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Intensiver Ausdauersport bei Typ-1-Diabetes

Intense endurance sports for patients with type I diabetes

  • Leitthema
  • Published:
Der Diabetologe Aims and scope

Zusammenfassung

Hintergrund

Intensiver Ausdauersport greift erheblich in die Glukosehomöostase ein. Dies wird vom Gesunden mit intakten Regulationsmechanismen problemlos toleriert. Trotz der nachgewiesenen positiven Effekte wird oft unterschätzt, dass intensive sportliche Aktivitäten bei Patienten mit Diabetes mellitus Typ 1 angesichts gestörter Anpassungsreaktionen gravierende metabolische Probleme induzieren können, sodass deren Diabetesmanagement eine interdisziplinäre therapeutische Herausforderung darstellt.

Therapie

Fein abgestufte Anpassungen sowohl der Insulintherapie als auch der Kohlenhydratzufuhr sind erforderlich, um v. a. hypoglykämische Stoffwechselentgleisungen zu vermeiden und gleichzeitig den gesundheitlichen Nutzen körperlicher Aktivitäten zu gewährleisten. Der Effekt des Ausdauersports auf die Glukosehomöostase wird sowohl durch die Belastungscharakteristika als auch die metabolische Ausgangslage beeinflusst. Empfehlungen verschiedener Fachgesellschaften und Arbeitsgruppen zu sportlicher Aktivität bei Typ-1-Diabetes basieren meist auf Untersuchungen mittels Fahrradergometrie und können für andere Sportarten im Hinblick auf die unterschiedlichen hämodynamischen und metabolischen Beanspruchungen allenfalls orientierenden Charakter haben.

Resümee

Um einen sicheren Umgang mit verschiedenartigen Ausdauersportaktivitäten bei Patienten mit Typ-1-Diabetes – insbesondere ab der 4. Lebensdekade – zu gewährleisten, bedarf es einer besonderen Fokussierung auf hypo- sowie hyperglykämische Stoffwechsellagen. Ziel ist es, einen aktiven Lebensstil langfristig zu fördern und zu unterstützen sowie potenzielle Risiken zu minimieren. Dies erfordert eine enge Zusammenarbeit zwischen Patienten, Ärzten und Trainern/Bewegungstherapeuten.

Abstract

Background

Intense exercise strongly affects glucose homeostasis in humans. In healthy individuals, plasma glucose concentrations are maintained within a narrow range through counterregulatory hormone responses. However, in type 1 diabetics there is dysregulation of this complex equilibrium leading to disturbances of glucose homeostasis. This poses a challenge for type 1 diabetics as well as for their treating physicians and exercise therapists.

Therapy

Adjustments in insulin dose and carbohydrate intake are required to allow safe participation in exercise and to optimize its health benefits in particular with regard to hypo-/hyperglycemia. Factors affecting glucose response to exercise include intensity, duration and type of activity as well as metabolic control. Guideline recommendations on diabetes management linked to physical activity are mainly based on cycle ergometer exercise testing and can therefore hardly provide guidance to running exercise due to different hemodynamic and metabolic loads. Therefore, practical implementation for different types of recreational sports with different muscular demands can become difficult.

Conclusion

A joint effort is required to ensure safe participation of patients with type 1 diabetes in different endurance activities, especially from the fourth decade of life onwards. Sustainable promotion of an active and healthy lifestyle in patients with type 1 diabetes should be regarded as a long-term objective in order to minimize potential risks, which requires close cooperation between patients, physicians, and exercise professionals.

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  1. Abteilung für präventive und rehabilitative Sport- und Leistungsmedizin, Institut für Kreislaufforschung und Sportmedizin, Deutsche Sporthochschule Köln, Am Sportpark Müngersdorf 6, 50933, Köln, Deutschland

    M. Kraus &  J. Latsch

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Correspondence to J. Latsch.

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M. Kraus und J. Latsch geben an, dass kein Interessenkonflikt besteht.

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Kraus, M., Latsch, J. Intensiver Ausdauersport bei Typ-1-Diabetes. Diabetologe 11, 641–644 (2015). https://doi.org/10.1007/s11428-015-0037-6

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