Clinical management of the physically active patient with type 1 diabetes

Physician and Sportsmedicine

Volumn 39, Issue 2, 2011, Pages 64-77

  Chu, Lisa ^a   Hamilton, Jill ^b   Riddell, Michael C ^a  

^a YORK UNIVERSITY   (Canada)

^b HOSPITAL FOR SICK CHILDREN   (Canada)

Author keywords

Adolescent; Diabetes technology; Exercise; Glycemic control; Puberty; Type 1 diabetes

Indexed keywords

CATECHOLAMINE; GLUCAGON; GLUCOSE; GLUCOSE TRANSPORTER 4; HEMOGLOBIN A1C; INSULIN; INSULIN DETEMIR; INSULIN GLARGINE; INSULIN LISPRO; INSULIN ZINC SUSPENSION; ISOPHANE INSULIN; KETONE; HUMAN INSULIN; INSULIN ASPART; INSULIN DERIVATIVE;

ADRENERGIC SYSTEM; ADVERSE OUTCOME; AEROBIC EXERCISE; ARTICLE; ATHLETE; BEDTIME DOSAGE; BIOSENSOR; BLOOD GLUCOSE MONITORING; BLOOD PH; BLURRED VISION; BODY WEIGHT; BULIMIA; CARBOHYDRATE INTAKE; CELL DESTRUCTION; CONTINUOUS GLUCOSE MONITORING; CONTINUOUS INFUSION; COPING BEHAVIOR; DEHYDRATION; DIABETES CONTROL; DIABETIC PATIENT; DIAGNOSTIC ACCURACY; DISEASE ASSOCIATION; DISEASE COURSE; DISEASE SEVERITY; DOSE TIME EFFECT RELATION; DRUG DOSE ESCALATION; DRUG DOSE INCREASE; DRUG DOSE REDUCTION; EATING DISORDER; ENERGY EXPENDITURE; EXERCISE; EXERCISE INTENSITY; FITNESS; FLUID THERAPY; GLUCAGON RELEASE; GLUCONEOGENESIS; GLUCOSE TRANSPORT; GLYCEMIC CONTROL; GLYCOGEN LIVER LEVEL; GLYCOGENOLYSIS; HEALTH CARE COST; HEMOGLOBIN BLOOD LEVEL; HUMAN; HYPERGLYCEMIA; HYPERINSULINEMIA; HYPOGLYCEMIA; INSULIN DEFICIENCY; INSULIN DEPENDENT DIABETES MELLITUS; INSULIN PUMP; INSULIN SENSITIVITY; INSULIN TREATMENT; KETOACIDOSIS; LETHARGY; LOW DRUG DOSE; METABOLIC REGULATION; MORNING DOSAGE; MULTICENTER STUDY (TOPIC); NIGHT; NOCTURNAL HYPOGLYCEMIA; NUTRITIONAL SUPPORT; OXYGEN CONSUMPTION; PANCREAS ISLET BETA CELL; PARENTAL BEHAVIOR; PHYSICAL ACTIVITY; PHYSICAL PERFORMANCE; POLYDIPSIA; POLYURIA; PRACTICE GUIDELINE; PUBERTY; REHYDRATION; RISK FACTOR; SELF MONITORING; SEX DIFFERENCE; SKIN IRRITATION; SUBCUTANEOUS TISSUE; SUBSTANCE ABUSE; WEIGHT REDUCTION; ADOLESCENCE; ADOLESCENT; ADULT; BODY MASS; CHILD; CHILD GROWTH; CLINICAL PRACTICE; DIABETES MELLITUS; DIABETIC KETOACIDOSIS; GLUCOSE BLOOD LEVEL; HORMONE RELEASE; HYDRATION; INFANT; INJECTION; INSULIN BLOOD LEVEL; INSULIN RELEASE; LABORATORY TEST; MEDICAL TECHNOLOGY; NUTRITION; PRESCHOOL CHILD; PSYCHOLOGICAL ASPECT; REPEATED DRUG DOSE; RISK; RISK BENEFIT ANALYSIS; SCHOOL CHILD; SENSOR; SOCIAL ASPECT; SPORT;

EID: 80054905909     PISSN: 00913847     EISSN: None     Source Type: Journal    
DOI: 10.3810/psm.2011.05.1896     Document Type: Article

References (84)

1. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2007;30(suppl 1):S42-S47.
2. Bell RA, Mayer-Davis EJ, Beyer JW, et al; SEARCH for Diabetes in Youth Study Group. Diabetes in non-Hispanic white youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32(suppl 2):S102-S111.
3. Patterson CC, Dahlquist GG, Gyürüs E, Green A, Soltész G; EURO-DIAB Study Group. Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: a multicentre prospective registration study. Lancet. 2009;373(9680): 2027-2033.
4. DIAMOND Project Group. Incidence and trends of childhood type 1 diabetes worldwide 1990-1999. Diabet Med. 2006;23(8): 857-866.
5. Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. J Pediatr. 1994;125(2): 177-188.
6. Nathan DM, Cleary PA, Backlund JY, et al; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353(25):2643-2653.
7. Writing Team for the Diabetes Control and Complications Trial/ Epidemiology of Diabetes Interventions and Complications Research Group. Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Interventions and Complications (EDIC) study. JAMA. 2003;290(16):2159-2167.
8. Albers JW, Herman WH, Pop-Busui R, et al; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Effect of prior intensive insulin treatment during the Diabetes Control and Complications Trial (DCCT) on peripheral neuropathy in type 1 diabetes during the Epidemiology of Diabetes Interventions and Complications (EDIC) Study. Diabetes Care. 2010;33(5):1090-1096.
9. Camacho RC, Galassetti P, Davis SN, Wasserman DH. Glucoregulation during and after exercise in health and insulin-dependent diabetes. Exerc Sport Sci Rev. 2005;33(1):17-23.
10. Tamborlane WV. Triple jeopardy: nocturnal hypoglycemia after exercise in the young with diabetes [editorial]. J Endocrinol Metab. 2007;92(3):815-816.
11. Nordfeldt S, Ludvigsson J. Fear and other disturbances of severe hypoglycaemia in children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab. 2005;18(1):83-91.
12. Brazeau AS, Rabasa-Lhoret R, Strychar I, Mircescu H. Barriers to physical activity among patients with type 1 diabetes. Diabetes Care. 2008;31(11):2108-2109.
13. Robertson K, Adolfsson P, Scheiner G, Hanas R, Riddell MC. Exercise in children and adolescents with diabetes. Pediatr Diabetes. 2009;10(suppl 12):154-168.
14. Waden J, Tikkanen H, Forsblom C, et al; FinnDiane Study Group. Leisure time physical activity is associated with poor glycemic control in type 1 diabetic women: the FinnDiane study. Diabetes Care. 2005;28(4):777-782.
15. Margeirsdottir HD, Larsen JR Brunborg C, Sandvik L, Dahl-Jørgensen K; Norwegian Study Group for Childhood Diabetes. Strong association between time watching television and blood glucose control in children and adolescents with type 1 diabetes. Diabetes Care. 2007;30(6): 1567-1570.
16. Daneman D. Type 1 diabetes. Lancet. 2006;367(9513):847-858.
17. Austin A, Warty V, Janosky J, Arslanian S. The relationship of physical fi tness to lipid and lipoprotein(a) levels in adolescents with IDDM. Diabetes Care. 1993;16(2):421-425.
18. Michaliszyn SF, Shaibi GQ, Quinn L, Fritschi C, Faulkner MS. Physical fi tness, dietary intake, and metabolic control in adolescents with type 1 diabetes. Pediatr Diabetes. 2009;10(6):389-394.
19. Wallberg-Henriksson H, Gunnarsson R, Henriksson J, et al. Increased peripheral insulin sensitivity and muscle mitochondrial enzymes but unchanged blood glucose control in type I diabetics after physical training. Diabetes. 1982;31(12):1044-1050.
20. Zinman B, Ruderman N, Campaigne BN, Devlin JT, Schneider SH; American Diabetes Association. Physical activity/exercise and diabetes. Diabetes Care. 2004;27(suppl 1):S58-S62.
21. Giannini C, Mohn A, Chiarelli F. Physical exercise and diabetes during childhood. Acta Biomed. 2006;77(suppl 1):18-25.
22. Moy CS, Songer TJ, LaPorte RE, et al. Insulin-dependent diabetes mellitus, physical activity, and death. Am J Epidemiol. 1993;137(1): 74-81.
