I’ve talked about this a few times on this blog, but for those of you who don’t know, I’ve bending research with type 1 diabetes and exercise since my Junior year of Undergrad. And a lot of people ask why that’s important… Well, for one, bold question that I respect. But also, of course much of the money that is given towards T1D is going towards finding a cure. And I do FULLY believe that a cure will be found in my life time, and probably in the next 10 years or so. But for the time being, and for the time of transition for people who won’t be able to get whatever said treatment for a cure may be, how can we make T1D better? And I believe a big part of that is exercise.
I did my research in undergrad looking at the onset of lactate threshold in type 1 diabetics versus non-diabetics. Lactate is a byproduct in energy production and is typically created more quickly than it is utilized (causing a sharp increase) when the exercise is at a higher intensity or shifting to a more anaerobic type of exercise. If the body is metabolizing correctly, and how we have assumed it does, this is more carbohydrate utilization. In my research, we found a significant difference in the timing of the onset of lactate threshold in people with type 1 diabetes versus people without diabetes. Meaning, people with type 1 diabetes were hitting their lactate threshold significantly earlier in a person without diabetes even when matched for demographics.
So I came to Wake Forest and have had the pleasure and opportunity to do a follow-up study for my thesis. My study now will be analyzing lactate as well, but will be focusing on what is called RER, or Respiratory Exchange Ratio. RER can be an indicator of what fuel source is being utilized for energy. The theoretical range for RER is 0.70-1.00, though many people have a resting RER of about 0.80 and far exceed 1.0 when participating in high intensity exercise. The lower end of that range indicates more fat utilization for energy whereas the higher end of that range indicates carbohydrates being utilized for energy. So why I care what energy source is being used? Because based on my previous study results, lactate being produced significantly earlier, it may be that the body is perceiving higher intensity exercise when in reality it is not that high intensity, or the body may not be metabolizing carbohydrates as a person without diabetes. The rate at which RER increases, as well as obtaining perceived exertion measures, can help us differentiate between those two options. Ultimately this can help us better prescribe exercise for a population that has a much better mortality rate when exercise is included in daily life.
I was a little worried going into my thesis because there hasn’t been much research on type 1 diabetes. Especially type 1 diabetes and exercise. Much more of the research has been focused on type 2 diabetes. I was ECSTATIC in October when I re-researched the epidemiology and more qualitative studies for type 1 diabetes and the SEARCH study has been going through multiple publications, shining light on the fact that TYPE 1 DIABETES IS NOT JUST GENETIC!! This research is opening the door for several others studies as well which is a w e s o m e. So stoked.
But what does that mean for me? Will I always do type 1 diabetes research?
I’ve been talking with a few PhD programs over the past several months, and it took me a while, but I’ve finally figured out exactly what I’m wanting out of pursuing another degree. And like I said before, there aren’t many people doing type 1 diabetes research.. especially with exercise. Most of that research is actually not evening done in the US. And I’m not willing to commit a 4-5 year program to a very specific disease if it’s not in an over-arching field that I love.
I had a phone interview with a school a couple of weeks ago and the professor I was talking with, like pretty much every other, was looking at my CV and said, “Well we don’t really do any type 1 diabetes research. None at all or anything really like it, is that going to be okay?” Because I have two studies where I’m at least a student Co-PI, so two of my major highlights on my CV are centered around T1D research. And my response felt so natural.. to say, “Yes sir, I completely understand that going into this program. Not many people are doing that research and I don’t want to just now be beginning my career and trying to focus on a disease that I 110% believe will have a cure by the time I get my first job as a professor somewhere, then I’d be out of funding and questions.”
Asking questions and being involved with JDRF will ALWAYS be a part of my life. And worst case scenario, there is no cure in 10 years and I still have all the tools to perform the research to answer more questions revolving around T1D. So yeah, a big part of my life will always revolve around type 1 diabetes, maybe even more of my research, but I’m SO confident that there will be a cure while I’m still working that I’m not willing to bet my career on it.
Cheers to that and turning Type One into Type None,
HP