Download PDF
Int J Sports Med 2020; 41(13): 972-980
DOI: 10.1055/a-1192-5992
Clinical Sciences

Nighttime Hypoglycemia in Children with Type 1 Diabetes after one Day of Football Tournament

Mikołaj Kamiński‡
1   Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
,
Andrzej Gawrecki  ‡
1   Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
,
Aleksandra Araszkiewicz
1   Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
,
Agnieszka Szadkowska
2   Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
,
Bogda Skowrońska
3   Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Poznan, Poland
,
Witold Stankiewicz
3   Department of Pediatric Diabetes and Obesity, Poznan University of Medical Sciences, Poznan, Poland
,
Arkadiusz Michalak 
2   Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
,
Aleksandra Cieluch
1   Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
,
Katarzyna Dżygało
4   Department of Pediatrics, Medical University of Warsaw, Warszawa, Poland
,
Sebastian Seget
5   Department of Children’s Diabetology, Medical University of Silesia, Katowice, Poland
,
Grzegorz Biegański
6   Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznan, Poland
,
Anna Adamska
1   Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
,
Katarzyna Ksiądz
1   Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
,
Elektra Szymańska-Garbacz
7   Department of Internal Medicine and Nephrodiabetology, Medical University of Lodz, Lodz, Poland
,
Justyna Flotyńska
1   Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
,
Dorota Zozulinska-Ziolkiewicz
1   Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
› Author Affiliations Funding Statement Novo Nordisk, Medtronic, and Ascensia were sponsors of the First Polish Football Championship for Children and Adolescents with Type 1 Diabetes. The sponsors were not involved in the study design, in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. We want to thank Proper Medical Writing for editorial and language assistance.
› Further Information
Also available at
    Permissions and Reprints

Abstract

The aim of the study was to investigate factors related to the occurrence of nighttime hypoglycemia after a football tournament in children with type 1 diabetes mellitus. The multicenter study (GoalDiab study) included 189 children and adolescents with type 1 diabetes mellitus, from 11 diabetes care centers in Poland. Hypoglycemia was defined according to the International Hypoglycemia Study Group Statement. We analyzed the data of 95 participants with completed protocols with regards to nighttime hypoglycemia (82% male), aged 11.6 (9.8–14.2) years, diabetes duration 5.0 (2.0–8.0) years. There were 47 episodes of nighttime Level 1 hypoglycemia (≤3.9 mmol/L). Occurrence of clinically important Level 2 hypoglycemia (<3.0 mmol/L) during a game period was positively associated with nighttime hypoglycemia (≤3.9 mmol/L) incident (Odds Ratio=10.7; 95% Confidence Interval: 1.1–100.2; p=0.04). Using Continuous Glucose Monitoring was negatively associated with the occurrence of nighttime hypoglycemia (≤3.9 mmol/L) compared with using glucose meters or Flash Glucose Monitoring (Odds Ratio=0.31; 95% Confidence Interval: 0.12–0.83; p=0.02). The occurrence of clinically important hypoglycemia related to physical activity is associated with the occurrence of hypoglycemia during the night. Continuous Glucose Monitoring is negatively associated with nighttime hypoglycemia after a day of competition.

