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Andrzej Gawrecki, Aleksandra Araszkiewicz, Agnieszka Szadkowska, Grzegorz Biegański, Jan Konarski, Katarzyna Domaszewska, Arkadiusz Michalak, Bogda Skowrońska, Anna Adamska, Dariusz Naskręt, Przemysława Jarosz-Chobot, Agnieszka Szypowska, Tomasz Klupa and Dorota Zozulińska-Ziółkiewicz

( 4 , 28 ). However, these rules for children and adolescents are less predictable due to more spontaneous physical activity. The main challenges in practicing sports by people with type 1 diabetes (T1DM) are prevention of hypoglycemia, fear of deterioration of diabetes control, and insufficient

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Michael C. Riddell, Oded Bar-Or, Beatriz V. Ayub, Randolph E. Calvert and George J.F. Heigenhauser

There are currently no guidelines regarding the carbohydrate (CHO) dosage required to prevent exercise-induced hypoglycemia in children with insulin-dependent diabetes mellitus (IDDM). To prevent hypoglycemia by matching glucose ingestion with total-CHO utilization, 20 adolescents with IDDM attended 2 trials: control (CT; drinking water) and glucose (GT; drinking 6-8% glucose). Participants performed 60 min of moderate-intensity cycling 100 min after insulin injection and breakfast. CT's total-CHO utilization during exercise was determined using indirect calorimetry. In GT, participants ingested glucose in the amount equal to total CHO utilization in the CT. A total of 9 participants had BG <4.0 mmol/L in CT compared to 3 in GT (p < .05). In conclusion, glucose ingestion equal to total-CHO utilization attenuates the drop in blood glucose and reduces the likelihood of hypoglycemia during exercise in adolescents with IDDM.

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Roy L.P.G. Jentjens and Asker E. Jeukendrup

Pre-exercise carbohydrate feeding may result in rebound hypoglycemia in some but not all athletes. The aim of the present study was to examine whether insulin sensitivity in athletes who develop rebound hypoglycemia is higher compared with those who do not show rebound hypoglycemia. Twenty trained athletes (V̇O2max of 61.8 ± 1.4 ml · kg−1 · min−1) performed an exercise trial on a cycle ergometer. Forty-five minutes before the start of exercise, subjects consumed 500 ml of a beverage containing 75 g of glucose. The exercise trial consisted of · 20 min of submaximal exercise at 74 ± 1% V̇O2max immediately followed by a time trial. Based upon the plasma glucose nadir reached during submaximal exercise, subjects were assigned to a Hypo group (<3.5 mmol/L) and a Non-hypo group (≥3.5 mmol/L). An oral glucose tolerance test was performed to obtain an index of insulin sensitivity (ISI). The plasma glucose nadir during submaximal exercise was significantly lower (p < .01) in the Hypo-group (n = 10) compared with the Non-hypo group (n = 10) (2.7 ± 0.1 vs. 4.1 ± 0.2 mmol/L, respectively). No difference was found in ISI between the Hypo and the Non-hypo group (3.7 ± 0.4 vs. 3.8 ± 0.5, respectively). The present results suggest that insulin sensitivity does not play an important role in the occurrence of rebound hypoglycemia.

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John G. Seifert, Greg L. Paul, Dennis E. Eddy and Robert Murray

The effects of preexercise hyperinsulinemia on exercising plasma glucose, plasma insulin, and metabolic responses were assessed during 50 min cycling at 62% VO2max. Subjects were fed a 6% sucrose/glucose solution (LCHO) or a 20% maltodextrin/glucose solution (HCHO) to induce changes in plasma insulin. During exercise, subjects assessed perceived nauseousness and lightheadedness. By the start of exercise, plasma glucose and plasma insulin had increased. In the LCHO trial, plasma glucose values significantly decreased below the baseline value at 30 min of exercise. However, by 40 min, exercise plasma glucose and insulin values were similar to the baseline value. Exercise plasma glucose and insulin did not differ from baseline values in the HCHO trial. Ingestion of LCHO or HCHO was not associated with nausea or lightheadedness. It was concluded that the hyperinsulinemia induced by preexercise feediigs of CHO did not result in frank hypoglycemia or adversely affect sensory or physiological responses during 50 min of moderate-intensity cycling.

