Blood Glucose Levels and Performance in a Sports Camp for Adolescents with Type 1 Diabetes Mellitus: A Field Study

Background. Acute hypo- and hyperglycemia causes cognitive and psychomotor impairment in individuals with type 1 diabetes mellitus (T1DM) that may affect sports performance. Objective. To quantify the effect of concurrent and antecedent blood glucose concentrations on sports skills and cognitive performance in youth with T1DM attending a sports camp. Design/Methods. 28 youth (ages 6–17 years) attending a sports camp carried out multiple skill-based tests (tennis, basketball, or soccer skills) with glucose monitoring over 4 days. Glucose levels at the time of testing were categorized as (a) hypoglycemic (<3.6 mM); (b) within an acceptable glycemic range (3.6–13.9 mM); or (c) hyperglycemic (>13.9 mM). Results. Overall, sports performance skill was ∼20% lower when glucose concentrations were hypoglycemic compared to either acceptable or hyperglycemic at the time of skill testing (P < .05). During Stroop testing, “reading” and “color recognition” also degraded during hypoglycemia, while “interference” scores improved (P < .05). Nocturnal hypoglycemia was present in 66% of subjects, lasting an average of 84 minutes, but this did not affect sports skill performance the following day. Conclusions. Mild hypoglycemia markedly reduces sports skill performance and cognition in young athletes with T1DM

Intermittent exotropia: are we underminusing by not overminusing?

In this invited commentary, the authors discuss whether the use of minus lenses to aid control of intermittent exotropia has an alternative method of action. Conventional theory suggests that the lenses induce accommodation and therefore accommodative convergence to reduce the angle of deviation. We discuss evidence which suggests that convergence is induced to control the primary deviation and that the minus lenses allow this control by correcting refractive blur caused by additional vergence accommodation

Integrating physiology into correlative models can alter projections of habitat suitability under climate change for a threatened amphibian

Rapid global change has increased interest in developing ways to identify suitable refu-gia for species of conservation concern. Correlative and mechanistic species distribu-tion models (SDMs) represent two approaches to generate spatially-explicit estimates of climate vulnerability. Correlative SDMs generate distributions using statistical associations between environmental variables and species presence data. In contrast, mechanistic SDMs use physiological traits and tolerances to identify areas that meet the conditions required for growth, survival and reproduction. Correlative approaches assume modeled environmental variables influence species distributions directly or indirectly; however, the mechanisms underlying these associations are rarely verified empirically. We compared habitat suitability predictions between a correlative-only SDM, a mechanistic SDM and a correlative framework that incorporated mechanis-tic layers (‘hybrid models’). Our comparison focused on green salamanders Aneides aeneus, a priority amphibian threatened by climate change throughout their disjunct range. We developed mechanistic SDMs using experiments to measure the thermal sensitivity of resistance to water loss (ri) and metabolism. Under current climate con-ditions, correlative-only, hybrid and mechanistic SDMs predicted similar overlap in habitat suitability; however, mechanistic SDMs predicted habitat suitability to extend into regions without green salamanders but known to harbor many lungless salaman-ders. Under future warming scenarios, habitat suitability depended on climate sce-nario and SDM type. Correlative and hybrid models predicted a 42% reduction or 260% increase in area considered to be suitable depending on the climate scenario. In mechanistic SDMs, energetically suitable habitat declined with both climate scenarios and was driven by the thermal sensitivity of ri. Our study indicates that correlative-only and hybrid approaches produce similar predictions of habitat suitability; however, discrepancies can arise for species that do not occupy their entire fundamental niche, which may hold consequences of conservation planning of threatened species

More Than Self-Management: Positive Youth Development at an Inclusive Type 1 Diabetic Camp

Diabetes-focused camps emerged as a way to provide ongoing diabetes self-management education to youth and their families in a physically active context. Past research suggests participation at camp can enhance youths’ glycemic control and glucose monitoring abilities; however, recent studies claim camps can also offer psychological and social benefits. Drawing upon a positive youth development (PYD) approach, the current study examined an inclusive diabetic-focused youth sport camp to (a) identify life skills developed, and (b) explain processes and factors involved in youths’ development of life skills. Focus groups were conducted with 54 youth living with type 1 diabetes mellitus (T1DM) attending an inclusive T1DM sport camp. The model of PYD through sport (Holt et al., 2017) guided the analysis. PYD outcomes (i.e., life skills developed through the camp) were (a) enhanced self-efficacy for self-monitoring of blood glucose, (b) enhanced self-efficacy for sport while living with T1DM, and (c) development of positive relationships. These outcomes were facilitated through the camp’s inclusive approach (i.e., including youth living with and without T1DM), and a PYD climate (implicitly), which included supportive relationships with counsellors and peers, and interestingly, the lack of parental involvement at the camp. The camp’s explicit life skills program focus (i.e., on diabetes self-care skills) also facilitated these outcomes. This study gives camp professionals insight into how an inclusive T1DM sport camp can facilitate life skills, and optimize PYD

Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association

The adoption and maintenance of physical activity are critical foci for blood glucose management and overall health in individuals with diabetes and prediabetes. Recommendations and precautions vary depending on individual characteristics and health status. In this Position Statement, we provide a clinically oriented review and evidence-based recommendations regarding physical activity and exercise in people with type 1 diabetes, type 2 diabetes, gestational diabetes mellitus, and prediabetes. Physical activity includes all movement that increases energy use, whereas exercise is planned, structured physical activity. Exercise improves blood glucose control in type 2 diabetes, reduces cardiovascular risk factors, contributes to weight loss, and improves well-being (1,2). Regular exercise may prevent or delay type 2 diabetes development (3). Regular exercise also has considerable health benefits for people with type 1 diabetes (e.g., improved cardiovascular fitness, muscle strength, insulin sensitivity, etc.) (4). The challenges related to blood glucose management vary with diabetes type, activity type, and presence of diabetes-related complications (5,6). Physical activity and exercise recommendations, therefore, should be tailored to meet the specific needs of each individual

Pharmacologic inhibition of somatostatin receptor 2 to restore glucagon counterregulation in diabetes

Glucose homeostasis is primarily maintained by pancreatic hormones, insulin and glucagon, with an emerging role for a third islet hormone, somatostatin, in regulating insulin and glucagon responses. Under healthy conditions, somatostatin secreted from pancreatic islet δ-cells inhibits both insulin and glucagon release through somatostatin receptor- induced cAMP-mediated downregulation and paracrine inhibition of β- and α-cells, respectively. Since glucagon is the body’s most important anti-hypoglycemic hormone, and because glucagon counterregulation to hypoglycemia is lost in diabetes, the study of somatostatin biology has led to new investigational medications now in development that may help to restore glucagon counterregulation in type 1 diabetes. This review highlights the normal regulatory role of pancreatic somatostatin signaling in healthy islet function and how the inhibition of somatostatin receptor signaling in pancreatic α-cells may restore normal glucagon counterregulation in diabetes mellitus

Restoration of CD28 Expression in CD28− CD8+ Memory Effector T Cells Reconstitutes Antigen-induced IL-2 Production

The control of many persistent viral infections by Ag-specific cytolytic CD8+ T cells requires a concurrent virus-specific CD4+ Th cell response. This reflects in part a requirement of activated effector CD8+ T cells for paracrine IL-2 production as a growth and survival factor. In human CMV and HIV infection, the majority of differentiated virus-specific CD8+ T cells notably lose the ability to produce IL-2 but also lose expression of CD28, a costimulatory molecule. Analysis of the fraction of memory CD8+ T cells that continue to express CD28 revealed these cells retain the ability to produce IL-2. Therefore, we examined if IL-2 production by CD28− CD8+ T cells could be restored by introduction of a constitutively expressed CD28 gene. Expression of CD28 in CD28− CD8+ CMV- and HIV-specific CD8+ T cells reconstituted the ability to produce IL-2, which could sustain an autocrine proliferative response after Ag recognition. These results suggest that the loss of CD28 expression during differentiation of memory/effector CD8+ T cells represents a decisive step in establishing regulation of responding CD8+ T cells, increasing the dependence on CD4+ Th for proliferation after target recognition, and has implications for the treatment of viral disease with adoptively transferred CD8+ T cells