Key words

type 1 diabetes - exercise - nighttime hypoglycemia - football

Appendix



Publication History

Received: 13 November 2019

Accepted: 18 May 2020

Article published online:
07 July 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Jiménez-Pavón D, Ruiz JR, Ortega FB. et al. Physical activity and markers of insulin resistance in adolescents: role of cardiorespiratory fitness levels–the HELENA study: Physical activity and insulin resistance. Pediatr Diabetes 2013; 14: 249-258
    CrossrefPubMedGoogle Scholar
  • 2 Laaksonen DE, Atalay M, Niskanen LK. et al. Aerobic exercise and the lipid profile in type 1 diabetic men: a randomized controlled trial. Med Sci Sports Exerc 2000; 32: 1541-1548
    CrossrefPubMedGoogle Scholar
  • 3 Riddell MC, Perkins BA. Type 1 Diabetes and vigorous exercise: Applications of exercise physiology to patient management. Can J Diabetes 2006; 30: 63-71
    CrossrefPubMedGoogle Scholar
  • 4 Nocon M, Hiemann T, Müller-Riemenschneider F. et al. Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil 2008; 15: 239-246
    CrossrefPubMedGoogle Scholar
  • 5 Colberg SR, Sigal RJ, Yardley JE. et al. Physical activity/exercise and diabetes: A position statement of the American Diabetes Association. Diabetes Care 2016; 39: 2065-2079
    CrossrefPubMedGoogle Scholar
  • 6 Adolfsson P, Riddell MC, Taplin CE. et al. ISPAD Clinical Practice Consensus Guidelines 2018: Exercise in children and adolescents with diabetes. Pediatr Diabetes 2018; 19: 205-226
    CrossrefPubMedGoogle Scholar
  • 7 Diabetology C. 2018 Guidelines on the management of diabetic patients. A position of Diabetes Poland. Clinical Diabetology 2018: 1-90
    PubMedGoogle Scholar
  • 8 Jabbour G, Henderson M, Mathieu M-E. Barriers to active lifestyles in children with type 1 diabetes. Can J Diabetes 2016; 40: 170-172
    CrossrefPubMedGoogle Scholar
  • 9 Murillo S, Brugnara L, Del Campo E. et al. Carbohydrate management in athletes with type 1 diabetes in a 10 km run competition. Int J Sports Med 2015; 36: 853-857
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Tamborlane WV. Triple Jeopardy: Nocturnal hypoglycemia after exercise in the young with diabetes. J Clin Endocrinol Metab 2007; 92: 815-816
    CrossrefPubMedGoogle Scholar
  • 11 MacDonald MJ. Postexercise late-onset hypoglycemia in insulin-dependent diabetic patients. Diabetes Care 1987; 10: 584-588
    CrossrefPubMedGoogle Scholar
  • 12 Buckingham B, Cobry E, Clinton P. et al. Preventing hypoglycemia using predictive alarm algorithms and insulin pump suspension. Diabetes Technol Ther 2009; 11: 93-97
    CrossrefPubMedGoogle Scholar
  • 13 Tsalikian E, Mauras N, Beck RW. et al. Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus. J Pediatr 2005; 147: 528-534
    CrossrefPubMedGoogle Scholar
  • 14 Metcalf KM, Singhvi A, Tsalikian E. et al. Effects of moderate-to-vigorous intensity physical activity on overnight and next-day hypoglycemia in active adolescents with type 1 diabetes. Diabetes Care 2014; 37: 1272-1278
    CrossrefPubMedGoogle Scholar
  • 15 Michalak A, Gawrecki A, Gałczyński S. et al. Assessment of exercise capacity in children with type 1 diabetes in the cooper running test. Int J Sports Med 2019; 40: 110-115
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Gawrecki A, Zozulinska-Ziolkiewicz D, Matejko B. et al. Safe completion of a trail running ultramarathon by four men with type 1 diabetes. Diabetes Technol Ther 2018; 20: 147-152
    CrossrefPubMedGoogle Scholar
  • 17 Yardley JE, Zaharieva DP, Jarvis C. et al. The ‘ups’ and ‘downs’ of a bike race in people with type 1 diabetes: Dramatic differences in strategies and blood glucose responses in the Paris-to-Ancaster Spring Classic. Can J Diabetes 2015; 39: 105-110
    CrossrefPubMedGoogle Scholar
  • 18 Hohendorff J, Ucieklak D, Skupien J. et al. Risk factors of hypoglycaemia in type 1 diabetes individuals during intensive sport exercise—Data from the SPORTGIVECHANCE event. Int J Clin Pract 2019; 73: e13411
    CrossrefPubMedGoogle Scholar
  • 19 Gawrecki A, Araszkiewicz A, Szadkowska A. et al. Assessment of safety and glycemic control during football tournament in children and adolescents with type 1 diabetes—results of goaldiab study. Pediatr Exerc Sci 2019; 31: 401-407
    CrossrefPubMedGoogle Scholar
