Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands.
Type 1 Diabetes Family Centre, Osborne Park, WA, Australia.
Diabet Med. 2019 Nov;36(11):1503-1507. doi: 10.1111/dme.14049. Epub 2019 Jul 4.
Maintaining glycaemic control during exercise presents a significant challenge for people living with Type 1 diabetes. Significant glycaemic variability has been observed in athletes with Type 1 diabetes in competitive contexts. While very-low-carbohydrate ketogenic diets have been shown to minimize glycaemic excursions, no published data have examined if this translates to exercise.
We report the case of a 37-year-old man with Type 1 diabetes who successfully undertook a 4011 km cycle across Australia over 20 consecutive days whilst consuming a very-low-carbohydrate ketogenic diet. Continuous glucose monitoring data capture was 98.4% for the ride duration and showed remarkable glycaemic stability, with a standard deviation of 2.1 mmol/l (average interstitial glucose 6.1 mmol/l) and 80.4% of time spent within a range of 3.9-10 mmol/l. Interstitial glucose was <3 mmol/l for 2.1% of this time, with only a single episode of symptomatic hypoglycaemia prompting brief interruption of exercise for carbohydrate administration.
This case demonstrates the viability of a very-low-carbohydrate ketogenic diet in an individual with Type 1 diabetes undertaking exercise. While the effect of a very-low-carbohydrate ketogenic diet is yet to be examined more broadly in athletes with Type 1 diabetes, the glycaemic stability observed suggests that fat adaptation may attenuate glycaemic swings and reduce reliance on carbohydrate consumption during exercise for maintaining euglycaemia.
对于患有 1 型糖尿病的人来说，在运动期间保持血糖控制是一项重大挑战。在竞技环境中，1 型糖尿病运动员的血糖波动非常大。虽然极低碳水化合物生酮饮食已被证明可以最大程度地减少血糖波动，但尚无发表的数据研究这是否适用于运动。
我们报告了一例 37 岁的男性患有 1 型糖尿病，他在连续 20 天内成功完成了 4011 公里的澳大利亚自行车骑行，同时摄入极低碳水化合物生酮饮食。连续血糖监测数据的采集在骑行期间的覆盖率为 98.4%，显示出显著的血糖稳定性，标准差为 2.1mmol/l（平均间质葡萄糖为 6.1mmol/l），80.4%的时间处于 3.9-10mmol/l 的范围内。在此期间，间质葡萄糖<3mmol/l 的时间占 2.1%，仅有一次症状性低血糖事件导致短暂中断运动以摄入碳水化合物。
该案例证明了 1 型糖尿病患者在进行运动时采用极低碳水化合物生酮饮食的可行性。虽然 1 型糖尿病运动员的极低碳水化合物生酮饮食的效果尚未更广泛地研究，但观察到的血糖稳定性表明，脂肪适应可能会减轻血糖波动，并减少在运动期间对碳水化合物摄入的依赖，以维持血糖正常。
