Skip to main content
SpringerLink
Log in

Extreme Sports and Type 1 Diabetes Mellitus: An Oxymoron or a Growing Reality?

  • Chapter
  • First Online:
Endocrinology of Physical Activity and Sport

Part of the book series: Contemporary Endocrinology ((COE))

  • 2803 Accesses

Abstract

Extreme sporting events are exceeding popular and a growing number of persons worldwide of all fitness-health levels are participating in them on an annual basis. Currently 350 million people are affected with diabetes worldwide; approximately 10% of those have type 1 diabetes and rely on insulin for maintaining their health. Once thought unimaginable and dangerous, a growing number of these subjects are now engaging in extreme sports events. This chapter reviews the very special challenge on glucose metabolism and counterregulation posed by such activities in type 1 diabetes, and it presents the existing scientific evidence supporting the notion they are compatible with this condition. At the same time, the areas where such data are lacking are underscored. The even more unlikely situation of type 2 diabetics and extreme sports is also addressed, emphasizing the almost complete void of scientific evidence in this arena. Studies are urgently needed to fill in the information gap and to provide the scientific grounds for professional guidance to diabetic patients. Until then, it is suggested that sports organizations along with health-care professionals based their recommendations on the best available evidence (as well as the personal experience of the health-care provider and the diabetic patient).

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. American Diabetes Association. Physical activity/exercise and diabetes. Position statement. Diabetes Care. 2004;27 Suppl 1:S58–62.

    Google Scholar 

  2. Vranic M, Gauthier C, Bilinski D, Wasserman D, El Tayeb K, Hetenyi Jr G, et al. Catecholamine responses and their interactions with other glucoregulatory hormones. Am J Physiol. 1984;247(2 Pt 1):E145–56.

    PubMed  CAS  Google Scholar 

  3. Mazzeo RS. Catecholamine response to acute and chronic exercise. Med Sci Sports Exerc. 1991;23(7):839–45.

    PubMed  CAS  Google Scholar 

  4. Goodyear LJ, Hirshman MF, Horton ES. Exercise-induced translocation of skeletal muscle glucose ­transporters. Am J Physiol. 1991;261(6 Pt 1):E795–9.

    PubMed  CAS  Google Scholar 

  5. Hayashi T, Wojtaszewski JF, Goodyear LJ. Exercise regulation of glucose transport in skeletal muscle. Am J Physiol. 1997;273(6 Pt 1):E1039–51.

    PubMed  CAS  Google Scholar 

  6. Drouin R, Lavoie C, Bourque J, Ducros F, Poisson D, Chiasson JL. Increased hepatic glucose production response to glucagon in trained subjects. Am J Physiol. 1998;274(1 Pt 1):E23–8.

    PubMed  CAS  Google Scholar 

  7. Lavoie C, Ducros F, Bourque J, Langelier H, Chiasson JL. Glucose metabolism during exercise in man: the role of insulin and glucagon in the regulation of hepatic glucose production and gluconeogenesis. Can J Physiol Pharmacol. 1997;75(1):36–43.

    Article  PubMed  CAS  Google Scholar 

  8. Jensen MD. Fate of fatty acids at rest and during exercise: regulatory mechanisms. Acta Physiol Scand. 2003;178(4):385–90.

    Article  PubMed  CAS  Google Scholar 

  9. Jentjens R, Jeukendrup A. Determinants of post-exercise glycogen synthesis during short-term recovery. Sports Med. 2003;33(2):117–44.

    Article  PubMed  Google Scholar 

  10. Bolli G, Calabrese G, De Feo P, Compagnucci P, Zega G, Angeletti G, et al. Lack of glucagon response in glucose-counter-regulation in type I (insulin-dependent) diabetics: absence of recovery after prolonged ­optimal insulin therapy. Diabetologia. 1982;22(2):100–5.

    Article  PubMed  CAS  Google Scholar 

  11. Dagogo-Jack SE, Craft S, Cryer PE. Hypoglycemia-associated autonomic failure in insulin-dependent diabetes mellitus. J Clin Invest. 1993;91(3):819–28.

    Article  PubMed  CAS  Google Scholar 

  12. Sandoval DA, Guy DL, Richardson MA, Ertl AC, Davis SN. Acute, same-day effects of antecedent exercise on counterregulatory responses to subsequent hypoglycemia in type 1 diabetes mellitus. Am J Physiol Endocrinol Metab. 2006;290(6):E1331–8.

    Article  PubMed  CAS  Google Scholar 

  13. Chansky ME, Corbett JG, Cohen E. Hyperglycemic emergencies in athletes. Clin Sports Med. 2009;28(3): 469–78.

    Article  PubMed  Google Scholar 

  14. Joint Position Statement of the American College of Sports Medicine. The American Dietetic Association and Dietitians of Canada: nutrition and athletic performance. J Am Diet Assoc. 2000;32(12):2130–45.

