Skip to main content
Log in

Blood glucose kinetics and physiological changes in a type 1 diabetic finisher of the Ultraman triathlon: a case study

  • Original Article
  • Published:
European Journal of Applied Physiology Aims and scope Submit manuscript

Abstract

Purpose

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

CGM:

Continuous glucose monitor

CK:

Creatine kinase

CRP:

C-reactive protein

FFA:

Free fatty acid

FFM:

Fat-free mass

SMBG:

Self-monitoring of blood glucose

T1D:

Type 1 diabetes

TBW:

Total body water

USG:

Urine specific gravity

References

  • Achten J, Venables MC, Jeukendrup AE (2003) Fat oxidation rates are higher during running compared with cycling over a wide range of intensities. Metabolism 52:747–752

    Article  CAS  PubMed  Google Scholar 

  • Aronoff SL, Berkowitz K, Shreiner B, Want L (2004) Glucose metabolism and regulation: beyond insulin and glucagon. Diabetes Spectr 17:183–190

    Article  Google Scholar 

  • Association AD (2004) Physical activity/exercise and diabetes. Diabetes Care 27:S58–S62

    Article  Google Scholar 

  • Bahr R, Høstmark AT, Newsholme EA, Grønnerød O, Sejersted OM (1991) Effect of exercise on recovery changes in plasma levels of FFA, glycerol, glucose and catecholamines. Acta Physiol Scand 143:105–115

    Article  CAS  PubMed  Google Scholar 

  • Baur DA, Bach CW, Hyder WJ, Ormsbee MJ (2016) Fluid retention, muscle damage, and altered body composition at the Ultraman triathlon. Eur J Appl Physiol 116:447–458

    Article  PubMed  Google Scholar 

  • Capostagno B, Bosch A (2010) Higher fat oxidation in running than cycling at the same exercise intensities. Int J Sport Nutr Exerc Metab 20:44–55

    Article  CAS  PubMed  Google Scholar 

  • Coyle EF, Coggan AR, Hemmert MK, Ivy JL (1986) Muscle glycogen utilization during prolonged strenuous exercise when fed carbohydrate. J Appl Physiol 61:165–172

    CAS  PubMed  Google Scholar 

  • Ebeling P, Tuominen JA, Bourey R, Koranyi L, Koivisto VA (1995) Athletes with IDDM exhibit impaired metabolic control and increased lipid utilization with no increase in insulin sensitivity. Diabetes 44:471–477

    Article  CAS  PubMed  Google Scholar 

  • Eubank M, Collins D, Lovell G, Dorling D, Talbot S (1997) Individual temporal differences in precompetition anxiety and hormonal concentration. Per Ind Diff 23:1031–1039

    Article  Google Scholar 

  • Gillespie KM (2006) Type 1 diabetes: pathogenesis and prevention. CMAJ 175:165–170

    Article  PubMed  PubMed Central  Google Scholar 

  • Guelfi KJ, Jones TW, Fournier PA (2005) The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes. Diabetes Care 28:1289–1294

    Article  CAS  PubMed  Google Scholar 

  • Guelfi KJ, Ratnam N, Smythe GA, Jones TW, Fournier PA (2007) Effect of intermittent high-intensity compared with continuous moderate exercise on glucose production and utilization in individuals with type 1 diabetes. Am J Physiol Endocrinol Metab 292:E865–E870

    Article  CAS  PubMed  Google Scholar 

  • Kennedy J, Hirshman M, Gervino E (1999) Acute exercise induces GLUT4 translocation in skeletal muscle of normal human subjects and subjects with type 2 diabetes. Diabetes 48:1–6. Available from: http://diabetes.diabetesjournals.org/content/48/5/1192.short

  • Kirwan JP, Hickner RC, Yarasheski KE, Kohrt WM, Wiethop BV, Holloszy JO (1992) Eccentric exercise induces transient insulin resistance in healthy individuals. J Appl Physiol 72:2197–2202

    Article  CAS  PubMed  Google Scholar 

  • Koivisto VA, Sane T, Fyhrquist F, Pelkonen R (1992) Fuel and fluid homeostasis during long-term exercise in healthy subjects and type I diabetic patients. Diabetes Care 15:1736–1741

    Article  CAS  PubMed  Google Scholar 

  • Loenneke JP, Barnes JT, Wilson JM, Lowery RP, Isaacs MN, Pujol TJ (2013) Reliability of field methods for estimating body fat. Clin Physiol Func Imag 33:405–408

    Article  Google Scholar 

  • Mikines KJ, Sonne B, Farrell PA, Tronier B, Galbo H (1988) Effect of physical exercise on sensitivity and responsiveness to insulin in humans. Am J Physiol 254:E248–E259

    CAS  PubMed  Google Scholar 

  • Murillo S, Brugnara L, Novials A (2010) One year follow-up in a group of half-marathon runners with type-1 diabetes treated with insulin analogues. J Sport M Phys Fit 50:506–510

    CAS  Google Scholar 

  • Riddell MC, Iscoe KE (2006) Physical activity, sport, and pediatric diabetes. Pediatr Diabetes 7:60–70

    Article  CAS  PubMed  Google Scholar 

  • Romijn JA, Coyle EF, Sidossis LS, Gastaldelli A, Horowitz JF, Endert E, Wolfe RR (1993) Regulation of endogenous fat and carbohydrate metabolism in relation to exercise intensity and duration. Am J Physiol 265:E380–E391

    CAS  PubMed  Google Scholar 

  • Sane T, Helve E, Pelkonen R, Koivisto VA (1988) The adjustment of diet and insulin dose during long-term endurance exercise in type 1 (insulin-dependent) diabetic men. Diabetologia 31:35–40

    CAS  PubMed  Google Scholar 

  • Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White RD (2006) Physical activity/exercise and type 2 diabetes: a consensus statement from the American Diabetes Association. In: Diabetes Care. 1433–1438

  • Vlahek P, Car S, Ostroški I (2013) Sweet 452 km—a report on the first type 1 diabetes patient to finish Double Ironman, a 30-hour endurance triathlon race. Croat Med J 54:306–307

    Article  PubMed  PubMed Central  Google Scholar 

  • Yardley JE, Kenny GP, Perkins B a, Riddell MC, Balaa N, Malcolm J, Boulay P, Khandwala F, Sigal RJ (2013) Resistance versus aerobic exercise: acute effects on glycemia in type 1 diabetes. Diabetes Care 36:537–542

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Yardley JE, Zaharieva DP, Jarvis C, Riddell MC (2015) The “Ups” and “Downs” of a bike race in people with type 1 diabetes: dramatic differences in strategies and blood glucose responses in the Paris-to-Ancaster spring classic. Can. J Diabetes 39:105–110

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank the race directors, Consuela and Trung Lively, for permitting us to collect data. In addition, we thank Fernanda De Carvalho Silva Vargas and Brittany Allman for assistance with the analysis of blood samples. Finally, thanks to Chuck Kemeny for introducing us to the race and facilitating data collection. This study was funded by the Institute of Sports Sciences and Medicine at Florida State University.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael J. Ormsbee.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Communicated by Fabio Fischetti.

This work was supported by the Florida State University Institute of Sports Sciences and Medicine.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bach, C.W., Baur, D.A., Hyder, W.S. et al. Blood glucose kinetics and physiological changes in a type 1 diabetic finisher of the Ultraman triathlon: a case study. Eur J Appl Physiol 117, 913–919 (2017). https://doi.org/10.1007/s00421-017-3575-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00421-017-3575-3

Keywords

Navigation