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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
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
Direct integration of CGM with smartwatch instead of transferring via smartphone
Dexcom offers direct integration with Apple Watch on the G7
In AppEx, a sensor sends respective values to the app and an alarm is triggered in critical situations signalling the amount of carbs or insulin needed
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
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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/.
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-2300285 V.0 May 2023
MAT-DK-2400109