Exercise Management for Young People With Type 1 Diabetes: A Structured Approach to the Exercise Consultation

Abstract

Regular physical activity during childhood is important for optimal physical and psychological development. For individuals with Type 1 Diabetes (T1D), physical activity offers many health benefits including improved glycemic control, cardiovascular function, blood lipid profiles, and psychological well-being. Despite these benefits, many young people with T1D do not meet physical activity recommendations. Barriers to engaging in a physically active lifestyle include fear of hypoglycemia, as well as insufficient knowledge in managing diabetes around exercise in both individuals and health care professionals. Diabetes and exercise management is complex, and many factors can influence an individual's glycemic response to exercise including exercise related factors (such as type, intensity and duration of the activity) and person specific factors (amount of insulin on board, person's stress/anxiety and fitness levels). International guidelines provide recommendations for clinical practice, however a gap remains in how to apply these guidelines to a pediatric exercise consultation. Consequently, it can be challenging for health care practitioners to advise young people with T1D how to approach exercise management in a busy clinic setting. This review provides a structured approach to the child/adolescent exercise consultation, based on a framework of questions, to assist the health care professional in formulating person-specific exercise management plans for young people with T1D.

Improving Clinical Outcomes in Newly Diagnosed Pediatric Type 1 Diabetes: Teamwork, Targets, Technology, and Tight Control—The 4T Study

“…It is essential for clinicians and health-care practitioners to encourage regular physical activity; however, this requires a more in-depth understanding of strategies to better manage glycemia during exercise ( 66 , 70 ). Clinical guidelines, consensus, and position statements on exercise provide some structured approaches to assist clinicians in forming individualized exercise management plans for youth with T1D ( 53 , 70 , 72 ). To reduce exercise-associated hypoglycemia, some strategies include reducing the basal insulin dose pre-exercise, reducing prandial insulin for the meal before exercise, and/or increasing carbohydrate feeding ( 53 ).…”

Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA)

“…Elevated blood ketone levels should lead to repeated glucose and blood ketone measurements after exercise to ensure that ketosis (blood ketones >1.5 mmol/l) or diabetic ketoacidosis is not developed. If sensor glucose is >15.0 mmol/l (>270 mg/dl) and blood ketones are ≤1.5 mmol/ l, then only mild aerobic exercise may be performed to avoid a further increase in glucose levels by sympathoadrenal responses to intense (an)aerobic exercise[98] (D).…”

Bolus calculator in personal insulin pumps — advantages, differences and practical tips

“…Bolus insulin must be taken into account during physical activity. The bolus calculator is a tool that allows the user to adjust the amount of active insulin to their training in a repeatable and precise manner [17]. The effect of physical activity is very individual and only on the basis of the patient's own experience it is possible to determine what amount of active insulin is appropriate for him or her.…”