@article{3107070,
    title = "Avoiding hypoglycemia: The use of insulin pump combined with continuous glucose monitor in type 1 diabetes crossing a Rocky Gorge",
    author = "Thomakos, P. and Vazeou, A. and Sakkas, D. and Panagopoulos, G. and Anifantakis, K. and Smyrnaki, P. and Arvanitaki, T. and Kyrlaki, E. and Kefalogiannis, N. and Mamoulakis, D. and Pappas, A. and Mitrakou, A.",
    journal = "QJM-MONTHLY JOURNAL OF THE ASSOCIATION OF PHYSICIANS",
    year = "2018",
    volume = "111",
    number = "9",
    pages = "629-633",
    publisher = "Oxford University Press",
    doi = "10.1093/qjmed/hcy136",
    keywords = "glucose;  insulin;  antidiabetic agent;  glycosylated hemoglobin;  insulin, adult;  area under the curve;  Article;  body mass;  clinical article;  controlled study;  disease duration;  female;  glucose blood level;  human;  hyperglycemia;  hypoglycemia;  insulin dependent diabetes mellitus;  insulin infusion;  male;  nocturnal hypoglycemia;  observational study;  physical activity;  priority journal;  prospective study;  adolescent;  analysis;  blood glucose monitoring;  devices;  drug administration;  exercise;  Greece;  hypoglycemia;  insulin dependent diabetes mellitus;  insulin infusion;  multivariate analysis;  statistical model;  young adult, Adolescent;  Adult;  Blood Glucose;  Blood Glucose Self-Monitoring;  Diabetes Mellitus, Type 1;  Drug Administration Schedule;  Exercise;  Female;  Glycated Hemoglobin A;  Greece;  Humans;  Hypoglycemia;  Hypoglycemic Agents;  Insulin;  Insulin Infusion Systems;  Linear Models;  Male;  Multivariate Analysis;  Prospective Studies;  Young Adult",
    abstract = "Background: Continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring systems (CGMS) have been proven very effective in diabetes management. Aim: This study evaluated the usefulness of these devices during prolonged, intense physical activity in an uncontrolled natural environment away from the clinical research center. Design: Non-randomized, prospective and observational study. Methods: During the summer, 38 participants with type 1 diabetes crossed the Samaria gorge, the second largest gorge in Europe (17 km). Twenty subjects on CSII combined with real-time CGMS and 18 on multiple daily injections (MDI) combined with professional (retrospective) CGMS participated in the program. All participants were unsupervised during the event. Results: All 38 participants managed to reach the destination point safely. There were no episodes of severe hypoglycemia. The duration of the exercise (mean 6SD) was 6.4 6 1.3 h. The CSII group exhibited significantly lower hypoglycemic episodes during exercise (0.1 6 0.3 vs. 0.4 6 0.6; P ¼ 0.047) as well as lower AUC below 70 mg/dl compared with the MDI, during the 24 h (0.61 6 0.78 vs. 1.84 6 1.55; P ¼ 0.007). Individuals on CSII were significantly less likely to develop a hypoglycemic episode during exercise (P ¼ 0.038). Exercise induced nocturnal hypoglycemia was not prevented effectively in neither group. Conclusions: CSII combined with CGMS is effective in controlling blood glucose levels in type 1 diabetics who perform prolonged strenuous exercise. The use of insulin pump technology in regions with hot Mediterranean climates is safe and can provide protection against exercise-induced hypoglycemia. Development of precise instructions for T1DM who occasionally get involved in exercise activities, requires further studies. © The Author(s) 2018. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved."
}