Advertisement

Impaired whole-body heat loss in type 1 diabetes during exercise in the heat: a cause for concern?

  • Sean R. Notley
  • Martin P. Poirier
  • Jane E. Yardley
  • Ronald J. Sigal
  • Glen P. KennyEmail author
Research Letter

To the Editor: Although regular exercise is recommended for type 1 diabetes management [1], exercise in hot conditions may pose a health concern [2]. This is primarily because even patients without neuropathy display impaired cutaneous vasodilation [3] and sweating [4], especially during vigorous exercise [5], which may increase dry heat gain by reducing blood-borne heat delivery to the skin and attenuate evaporative heat loss. The resulting reductions in total heat loss (dry + evaporative heat loss) can elevate heat illness risk by exacerbating body heat storage and the subsequent increase in body core temperature [6]. However, since those previous studies [3, 4, 5] measured cutaneous vasodilation and sweating at only a handful of small surfaces (~1–3 cm2) on the body, it remains unclear whether such impairments translate into clinically meaningful decrements in whole-body total heat loss (i.e. from all body surfaces). We therefore used our unique direct air calorimeter (the gold...

Keywords

Body core temperature Calorimetry Diabetes Exercise Heat stress Thermoregulation 

Notes

Acknowledgements

We thank S. Dervis, formerly from the Human and Environmental Physiology Research Unit (www.HEPRU.ca), who performed data collection.

Contribution statement

SRN and GPK conceptualised and designed the research; MPP performed data collection. SRN performed statistical analysis, prepared figures and drafted manuscript; SRN, GPK, JEY and RJS interpreted results; all authors edited, revised and approved the final version. GPK is the guarantor of this work and, as such, had full access to all the data and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

This project was supported by the Canadian Institutes of Health Research (grant no. 286363; funds held by GPK and RJS). SRN is supported by a Postdoctoral Fellowship from HEPRU. MPP was supported by an NSERC Canada Alexander Graham Bell Graduate Scholarship (CGS-D). GPK is supported by a University of Ottawa Research Chair.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

References

  1. 1.
    American Diabetes Association (2019) 5. Lifestyle management: standards of medical care in diabetes—2019. Diabetes Care 42(Suppl 1):S46–S60.  https://doi.org/10.2337/dc19-S005 CrossRefGoogle Scholar
  2. 2.
    Yardley JE, Stapleton JM, Carter MR, Sigal RJ, Kenny GP (2013) Is whole-body thermoregulatory function impaired in type 1 diabetes mellitus? Curr Diabetes Rev 9(2):126–136PubMedGoogle Scholar
  3. 3.
    Wilson SB, Jennings PE, Belch JJ (1992) Detection of microvascular impairment in type I diabetics by laser Doppler flowmetry. Clin Physiol 12(2):195–208.  https://doi.org/10.1111/j.1475-097X.1992.tb00306.x CrossRefPubMedGoogle Scholar
  4. 4.
    Hoeldtke RD, Bryner KD, Hoeldtke ME et al (2006) Sympathetic sudomotor disturbance in early type 1 diabetes mellitus is linked to lipid peroxidation. Metabolism 55(11):1524–1531.  https://doi.org/10.1016/j.metabol.2006.06.023 CrossRefPubMedGoogle Scholar
  5. 5.
    Carter MR, McGinn R, Barrera-Ramirez J, Sigal RJ, Kenny GP (2014) Impairments in local heat loss in type 1 diabetes during exercise in the heat. Med Sci Sports Exerc 46(12):2224–2233.  https://doi.org/10.1249/MSS.0000000000000350 CrossRefPubMedGoogle Scholar
  6. 6.
    Kenny GP, Wilson TE, Flouris AD, Fujii N (2018) Heat exhaustion. Handb Clin Neurol 157:505–529CrossRefGoogle Scholar
  7. 7.
    Kenny GP, Notley SR, Gagnon D (2017) Direct calorimetry: a brief historical review of its use in the study of human metabolism and thermoregulation. Eur J Appl Physiol 117(9):1765–1785.  https://doi.org/10.1007/s00421-017-3670-5 CrossRefPubMedGoogle Scholar
  8. 8.
    Gibbons CH, Illigens BM, Wang N, Freeman R (2009) Quantification of sweat gland innervation: a clinical-pathologic correlation. Neurology 72(17):1479–1486.  https://doi.org/10.1212/WNL.0b013e3181a2e8b8 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sean R. Notley
    • 1
  • Martin P. Poirier
    • 1
  • Jane E. Yardley
    • 2
    • 3
  • Ronald J. Sigal
    • 1
    • 4
    • 5
    • 6
    • 7
  • Glen P. Kenny
    • 1
    • 7
    Email author
  1. 1.Human and Environmental Physiology Research Unit, School of Human Kinetics, 125 University, Room 367, Montpetit HallUniversity of OttawaOttawaCanada
  2. 2.Augustana FacultyUniversity of AlbertaCamroseCanada
  3. 3.Alberta Diabetes InstituteEdmontonCanada
  4. 4.Department of MedicineUniversity of CalgaryCalgaryCanada
  5. 5.Department of Community Health SciencesUniversity of CalgaryCalgaryCanada
  6. 6.Department of Cardiac SciencesUniversity of CalgaryCalgaryCanada
  7. 7.Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada

Personalised recommendations