    Google Scholar 

  15. Jimenez CC, Corcoran MH, Crawley JT, Guyton Hornsby W, Peer KS, Philbin RD, et al. National Athletic Trainers’ Association position statement: management of the athlete with type 1 diabetes mellitus. J Athl Train. 2007;42(4):536–45.

    PubMed  Google Scholar 

  16. Hartvig Jensen T, Darre E, Holmich P, Jahnsen F. Insulin-dependent diabetes mellitus and marathon running. Br J Sports Med. 1987;21(1):51–2.

    Article  PubMed  CAS  Google Scholar 

  17. Meinders AE, Willekens FL, Heere LP. Metabolic and hormonal changes in IDDM during long-distance run. Diabetes Care. 1988;11(1):1–7.

    Article  PubMed  CAS  Google Scholar 

  18. Tuominen JA, Ebeling P, Koivisto VA. Exercise increases insulin clearance in healthy man and insulin-dependent diabetes mellitus patients. Clin Physiol. 1997;17(1):19–30.

    Article  PubMed  CAS  Google Scholar 

  19. Boehncke S, Poettgen K, Maser-Gluth C, Reusch J, Boehncke WH, Badenhoop K. Endurance capabilities of triathlon competitors with type 1 diabetes mellitus. Dtsch Med Wochenschr. 2009;134(14):677–82.

    Article  PubMed  CAS  Google Scholar 

  20. Murillo S, Brugnara L, Novials A. One year follow-up in a group of half-marathon runners with type-1 diabetes treated with insulin analogues. J Sports Med Phys Fitness. 2010;50(4):506–10.

    PubMed  CAS  Google Scholar 

  21. Cauza E, Hanusch-Enserer U, Strasser B, Ludvik B, Kostner K, Dunky A, et al. Continuous glucose monitoring in diabetic long distance runners. Int J Sports Med. 2005;26(9):774–80.

    Article  PubMed  CAS  Google Scholar 

  22. Hillson RM. Diabetes outward bound mountain course, Eskdale, Cumbria. Diabet Med. 1984;1(1):59–63.

    Article  PubMed  CAS  Google Scholar 

  23. Moore K, Vizzard N, Coleman C, McMahon J, Hayes R, Thompson CJ. Extreme altitude mountaineering and type 1 diabetes; the Diabetes Federation of Ireland Kilimanjaro expedition. Diabet Med. 2001;18(9):749–55.

    Article  PubMed  CAS  Google Scholar 

  24. Pavan P, Sarto P, Merlo L, Casara D, Ponchia A, Biasin R, et al. Metabolic and cardiovascular parameters in type 1 diabetes at extreme altitude. Med Sci Sports Exerc. 2004;36(8):1283–9.

    Article  PubMed  Google Scholar 

  25. Kalson NS, Davies AJ, Stokes S, Frost H, Whitehead AG, Tyrrell-Marsh I, et al. Climbers with diabetes do well on Mount Kilimanjaro. Diabet Med. 2007;24(12):1496.

    Article  PubMed  CAS  Google Scholar 

  26. Braun B, Mawson JT, Muza SR, Dominick SB, Brooks GA, Horning MA, et al. Women at altitude: carbohydrate utilization during exercise at 4,300 m. J Appl Physiol. 2000;88:246–56.

    PubMed  CAS  Google Scholar 

  27. Fink KS, Christensen DB, Ellsworth A. Effect of high altitude on blood glucose meter performance. Diabetes Technol Ther. 2002;4(5):627–35.

    Article  PubMed  Google Scholar 

  28. Oberg D, Ostenson CG. Performance of glucose dehydrogenase- and glucose oxidase-based blood glucose meters at high altitude and low temperature (Letter). Diabetes Care. 2005;28:1261.

    Article  PubMed  Google Scholar 

  29. Burbaker PL. Adventure travel and type 1 diabetes: the complicating effects of high altitude. Diabetes Care. 2005;28(10):2563–72.

    Article  Google Scholar 

  30. Lynch JH, Bove AA. Diving medicine: a review of current evidence. J Am Board Fam Med. 2009;22(4): 399–407.

    Article  PubMed  Google Scholar 

  31. PADI—Professional Association of Diving Instructors. Worldwide Corporate Statistics 2010. http://www.padi.com/scuba/uploadedFiles/2010%20WW%20Statistics.pdf

  32. Dear Gde L, Dovenbarger JA, Corson KS, Stolp BW, Moon RE. Diabetes among recreational divers. Abstract of the undersea and hyperbaric medical society. Annual Scientific Meeting, Denver, CO; 22–26 June 1994.

