Use of Continuous Glucose Monitoring Trends to Facilitate Exercise in Children with Type 1 Diabetes

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)

“…CGM and isCGM systems can be used as effective tools to help indicate when carbohydrate intake should be initiated to prevent or treat hypoglycaemia during prolonged exercise, as seen in experimental studies in children and adolescents with type 1 diabetes [44,45]. However, the significant lag time in these technologies should be taken into consideration when using them to determine when to consume carbohydrates [27].…”

“…With CGM, alerts could also be activated regarding the rate of change in glucose, providing the user with valuable information. For the majority of adults with type 1 diabetes who are at a low risk of hypoglycaemia, at a glycaemic threshold of 7.0 mmol/l (126 mg/dl) accompanied by a horizontal trend arrow, 10-15 g of carbohydrates should be consumed; 15-25 g carbohydrates should be consumed immediately if accompanied by a (slightly) downward trend arrow; 20-35 g of carbohydrates should be consumed if accompanied with a downward trending arrow (Table 2) [38] (D), [39] (D), [40] (D), [44] (D), [45] (D). Carbohydrates should be consumed regularly (e.g., every 15 to 20 min) when reaching the lower glycaemic threshold, and carbohydrate supplementation should be repeated if sensor glucose is not rising according to the trend arrows within 30 min.…”

“…People using a CGM system should, therefore, set the hypoglycaemia alert at 4.4 mmol/l (80 mg/dl) during the night-time period, or higher for groups with an elevated risk of hypoglycaemia to allow for earlier proactive treatments [76] (D). When reaching glucose levels of 4.4 mmol/l (80 mg/dl), or higher if deemed necessary, the following carbohydrate guidance can be applied [38] (D), [39] (D), [40] (D), [44] (D), [45] (D): with a horizontal trend arrow,~10 g of carbohydrates are recommended to be consumed; 15 g of carbohydrates should be consumed if Sensor glucose targets are detailed for the following groups in type 1 diabetes (T1D): intensively exercising and/or low risk of hypoglycaemia (Ex 2); moderately exercising and/or moderate risk of hypoglycaemia (Ex 1), minimally exercising and/or high risk of hypoglycaemia (Ex 0) a 50% of regular insulin correction factor when sensor glucose is close to the upper glycaemic threshold b Delay exercise until reaching at least 5.0 mmol/l (90 mg/dl) and, ideally, from 7.0 mmol/l to 10.0 mmol/l (126 mg/dl to 180 mg/dl) or higher in those with an increased risk of hypoglycaemia accompanied by , , or…”

“…Hypo-and hyperglycaemic alerts should be set at 5.6 mmol/l (100 mg/dl) and 10.0 mmol/l (180 mg/dl) or individualised if required [40] (D), [44] (D), [45] (D). The rate-of-glucose-change alerts should be used to initiate an earlier action [40] (D), [44] (D), [45] (D). The use of remote monitors (e.g., via a mobile phone application to remotely follow sensor glucose in realtime) should be used to assess and react to glycaemic excursions during exercise [40] (D).…”

“…If sensor glucose concentration is below these glycaemic targets, then small amounts of oral carbohydrates should be consumed (e.g. 10-15 g of carbohydrates) [40] (D), [44] (D), [45] (D). Exercise may be started when reaching 5.0 mmol/l (90 mg/dl) glucose and, ideally, from 7.0 mmol/l to 10.0 mmol/l (126 mg/dl to 180 mg/dl) or higher in those with an increased risk of hypoglycaemia (Table 5) Table 5 should be applied to achieve the recommended glycaemic targets [40] (D), [44] (D), [45] (D).…”