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Monitoring physical activity is a very important issue, especially in type 1 diabetes. One of the parameters assessing the intensity of exercise is the concentration of lactate in the blood. Aim of the study We assessed the intensity of PE and changes in lactate levels in children and adolescents with type 1 diabetes (T1D) during a football tournament.We enrolled 141 participants, the results of 70 of whom were analyzed, playing in two age categories: 10-13 and 14-17 years. Lactate levels were measured in the capillary blood before and after matches. Blood lactate of 4 mmol/l (Onset Blood Lactate Accumulation OBLA) was used as parameter indicating the prevalence of anaerobic metabolic changes.The median lactate level was 1.8 mmol/l before and 4.4 mmol/l after matches (p0.001). The increase in lactate levels was higher in the older age category (4.3 vs. 1.8, p = 0.001) and was independent on gender (3.2 vs. 2.1, p = 0.597), personal insulin pump vs insulin pen use (3.0 vs. 1.5, p = 0.145) or training in a sports club (1.4 vs. 3.0, p = 0.084). A positive correlation was noted between increased lactate levels and age (Rs = 0.253, p = 0.034). 61% of the participants exceeded lactate levels ≥ 4 mmol/l. In univariate logistic regression analysis age was a significantly associated with lactate level ≥ 4 mmol/l [OR = 1.45 (1.08-1.95)] independent of HbA1c, gender, treatment method and training in a sports club.PE intensity levels during football matches were found to be mixed aerobic-anaerobic. Increases in lactate levels were greater in the older subjects independently on the assessed factors.Monitorowanie aktywności fizycznej jest bardzo ważne, szczególnie w cukrzycy typu 1. Jednym z parametrów oceniających intensywność aktywności jest stężenie mleczanu we krwi. Cel pracy Ocena intensywności wysiłku fizycznego i zmiany poziomu mleczanu we krwi u dzieci i młodzieży z cukrzycą typu 1 podczas turnieju piłkarskiego.Do badania zakwalifikowano 141 osób, w analizach uwzględniono wyniki 70 zawodników, grających w dwóch kategoriach wiekowych: 10–13 oraz 14–17 lat. Stężenia mleczanu mierzono przed i po zakończeniu każdego meczu. Stężenie mleczanu 4 mmol/l (OBLA) zostało użyte jako parametr wskazujący początek beztlenowych przemian metabolicznych.Mediana stężeń mleczanu wynosiła przed 1,8 mmol/l i wzrosła do 4,4 mmol/l po meczach (p0,001). Przyrost mleczanów był wyższy u starszych dzieci (4,3 vs 1,8; p = 0,001), nie zależał od płci (3,2 vs 2,1, p = 0,597), stosowania osobistej pompy insulinowej lub penów insulinowych (3,0 vs 1,5, p = 0,145) oraz trenowania w klubie sportowym (1,4 vs 3,0, p = 0,084). Odnotowano dodatnią korelację pomiędzy przyrostem stężenia mleczanu a wiekiem (Rs = 0,253, p = 0,034). 61% zawodników podczas meczu przekroczyło intensywność wysiłku odpowiadającą własnemu obciążeniu progowemu czego efektem był poziom mleczanu (≥ 4 mmol/l). W analizie regresji logistycznej udowodniliśmy, że wiek był istotnie związany ze stężeniem mleczanu ≥ 4 mmol/l [OR = 1,45 (1,08–1,95)]). Związek ten jest niezależny od wartości HbA1c, płci, metody leczenia i trenowania w klubie sportowym.Intensywność wysiłku fizycznego u nastolatków z cukrzycą typu 1 podczas meczów piłkarskich była mieszana – tlenowo-beztlenowa. Wzrost stężenia mleczanów po wysiłku fizycznym był wyższy u starszych uczestników oraz nie zależał od innych czynników.