23. Wasserman DH. Four grams of glucose. Am J Physiol Endocrinol Metab. 2009;296(1):E11-E21.
24. Ertl AC, Davis SN. Evidence for a vicious cycle of exercise and hypoglycemia in type 1 diabetes mellitus. Diabetes Metab Res Rev. 2004;20(2):124-130.
25. Davis SN, Galassetti P, Wasserman DH, Tate D. Effects of antecedent hypoglycemia on subsequent counterregulatory responses to exercise. Diabetes. 2000;49(1):73-81.
26. Galassetti P, Mann S, Tate D, Neill RA, Wasserman DH, Davis SN. Effect of morning exercise on counterregulatory responses to subsequent, afternoon exercise. J Appl Physiol. 2001;91(1): 91-99.
27. Koivisto VA, Felig P. Effects of leg exercise on insulin absorption in diabetic patients. N Engl.J Med. 1978;298(2):79-83.
28. Kraniou GN, Cameron-Smith D, Hargreaves M. Effect of short-term training on GLUT-4 mRNA and protein expression in human skeletal muscle. Exp Physiol. 2004;89(5):559-563.
29. MacDonald MJ. Postexercise late-onset hypoglycemia in insulin-dependent diabetic patients. Diabetes Care. 1987;10(5): 584-588.
30. 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(3):963-968.
31. Tsalikian E, Mauras N, Beck RW, et al; Diabetes Research In Children Network Direcnet Study Group. Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus. J Pediatr. 2005;147(4):528-534.
32. Schneider SH, Vitug A, Ananthakrishnan R, Khachadurian AK. Impaired adrenergic response to prolonged exercise in type I diabetes. Metabolism. 1991;40(11):1219-1225.
33. Sandoval DA, Guy DL, Richardson MA, Ertl AC, Davis SN. Effects of low and moderate antecedent exercise on counterregulatory responses to subsequent hypoglycemia in type 1 diabetes. Diabetes. 2004;53(7):1798-1806.
34. Galassetti P, Tate D, Neill RA, Morrey S, Wasserman DH, Davis SN. Effect of antecedent hypoglycemia on counterregulatory responses to subsequent euglycemic exercise in type 1 diabetes. Diabetes. 2003;52(7):1761-1769.
35. Purdon C, Brousson M, Nyveen SL, et al. The roles of insulin and catecholamines in the glucoregulatory response during intense exercise and early recovery in insulin-dependent diabetic and control subjects. J Clin Endocrinol Metab. 1993;76(3):566-573.
36. Hargreaves M, Angus D, Howlett K, Conus NM, Febbraio M. Effect of heat stress on glucose kinetics during exercise. J Appl Physiol. 1996;81(4):1594-1597.
37. Ronnemaa T, Marniemi J, Leino A, Karanko H, Puukka P, Koivisto VA. Hormone response of diabetic patients to exercise at cool and warm temperatures. Eur J Appl Physiol Occup Physiol. 1991;62(2): 109-115.
38. Riddell MC, Perkins BA. Type 1 diabetes and vigorous exercise: applications of exercise physiology to patient management. CJD. 2006;30(1):63-71.
39. Iscoe KE, Riddell MC. Continuous moderate-intensity exercise with or without intermittent high-intensity work: effects on acute and late glycaemia in athletes with type 1 diabetes mellitus [published online ahead of print March 9, 2011]. Diabet Med.
40. Sigal RJ, Purdon C, Fisher SJ, Halter JB, Vranic M, Marliss EB. Hyperinsulinemia prevents prolonged hyperglycemia after intense exercise in insulin-dependent diabetic subjects. J Clin Endocrinol Metab. 1994;79(4):1049-1057.
41. Riddell MC, Bar-Or O, Ayub BV, Calvert RE, Heigenhauser GJ. Glucose ingestion matched with total carbohydrate utilization attenuates hypoglycemia during exercise in adolescents with IDDM. Int J Sport Nutr. 1999;9(1):24-34.
42. Jimenez CC, Corcoran MH, Crawley JT, et al. National Athletic Trainers' Association position statement: management of the athlete with type 1 diabetes mellitus. J Athl Train. 2007;42(4): 536-545.
43. Toni S, Reali MF, Barni F, Lenzi L, Festini F. Managing insulin therapy during exercise in type 1 diabetes mellitus. Acta Biomed. 2006;77(suppl 1):34-40.
44. Robertson K, Adolfsson P, Riddell MC, Scheiner G, Hanas R. Exercise in children and adolescents with diabetes. Pediatr Diabetes. 2008;9(1):65-77.
