“Stunned Endothelium” during Maximal Effort in a Well-Trained Type 1 Diabetic Patient
Abstract Number: 2331-PO
Authors: ROSA FABREGATE, OLIVIA SANCHEZ, MARTIN FABREGATE, ELENA SANCHEZ-LARGO, DAVID COCA, J. LARGO, E. RAMOS-HERNAN, JUDITH MARQUEZ, JOSE SABAN-RUIZ.
Institutions: Madrid, Spain.
Results: CASE REPORT: A 48-year-old male, with a 26-year history of type1 DM. Regular amateur bicycle training. METHODS: Bioelectrical impedance (BI): OMRON BF300.Microcirculation: DRT4, MOOR. Glucose monitoring: MiniMed CGMS. Insulin pumps: Minimed. Hs-CRP: DRG EIA. Plasma insulin. DPC. IGF-1: RIA. ACTH: IRMA.Cortisol: Chemiluminescent. Betahydroxybutyrate: COBAS MIRA.Lactate: Aeroset System.Growth hormone (GH): Immulite 2000. PROTOCOL: Warming-up, light, moderate and maximum exercise phases. Stopping exercise at minute 60, reaching a maximum PR of 184 bpm. RESULTS 1- HbA1c: 5,5 %. Previous 72h glycaemia average: 120 mg/dl. Baseline glycaemias: 60-117 mg/dl. Maximum lactate at 60 minutes of exercise, coinciding with maximal exercise: 9,29 mmol/l. Beta-hydroxybutyrate: -15min: 0,893 mmol/l; baseline: 0,614; 30min: 0,56; 60min: 0,536. 2- Basal and post-exercise bioimpedance: 18,5% 11,6 Kg fatty mass and 16,5% 10,3 Kg fatty mass, respectively. 3- Counterinsulin system behaviour: ACTH and GH peaks at 60 min coinciding with the maximum effort: ACTH peak 18.80 pg/ml respect to the basal 3.1 pg/ml; GH peak 0.49 ng/ml respect to the basal 0.32 ng/ml; Cortisol peak at 30 min of the recovering period: 24.80 ug/dL respect to the basal 8.88 ug/dL. 4- Biphasic behaviour of the IGF-1 with initial fall (values: 78.20 ng/ml vs 81.9 ng/ml) and later fall (71.90 ng/ml vs 82.40 ng/ml). 5- hs-CRP: maximum at 30 minutes post-exercise: 12 mg/L vs 4.3mg/L during the test. 6- DRT4: Pre-exercise. In hyperemia period, post-ischemia, ΔF 77.6% Post-exercise. ΔF 0.0% CONCLUSIONS: After one hour of intensive exercise the fat mass is reduced in over 1 Kg. Lactate increases but there is no high production of ketones. Expected counterinsulin system behaviour. Biphasic behaviour of the IGF-1. Unexpected response of hs-CRP. No response of EDV after maximal exercise due to an “exhausted or stunned endothelium” phenomenon.