The widespread use of personal insulin pumps in the treatment of type 1 diabetes has significantly improved the effects of therapy. Patients achieved better metabolic control of diabetes, but also increased comfort of life and professional opportunities. One of the func­tions that increased the effectiveness of insulin therapy using a personal insulin pump is the bolus calculator. The bolus calculator function allows the user to dose their insulin more accurately before meals and to correct hyperglycaemia. The bolus calculator algorithms in insulin pumps of individual manufacturers differ in the way they calculate the correction dose and the amount of so-called active insulin. Consequently, with the same treatment parameters, individual bolus calculators may offer a different dose of insulin. Understanding the principles of the bolus calculator by therapeutic team members and patients is very important for proper diabetes education and diabetes management.

Long-term insulin treatment can slow the growth process and decrease physical fitness level in children. In diabetic children, these two developments should be constantly monitored. The aim of the present study was to examine differences in somatic and physical fitness characteristics between soccer-training boys with type 1 diabetes and healthy boys of the same age (reference values based on Polish population norms for somatic and motor parameters). The participants were 94 boys (8–17 years), diagnosed with diabetes, who participated in soccer training on a regular basis and received routine medical care. The study involved (a) anthropometric and body composition measurements, (b) general motor ability assessments, and (c) comparison of those characteristics with the healthy Polish population. The diabetic boys were found to have lower levels of almost all somatic traits and motor abilities as compared with the healthy boys (p ≤ 0.05). Handgrip strength was a variable with the smallest difference between the two groups. The observed differences indicate the necessity to design an appropriate control and assessment system based on simple medical and fitness field tests for diabetic children and adolescents. It will allow optimizing advanced training as well as minimize health risks before, during, or after exercise.

The aim of the study was to investigate factors related to the occurrence of nighttime hypoglycemia after a football tournament in children with type 1 diabetes mellitus. The multicenter study (GoalDiab study) included 189 children and adolescents with type 1 diabetes mellitus, from 11 diabetes care centers in Poland. Hypoglycemia was defined according to the International Hypoglycemia Study Group Statement. We analyzed the data of 95 participants with completed protocols with regards to nighttime hypoglycemia (82% male), aged 11.6 (9.8–14.2) years, diabetes duration 5.0 (2.0–8.0) years. There were 47 episodes of nighttime Level 1 hypoglycemia (≤3.9 mmol/L). Occurrence of clinically important Level 2 hypoglycemia (

BACKGROUND Factory-calibrated intermittently-scanned Continuous Glucose Monitoring (isCGM) device FreeStyle Libre (FSL) has recently received improvements in its glucose tracking algorithm and calibration procedures, which are claimed to have improved its accuracy. OBJECTIVE To compare the accuracy of two generations of 14-days FSL devices (A in 2016, B in 2019) to self-monitored blood glucose measurements (SMBG) in children with type 1 diabetes in real-life conditions during a summer camp. MATERIALS AND METHODS Two largely independent groups of youth with type 1 diabetes took part in summer camps. In 2016 they used FSL-A, in 2019 FSL-B. On scheduled days, participants performed supervised 8-point glucose profiles with FSL and SMBG. The accuracy vs SMBG was assessed with mean absolute relative difference (MARD) and clinical surveillance error grid (SEG). RESULTS We collected 1655 FSL-SMBG measurement pairs from 78 FSL-A patients (age 13 ± 2.3 years old; HbA1c: 7.6 ± 0.8%) and 1796 from 58 in FSL-B group (age 13.8 ± 2.3 years old, HbA1c: 7.5 ± 1.1%)-in total 3451 measurements. FSL-B displayed lower MARD than FSL-A (11.3 ± 3.1% vs 13.7 ± 4.6%, P = .0003), lower SD of errors (20.2 ± 6.7 mg/dL vs 24.1 ± 9.6 mg/dL, P = .0090) but similar bias (-7.6 ± 11.8 mg/dL vs -6.5 ± 8 mg/dL, P = .5240). Both FSL-A and FSL-B showed significantly higher MARD when glycaemia was decreasing >2 mg/dL/min (FSL-A:22.3 ± 18.5%; FSL-B:17.9 ± 15.8%, P

