Exercise‐induced hypoglycaemia in type 1 diabetes

Abstract

Exercise is a key component for the management of type 1 diabetes mellitus (T1D) and is associated with reduced risk of cardiovascular disease, decreased daily insulin requirements and improved quality of life. Owing to these benefits, people with T1D are recommended to undertake regular physical activity, 150 min per week for adults and 60 min per day for children and adolescents. Despite the recommendations, many people do not meet these targets. One of the commonly cited barriers to exercise is fear of hypoglycaemia along with limited knowledge of effective preventative strategies. Hypoglycaemia can be difficult to predict, and symptoms are often masked during exercise or stress of competition. For athletes with T1D, hypoglycaemia can also limit sporting success. Hypoglycaemia before an event increases the risks of hypoglycaemia during competition and can reduce performance. To avoid hypoglycaemia, people with T1D may avoid exercise altogether or consume excessive amounts of carbohydrates, which mitigates many of the health benefits of exercise. Increased understanding of approaches to prevent or manage hypoglycaemia is therefore important to help increase levels of physical activity in people with T1D and to support athletes with T1D to compete at the highest level. This review outlines the prevalence of exercise-related hypoglycaemia, its underlying physiology and the strategies that can be used to prevent and manage exercise-induced hypoglycaemia in T1D. Our hope is that this knowledge will be used by people with T1D and their clinicians to find individual approaches to manage exercise-related hypoglycaemia.

No more hypoglycaemia on days with physical activity and unrestricted diet when using a closed‐loop system for 12 weeks: A post hoc secondary analysis of the multicentre, randomized controlled Diabeloop WP7 trial

“…Various approaches have been used to prevent or manage hypoglycaemia, and help people with T1D to engage in safe and regular PA 2‐4 . These include education concerning the timing and type of PA 2,4 .…”

“…A meta‐analysis of 27 randomized controlled trials (RCTs) by Weisman et al 1 showed that closed‐loop (CL) artificial pancreas systems allow staying within the glycaemic target for a significantly longer time compared with conventional pump therapy (continuous subcutaneous insulin infusion with blinded continuous glucose monitoring [CGM] or unblinded sensor‐augmented pump [SAP] therapy). However, CL systems often do not protect against sudden drops in blood glucose caused by moderate intensity physical exercise (PE) 2‐4 …”

“…However, CL systems often do not protect against sudden drops in blood glucose caused by moderate intensity physical exercise (PE). [2][3][4] In 12 patients under glycaemic control with a Medtronic-derived CL system, Patel et al 5 showed that a simple method to prevent hypoglycaemia was to eat a snack just before and in the middle of the PE period (see also de Bock et al 6 ). Turksoy et al 7 reported that consuming an appropriate amount of carbohydrates (CHO) combined with predictive hypoglycaemia alarms can prevent most hypoglycaemic events.…”

“…However, CL systems often do not protect against sudden drops in blood glucose caused by moderate intensity physical exercise (PE). 2 , 3 , 4 …”

The clinical and metabolic benefits of exercise for people with type 1 diabetes

“…2020); and (4) the prevalence of exercise‐related hypoglycaemia and a list of recommendations for strategies that can be used to prevent and manage exercise‐induced hypoglycaemia (Cockcroft et al. 2020).…”