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Kevin R. Short, Melinda Sheffield-Moore and David L. Costill

This investigation was undertaken to determine whether consuming several small feedings of preexercise carbohydrate (CHO), rather than a single bolus, would affect blood glucose and insulin responses during rest and exercise. Eight trained cyclists ingested 22.5,45, or 75 total g maltodextrin and dextrose dissolved in 473 ml of water or an equal volume of placebo (PL). Drinks were divided into four portions and consumed at 15-min intervals in the hour before a 120-min ride at 66% VO2max. Serum glucose values were elevated by the CHO feedings at rest and fell significantly below baseline and PL at 15 min of exercise. However, glucose concentrations were similar in each of the CHO trials. Insulin concentrations also increased rapidly during rest, then fell sharply at the onset of exercise. The findings demonstrate that CHO consumed within an hour before exercise, even when taken in several small feedings, can produce transient hypoglycemia near the onset of exercise. Additionally, the magnitude of the response appears to be unrelated to either the amount of CHO ingested or the insulin response.

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Gregg Afman, Richard M. Garside, Neal Dinan, Nicholas Gant, James A. Betts and Clyde Williams

Current recommendations for nutritional interventions in basketball are largely extrapolated from laboratory-based studies that are not sport-specific. We therefore adapted and validated a basketball simulation test relative to competitive basketball games using well-trained basketball players (n = 10), then employed this test to evaluate the effects of two common preexercise nutritional interventions on basketball-specific physical and skilled performance. Specifically, in a randomized and counterbalanced order, participants ingested solutions providing either 75 g carbohydrate (sucrose) 45 min before exercise (Study A; n = 10) or 2 × 0.2 g·kg−1 sodium bicarbonate (NaHCO3) 90 and 20 min before exercise (Study B; n = 7), each relative to appropriate placebos (H2O and 2 × 0.14 g·kg−1 NaCl, respectively). Heart rate, sweat rate, pedometer count, and perceived exertion did not systematically differ between the 60-min basketball simulation test and competitive basketball, with a strong positive correlation in heart rate response (r = .9, p < .001). Preexercise carbohydrate ingestion resulted in marked hypoglycemia (< 3.5 mmol·l−1) throughout the first quarter, coincident with impaired sprinting (+0.08 ± 0.05 second; p = .01) and layup shooting performance (8.5/11 versus 10.3/11 baskets; p < .01). However, ingestion of either carbohydrate or sodium bicarbonate before exercise offset fatigue such that sprinting performance was maintained into the final quarter relative to placebo (Study A: –0.07 ± 0.04 second; p < .01 and Study B: -0.08 ± 0.05 second; p = .02), although neither translated into improved skilled (layup shooting) performance. This basketball simulation test provides a valid reflection of physiological demands in competitive basketball and is sufficiently sensitive to detect meaningful changes in physical and skilled performance. While there are benefits of preexercise carbohydrate or sodium bicarbonate ingestion, these should be balanced against potential negative side effects.

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Carolyn C. Jimenez

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Mindy Millard-Stafford, Linda B. Rosskopf, Teresa K. Snow and Bryan T. Hinson

Twelve highly trained male runners ran 15 km at self-selected pace on a treadmill in warm conditions to demonstrate differences in physiological responses, fluid preferences, and performance when ingesting sports drinks or plain water before and during exercise. One hour prior to the start of running, an equal volume (1,000 ml) of either water or a 6% or an 8% carbohydrate-electrolyte (CE) drink was ingested. Blood glucose was significantly higher 30 min following ingestion of 6% and 8% CE compared to water, significantly lower at 60 min postingestion with both sports drinks than with water, but similar after 7.5 km of the run for all beverages. During the first 13.4 km, oxygen uptake and run times were not different between trials; however, the final 1.6-km performance run was faster with both CE drinks compared to water. Despite a lower preexercise blood glucose, CE consumption prior to and during exercise significantly improved performance in the last 1.6 km of a 15-km run compared to water.

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Romain Meeusen and Lieselot Decroix

carbohydrate feeding. The beneficial effect of carbohydrate supplementation during prolonged exercise could also relate to increased (or maintained) substrate delivery for the brain, with a number of studies indicating that hypoglycemia affects brain function and cognitive performance ( Meeusen, 2014 ). The

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Susan J. Coram and Michael Mangum

The large number of diabetic individuals, children and adults, and the potential problems that may arise in a fitness setting calls for a better understanding of the diabetic state. This review is therefore intended to stimulate an awareness of the complexity of the diabetic state and to emphasize the beneficial and potential hazardous effects of exercise. An overview is provided to orient the reader to basic concepts concerning diabetes. A variety of topics related to exercise and the diabetic are then presented. These include the metabolic benefits from exercise, exercise and coronary heart disease risk factors, factors influencing decreased exercise performance in diabetics, hypoglycemia and ketoacidosis, preliminary considerations and precautions for diabetic participants, and the role of education and self-discipline in diabetic control. Finally, practical guidelines for the diabetic and the physical educator are suggested.