45. Riddell MC, Iscoe KE. Physical activity, sport, and pediatric diabetes. Pediatr Diabetes. 2006;7(1):60-70.
46. Hamilton J, Daneman D. Deteriorating diabetes control during adolescence: physiological or psychosocial? J Pediatr Endocrinol Metab. 2002;15(2):115-126.
47. Mortensen HB, Hougaard P. Comparison of metabolic control in a cross-sectional study of 2,873 children and adolescents with IDDM from 18 countries. The Hvidøre Study Group on Childhood Diabetes. Diabetes Care. 1997;20(5):714-772.
48. Moran A, Jacobs DR Jr, Steinberger J, et al. Insulin resistance during puberty: results from clamp studies in 357 children. Diabetes. 1999;48(10):2039-2044.
49. Amiel SA, Sherwin RS, Simonson DC, Lauritano AA, Tamborlane WV. Impaired insulin action in puberty. A contributing factor to poor glycemic control in adolescents with diabetes. N Engl J Med. 1986;315(4):215-219.
50. Moran A, Jacobs DR Jr, Steinberger J, et al. Association between the insulin resistance of puberty and the insulin-like growth factor-I/growth hormone axis. J Clin Endocrinol Metab. 2002;87(10): 4817-4820.
51. Caprio S, Plewe G, Diamond MP, et al. Increased insulin secretion in puberty: a compensatory response to reductions in insulin sensitivity. J Pediatr. 1989;114(6):963-967.
52. Arutchelvam V, Heise T, Dellweg S, Elbroend B, Minns I, Home PD. Plasma glucose and hypoglycaemia following exercise in people with type 1 diabetes: a comparison of three basal insulins. Diabet Med. 2009;26(10):1027-1032.
53. Welsh JB, Kannard B, Nogueira K, Kaufman FR, Shah R. Insights from a large observational database of continuous glucose monitoring adoption, insulin pump usage and glycemic control: the CareLink database. Pediatr Endocrinol Rev. 2010;7(suppl 3):413-416.
54. Radermecker RP, Saint Remy A, Scheen AJ, Bringer J, Renard E. Continuous glucose monitoring reduces both hypoglycaemia and HbA1 in hypoglycaemia-prone type 1 diabetic patients treated with a portable pump. Diabetes Metab. 2010;36(5):409-413.
55. Bergenstal RM, Tamborlane WV, Ahmann A, et al; STAR 3 Study Group. Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. N Engl J Med. 2010;363(4):311-320.
56. Rabasa-Lhoret R, Bourque J, Ducros F, Chiasson JL. Guidelines for premeal insulin dose reduction for postprandial exercise of different intensities and durations in type 1 diabetic subjects treated intensively with a basal-bolus insulin regimen (ultralente-lispro). Diabetes Care. 2001;24(4):625-630.
57. Berger M, Berchtold P, Cüppers HJ, et al. Metabolic and hormonal effects of muscular exercise in juvenile type diabetics. Diabetologia. 1977;13(4):355-365.
58. Perkins BA, Riddell MC. Type 1 diabetes and exercise: using the insulin pump to maximum advantage. Can J Diabetes. 2006;30(1): 72-79.
59. Tsalikian E, Kollman C, Tamborlane WB, et al; Diabetes Research in Children Network (DirecNet) Study Group. Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin. Diabetes Care. 2006;29(10):2200-2204.
60. Admon G, Weinstein Y, Falk B, et al. Exercise with and without an insulin pump among children and adolescents with type 1 diabetes mellitus. Pediatrics. 2005;116(3):e348-e355.
61. Taplin CE, Cobry E, Messer L, McFann K, Chase HP, Fiallo-Scharer R. Preventing post-exercise nocturnal hypoglycemia in children with type 1 diabetes. J Pediatr. 2010;157(5):784-788.e1.
62. Riddell M, Perkins BA. Exercise and glucose metabolism in persons with diabetes mellitus: perspectives on the role for continuous glucose monitoring. J Diabetes Sci Technol. 2009;3(4): 914-923.
63. Wasserman DH, Zinman B. Exercise in individuals with IDDM. Diabetes Care. 1994;17(8):924-937.
64. Bode BW Clinical utility of the continuous glucose monitoring system. Diabetes Technol Ther. 2000;2(suppl 1):S35-S41.
65. Davey RJ, Low C, Jones TW, Fournier PA. Contribution of an intrinsic lag of continuous glucose monitoring systems to differences in measured and actual glucose concentrations changing at variable rates in vitro. J Diabetes Sci Technol. 2010;4(6): 1393-1399.
