Fuel metabolism during exercise in euglycaemia and hyperglycaemia in patients with type 1 diabetes mellitus – a prospective single-blinded randomised crossover trial. Diabetologia 2008; 51: 1457-1465
• 13 Kilbride L, Charlton J, Aitken G, Hill GW, Davison RC, McKnight JA. Managing blood glucose during and after exercise in type 1 diabetes: reproducibility of glucose response and a trial of a structured algorithm adjusting insulin and carbohydrate intake. J Clin Nurs 2011; 20: 3424-3429
• 14 Macknight JM, Mistry DJ, Pastors JG, Holmes V, Rynders CA. The daily management of athletes with diabetes. Clin Sports Med 2009; 28: 479-495
• 15 Marliss EB, Vranic M. Intense exercise has unique effects on both insulin release and its roles in glucorregulation: implications for diabetes. Diabetes 2002; 51 (Suppl. 01) S271-S283
• 16 Murillo S, Brugnara L, Novials A. One year follow-up in a group of half-marathon runners with type-1 diabetes treated with insulin analogues. J Sports Med Phys Fitness 2010; 50: 506-510
• 17 Nagi D. Exercise and Sport in Diabetes. 2^a edition Chichester: Wiley & Sons; 2006
• 18 O’donovan G, Kearney EM, Nevill AM, Woolf-May K, Bird SR. The effects of 24 weeks of moderate- or high-intensity exercise on insulin resistance. Eur J Appl Physiol 2005; 95: 522-528
• 19 Petersen KF, Price TB, Bergeron R. Regulation of net glycogenolysis and gluconeogénesis during exercise: impacto f type 1 diabetes. J Clin Endocrinol Metab 2004; 89: 4656-4664
• 20 Rudermann N, Devlin JT, Schneider SH, Kriska AM. American Diabetes Association . Handbook of exercise in diabetes. 2^a edición Alexandria: American Diabetes Association; Alexandria; 2002
• 21 Sigal RJ, Fisher SJ, Halter JB, Vranic M, Halter JB, Marliss EB. Glucoregulation during and after intense exercise: effects of beta-adenergic blockade in subjects with type 1 diabetes mellitus. J Clin Endocrinol Metab 1999; 84: 3961-3671
• 22 terBraak EW, Appelman AM, van de Laak M, Stolk RP, van Haeften TW, Erkelens DW. Clinical characteristics of type 1 diabetic patients with and without severe hypoglycemia. Diabetes Care 2000; 23: 1467-1471
• 23 The Diabetes Control and Complications Trial research group . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977-986
• 24 West DJ, Stephens JW, Bain SC, Kilduff LP, Luzio S, Still R, Bracken RM. A combined insulin reduction and carbohydrate feeding strategy 30 min before running best preserves blood glucose concentration after exercise through improved fuel oxidation in type 1 diabetes mellitus. J Sports Sci 2011; 29: 279-289
• 25 Yamakita T, Ishii T, Tamagami K, Yamamoto T, Miyamoto M, Hosoi M, Yoshioka K, Sato T, Onishi S, Tanaka S, Fujii S. Glycemic response during exercise after administration of insulin lispro compared with after administration of regular human insulin. Diabetes Res Clin Pract 2002; 57: 17-22