New Advice on Exercise for Those With Type 1 Diabetes

Miriam E Tucker

January 30, 2017

A new consensus statement advises individuals with type 1 diabetes on how to exercise safely.

"Regular exercise can help individuals with diabetes to achieve their blood lipid, body composition, fitness, and blood sugar goals," said lead author Michael C Riddell, PhD, of the Muscle Health Research Centre, York University, Toronto, Ontario, in a statement.

But, he adds, "For people living with type 1 diabetes, the fear of hypoglycemia, loss of glycemic control, and inadequate knowledge around exercise management are major barriers....This is a big struggle for both type 1 diabetes patients and their healthcare providers."

The statement was published online January 23 in Lancet Diabetes & Endocrinology.

Type 1 Diabetes Patients Are Now Overweight and Obese

In contrast to the past, about two-thirds of people with type 1 diabetes today are overweight or obese. Roughly the same proportion has hypertension, 40% have dyslipidemia, and most don't engage in enough regular physical activity, Dr Riddell and colleagues note.

Their statement recommends at least 150 minutes of accumulated physical activity per week, with no more than 2 consecutive days without activity. Resistance exercise is also recommended two to three times a week.

For children and young people with diabetes, the guidelines call for at least 60 minutes of physical exercise a day.

Detailed recommendations are provided for glucose targets, insulin adjustments, and glucose monitoring before and after exercise, nutritional management around exercise, and cautions and contraindications including recent hypoglycemia, ketones, and diabetes complications.

In general, aerobic exercise is associated with reductions in glycemia, whereas anaerobic exercise might be associated with a transient increase in glucose concentrations. And both forms of exercise can cause delayed-onset hypoglycemia during recovery.

For aerobic exercise, reductions in basal or bolus insulin, or both, before the activity can help reduce the hypoglycemia risk, as can increasing carbohydrate intake to 60 g/h or more, according to the statement.

And more conservative insulin-dose corrections might also be required for anaerobic exercise, although even this could increase the risk for nocturnal hypoglycemia, especially if done later in the day.

Regardless, glucose monitoring should be done more frequently before, during, and after physical activity, the researchers conclude.

Dr Riddell has received personal fees from Medtronic Diabetes, Lilly, Ascensia Diabetes Care, and Insulet. Disclosures for the coauthors are listed in the paper.

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Lancet. Published January 23, 2017. Article


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