Maintenance of Glucose Control in Patients With Type 1 Diabetes During Acute Mental Stress by Riding High-Speed Rollercoasters
- Peter Wiesli, MD12,
- Pierre-Alexandre Krayenbühl, MD3,
- Oranna Kerwer1,
- Burkhardt Seifert, PHD4 and
- Christoph Schmid, MD1
- 1Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital of Zurich, Zurich, Switzerland
- 2Medizinische Klinik, Endokrinologie und Diabetologie Kantonsspilal Frauenfeld, Frauenfeld, Switzerland
- 3Department of Internal Medicine, Medical Policlinic, University Hospital of Zurich, Zurich, Switzerland
- 4Department of Biostatistics, University of Zurich, Zurich, Switzerland
- Address correspondence and reprint requests to Peter Wiesli, MD, Kantonsspital Frauenfeld, Medizinische Klinik, Endokrinologie und Diabetologie, Frauenfeld, Switzerland. E-mail: peter.wiesli{at}stgag.ch
Patients with diabetes and health care providers are often confronted with questions concerning psychological stress as a possible reason for glucose excursions; chronic psychosocial stress has been associated with higher levels of A1C and poor adherence to treatment (1,2). Few studies have addressed the effect of acute psychological stress on glucose concentrations in patients with type 1 diabetes, showing no or only minor effects, such as an increase in insulin resistance and slightly delayed decreases in glucose concentrations following moderate stress in the postprandial period (3–5). Since many patients and caregivers have challenged this view, we asked patients with type 1 diabetes to monitor glucose concentrations during a strongly stressing experiment.
RESEARCH DESIGN AND METHODS—
A total of 20 patients with type 1 diabetes (all on intensified insulin treatment) were recruited from a recent study investigating the effect of acute moderate psychosocial stress on glucose concentrations (5). Patients were exposed to acute mental stress by riding on two different rollercoasters within 15 min. The first rollercoaster was a steel coaster starting from a height of 240 feet and reaching a speed of 79 mph with four positive Gs and the second an indoor coaster in absolute darkness. Blood pressure (by an ambulatory blood pressure monitoring device), heart rate (by 24-h electrocardiogram), and salivary cortisol were monitored during a preceding control day without stress application and on the stress testing day. Glucose concentrations were monitored in 5-min intervals by the Medtronic MiniMed continuous glucose monitoring system (CGMS). Capillary blood glucose concentrations were determined in 15- to 30-min …