Regular physical activity increases lifespan for those with type 1 diabetes. However, disease-related barriers may deter children from exercise and affect their fitness. This study examined the safety of the Cooper test concerning diabetes-related acute complications in children with type 1 diabetes and their fitness. Blood glucose was recorded before and 0, 30, 60 min after the test. The covered distances were transformed to z-scores based on the national charts. Body mass index, body fat percentage and glycated hemoglobin were measured. The run was completed by 80 individuals (45% boys, age 13.6±2.1 years; diabetes duration 6.3±3.5 years). During the follow-up 11 children reached glucose alert values (3–3.9 mmol/L), 3 presented clinically significant hypoglycemia (

The purpose of this study was to evaluate the impact of high intensity exercise on glucose levels and risk of metabolic decompensation in males with type 1 diabetes (T1D), depending on the method of insulin administration. The study comprised 29 males (aged 25.3±5.1 years; duration of diabetes 10.3±3.2 years) treated with continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injections (MDI). Treadmill exercise test was performed twice in each patient until subjective exhaustion as maximum according to the Borg scale. All the patients achieved ≥85% of the maximal heart rate. Distance during the test was 4 500±1 400 m and 4 473±1 559 m in the MDI and CSII groups, respectively, which was achieved in 31±8 min. During the test and in the 6 h after, no clinically significant episodes of hypoglycemia occurred. Mean glucose levels did not exceed 10 mmol/L in most patients. The risk of the composite endpoint (hypoglycemia3.8 mmol/L, hyperglycemia≥16.6 mmol/L, ketones≥0.6 mmol/L, and lactate2.2 mmol/L) was higher in patients treated with MDI than CSII (OR3.75, 95%CI:1.22-11.52, p=0.02). In conclusion, planned high intensity physical effort in men with well-controlled T1D is metabolically safe. CSII shows greater metabolic advantage over MDI during and after high intensity exercise in men with T1D.

In this study, the aim was to provide observational data from an ascent to the summit of Mount Damavand (5670 meters above sea level (m.a.s.l), Iran) by a group of people with type 1 diabetes (T1DM), with a focus on their physiological characteristics. After a 3-day expedition, 18 T1DM patients, all treated with personal insulin pumps, successfully climbed Mount Damavand. Information was collected on their physiological and dietary behaviors, as well as medical parameters, such as carbohydrate consumption, glucose patterns, insulin dosing, and the number of hypo- and hyperglycemic episodes during this time frame. The participants consumed significantly less carbohydrates on day 3 compared to day 1 (16.4 vs. 23.1 carbohydrate units; p = 0.037 ). Despite this, a gradual rise in the mean daily glucose concentration as measured with a glucometer was observed. Interestingly, the patients did not fully respond to higher insulin delivery as there was no significant difference in mean daily insulin dose during the expedition. There were more hyperglycemic episodes (≥180 mg/dL) per patient on day 3 vs. day 1 ( p < 0.05 ) and more severe hyperglycemic episodes (>250 mg/dL) per patient on days 2 ( p < 0.05 ) and 3 ( p < 0.05 ) vs. day 1. In summary, high mountain trekking is feasible for T1DM patients with good glycemic control and no chronic complications. However, some changes in dietary preferences and an observable rise in glucose levels may occur. This requires an adequate therapeutic response.

The purpose of this study was to investigate the influence of maximal oxygen uptake (VO2 max) on the glycemic changes during low and high intensity exercises in young type 1 diabetic patients. Twenty boys (age: 14.3 &plusmn, 1.6 years, height: 171.0 &plusmn, 11.3 cm, weight, 59.5 &plusmn, 12.8 kg) were divided into low-fit group (LFG, n = 10) and high-fit group (HFG, n = 10). According to the experimental design, participants performed three physical efforts (VO2 max test, mixed aerobic&ndash, anaerobic effort and aerobic effort) on the cycloergometer, during which real-time glycemia was measured. Mixed aerobic&ndash, anaerobic exercise demanded significantly smaller carbohydrate supplementation (0.2 &plusmn, 0.2 g/kg during exercise) than the aerobic test session (0.4 &plusmn, 0.3 g/kg during exercise). Moreover, patients with higher VO2 max had lower tendency for glycemic changes during the aerobic effort. The results of the current study suggest that young type 1 diabetic patients should perform different intensity activities using continuous glycemic monitoring system to avoid acute and chronic complications of the disease.

