title: Blood glucose kinetics and physiological changes in a type 1 diabetic finisher of the Ultraman triathlon: a case study.
abstract: OBJECTIVE
  To investigate the blood glucose kinetics and physiological effects experienced by a type 1 diabetic (T1D) finisher of a 3-day, multi-stage ultra endurance triathlon consisting of a 10 km swim and 144.8 km bike (stage 1), a 275.4 km bike (stage 2), and an 84.4 km run (stage 3).
  
  
  METHODS
  The athlete self-monitored blood glucose (SMBG) levels via fingerstick blood draw and hand-held glucometer. Researchers evaluated blood glucose kinetics via a continuous glucose monitoring device. The athlete maintained normal dietary and insulin patterns before, during and after competition daily. Weight and body composition were measured via bioelectrical impedance and select biomarkers were measured in blood.
  
  
  RESULTS
  The athlete spent 73.0, 3.4, and 15.1% of during race time in a hyperglycemic state (≥130 mg dL-1) during stages 1, 2, and 3, respectively, and 0.0, 78.6, and 33.6% in a hypoglycemic state (≤80 mg dL-1). Nocturnal glycemic levels showed the athlete spent 86.1, 83.0, and 84.8% of sleep in a hyperglycemic state during nights 1, 2, and 3, respectively, and 9.0, 0.0, and 0.0% in a hypoglycemic state. From pre- to post-race, body weight (73.2 to 76.9 kg) and total body water increased (49.2-51.6 kg). In addition, there were dramatic increases in creatine kinase (271.7-9252.8 µ L-1), cortisol (137.1-270.2 pg mL-1), CRP (188.3-8046.9 ng mL-1), and aldosterone (449.1-1679.6 pg mL-1).
  
  
  CONCLUSIONS
  It is possible for a T1D athlete to complete a multi-stage ultraendurance triathlon and maintain glycemic control using SMBG methods. In addition, a T1D athlete participating in an ultraendurance triathlon results in substantial changes in body composition, hormones, and muscle damage.
authors.affiliation: Department of Nutrition, Food, and Exercise Sciences, Institute of Sports Sciences and Medicine, Florida State University, 1104 Spirit Way, Tallahassee, FL, 32306, USA.|Nebraska Athletic Performance Laboratory, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Bach
authors.affiliation: Department of Nutrition, Food, and Exercise Sciences, Institute of Sports Sciences and Medicine, Florida State University, 1104 Spirit Way, Tallahassee, FL, 32306, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Baur
authors.affiliation: Department of Nutrition, Food, and Exercise Sciences, Institute of Sports Sciences and Medicine, Florida State University, 1104 Spirit Way, Tallahassee, FL, 32306, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Hyder
authors.affiliation: Department of Nutrition, Food, and Exercise Sciences, Institute of Sports Sciences and Medicine, Florida State University, 1104 Spirit Way, Tallahassee, FL, 32306, USA. mormsbee@fsu.edu.|Biokinetics, Exercise and Leisure Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa. mormsbee@fsu.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ormsbee
mesh_terms: D000328:Adult; D056352:Athletes; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D017079:Exercise Tolerance; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D013177:Sports
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: Diabetes; Fat mass; Hydration; Insulin; Muscle damage; Type 1 diabetes; Ultraendurance