  • 20 Harriss DJ, Macsween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Riddell MC, Gallen IW, Smart CE. et al. Exercise management in type 1 diabetes: A consensus statement. Lancet Diabetes Endocrinol 2017; 5: 377-390
    CrossrefPubMedGoogle Scholar
  • 22 DiMeglio LA, Acerini CL, Codner E. et al. ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatr Diabetes 2018; 19: 105-114
    CrossrefPubMedGoogle Scholar
  • 23 International Hypoglycaemia Study Group Glucose concentrations of less than 3.0 mmol/L (54 mg/dL) should be reported in clinical trials: A joint position statement of the American Diabetes Association and the European Association for the Study of Diabetes: . Diabetes Care 2017; 40: 155-157
    CrossrefPubMedGoogle Scholar
  • 24 ggplot2 - Elegant Graphics for Data Analysis | Hadley Wickham | Springer, https://www.springer.com/us/book/9780387981413 (2018, accessed 15 February 2018)
    PubMed
  • 25 Szadkowska A, Baranowska-Jaźwiecka A, Michalak A. et al. A nationwide evaluation of glycaemic control in children and young adult patients with type 1 diabetes in Poland: the PolPedDiab HbA1c study. 55th EASD Annual Meeting of the European Association for the Study of Diabetes: Barcelona, Spain, 16 – 20 September 2019. Diabetologia 2019; 62: 1-600
    CrossrefPubMedGoogle Scholar
  • 26 McMahon SK, Ferreira LD, Ratnam N. et al. Glucose requirements to maintain euglycemia after moderate-intensity afternoon exercise in adolescents with type 1 diabetes are increased in a biphasic manner. J Clin Endocrinol Metab 2007; 92: 963-968
    CrossrefPubMedGoogle Scholar
  • 27 Jones TW, Porter P, Sherwin RS. et al. Decreased epinephrine responses to hypoglycemia during sleep. N Engl J Med 1998; 338: 1657-1662
    CrossrefPubMedGoogle Scholar
  • 28 Taplin CE, Cobry E, Messer L. et al. Preventing post-exercise nocturnal hypoglycemia in children with type 1 diabetes. J Pediatr 2010; 157: 784.e1-788.e1
    CrossrefPubMedGoogle Scholar
  • 29 Sherr JL, Cengiz E, Palerm CC. et al. Reduced hypoglycemia and increased time in target using closed-loop insulin delivery during nights with or without antecedent afternoon exercise in type 1 diabetes. Diabetes Care 2013; 36: 2909-2914
    CrossrefPubMedGoogle Scholar
  • 30 Hernandez JM, Moccia T, Fluckey JD. et al. Fluid snacks to help persons with type 1 diabetes avoid late onset postexercise hypoglycemia. Med Sci Sports Exerc 2000; 32: 904-910
    CrossrefPubMedGoogle Scholar
  • 31 Dovc K, Macedoni M, Bratina N. et al. Closed-loop glucose control in young people with type 1 diabetes during and after unannounced physical activity: a randomised controlled crossover trial. Diabetologia 2017; 60: 2157-2167
    CrossrefPubMedGoogle Scholar
  • 32 Slattery D, Choudhary P. Clinical use of continuous glucose monitoring in adults with type 1 diabetes. Diabetes Technol Ther 2017; 19: S55-S61
    CrossrefPubMedGoogle Scholar
  • 33 Kaufman FR, Gibson LC, Halvorson M. et al. A pilot study of the continuous glucose monitoring system: clinical decisions and glycemic control after its use in pediatric type 1 diabetic subjects. Diabetes Care 2001; 24: 2030-2034
    CrossrefPubMedGoogle Scholar
  • 34 Bergenstal RM, Klonoff DC, Garg SK. et al. Threshold-based insulin-pump interruption for reduction of hypoglycemia. N Engl J Med 2013; 369: 224-232
    CrossrefPubMedGoogle Scholar
  • 35 Weiss R, Garg SK, Bode BW. et al. Hypoglycemia reduction and changes in hemoglobin a1c in the aspire in-home study. Diabetes Technol Ther 2015; 17: 542-547
    CrossrefPubMedGoogle Scholar
  • 36 Weiss R, Garg SK, Bergenstal RM. et al. Predictors of hypoglycemia in the aspire in-home study and effects of automatic suspension of insulin delivery. J Diabetes Sci Technol 2015; 9: 1016-1020
    CrossrefPubMedGoogle Scholar
  • 37 Biester T, Kordonouri O, Holder M. et al. ‘Let the algorithm do the work’: Reduction of hypoglycemia using sensor-augmented pump therapy with predictive insulin suspension (smartguard) in pediatric type 1 diabetes patients. Diabetes Technol Ther 2017; 19: 173-182
    CrossrefPubMedGoogle Scholar
  • 38 Petruzelkova L, Pickova K, Sumnik Z. et al. Effectiveness of smartguard technology in the prevention of nocturnal hypoglycemia after prolonged physical activity. Diabetes Technol Ther 2017; 19: 299-304
    CrossrefPubMedGoogle Scholar