Purpose: To assess glycemic control and safety of children and adolescents with type 1 diabetes participating in a 2-day football tournament. Methods: In total, 189 children with type 1 diabetes from 11 diabetes care centers, in Poland, participated in a football tournament in 3 age categories: 7–9 (21.2%), 10–13 (42.9%), and 14–17 (36%) years. Participants were qualified and organized in 23 football teams, played 4 to 6 matches of 30 minutes, and were supervised by a medical team. Data on insulin dose and glycemia were downloaded from personal pumps, glucose meters, continuous glucose monitoring, and flash glucose monitoring systems. Results: The median level of blood glucose before the matches was 6.78 (4.89–9.39) mmol/L, and after the matches, it was 7.39 (5.5–9.87) mmol/L (P = .001). There were no episodes of severe hypoglycemia or ketoacidosis. The number of episodes of low glucose value (blood glucose ≤3.9 mmol/L) was higher during the tournament versus 30 days before: 1.2 (0–1.5) versus 0.7 (0.3–1.1) event/person/day, P P Conclusions: Large football tournaments can be organized safely for children with type 1 diabetes. For the majority of children, moderate mixed aerobic–anaerobic effort did not adversely affect glycemic results and metabolic safety.

Continuous glucose monitoring (CGM) systems have revolutionized the treatment and monitoring of diabetes. These devices are recommended for diabetic patients treated with insulin, especially with recurring episodes of hypoglycemia or large circadian variation of glucose levels. CGM allows more effective adjustment of insulin doses to blood glucose trends, resulting in better metabolic control: more time spend in glucose target range, lower time spend in hypoglycemic range, lower glucose variability and improved quality of life of patients and their family members. Real time CGM provides patients not only with continuous information on glucose levels but also alerts for hypo- or hyperglycemic events. Traditional transcutaneous CGM have some limitations, which can be resolved by the system with an implantable sensor. The Eversense CGM is the only long-term implantable rtCGM. The subcutaneous implantation procedure has proved to be simple and uncomplicated. This CGM system can be recommended in particular for patients who, due to their profession and sports discipline, cannot or do not want to use traditional transcutaneous sensors. Further groups are patients with skin complications associated with the use of traditional sensors, people who perceive frequent sensor replacement as a burden or would benefit from on-body vibration alerts. The studies showed that the patients were satisfied with Eversense, and the majority used it several times after the study ended. The main reason for resigning from the next implantation was cost of the device.

In this brief report, we describe the feat of four men with type 1 diabetes mellitus (T1DM) who decided to take part in a mountain ultramarathon in Bieszczady, Poland on May 27, 2016. Before participating in the competition, they asked two diabetologists for a consultation and to assist in diabetic control during the marathon. The aim of the study was to assess the metabolic safety in people with T1DM during extreme physical exertion in a mountain ultramarathon. All subjects were treated with continuous subcutaneous insulin infusion. The marathon route was 82 km, and the sum of the climbs and descents was 3235 and 3055 m, respectively. Diabetologists controlled glucose levels using a glucometer, plasma lactate levels, and ketones in the capillary blood. In addition, they monitored the intake of carbohydrates and fluids. Clinical tests were performed at the three checkpoints (at 32, 49, and 66 km) during the race and after completing the race (at 82 km). This study shows that extreme physical exertion by a person with type 1 diabetes is possible. All subjects avoided severe hypoglycemia by significantly reducing their insulin dose and consuming additional carbohydrates. Such actions, despite the occurrence of hyperglycemia250 mg/dL did not result in ketoacidosis. Safe participation in mountain ultramarathons by people with type 1 diabetes can be achieved if they undertake appropriate physical and diabetologic preparation.

