Sport and type 1 diabetes mellitus

Sportowcy chorzy na cukrzycę wymagają indywidualnej edukacji i dostosowania modelu leczenia do wymagań sportowych. Dobre wyrównanie metaboliczne cukrzycy stanowi kluczowy element efektywności treningu fizycznego i sukcesu sportowego. Błędy w zakresie insulinoterapii nie tylko negatywnie wpływają na osiągnięcia sportowe, ale, co ważniejsze, zwiększają ryzyko wystąpienia ostrych powikłań cukrzycy, hipoglikemii i kwasicy cukrzycowej ketonowej. (Diabet. Prakt. 2011; 12, 2: 52–55)Athletes with diabetes call for individual diabetic education and their insulin treatment should be adapted to sporty demand. Good metabolic control of diabetes is a key element of physical training efficiency. Misstatements in insulin treatment have negative effect on athletic accomplishments and increase the risk of acute diabetic complications such as hypoglycemia and diabetic ketoacidosis. (Diabet. Prakt. 2011; 12, 2: 52–55

Projekt „5000 metrów nad poziomem cukru”

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Selected aspects of insulin pump theraphy in adults with type 1 diabetes

Cukrzyca typu 1 jest chorobą spowodowaną bezwzględnym niedoborem insuliny. Rozpoznaje się ją u coraz większej liczby dzieci, młodzieży oraz młodych dorosłych. Leczeniem z wyboru jest metoda intensywnej czynnościowej insulinoterapii. U większości pacjentów jest ona realizowana za pomocą wstrzykiwaczy typu pen. W ostatnich latach wzrasta jednak liczba pacjentów leczonych za pomocą osobistej pompy insulinowej. Terapia ta wymaga odpowiedniego przygotowania nie tylko ze strony pacjenta, ale również zespołu leczącego. (Diabet. Prakt. 2011, tom 12, nr 4, 128–133)Type 1 diabetes is a disease caused by absolute insulin deficiency. Cases are found in a growing number of children, adolescents and young adults. Treatment of choice for type 1 diabetes is a method of intensive functional insulin therapy. In most patients it is implemented using pens. However, in recent years an increasing number of patients treated with a personal insulin pump. This therapy requires adequate preparation by the patient, but also the treatment team. (Diabet. Prakt. 2011, vol. 12, no 4, 128–133

Assessment of glycaemia increment after protein-fat containing meal in type 1 diabetic patients treated with continous subcutaneous insulin infusion

WSTĘP. Glikemia poposiłkowa stanowi istotny element kontroli cukrzycy. Celem badania była ocena wpływu posiłku białkowo-tłuszczowego na glikemię u chorych na cukrzycę typu 1 leczonych za pomocą osobistej pompy insulinowej, w zależności od iniekcji bolusa insuliny przed posiłkiem. MATERIAŁ I METODY. Badaniem objęto 30 chorych na cukrzycę typu 1 w wieku 18-50 lat (26,3 &#177; 7,1 roku), ze średnim czasem trwania cukrzycy 12,3 &#177; 6,4 roku, leczonych za pomocą osobistej pompy insulinowej. Wszyscy badani spożyli wystandaryzowany posiłek składający się z 7 wymienników białkowo-tłuszczowych (WBT) i oznaczali glikemię co 30 minut przez 8 godzin. Piętnaście wybranych losowo osób (grupa interwencyjna) przyjęło przed posiłkiem insulinę (3,5 jednostki insuliny) w formie bolusa przedłużonego na 8 godzin, a kolejnych 15 (grupa kontrolna) - nie zastosowało bolusa insuliny. WYNIKI. Glikemia w grupie interwencyjnej była znamiennie mniejsza niż w grupie kontrolnej w 180., 330., 420., 450. i 480. minucie. Na podstawie analizy zmian wartości glikemii w poszczególnych grupach stwierdzono istotny statystycznie wzrost glikemii między 90. a 420. minutą testu w grupie kontrolnej, ale nie w interwencyjnej (p < 0,05). WNIOSKI. Spożywanie białka i tłuszczu wymaga dodatkowej dawki insuliny w formie bolusa przedłużonego. Ilość insuliny bilansująca 1 WBT powinna być przynajmniej o połowę mniejsza niż w przypadku wymiennika węglowodanowego. Czas bolusa przedłużonego po spożyciu 7 WBT powinien być krótszy niż 8 godzin. (Diabet. Prakt. 2010; 11, 1: 9-16)BACKGROUND. Postprandial glycaemia is an important component of metabolic control in diabetics. The goal of this study was to evaluate the influence of fatprotein containing meal on glycaemia in type 1 diabetic patients treated with continous subcutaneous insulin infusion pump who were given square insulin bolus before meal. MATERIAL AND METHODS. Thirtieth type 1 diabetic patients aged 18-50 years (26.3 &#177; 7.1), with the mean duration of the disease 12.3 &#177; 6.4 years, using continous subcutaneous insulin infusion pump were included in this study. All patients received the standardised meal containing 7 protein-fat exchanges and had blood glucose levels checked every 30 minutes during 8 hours period. Patients were randomized into 2 groups: 15 patients of the investigated group gave square insulin bolus (3.5 insulin units) before meal, 15 of the control group did not. RESULTS. The glycaemia in the investigated group was significantly lower then in the control group in 180, 330, 420, 450 and 480 minute. The analysis of the glycaemia in both groups revealed statistically significant increase of blood glucose between 90 and 420 minute in the control group, but not in the investigated group (p < 0.05). CONCLUSIONS. Protein and fat intake necessitates additional dose of insulin given as square bolus. The insulin dose for 1 protein-fat exchange should be lowered at least by half when compared with carbohydrate/insulin ratio. The duration of square insulin bolus given for 7 protein-fat exchanges should be shorter than 8 hours. (Diabet. Prakt. 2010; 11, 1: 9-16