66. Wilson DM, Beck RW, Tamborlane WV, et al; DirecNet Study Group. The accuracy of the FreeStyle Navigator continuous glucose monitoring system in children with type 1 diabetes. Diabetes Care. 2007;30(1):59-64.
67. Iscoe KE, Campbell JE, Jamnik V, Perkins BA, Riddell MC. Efficacy of continuous real-time blood glucose monitoring during and after prolonged high-intensity cycling exercise: spinning with a continuous glucose monitoring system. Diabetes Technol Ther. 2006;8(6): 627-635.
68. 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;32(3):182-189.
69. Maran A, Pavan P, Bonsembiante B, et al. Continuous glucose monitoring reveals delayed nocturnal hypoglycemia after intermittent high-intensity exercise in nontrained patients with type 1 diabetes. Diabetes Technol Ther. 2010;12(10):763-768.
70. Deiss D, Bolinder J, Riveline JP, et al. Improved glycemic control in poorly controlled patients with type 1 diabetes using real-time continuous glucose monitoring. Diabetes Care. 2006;29(12):2730-2732.
71. Diabetes Research in Children Network (DirecNet) Study Group; Buckingham B, Beck RW, Tamborlane WV, et al. Continuous glucose monitoring in children with type 1 diabetes. J Pediatr. 2007;151(4): 388-393.e1-e2.
72. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Effectiveness of continuous glucose monitoring in a clinical care environment: evidence from the Juvenile Diabetes Research Foundation continuous glucose monitoring (JDRF-CGM) trial. Diabetes Care. 2010;33(1):17-22.
73. Battelino T, Phillip M. Real-time continuous glucose monitoring in randomized control trials. Pediatr Endocrinol Rev. 2010;7(suppl 3): 401-404.
74. Carchidi C, Holland C, Minnock P, Boyle D. New technologies in pediatric diabetes care. MCN Am J Matern Child Nurs. 2011;36(1):32-39.
75. Kaufman FR, Halvorson M, Kaufman ND. Evaluation of a snack bar containing uncooked cornstarch in subjects with diabetes. Diabetes Res Clin Pract. 1997;35(1):27-33.
76. Kalergis M, Schiffrin A, Gougeon R, Jones PJ, Yale JF. Impact of bedtime snack composition on prevention of nocturnal hypoglycemia in adults with type 1 diabetes undergoing intensive insulin management using lispro insulin before meals: a randomized, placebo-controlled, crossover trial. Diabetes Care. 2003;26(1):9-15.
77. Convertino VA, Armstrong LE, Coyle EF, et al. American College of Sports Medicine position stand. Exercise and fl uid replacement. Med Sci Sports Exerc. 1996;28(1):1-7.
78. Perrone C, Laitano O, Meyer F. Effect of carbohydrate ingestion on the glycemic response of type 1 diabetic adolescents during exercise. Diabetes Care. 2005;28(100):2537-2538.
79. Climatic heat stress and the exercising child and adolescent. American Academy of Pediatrics. Committee on Sports Medicine and Fitness. Pediatrics. 2000;106(1 pt 1):158-159.
80. Temple MY, Bar-Or O, Riddell MC. The reliability and repeatability of the blood glucose response to prolonged exercise in adolescent boys with IDDM. Diabetes Care. 1995;18(3):326-332.
81. Kelly D, Hamilton JK, Riddell MC. Blood glucose levels and performance in a sports camp for adolescents with type 1 diabetes mellitus: a field study. Int J Pediatr. 2010. http://www.hindawi.com/journals/ ijped/2010/216167/ref. Accessed May 5, 2011.
82. Stettler C, Jenni S, Allemann S, et al. Exercise capacity in subjects with type 1 diabetes mellitus in eu- and hyperglycaemia. Diabetes Metab Res Rev. 2006;22(4):300-306.
83. Riddell MC, Milliken J. Preventing exercise-induced hypoglycemia in type 1 diabetes using real-time continuous glucose monitoring and a new carbohydrate intake algorithm: an observational field study. Diabetes Technol Ther. In press.
84. American Diabetes Association. Standards of medical care in diabetes-2011. Diabetes Care. 2011; 34(suppl 1):S11-S61.