To evaluate the clinical accuracy of a flash glucose monitoring device FreeStyle Libre (FSL) among children with type 1 diabetes in real-world settings during a summer camp.During a summer camp, children with type 1 diabetes (n = 79, aged 8-18 years) were provided with FSLs for 12 days. On days 3, 7, and 11 of the study, they underwent supervised glucose testing at 8 timepoints. Glycemia was estimated by using FSL and measured with a personal glucometer within a period of 2 min. The glucose trend arrows were recorded.The study was completed by 78 children (median: age 12.8 years, diabetes duration 5.8 years, HbA1c 58.5 mmol/mol). Mean absolute relative difference (MARD) between the FSL and the glucometer was 13.5% ± 12.9%. FSL was the most accurate in stable glycemic conditions: MARD 11.4% ± 10.4%, less accurate when glycemia was falling2 mg/(dL·min) [0.111 mmol/(L·min)-MARD 22.6% ± 18.6%; P 0.001 vs. stable conditions] and when the device could not determine the glucose trends (16.5% ± 16.3%, P = 0.01 vs. stable conditions). The FSL demonstrated lower accuracy during the day than the night [MARD 14.9% ± 14% vs. 11.2% ± 10.6%, P 0.0001]. Out of 1655 data pairs of glucometer and FSL, using the Surveillance Error Grid methodology we determined that 80.36% of FSL readings were associated with no clinical risk, 18.73% with slight risk and only one high-risk measurement was detected.FSL is accurate in children, but its accuracy depends on the glucose trend. Results flagged by the rapid fall flag and "trend undetermined" should be verified by blood glucose measurements.

Nowadays, self-management of diabetes is more and more often based on continuous and flash glucose monitoring systems. In addition to measuring current glucose levels, both systems provide blood glucose levels from the past few hours in the form of a graph, as well as an indication of glucose trends via arrows. This information adds a new dimension to the self-management of diabetes, and should result in the modification of diabetes therapy. The paper presents proposals for modifications of treatment decisions based on glucose trends in patients with type 1 diabetes. By considering glucose trends, it is hoped that glycemic variability and numbers of hypoglycemia and hyperglycemia episodes will be reduced.Obecnie samokontrola cukrzycy coraz częściej opiera się na systemach ciągłego monitorowania glikemii oraz monitorowania glikemii metodą skanowania. Oba te systemy, poza aktualną wartością glikemii, dostarczają dwóch ważnych informacji: wyniki glikemii z ostatnich kilku godzin pod postacią wykresu oraz strzałki trendu zmian glikemii. Uwzględnienie tych informacji nadaje nowy wymiar samokontroli cukrzycy i powinno powodować modyfikację terapii cukrzycy. W pracy przedstawiono propozycje modyfikacji decyzji terapeutycznych w zależności od trendów glikemii u pacjentów z cukrzycą typu 1 leczonych metodą funkcjonalnej intensywnej insulinoterapii. Uwzględnienie trendów w podejmowaniu decyzji terapeutycznych powinno pozwolić na zmniejszenie zmienności glikemii oraz liczby epizodów hipo- i hiperglikemii.