Selected aspects of insulin pump theraphy in adults with type 1 diabetes

Cukrzyca typu 1 jest chorobą spowodowaną bezwzględnym niedoborem insuliny. Rozpoznaje się ją u coraz większej liczby dzieci, młodzieży oraz młodych dorosłych. Leczeniem z wyboru jest metoda intensywnej czynnościowej insulinoterapii. U większości pacjentów jest ona realizowana za pomocą wstrzykiwaczy typu pen. W ostatnich latach wzrasta jednak liczba pacjentów leczonych za pomocą osobistej pompy insulinowej. Terapia ta wymaga odpowiedniego przygotowania nie tylko ze strony pacjenta, ale również zespołu leczącego. (Forum Zaburzeń Metabolicznych 2011, tom 2, nr 2, 143&#8211;150)Type 1 diabetes is a disease caused by absolute insulin deficiency. Cases are found in a growing number of children, adolescents and young adults. Treatment of choice for type 1 diabetes is a method of intensive functional insulin therapy. In most patients it is implemented using pens. However, in recent years an increasing number of patients treated with a personal insulin pump. This therapy requires adequate preparation by the patient, but also the treatment team. (Forum Zaburzen Metabolicznych 2011, vol. 2, no 2, 143&#8211;150

The association between the level of baseline daily physical activity and selected clinical and biochemical parameters during mountain trekking in patients with type 1 diabetes

Introduction. There is a general agreement that regular physical activity should be recommended for patients with type 1 diabetes mellitus (T1DM), as it positively affects blood pressure and lipid levels and diminishes the risk of T1DM complications. Aim of this study was to search for a correlation between lactate level, de­gree of fatigue, and patient-reported physical activity in T1DM patients while trekking up to 3000 meters above sea level (masl). Material and methods. Study group consisted of 19 participants (2 women) in mean age of 31 years with T1DM who summited 3000 masl in Alps. Clinical infor­mation was taken from patient questionnaire, personal insulin pumps and blood analysis (glucose, lactate level). Additionally patient self-assessment of physical activity and fatigue (Borg scale) was used. Results. Declared physical activity in the last six months correlated with the initial, second, and final ratings of fatigue according to the Borg Scale during the expedition day, p = 0.02, r = –0.65; p = 0.02, r = –0.54; p = 0.01, r = –0.61, respectively. Blood lactate levels tended to increase with duration of exercise and altitude. Also, the average level of lactate on the expedition correlated with the average level of fatigue (p = 0.02, r = 0.57). Conclusion. Before undertaking day-long mountain trekking, T1DM patients with a sedentary lifestyle should improve their fitness. The measurement of lactate levels can be a useful tool to predict fatigue as measured with the Borg Scale. (Clin Diabetol 2017; 6, 3: 77–80)Introduction. There is a general agreement that regular physical activity should be recommended for patients with type 1 diabetes mellitus (T1DM), as it positively affects blood pressure and lipid levels and diminishes the risk of T1DM complications. Aim of this study was to search for a correlation between lactate level, de­gree of fatigue, and patient-reported physical activity in T1DM patients while trekking up to 3000 meters above sea level (masl). Material and methods. Study group consisted of 19 participants (2 women) in mean age of 31 years with T1DM who summited 3000 masl in Alps. Clinical infor­mation was taken from patient questionnaire, personal insulin pumps and blood analysis (glucose, lactate level). Additionally patient self-assessment of physical activity and fatigue (Borg scale) was used. Results. Declared physical activity in the last six months correlated with the initial, second, and final ratings of fatigue according to the Borg Scale during the expedition day, p = 0.02, r = –0.65; p = 0.02, r = –0.54; p = 0.01, r = –0.61, respectively. Blood lactate levels tended to increase with duration of exercise and altitude. Also, the average level of lactate on the expedition correlated with the average level of fatigue (p = 0.02, r = 0.57). Conclusion. Before undertaking day-long mountain trekking, T1DM patients with a sedentary lifestyle should improve their fitness. The measurement of lactate levels can be a useful tool to predict fatigue as measured with the Borg Scale. (Clin Diabetol 2017; 6, 3: 77–80

Physiological characteristics of type 1 diabetes patients during high mountain trekking

In this study, the aim was to provide observational data from an ascent to the summit of Mount Damavand (5670 meters above sea level (m.a.s.l), Iran) by a group of people with type 1 diabetes (T1DM), with a focus on their physiological characteristics. After a 3-day expedition, 18 T1DM patients, all treated with personal insulin pumps, successfully climbed Mount Damavand. Information was collected on their physiological and dietary behaviors, as well as medical parameters, such as carbohydrate consumption, glucose patterns, insulin dosing, and the number of hypo- and hyperglycemic episodes during this time frame. The participants consumed significantly less carbohydrates on day 3 compared to day 1 (16.4 vs. 23.1 carbohydrate units; p=0.037). Despite this, a gradual rise in the mean daily glucose concentration as measured with a glucometer was observed. Interestingly, the patients did not fully respond to higher insulin delivery as there was no significant difference in mean daily insulin dose during the expedition. There were more hyperglycemic episodes (≥180 mg/dL) per patient on day 3 vs. day 1 (p250 mg/dL) per patient on days 2 (p<0.05) and 3 (p<0.05) vs. day 1. In summary, high mountain trekking is feasible for T1DM patients with good glycemic control and no chronic complications. However, some changes in dietary preferences and an observable rise in glucose levels may occur. This requires an adequate therapeutic response