Risks of marathon running and hypoglycaemia in Type 1 diabetes
- 21 April 2010
- journal article
- case report
- Published by Wiley in Diabetic Medicine
- Vol. 27 (5), 585-588
- https://doi.org/10.1111/j.1464-5491.2010.02969.x
Abstract
Exercise-induced hypoglycaemia is common in people with insulin-treated diabetes and if severe can provoke neurological morbidity including coma and seizures. Depending on the duration and demands of the physical activity, various strategies can be used to limit the risk of hypoglycaemia with strenuous exercise. However, metabolic events occurring in the 48 h before the exercise can influence the risk and responses to exercise-induced hypoglycaemia. A 27-year-old man with Type 1 diabetes suffered an episode of nocturnal hypoglycaemia which provoked a tonic-clonic seizure. Despite this he ran in a marathon the following day during which he collapsed with severe hypoglycaemia and a further associated seizure. He subsequently developed severe myalgia accompanied by a pronounced and persistent elevation of plasma creatine kinase, indicating rhabdomyolysis, and deranged liver function, suggestive of hypoxic hepatitis. The biochemical abnormalities and symptoms lasted for several weeks. The case highlights the dangers of intense and prolonged physical exercise following severe hypoglycaemia, demonstrating the risks of acute damage to skeletal muscle and to organs such as the liver, in addition to the risk of severe neuroglycopenia and the induction of seizures. The mechanisms underlying these problems are discussed. People with insulin-treated diabetes should be advised not to undertake prolonged intensive exercise after severe hypoglycaemia.Keywords
This publication has 27 references indexed in Scilit:
- Rhabdomyolysis and Acute Kidney InjuryThe New England Journal of Medicine, 2009
- Guidelines on the current best practice for the management of type 1 diabetes, sport and exercisePractical Diabetes International, 2009
- Exercise-induced and other daytime hypoglycemic events in patients with diabetes: prevention and treatmentDiabetes Research and Clinical Practice, 2004
- Regulation of Net Hepatic Glycogenolysis and Gluconeogenesis during Exercise: Impact of Type 1 DiabetesJournal of Clinical Endocrinology & Metabolism, 2004
- Rhabdomyolysis: A reviewMuscle & Nerve, 2002
- Sequential serum creatine kinase determination differentiates vaso-vagal syncope from generalized tonic-clonic seizuresActa Neurologica Scandinavica, 1997
- The Roles of Catecholamines in Glucoregulation in Intense Exercise as Defined by the Islet Cell Clamp TechniqueDiabetes, 1996
- Inhibition of muscle glycogen synthase activity and non-oxidative glucose disposal during hypoglycaemia in normal manDiabetologia, 1996
- Comparison of serum creatine kinase and creatine kinase MB activities post marathon race versus post myocardial infarctionClinica Chimica Acta; International Journal of Clinical Chemistry, 1984
- The Spectrum of RhabdomyolysisMedicine, 1982