Metabolic and hormonal response to intermittent high-intensity and continuous moderate intensity exercise in individuals with type 1 diabetes: a randomised crossover study.

AIMS/HYPOTHESIS To investigate exercise-related fuel metabolism in intermittent high-intensity (IHE) and continuous moderate intensity (CONT) exercise in individuals with type 1 diabetes mellitus. METHODS In a prospective randomised open-label cross-over trial twelve male individuals with well-controlled type 1 diabetes underwent a 90 min iso-energetic cycling session at 50% maximal oxygen consumption ([Formula: see text]), with (IHE) or without (CONT) interspersed 10 s sprints every 10 min without insulin adaptation. Euglycaemia was maintained using oral (13)C-labelled glucose. (13)C Magnetic resonance spectroscopy (MRS) served to quantify hepatocellular and intramyocellular glycogen. Measurements of glucose kinetics (stable isotopes), hormones and metabolites complemented the investigation. RESULTS Glucose and insulin levels were comparable between interventions. Exogenous glucose requirements during the last 30 min of exercise were significantly lower in IHE (p = 0.02). Hepatic glucose output did not differ significantly between interventions, but glucose disposal was significantly lower in IHE (p < 0.05). There was no significant difference in glycogen consumption. Growth hormone, catecholamine and lactate levels were significantly higher in IHE (p < 0.05). CONCLUSIONS/INTERPRETATION IHE in individuals with type 1 diabetes without insulin adaptation reduced exogenous glucose requirements compared with CONT. The difference was not related to increased hepatic glucose output, nor to enhanced muscle glycogen utilisation, but to decreased glucose uptake. The lower glucose disposal in IHE implies a shift towards consumption of alternative substrates. These findings indicate a high flexibility of exercise-related fuel metabolism in type 1 diabetes, and point towards a novel and potentially beneficial role of IHE in these individuals. TRIAL REGISTRATION ClinicalTrials.gov NCT02068638 FUNDING: Swiss National Science Foundation (grant number 320030_149321/) and R&A Scherbarth Foundation (Switzerland)

Endokrinologische Notfälle

Die meisten Krankheitsbilder in der Endokrinologie zeichnen sich durch ein schleichendes Auftreten aus. Entsprechend besteht bei der Diagnosestellung und Therapieeinleitung meist keine Eile. Dennoch gibt es endokrinologische Notfallsituationen, in denen ein sofortiges Handeln nötig ist und die auch den Allgemeininternisten bekannt sein sollten. Für viele der hier vorgestellten Notfallsituationen gibt es keine prospektiv randomisierten, kontrollierten Studien. Die hier abgegebenen Empfehlungen beruhen daher auch auf Expertenmeinungen und Guidelines der einschlägigen Fachgesellschaften

A rare cause of a 46, XY disorder of sex development diagnosed in an adult patient

The defective conversion of testosterone to dihydrotestosterone due to a steroid 5-alpha-reductase 2 deficiency results in a unique form of 46, XY disorder of sexual development (DSD). Dihydrotestosterone is essential for the embryonic differentiation of the external male genitalia and the prostate. Steroid 5-alpha-reductase 2 deficiency is an autosomal recessive disorder in which genetic males have a predominantly female phenotype with female external genitalia but male internal urogenital tract. We describe the case of an adult patient having migrated from Pakistan to Switzerland in whom a steroid 5-alpha-reductase 2 deficiency was diagnosed at the age of 29. Molecular genetic analysis identified a homozygous point mutation in exon 4 of the 5-alpha-reductase 2 gene, leading to an amino acid change from glutamic acid to lysine. To our knowledge, this is the second case of this mutation in the steroid 5-alpha-reductase 2 gene (SRD5A2) which was first described in 1997 (Anwar et al.)