The diabetes service at Buckinghamshire Hospitals has developed a national reputation for the specialist care of people with diabetes who want to progress their sporting ambitions. Care has been provided to Olympic athletes, professional sportsmen, club and county swimmers, rowers, cyclist and runners. We have even helped people control their diabetes whilst they swim the channel, row the Atlantic or climb the highest of mountains.
Many people with type 1 diabetes wish to perform sport and exercise, however this effort is usually associated with profound reduction in glucose with the associated risk of hypoglycaemia.
In the Diabetes Department at Wycombe Hospital we are currently looking for people to help us with research looking at how best to manage insulin pumps for exercise. If you have been on an insulin pump for at least 3 months, exercise regularly for more than one hour per week and are interested in taking part, then please call us on 01494 425349 or email us at firstname.lastname@example.org for more details. We are also looking for people to help us with a study comparing the effects of insulin glargine (Lantus) and insulin detemir (Levemir) with exercise. The study will require 3 visits to High Wycombe. If you are using either of these insulins at the moment, exercise for at least one hour each week on average, and are interested in taking part then then please call us on 01494 425349 or email us at email@example.com for more details.
Over the last 10 years, a variety of strategies have been developed by our team to help people control their diabetes without risking changes in blood glucose. These strategies typically involve changes in insulin dose or taking extra food. Whilst effective these strategies do usually require pre planning which may not be practical.
The award winning reseach team has developed hypothesis about alternate strategies which may be employed. One of these hypothesis tested was that administration of caffeine, will reduce hypoglycaemia, and promote performance during, and following, exercise in Type 1 diabetes.
Caffeine augments the sympatho-adrenal system, and its responses. At a dose similar to up to twice mean daily UK intake, it has been shown to reduce the occurrence and augment the physiological responses to hypoglycaemia in Type 1 diabetes. Caffeine ingestion in healthy subjects (5mg/kg) has been reported to increase exercise time to exhaustion in prolonged aerobic , and in shorter duration intense exercise. Whilst lower dose caffeine ingestion (3mg/kg) increases exercise duration, these effects seem only to be mediated through an augmented catecholamine response, and by increased free fatty acid and glycerol mobilization at higher caffeine doses (6-9mg/kg) . Furthermore, improvement in exercise in healthy subjects is not associated with changes in the carbohydrate or fat metabolism of muscle . At maximum effort, caffeine does not seem to increase peak power, work output, and may be detrimental to anaerobic performance . The objectives of this study are to investigate whether caffeine administration reduces changes in blood glucose, intermediary metabolites and normalizes measures of work output using a group of subjects that have Type 1 diabetes.
The results of the study were that caffeine ingestion prior to exercise reduces the fall in blood glucose, and the requirement for glucose ingestion during exercise in T1DM. Caffeine ingestion does not alter work output or the increase in lactate levels. These data imply that caffeine does not alter substrate oxidation, and that caffeine augments endogenous glucose production and oxidation with exercise. Caffeine may be an additional tool to reduce hypoglycaemia during exercise in T1DM.
This study was be presented at the American diabetes Association in June 2010.