In Reply to Dr Lankford

To the Editor:

We read with enthusiasm the letter from Dr Lankford ¹ in response to our recently published letter to the editor “Ultraendurance athletes with type 1 diabetes: Leadville 100 experience.” ² We are pleased that our findings have started to generate discussion among clinicians and researchers. As Dr Lankford mentioned in his letter, there is a lack of specific guidelines for endurance athletes with type 1 diabetes mellitus (DM1). ¹ Anecdotally, most of our athletes with DM1 did not use insulin pumps. Although we had glucose monitoring capabilities at our medical aid stations, most of our athletes with DM1 used their own glucose monitors. Unfortunately, we are unable to answer any other specific questions raised by Dr Lankford owing to the retrospective nature of our study.

We hope this reply has made it clear that until we have large-scale prospective studies, an individualized and well-thought-out plan designed and reviewed by the athletes with DM1, the athletes’ physicians, and the race medical team should be used to achieve optimal glycemic control during these long races. In addition to the standard medical alert bracelets, we recommend using medical wristbands for each athlete highlighting the information about pertinent medical conditions, medications, and allergies. ³