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Managing type 1 diabetes in the active population

Nicola Keay Orcid Logo, Richard Bracken Orcid Logo

British Journal of Sports Medicine, Volume: 54, Issue: 13, Pages: 809 - 810

Swansea University Author: Richard Bracken Orcid Logo

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DOI (Published version): 10.1136/bjsports-2019-101368

Abstract

Many high-profile athletes participate across a wide range of sports with type 1 diabetes. Team Type 1 encourages and supports those with type 1 diabetes to participate in physical activity, with professional cycling’s Team Novo Nordisk composed entirely of individuals with type 1 diabetes. Type 1 d...

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Published in: British Journal of Sports Medicine
ISSN: 0306-3674 1473-0480
Published: BMJ 2020
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URI: https://cronfa.swan.ac.uk/Record/cronfa52862
first_indexed 2019-11-25T13:13:42Z
last_indexed 2023-03-15T04:06:55Z
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spelling 2023-03-14T09:22:45.2951973 v2 52862 2019-11-25 Managing type 1 diabetes in the active population f5da81cd18adfdedb2ccb845bddc12f7 0000-0002-6986-6449 Richard Bracken Richard Bracken true false 2019-11-25 EAAS Many high-profile athletes participate across a wide range of sports with type 1 diabetes. Team Type 1 encourages and supports those with type 1 diabetes to participate in physical activity, with professional cycling’s Team Novo Nordisk composed entirely of individuals with type 1 diabetes. Type 1 diabetes is likely to present early in an athlete’s career, a time when athletes may present with fatigue due to increased training loads. All physicians need to distinguish between possible causes of fatigue in these athletes.Type 1 diabetes is an autoimmune condition with T-cell-mediated destruction of the pancreatic β cells of the islets of Langerhans, resulting in failure to produce sufficient insulin. The clinical outcome is an inability to adequately control glucose metabolism. Effective glucose metabolism is crucial in long-duration and high-intensity exercise. Self-administered exogenous insulin is required as a treatment to manage blood glucose.The physiological response to exercise is a progressive decrease in insulin and increase in the pancreatic α-cell-derived antagonist hormone glucagon, while exercise also increases insulin sensitivity (increased ‘sensitivity’ means that for a given dose, there is a more pronounced effect—insulin does its job ‘better’). In addition, there is an exercise-induced rise in sympathoadrenal hormones (epinephrine and norepinephrine). This hormonal response influences circulating glucose and fat use, and is usually well-regulated. This is not the case in athletes with type 1 diabetes, where there is a substantial risk of both hyperglycaemia and hypoglycaemia. Patients often have the low bottom of range blood glucose for many hours after exercise. Individual with type 1 diabetes often need 48 hours to reset their autonomic function and replenish glycogen stores. Journal Article British Journal of Sports Medicine 54 13 809 810 BMJ 0306-3674 1473-0480 17 6 2020 2020-06-17 10.1136/bjsports-2019-101368 http://dx.doi.org/10.1136/bjsports-2019-101368 COLLEGE NANME Engineering and Applied Sciences School COLLEGE CODE EAAS Swansea University 2023-03-14T09:22:45.2951973 2019-11-25T10:52:33.6275522 Faculty of Science and Engineering School of Engineering and Applied Sciences - Sport and Exercise Sciences Nicola Keay 0000-0001-6663-7010 1 Richard Bracken 0000-0002-6986-6449 2 52862__15949__f69011bcdaa44fe9a569029aecb861f3.pdf keay2019.pdf 2019-11-25T10:56:03.0414008 Output 442964 application/pdf Version of Record true 2019-11-25T00:00:00.0000000 false © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
title Managing type 1 diabetes in the active population
spellingShingle Managing type 1 diabetes in the active population
Richard Bracken
title_short Managing type 1 diabetes in the active population
title_full Managing type 1 diabetes in the active population
title_fullStr Managing type 1 diabetes in the active population
title_full_unstemmed Managing type 1 diabetes in the active population
title_sort Managing type 1 diabetes in the active population
author_id_str_mv f5da81cd18adfdedb2ccb845bddc12f7
author_id_fullname_str_mv f5da81cd18adfdedb2ccb845bddc12f7_***_Richard Bracken
author Richard Bracken
author2 Nicola Keay
Richard Bracken
format Journal article
container_title British Journal of Sports Medicine
container_volume 54
container_issue 13
container_start_page 809
publishDate 2020
institution Swansea University
issn 0306-3674
1473-0480
doi_str_mv 10.1136/bjsports-2019-101368
publisher BMJ
college_str Faculty of Science and Engineering
hierarchytype
hierarchy_top_id facultyofscienceandengineering
hierarchy_top_title Faculty of Science and Engineering
hierarchy_parent_id facultyofscienceandengineering
hierarchy_parent_title Faculty of Science and Engineering
department_str School of Engineering and Applied Sciences - Sport and Exercise Sciences{{{_:::_}}}Faculty of Science and Engineering{{{_:::_}}}School of Engineering and Applied Sciences - Sport and Exercise Sciences
url http://dx.doi.org/10.1136/bjsports-2019-101368
document_store_str 1
active_str 0
description Many high-profile athletes participate across a wide range of sports with type 1 diabetes. Team Type 1 encourages and supports those with type 1 diabetes to participate in physical activity, with professional cycling’s Team Novo Nordisk composed entirely of individuals with type 1 diabetes. Type 1 diabetes is likely to present early in an athlete’s career, a time when athletes may present with fatigue due to increased training loads. All physicians need to distinguish between possible causes of fatigue in these athletes.Type 1 diabetes is an autoimmune condition with T-cell-mediated destruction of the pancreatic β cells of the islets of Langerhans, resulting in failure to produce sufficient insulin. The clinical outcome is an inability to adequately control glucose metabolism. Effective glucose metabolism is crucial in long-duration and high-intensity exercise. Self-administered exogenous insulin is required as a treatment to manage blood glucose.The physiological response to exercise is a progressive decrease in insulin and increase in the pancreatic α-cell-derived antagonist hormone glucagon, while exercise also increases insulin sensitivity (increased ‘sensitivity’ means that for a given dose, there is a more pronounced effect—insulin does its job ‘better’). In addition, there is an exercise-induced rise in sympathoadrenal hormones (epinephrine and norepinephrine). This hormonal response influences circulating glucose and fat use, and is usually well-regulated. This is not the case in athletes with type 1 diabetes, where there is a substantial risk of both hyperglycaemia and hypoglycaemia. Patients often have the low bottom of range blood glucose for many hours after exercise. Individual with type 1 diabetes often need 48 hours to reset their autonomic function and replenish glycogen stores.
published_date 2020-06-17T07:37:37Z
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