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Exercise in type 1 diabetes

Reading time: 3 min. 

Webinar for physicians and nurses treating type 1 diabetes

Exercising is important, but managing T1D before, during and after exercise is often challenging. It requires knowledge, different insulin doses and nutritional adjustments based on the form and intensity of the exercise. Loss of glycaemic control and fear of hypoglycaemia are also possible barriers where individuals with T1D need help. Therefore, HCPs and patients with T1D need to fully understand the effects of exercise on glucose control and further incorporate exercise as part of diabetes management.

Meet the speakers

Dr. Peter Adolfsson

Senior Physician at the Hospitals of Halland, Kungsbacka and Halmstad

Dr. Elina Pimïa

Head of Tampere Diabetes Outpatient Clinic and Chief Physician in the Finnish Diabetes Association

Prof. Bastiaan de Galan

Medical Specialist and Professor of Diabetology at the Maastricht University Medical Centre and the Radboud University Medical Centre

Kristina Grimstad Nordstrand

Powerlifting champion
with type 1 diabetes

Key takeaways

  • Diabetes or hypoglycaemia should not be a barrier to start and continue exercise
  • HCPs should be educated and give personalized support related to exercise to people with T1D
  • Technology helps in diabetes management with proper knowledge and training 

Evidences: T1D and exercise

Reduced mortality rate 

  • Moving from sedentary to physical activity thrice a week seems to reduce the mortality risk more than what happens with reducing HbA1c1

Competitive athlete

  • Being a competitive athlete with T1D can be challenging, but several strategies can be implemented to help glycaemic management (Fig 2)7

Personalised diabetes management 

  • Each type of exercise has different outcome on glucose trend and requires personalized diabetes management2,3

Exercise management

  • Variability is observed in blood glucose responses to different forms of exercise in people with T1D (Fig 1)4

ISPAD exercise guidelines
 

  • The guidelines cover many broad aspects of exercise and diabetes for children and adolescents with T1D and T2D3
  • Describes insulin pump/MDI insulin adjustments and nutrition recommendations for before, immediately after and overnight for aerobic, mixed and anaerobic activity
  • Guidance on AID systems and exercise

Supporting materials

JDRF

GNL

YouTube

Sports & Diabetes

Preventing hypos

  • CGM devices can provide intermittently scanned or real-time glucose data before, during and after exercise5
  • Sensor glucose value should be interpreted together with the corresponding trend arrow

Evidence-based recommendations 

According to 37 evidence-based clinical practice recommendations in AACE guideline6:

  • CGM is recommended to everyone on insulin
  • Lifestyle and other factors should be considered
  • Real-time CGM is easier for anyone doing exercise

Kristina, a power-lifting athlete living with T1D

Kristina Grimstad Nordstrand is a powerlifting champion living with diabetes for around 15 years now, who combines exercise with diabetes management. In 2014, she started her powerlifting journey which eventually helped in stabilising her blood glucose levels.

 Needs of the clinics 

  • Deeper knowledge on T1D and exercise among clinicians and nurses 
  • Clear personalized guidance on what to do before, during and after 
  • Motivation and understanding of the benefits of exercise 

Benefits of exercise 

  • Positive benefits to overall health
  • Less glycaemic variability
  • Improved quality of life

Tools & apps

Topics of the expert panel discussion

Aerobic/mixed/anaerobic exercises have different effects on glucose levels and require personalized diabetes management

Sudden drop in blood glucose level

Interruption in workout

Availability of food instantly

Hypoglycaemia during aerobic exercise

Adrenaline and stress

Hyperglycaemia during exercise

Planning food/meals and timing

Insulin treatment before and after exercise

Hypoglycaemia management

Insulin 

  • A wide range of insulin adjustment and nutrition strategies can be combined for optimal glucose management and to prevent exercise induced-hypoglycaemia3
  • Duration of exercise and planning is important

Technology

  • Managing glucose levels when exercising might be challenging even with hybrid closed-loop pumps as exercise target optimally needs to be set well in advance of aerobic exercise3
  • CGM and especially real-time CGM has many benefits when exercising but it is also important to understand the limitations and need of understanding glucose value5

Clinicians should discuss with patients about the different types of exercise and their effect on glucose management, and give personalized advice and encourage people with T1D to exercise 

Fig 1. Variability in blood glucose responses to different forms of exercise in people with T1D

Fig 2. The competitive athlete with T1D

References

  1. Reddigan JI, et al. Diabetologia. 2012;55(3):632-635;
  2. Chetty T, et al. Front Endocrinol (Lausanne). 2019;10:326;
  3. Adolfsson P, et al. Pediatr Diabetes. 2022;23(8):1341-1372; https://pubmed.ncbi.nlm.nih.gov/36537529/;
  4. Riddell MC, et al. Lancet Diabetes Endocrinol. 2017;5(5):377-390;
  5. Moser O, et al. Pediatr Diabetes. 2020;21(8):1375-1393; https://pubmed.ncbi.nlm.nih.gov/33047481/
  6. Grunberger G, et al. Endocr Pract. 2021;27(6):505-537;
  7.  Riddell MC, et al. Diabetologia. 2020;63(8):1475-1490; https://pubmed.ncbi.nlm.nih.gov/32533229/.

Abbreviations

AID, automated insulin devises; CGM, continuous glucose monitoring; GNL, glucose never lies; HbA1c, glycated haemoglobin; HCPs, healthcare professionals; ISPAD, International Society for Pediatric and Adolescent Diabetes; JDRF, Juvenile Diabetes Research Foundation; MDI, multiple daily injection; T1D, type 1 diabetes; T2D, type 2 diabetes.

MAT-DK-2400109