Wstęp. Pacjenci z cukrzycą typu 1, bez szczególnych przeciwwskazań, powinni być zachęcani do dużej aktywności fizycznej. Jedną z form tego rodzaju aktywności mogą być wyprawy górskie. Optymalizacja kontroli metabolicznej w trakcie intensywnego wysiłku w warunkach górskich ciągle pozostaje jednak dużym wyzwaniem. Celem niniejszej pracy było poszukiwanie związków między ocenianymi w trakcie wyprawy górskiej poziomem zmęczenia (10-stopniowa skala Borga) a stężeniem mleczanów, średnią glikemią w samokontroli (dane z ankiety i prowadzonego dzienniczka samokontroli) oraz deklarowaną wcześniejszą aktywnością fizyczną grupy chorych z cukrzycą typu 1. Materiał i metody. W wyprawie górskiej na wysokość 3000 m. n.p.m. w Alpach (Similaun Hütte 3019 m. n.p.m., Alpy Otzelskie) udział wzięło 19 osób (w tym 2 kobiety) chorych na cukrzycę typu 1 w wieku średnio 31 lat, ze wskaźnikiem masy ciała (BMI) wynoszącym 23,5 kg/m2, średnim odsetkiem HbA1c 6,5% (5,4-7,8%), chorujących średnio od ponad 12 lat, bez późnych powikłań cukrzycowych. Większość była leczona za pomocą osobistej pompy insulinowej (2 osoby - wielokrotne wstrzyknięcia insuliny). Wszyscy uczestnicy wypełniali w dniu wyprawy autorski kwestionariusz dotyczący uprzedniej aktywności fizycznej, pobierano im krew włośniczkową w celu oznaczenia stężenia mleczanów w 4 punktach czasowych: na początku wyprawy, na 2500 m n.p.m., na 3019 m. n.p.m. oraz po powrocie do autokaru. Do oceny związku między zmiennymi zastosowano korelację nieparametryczną Spearmana. Analizy statystyczne wykonano w programie R wer. 3.2.3. Dodatkowo uwzględniono ocenę własną aktywności chorych i odczuwanego przez nich zmęczenia (w skali Borga). Wyniki. Początkowy, końcowy oraz średni poziom zmęczenia według skali Borga korelował negatywnie z deklarowaną aktywnością fizyczną w ostatnim półroczu (od braku aktywności aż do dużej aktywności, 8 stopni), odpowiednio p = 0,02, r = -0,65; p = 0,02, r = -0,54; p = 0,01, r = -0,61. Ponadto średni poziom zmęczenia (3,6 w skali Borga) korelował ze średnim stężeniem mleczanów. Nie stwierdzono istotnych korelacji pomiędzy poziomem zmęczenia a średnimi glikemiami w dniu wyprawy. Wnioski. Przed całodniową wyprawą górską chorzy z T1DM prowadzący siedzący tryb życia powinni poprawić swoją sprawność fizyczną. Pacjenci z cukrzycą typu 1 wykonujący regularnie ćwiczenia fizyczne wykazują lepszą adaptację ustrojową do wysiłku w warunkach wypraw wysokogórskich Introduction. There is a general agreement that regular physical activity should be recommended for patients with type 1 diabetes mellitus (T1DM), as it positively affects blood pressure and lipid levels and diminishes the risk of T1DM complications. Aim of this study was to search for a correlation between lactate level, degree of fatigue, and patient-reported physical activity in T1DM patients while trekking up to 3000 meters above sea level (masl). Material and methods. Study group consisted of 19 participants (2 women) in mean age of 31 years with T1DM who summited 3000 masl in Alps. Clinical information was taken from patient questionnaire, personal insulin pumps and blood analysis (glucose, lactate level). Additionally patient self-assessment of physical activity and fatigue (Borg scale) was used. Results. Declared physical activity in the last six months correlated with the initial, second, and final ratings of fatigue according to the Borg Scale during the expedition day, p = 0.02, r = -0.65; p = 0.02, r = -0.54; p = 0.01, r = -0.61, respectively. Blood lactate levels tended to increase with duration of exercise and altitude. Also, the average level of lactate on the expedition correlated with the average level of fatigue (p = 0.02, r = 0.57). Conclusion. Before undertaking day-long mountain trekking, T1DM patients with a sedentary lifestyle should improve their fitness. The measurement of lactate levels can be a useful tool to predict fatigue as measured with the Borg Scale.

