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Type 1 diabetes and exercise benefits and barriers when exercising

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The complexities of working out with T1D

Welcome to this dedicated section providing valuable insights into the risks and benefits of exercise for patients with type 1 diabetes (T1D). As trusted medical experts, understanding the complexities of T1D management during physical activity is crucial to optimize patient outcomes. Explore evidence-based information on how exercise impacts blood glucose levels, insulin requirements, and overall health in T1D patients. Gain valuable knowledge and practical guidance to support your patients in achieving a balanced and active lifestyle while effectively managing their condition.

Meet Frederik

Sex: Male 

Age: 24 years

Occupation: Digital Marketing Specialist 

Family: Lives with his partner in Oslo 

Because of his recent diagnosis with type 1 diabetes, the thought of starting an exercise routine seems daunting and scary to Frederik. He is anxious to start working out because of the possible effects on his blood glucose level and the fear of potential complications weighs heavily on his mind. 

What are the benefits of Frederik initiating an exercise routine as a type 1 diabetic?


Exercise is a key pillar of metabolic health in people with diabetes, and benefits of working out with type 1 diabetes include:

  • Improved Physical Fitness and Strength: Engaging in regular physical exercise can lead to significant improvements in physical fitness and strength for patients with Type 1 Diabetes. Studies, such as Chimen et al. (2012), have shown that exercise can enhance cardiovascular endurance, muscular strength, and overall physical performance, contributing to better functional capacity and quality of life.
     
  • Reduced Insulin Requirements: Physical exercise has the remarkable ability to increase insulin sensitivity in individuals with Type 1 Diabetes, leading to reduced insulin requirements. As highlighted in the study by Bai et al. (2021), regular exercise can help patients achieve better glycemic control, potentially lowering the reliance on exogenous insulin and improving diabetes management.
     
  • Reduced Cardiovascular Risk Factors: Incorporating exercise into the daily routine of Type 1 Diabetes patients can positively impact cardiovascular risk factors. Research suggests that exercise can lower blood pressure, improve lipid profiles, and reduce the risk of obesity, all of which contribute to a healthier cardiovascular profile and a reduced risk of heart-related complications.
     
  • Associated with Reduced Risk of Microvascular Complications: Evidence from Chimen et al. (2012) and other studies indicates that engaging in regular physical exercise is associated with a decreased risk of microvascular complications in Type 1 Diabetes patients. These complications, such as retinopathy, neuropathy, and nephropathy, can be mitigated by the positive effects of exercise on glycemic control and overall vascular health.
     
  • Reduced Cardiovascular Disease and Mortality: Exercise has been shown to have a protective effect against cardiovascular disease and mortality in individuals with Type 1 Diabetes. By improving cardiovascular health, exercise can reduce the risk of heart attacks, strokes, and other cardiovascular events, ultimately leading to improved longevity and well-being.
     
  • Greater Satisfaction with Life and Well-being: Physical exercise is not only beneficial for physical health but also for mental and emotional well-being. Studies have demonstrated that regular exercise is associated with increased satisfaction with life and overall well-being in Type 1 Diabetes patients. Engaging in enjoyable physical activities can boost mood, reduce stress, and improve mental health.
     
  • Improved Cognitive Function: Research indicates that exercise may positively influence cognitive function in individuals with Type 1 Diabetes. Regular physical activity has been associated with enhanced memory, attention, and overall cognitive performance, providing additional benefits beyond glycemic control and cardiovascular health.

 

In conclusion, physical exercise offers a myriad of benefits for patients with Type 1 Diabetes, ranging from improved physical fitness and reduced insulin requirements to enhanced cardiovascular health and greater well-being. Emphasizing the importance of regular exercise in diabetes management can significantly improve patients' overall health and quality of life.

What is Frederik nervous about?

Frederik is concerned about some of the many possible barriers that people with type 1 diabetes are facing when it comes to physical exercise. 

Key barriers to physical activity identified by a survey of 100 adults with type 1 diabetes

Factors associated with these barriers included a poor understanding of insulin pharmacokinetics and strategies to prevent hypoglycemia

  • Fear of hypoglycemia
     
  • Work schedule
     
  • Loss of control over diabetes
     
  • Low fitness level

 

In Frederik’s case, he has a very busy work life and was recently diagnosed with type 1 diabetes, therefore, he is not confident in how his body will react, as he is not very educated on the topic - yet. 

According to the study by Brazeu et al. (2018), worries about one's work schedule can be a significant barrier for individuals with type 1 diabetes when it comes to exercising. These are often rooted in concerns about the unpredictable and demanding nature of work schedules, which may pose as a challenge in managing blood glucose levels and adhering to a consistent exercise routine.

