People with type 1 diabetes (T1D) have personal strategies for maintaining euglycemia while exercising which generally serves them well during training. Their strategy often yields wildly differing results during a competition. The influence of competition stress (notably, epinephrine causing prompt elevations in glucose) and high-intensity and/or long-duration efforts can yield dysglycemia. Two different studies were conducted to observe this phenomenon. In a small study of subjects with T1D completing athletic competitions, perceived stress level as reported by the individual is insufficient for determination impact upon glycemia. An elevated heart rate during the competition over what was observed at the same running pace in training was a better indicator of an increase in glycemia. To recreate an athletic stress scenario in a clinical setting, 13 subjects with T1D completed a low intensity treadmill protocol for 3 sessions: non-stress, verbally reported mental math with an audience, and stressful video games to observe the influence on glycemia and heart rate. The treadmill protocol, prior meal, and insulin doses were matched for each individual for the 3 sessions. When compared to the non-stress treadmill session, an elevated average heart rate was observed in 10 of the 13 video game sessions and an elevated average glucose was observed in 9 of the 13 video game sessions. In the mental math sessions, an average heart rate elevated heart rate was observed in 6 of the 13 sessions with 7 of 13 having a higher average glucose compared to the non-stress session. While individual response to acute stress yields a high degree of intersubject variability, the video game sessions may more closely match the competition stress experienced and physiological response to stress observed during an athletic competition. The cause of the stressor may be critical in detection of stress and predicting glycemic response for the management of T1D.


N. Hobbs: None. M. Park: None. M. Chu: None. Y. Song: None. L.T. Quinn: None. M. Sevil: None. A. Cinar: Research Support; Self; Dexcom, Inc., JDRF. Stock/Shareholder; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S, Tandem Diabetes Care.


JDRF (A18-0036-001); National Institutes of Health (DP3DK101075, F31DK116524)

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