    Google Scholar 

  33. Edge CJ, St Leger Dowse M, Bryson P. Scuba diving with diabetes mellitus—the UK experience 1991–2001. Undersea Hyperb Med. 2005;32(1):27–37.

    PubMed  CAS  Google Scholar 

  34. Edge CJ, Grieve AP, Gibbons N, O’Sullivan F, Bryson P. Control of blood glucose in a group of diabetic scuba divers. Undersea Hyperb Med. 1997;24(3):201–7.

    PubMed  CAS  Google Scholar 

  35. Dear Gde L, Pollock NW, Uguccioni DM, Dovenbarger J, Feinglos MN, Moon RE. Plasma glucose responses in recreational divers with insulin-requiring diabetes. Undersea Hyperb Med. 2004;31(3):291–301.

    PubMed  Google Scholar 

  36. Adolfsson P, Ornhagen H, Jendle J. Accuracy and reliability of continuous glucose monitoring in individuals with type 1 diabetes during recreational diving. Diabetes Technol Ther. 2009;11(8):493–7.

    Article  PubMed  CAS  Google Scholar 

  37. Bonomo M, Cairoli R, Verde G, Morelli L, Moreo A, Grottaglie MD, et al. Safety of recreational scuba diving in type 1 diabetic patients: the Deep Monitoring programme. Diabetes Metab. 2009;35(2):101–7.

    Article  PubMed  CAS  Google Scholar 

  38. Pollock NW, Uguccioni DM, Dear GdeL, editors. Diabetes and recreational diving: guidelines for the future. Proceedings of the UHMS/DAN 2005 June 19 Workshop. Durham, NC: DAN; 2005.

    Google Scholar 

  39. May AL, Kuklina EV, Yoon PW. Prevalence of cardiovascular disease risk factors among US adolescents, 1999–2008. Pediatrics. 2012;129:1035–41.

    Article  PubMed  Google Scholar 

  40. Galbo H, Tobin L, van Loon LJC. Responses to acute exercise in type 2 diabetes, with an emphasis on metabolism and interaction with oral hypoglycemic agents and food intake. Appl Physiol Nutr Metab. 2007; 32:568–75.

    Article  Google Scholar 

  41. Gillen JB, Little JP, Punthakee Z, Tarnopolsky MA, Riddell MC, Gibala MJ. Acute high-intensity interval exercise reduces the postprandial glucose response and prevalence of hyperglycaemia in patients with type 2 diabetes. Diabetes Obes Metab. 2012;14(6):575–7.

    Article  PubMed  CAS  Google Scholar 

  42. Van Dijk JW, Manders RJF, Tummers K, Bonomi AG, Stehouwer CDA, Hartgens F, et al. Both resistance- and endurance-type exercise reduce the prevalence of hyperglycaemia in individuals with impaired glucose tolerance and in insulin-treated and non-insulin-treated type 2 diabetic patients. Diabetologia. 2012;55:1273–82.

    Article  PubMed  Google Scholar 

  43. Diabetic brothers complete triathlon. http://www.ksl.com/?nid=1010&sid=16138518. Accessed 9 June 2012.

  44. Marathon and type 2? http://www.diabeteswith.com/type-2/diabetic-1450.html. Accessed 9 June 2012.

Download references

Author information

Authors and Affiliations

  1. Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel

    Karen Tordjman MD

  2. Applied Physiology Laboratory, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA

    Anthony C. Hackney PHD, DSC

  3. Department of Orthopedic Surgery, Sport Medicine Center, The Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Naama Constantini MD

Authors
  1. Karen Tordjman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anthony C. Hackney PHD, DSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naama Constantini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karen Tordjman MD .

Editor information

Editors and Affiliations

  1. , Department of Orthopedic Surgery, Hadassah-Hebrew UMC, 4 Ha'razim St, Jerusalem, 91120, Jerusalem, Israel

    Naama Constantini

  2. , Applied Physiology Laboratory, UNC at Chapel Hill, 203 Fezter Hall, Chapel Hill, 27599, North Carolina, USA

    Anthony C. Hackney

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Tordjman, K., Hackney, A.C., Constantini, N. (2013). Extreme Sports and Type 1 Diabetes Mellitus: An Oxymoron or a Growing Reality?. In: Constantini, N., Hackney, A. (eds) Endocrinology of Physical Activity and Sport. Contemporary Endocrinology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-314-5_26

Download citation

  • DOI: https://doi.org/10.1007/978-1-62703-314-5_26

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-62703-313-8

  • Online ISBN: 978-1-62703-314-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation