Original ResearchTechniques for Exercise Preparation and Management in Adults with Type 1 Diabetes
Introduction
Regular exercise has numerous physiologic and psychological benefits for people of all ages who are living with type 1 diabetes (1) and currently, the American Diabetes Association recommends physical activity as part of managing all forms of diabetes (2). Despite these recommendations, however, most adults with type 1 diabetes participate less frequently in physical activity than people without diabetes (3). Although the reasons for this are multifactorial, including low fitness levels, the overriding barrier to participating in exercise for individuals with type 1 diabetes appears to be fear of severe hypoglycemia coupled with a lack of knowledge of effective strategies for hypoglycemia avoidance (4).
The impact of exercise on blood glucose (BG) levels in type 1 diabetes is influenced by the type and intensity of the activity, with aerobic activities associated with a greater risk for hypoglycemia than anaerobic activities 5, 6, 7, 8, 9, 10. Duration of physical activity also has an impact, with longer periods of exercise increasing the risk for hypoglycemia. Therefore, for individuals with type 1 diabetes interested in participating in exercise, there is an unmet need to understand the risks, benefits and potential consequences associated with sustained physical activity and also to develop strategies to minimize their personal risks for hypo- or hyperglycemia. Recommendations include modifying rates of basal insulin, changing the dose of rapid-acting mealtime insulin before and after exercise, consuming additional carbohydrates and using continuous glucose monitoring (CGM) to monitor glucose levels more closely than can be achieved by fingerstick alone 1, 11, 12, 13.
The aim of this study was to identify the current strategies that free-living adults with type 1 diabetes use to prepare, monitor and adjust their diabetes management regimens before, during and after physical activity and to determine how overall diabetes management of physical activity may be influenced by the use of differing diabetes-related technologies for glucose monitoring and insulin delivery.
Section snippets
Methods
We conducted an online survey of individuals with type 1 diabetes that assessed exercise-management techniques and evaluated how these techniques vary depending on the technologies relied upon for diabetes management. These technologies included use of 1) CGM without continuous subcutaneous insulin infusion (CSII); 2) CSII without CGM; 3) CSII and CGM together (Combined) or 4) fingerstick self-monitoring of blood glucose (SMBG) only (without CSII or CGM). The survey also focused on target BG
Participant characteristics, device uses and exercise behaviours
The 85-item survey (Supplement) was available on Glu for 23 days. Individual items were optional (participants were permitted to skip an item and go forward). A total of 502 Glu users completed at least 70% of the survey and were included in the analysis. Of this sample, 68% were women, and the mean age was 42.4±15.3 years (range, 18 to 82 years). For further analysis, participants were divided into groups based on which devices they currently used to manage their type 1 diabetes: SMBG only
Discussion
The purpose of this study was to examine exercise preparation and management techniques by individuals living with type 1 diabetes and to determine how use of differing diabetes technologies may affect health-related behaviours in relation to exercise. In general, our findings suggest that individuals with type 1 diabetes are well aware of the risk for hypoglycemia during physical activity, immediately after physical activity and overnight 7 to 11 hours later (14), as well as understanding the
Authors' Contributions
JEP, AK, DEG, BES, SKS and ED authored, edited and reviewed the manuscript; DEG and HO performed statistical analysis for the manuscript; DK edited and reviewed the manuscript, was the principal investigator of this project and is the guarantor of this work; as such, DK had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Acknowledgments
We acknowledge Type 1 Diabetes Exchange, a program of Unitio, Inc., for supporting this study, and we thank the Glu community for their participation.
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Cited by (48)
Barriers to Physical Activity in Children and Adults Living With Type 1 Diabetes: A Complex Link With Real-life Glycemic Excursions
2023, Canadian Journal of DiabetesIs Better Understanding of Management Strategies for Adults With Type 1 Diabetes Associated With a Lower Risk of Developing Hypoglycemia During and After Physical Activity?
2022, Canadian Journal of DiabetesCitation Excerpt :Although the use of CGMS may help PWT1D to detect and react more quickly to fluctuations in BG, CGMS users in our study did not report less hypoglycemia than those not using CGMS. However, studies have suggested that CGMS users may be more aware of hypoglycemia both during and after PA (15,19). Furthermore, the impact of PA on BG levels was associated with more frequent hypoglycemic episodes at night among PWT1D managed with CSII.
Activity detection and classification from wristband accelerometer data collected on people with type 1 diabetes in free-living conditions
2021, Computers in Biology and MedicineFlexible insulin therapy with a hybrid regimen of insulin degludec and continuous subcutaneous insulin infusion with pump suspension before exercise in physically active adults with type 1 diabetes (FIT Untethered): a single-centre, open-label, proof-of-concept, randomised crossover trial
2020, The Lancet Diabetes and EndocrinologyCitation Excerpt :In a T1D Exchange Glu survey,17 29% of respondents admitted to disconnecting their tubed pump for exercise, many doing so always or most of the time. Since only 45–57% of CSII users make any modification to their basal insulin delivery rate before exercise,16 this proportion could actually represent most CSII users who make any adjustment to their pump basal delivery rates before exercise. The impulse to disconnect (or suspend) an insulin pump before exercise could be based on the avoidance of hypoglycaemia (by preferring to maintain higher circulating blood glucose concentrations and lower insulin concentrations), or it might be done as a habit of convenience to reduce the burden of wearing the pump, particularly for certain forms of exercise.