Wstęp. Pacjenci z cukrzycą typu 1, bez szczególnych przeciwwskazań, powinni być zachęcani do dużej aktywności fizycznej. Jedną z form tego rodzaju aktywności mogą być wyprawy górskie. Optymalizacja kontroli metabolicznej w trakcie intensywnego wysiłku w warunkach górskich ciągle pozostaje jednak dużym wyzwaniem. Celem niniejszej pracy było poszukiwanie związków między ocenianymi w trakcie wyprawy górskiej poziomem zmęczenia (10-stopniowa skala Borga) a stężeniem mleczanów, średnią glikemią w samokontroli (dane z ankiety i prowadzonego dzienniczka samokontroli) oraz deklarowaną wcześniejszą aktywnością fizyczną grupy chorych z cukrzycą typu 1. Materiał i metody. W wyprawie górskiej na wysokość 3000 m. n.p.m. w Alpach (Similaun Hütte 3019 m. n.p.m., Alpy Otzelskie) udział wzięło 19 osób (w tym 2 kobiety) chorych na cukrzycę typu 1 w wieku średnio 31 lat, ze wskaźnikiem masy ciała (BMI) wynoszącym 23,5 kg/m2, średnim odsetkiem HbA1c 6,5% (5,4-7,8%), chorujących średnio od ponad 12 lat, bez późnych powikłań cukrzycowych. Większość była leczona za pomocą osobistej pompy insulinowej (2 osoby - wielokrotne wstrzyknięcia insuliny). Wszyscy uczestnicy wypełniali w dniu wyprawy autorski kwestionariusz dotyczący uprzedniej aktywności fizycznej, pobierano im krew włośniczkową w celu oznaczenia stężenia mleczanów w 4 punktach czasowych: na początku wyprawy, na 2500 m n.p.m., na 3019 m. n.p.m. oraz po powrocie do autokaru. Do oceny związku między zmiennymi zastosowano korelację nieparametryczną Spearmana. Analizy statystyczne wykonano w programie R wer. 3.2.3. Dodatkowo uwzględniono ocenę własną aktywności chorych i odczuwanego przez nich zmęczenia (w skali Borga). Wyniki. Początkowy, końcowy oraz średni poziom zmęczenia według skali Borga korelował negatywnie z deklarowaną aktywnością fizyczną w ostatnim półroczu (od braku aktywności aż do dużej aktywności, 8 stopni), odpowiednio p = 0,02, r = -0,65; p = 0,02, r = -0,54; p = 0,01, r = -0,61. Ponadto średni poziom zmęczenia (3,6 w skali Borga) korelował ze średnim stężeniem mleczanów. Nie stwierdzono istotnych korelacji pomiędzy poziomem zmęczenia a średnimi glikemiami w dniu wyprawy. Wnioski. Przed całodniową wyprawą górską chorzy z T1DM prowadzący siedzący tryb życia powinni poprawić swoją sprawność fizyczną. Pacjenci z cukrzycą typu 1 wykonujący regularnie ćwiczenia fizyczne wykazują lepszą adaptację ustrojową do wysiłku w warunkach wypraw wysokogórskich Introduction. There is a general agreement that regular physical activity should be recommended for patients with type 1 diabetes mellitus (T1DM), as it positively affects blood pressure and lipid levels and diminishes the risk of T1DM complications. Aim of this study was to search for a correlation between lactate level, degree of fatigue, and patient-reported physical activity in T1DM patients while trekking up to 3000 meters above sea level (masl). Material and methods. Study group consisted of 19 participants (2 women) in mean age of 31 years with T1DM who summited 3000 masl in Alps. Clinical information was taken from patient questionnaire, personal insulin pumps and blood analysis (glucose, lactate level). Additionally patient self-assessment of physical activity and fatigue (Borg scale) was used. Results. Declared physical activity in the last six months correlated with the initial, second, and final ratings of fatigue according to the Borg Scale during the expedition day, p = 0.02, r = -0.65; p = 0.02, r = -0.54; p = 0.01, r = -0.61, respectively. Blood lactate levels tended to increase with duration of exercise and altitude. Also, the average level of lactate on the expedition correlated with the average level of fatigue (p = 0.02, r = 0.57). Conclusion. Before undertaking day-long mountain trekking, T1DM patients with a sedentary lifestyle should improve their fitness. The measurement of lactate levels can be a useful tool to predict fatigue as measured with the Borg Scale.

High-altitude trekking can expose people to extreme environmental conditions, like low temperatures and hypobaric hypoxia. Such extreme conditions make it more difficult for people with type 1 diabetes mellitus (T1DM) to maintain glycemic control. Intensive blood glucose monitoring using either glucose meters or continuous systems is imperative in these cases. In this observational study, we report metabolic control of T1DM patients and the performance of various insulin pumps at high altitude. All 19 patients with T1DM included in this study participated in the final step of the "5000 meters above sugar level" initiative, which involved trekking Damavand Mountain to an altitude of 5670 meters above sea level. We found that all pump models worked well without any disruption and no cases of diabetes decompensation or severe hypoglycemia occurred. Therefore, healthy, physically fit, and experienced individuals with T1DM should not be discouraged from participating in mountain trekking activities, as modern personal insulin pumps work well at high altitudes.