title: Strategies used by Patients with Type 1 Diabetes to Avoid Hypoglycemia in a 24×1-Hour Marathon: Comparison with the Amounts of Carbohydrates Estimated by a Customizable Algorithm.
abstract: OBJECTIVE
  The preferred countermeasure to avoid exercise-related hypoglycemia was investigated in a group of patients with type 1 diabetes participating in a stressful event, a 24×1-hour relay marathon. The carbohydrates actually consumed were compared to those estimated for each patient by applying a customizable algorithm, Exercise Carbohydrates Requirement Estimating Software (ECRES), based on patient's usual therapy and diet and on the exercise characteristics.
  
  
  METHODS
  Glycemia was tested at the start, middle and end of the races. Usual therapies and diets and the adopted countermeasures were recorded in detail.
  
  
  RESULTS
  We studied 19 patients who walked/ran 10.4±2.8 km with a heart rate of 167±11 beats per minute. Of the 19 patients, 7 patients reduced the administered insulin (premeal bolus or basal infusion rate). Glycemia fell by the end of the races (p=0.006; median -1.8 mmol⋅L-1; interquartile range -0.4 mmol⋅L-1to -5.3 mmol⋅L-1), despite 9 patients being hyperglycemic at the start. Of the patients, 14 concluded the race with glycemia on target, and 4 patients were hyperglycemic. Amounts of carbohydrates actually consumed (median 30 g; interquartile range 0 g to 71 g) were not significantly different from those estimated by ECRES (median 38 g; interquartile range 24 g to 68 g), the 2 quantities being significantly related (R=0.64; p=0.003). ECRES estimated lower carbohydrate levels (-13 g) than the amounts actually consumed by the 4 patients who concluded their exercises with hyperglycemia.
  
  
  CONCLUSIONS
  Patients preferred to consume extra carbohydrates to avoid the possible exercise-induced hypoglycemia. ECRES would provide satisfactory estimates of the carbohydrate requirements, even for a stressful condition, and almost equal to the quantities consumed following medical advice.
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
authors.forename: Alex
authors.initials: A
authors.lastname: Buoite Stella
authors.affiliation: Diabetology Department, AAS2 Bassa-Friulana Isontina, Udine, Monfalcone (GO), Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Assaloni
authors.affiliation: Department for Endocrinology and Metabolism, AOU SM della Misericordia of Udine, Udine, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Tonutti
authors.affiliation: Diabetes Center, ASUITS, Trieste, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Manca
authors.affiliation: Diabetology Department, AAS2 Bassa-Friulana Isontina, Udine, Monfalcone (GO), Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Tortul
authors.affiliation: Diabetes Center, ASUITS, Trieste, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Candido
authors.affiliation: Department of Medical and Biological Sciences, University of Udine, Udine, Italy. Electronic address: mariapia.francescato@uniud.it.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Francescato
mesh_terms: D000328:Adult; D000465:Algorithms; D001786:Blood Glucose; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D004035:Diet Therapy; D004040:Dietary Carbohydrates / Q000627:therapeutic use*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000178:diet therapy / Q000517:prevention & control*; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012984:Software
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007328:Insulin
keywords: chronic disease; competition; compétition; exercice; exercise; glycemia; glycémie; maladie chronique; metabolism; métabolisme