Solution Geochemistry of the Water of Limestone Terrains

Limestone groundwater flows mainly in openings it has solutionally enlarged, thus an understanding of the water\u27s state of saturation relative to calcite (the principal mineral component of limestone) is fundamental to an understanding of the nature and evolution of the limestone aquifer. This study investigated the Mammoth Cave-Sinkhole Plain (MCSP) and Cave Hollow (CH) aquifers in Kentucky, both in Missippian limestones. Both aquifers were always undersaturated with calcite. Except for completely ventilated vadose flows (usually) and some vadose seepage (occasionally), all recharges sampled (sinking streams, vadose flows, and vadose seepage) were also undersaturated. The lack of saturation in the MCSP aquifer was due to the introduction of carbon dioxide into the water in amounts difficult to explain by the carbon dioxide content of the above recharges. In both vadose flows and seepage, undersaturatlon tended to correlate directly with flow volume, and there was an inverse correlation between the amount of carbon dioxide and calcite saturation in most of the waters sampled. In vadose seepage this relationship was so strong as to suggest seasonal invariance of carbon dioxide content of the water prior to out gassing. Results suggest solutional enlargement is greatest near recharge points in ventilated aquifers (CH) but the carbon dioxide introduction phenomenon (MCSP) allows solution over wide areas in unventilated aquifers

Glycemic responses to strenuous training in male professional cyclists with type 1 diabetes: a prospective observational study

Introduction This prospective observational study sought to establish the glycemic, physiological and dietary demands of strenuous exercise training as part of a 9-day performance camp in a professional cycling team with type 1 diabetes (T1D).Research design and methods Sixteen male professional cyclists with T1D on multiple daily injections (age: 27±4 years; duration of T1D: 11±5 years; body mass index: 22±2 kg/m2; glycated hemoglobin: 7%±1% (50±6 mmol/mol); maximum rate of oxygen consumption: 73±4 mL/kg/min) performed road cycle sessions (50%–90% of the anaerobic threshold, duration 1–6 hours) over 9 consecutive days. Glycemic (Dexcom G6), nutrition and physiological data were collected throughout. Glycemic data were stratified into predefined glycemic ranges and mapped alongside exercise physiology and nutritional parameters, as well as split into daytime and night-time phases for comparative analysis. Data were assessed by means of analysis of variance and paired t-tests. A p value of ≤0.05 (two-tailed) was statistically significant.Results Higher levels of antecedent hypoglycemia in the nocturnal hours were associated with greater time spent in next-day hypoglycemia overall (p=0.003) and during exercise (p=0.019). Occurrence of nocturnal hypoglycemia was associated with over three times the risk of next-day hypoglycemia (p<0.001) and a twofold risk of low glucose during cycling (p<0.001). Moreover, there was trend for a greater amount of time spent in mild hypoglycemia during the night compared with daytime hours (p=0.080).Conclusion The higher prevalence of nocturnal hypoglycemia was associated with an increased risk of next-day hypoglycemia, which extended to cycle training sessions. These data highlight the potential need for additional prebed carbohydrates and/or insulin dose reduction strategies around exercise training in professional cyclists with T1D.Trial registration number DRKS00019923

Review article: Natural hazard risk assessments at the global scale

Since 1990, natural hazards have led to over 1.6 million fatalities globally, and economic losses are estimated at an average of around $260–310 billion per year. The scientific and policy community recognise the need to reduce these risks. As a result, the last decade has seen a rapid development of global models for assessing risk from natural hazards at the global scale. In this paper, we review the scientific literature on natural hazard risk assessments at the global scale, and specifically examine whether and how they have examined future projections of hazard, exposure, and/or vulnerability. In doing so, we examine similarities and differences between the approaches taken across the different hazards, and identify potential ways in which different hazard communities can learn from each other. For example, we show that global risk studies focusing on hydrological, climatological, and meteorological hazards, have included future projections and disaster risk reduction measures (in the case of floods), whilst these are missing in global studies related to geological hazards. The methods used for projecting future exposure in the former could be applied to the geological studies. On the other hand, studies of earthquake and tsunami risk are now using stochastic modelling approaches to allow for a fully probabilistic assessment of risk, which could benefit the modelling of risk from other hazards. Finally, we discuss opportunities for learning from methods and approaches being developed and applied to assess natural hazard risks at more continental or regional scales. Through this paper, we hope to encourage dialogue on knowledge sharing between scientists and communities working on different hazards and at different spatial scales