Practical Aspects and Exercise Safety Benefits of Automated Insulin Delivery Systems in Type 1 Diabetes

Abstract

Regular exercise is essential to overall cardiovascular health and well-being in people with type 1 diabetes, but exercise can also lead to increased glycemic disturbances. Automated insulin delivery (AID) technology has been shown to modestly improve glycemic time in range (TIR) in adults with type 1 diabetes and significantly improve TIR in youth with type 1 diabetes. Available AID systems still require some user-initiated changes to the settings and, in some cases, significant pre-planning for exercise. Many exercise recommendations for type 1 diabetes were developed initially for people using multiple daily insulin injections or insulin pump therapy. This article highlights recommendations and practical strategies for using AID around exercise in type 1 diabetes.

Assessment of Glycemia Risk Index and Standard Continuous Glucose Monitoring Metrics in a Real-World Setting of Exercise in Adults With Type 1 Diabetes: A Post-Hoc Analysis of the Type 1 Diabetes and Exercise Initiative

“…Thus, people with T1D who wish to exercise while minimizing the risk of hypoglycemia should consider avoiding postprandial exercise (i.e., within two hours post-meal bolus) or be prepared to initiate carbohydrate feeding, as needed. Indeed, current guidelines for pre-exercise preparation in people with T1D include recommendations targeted at minimizing insulin on board (IoB) at exercise onset, 19,20 as starting IoB is strongly correlated with the change in glucose during exercise. 2 However, GRI across the whole day when postprandial exercise occurred remained significantly lower than sedentary days, further highlighting the cumulative benefit of exercise on glucose control, even when performed under suboptimal conditions.…”

The Hybrid Closed-Loop System Tandem t:slim X2™ with Control-IQ Technology: Expert Recommendations for Better Management and Optimization

“…The advice is to switch to this profile 60–90 min before exercise on top of activating the exercise mode until 60–90 min after the exercise ends. If exercise-related hypoglycemia is still a problem, it is usually due to automated boluses, and in these cases a good tip is to administer a very low dose bolus (0.05 IU) just before exercise, which can even be cancelled, ensuring that no automated bolus will be administered in the following 60 min [ 19 ].…”

Swimming With the Omnipod 5 Automated Insulin Delivery System: Connectivity in the Water

“…Individuals with type 1 diabetes face unique glycemic challenges during exercise, and glucose responses can vary depending on the type, intensity, and duration of activity ( 1 ). Automated insulin delivery (AID) systems can help by adjusting insulin delivery as glucose changes occur during exercise ( 2 ).…”