Several key factors contribute to this barrier:

Time constraints

Individuals with type 1 diabetes who have unpredictable work schedules may find it difficult to set aside dedicated time for exercise. Work demands, long hours, and irregular shifts can lead to time constraints, leaving limited opportunities for physical activity.

Glycemic control challenges

Managing blood glucose levels during and after exercise is crucial for individuals with type 1 diabetes. Fear of work schedule disruptions can make it challenging to predict when exercise can be incorporated, potentially leading to fluctuations in blood glucose levels and impacting overall glycemic control.

Inconsistent meal timing

Irregular work schedules may lead to inconsistent meal times, making it difficult for individuals with type 1 diabetes to plan and time their pre-exercise meals and insulin dosages effectively. This can result in blood glucose fluctuations during exercise and afterward.

Stress and fatigue 

Unpredictable work schedules can lead to increased stress and fatigue, making it challenging for individuals with type 1 diabetes to find the energy and motivation to engage in regular physical activity.

Lack of routine

Regularity and routine are essential for successful diabetes management. Fear of work schedule disruptions may hinder the establishment of a consistent exercise routine, which is critical for reaping the long-term benefits of physical activity.

Fear of hypoglycemia

Individuals with type 1 diabetes may fear experiencing hypoglycemic episodes during or after exercise, especially if their work schedule makes it difficult to predict meal times and insulin dosages accurately.

How can we address the fear of work schedule barriers?

  • Identify pockets of available time for exercise within their work schedule.
     
  • Adjust insulin dosages and meal timings to accommodate changing work hours and exercise routines.
     
  • Educate patients on managing blood glucose levels before, during, and after exercise to reduce the risk of hypoglycemia and hyperglycemia.
     
  • Encourage the use of wearable glucose monitoring devices to enhance awareness and control of blood glucose levels throughout the day.
     
  • Explore different types of exercises that can be easily incorporated into a busy work schedule, such as short bursts of activity or desk exercises.
     
  • By addressing the fear of work schedule barrier and providing practical solutions, healthcare professionals can empower individuals with Type 1 Diabetes to embrace regular exercise as an essential component of their diabetes management plan.

Deep dive into the other barriers

Learn more about the common concerns of people with T1D engaging, or planning to engage in exercise, as well as strategies for supporting them in addressing these concerns. 

Fear of hypoglycemia

Hypoglycemia, or low blood glucose levels, is a common concern among individuals with type 1 diabetes during exercise. Fear of experiencing hypoglycemia can act as a significant barrier to engaging in physical activity. Hypoglycemia can occur due to increased insulin sensitivity during exercise, which may lead to an excessive drop in blood glucose levels. This fear may deter individuals from participating in exercise, as they worry about the potential consequences of low blood sugar, such as dizziness, confusion, and loss of consciousness.

Addressing this barrier:

Educate patients about strategies to prevent and manage hypoglycemia during exercise, such as adjusting insulin dosages, choosing appropriate pre-exercise snacks, and monitoring blood glucose levels before, during, and after physical activity. Emphasize the importance of carrying fast-acting carbohydrates during exercise to treat hypoglycemia promptly.

Loss of control over diabetes

Some individuals with type 1 diabetes may perceive exercise as a disruptive factor that can lead to a loss of control over their diabetes management. The fear of destabilizing blood glucose levels or experiencing unpredictable responses to exercise can discourage them from being physically active. This sense of loss of control over diabetes can create anxiety and apprehension around exercise, resulting in reduced motivation to engage in physical activity.

Addressing this barrier:

Provide education and support to help individuals understand how exercise can enhance diabetes management. Work with patients to create personalized exercise plans that align with their diabetes treatment goals and preferences. Encourage self-monitoring of blood glucose levels and facilitate a proactive approach to adjustments in insulin dosages and carbohydrate intake during exercise.

Low fitness level

Individuals with low fitness levels may find the idea of starting an exercise routine overwhelming and daunting. The fear of not being able to keep up with the physical demands of exercise, along with concerns about potential complications, can be significant barriers. The fear of discomfort or inadequacy during exercise may lead to avoidance of physical activity altogether.

Addressing this barrier:

Start with a gradual and progressive exercise program tailored to each individual's fitness level. Incorporate activities that are enjoyable and achievable, such as walking, swimming, or cycling. Focus on building confidence and self-efficacy by setting realistic goals and celebrating small achievements along the way.

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