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Runsweet is aligning our advice to the JDRF Peak Program. This advice comes from the world's leading experts on exercise and diabetes coming together to provide the best available advice for people with T1DM who want to exercise.

Things to consider before exercise

Some important factors which alter blood glucose before exercise. These may add to exercise induced blood glucose variability.

CHO intake

  • Variation in CHO quantity (including inaccuracy to evaluate intake) and type will impact glycaemic excursions.

Self-monitored capillary glucose measurements and CGM

  • Errors in SMBG sampling or measurement errors (SMBG, CGM) may result in inappropriate insulin dose estimations
  • CGM accuracy, while improving, can be compromised by poor SMBG accuracy and calibrations methods
  • Lag time in CGM may impact accuracy during exercise

Medications/ alcohol

  • Insulin sensitivity may be impacted as might glucose monitoring tools

Physiological cycles

  • Diurnal endocrine variation, menstrual cycle and pregnancy impact insulin sensitivity and impact glycaemic patterns during rest  and perhaps during exercise

Changes in work and sleep patterns

  • Require changes in timing of insulin basal dose administration
  • Timing of PA should be considered relative to insulin sensitivity and nocturnal hypoglycaemia risk

Intercurrence illness and stress

  • May require changes in both basal and bolus insulin dose
  • Vigorous exercise contraindicated

Starting blood glucose​ and ketone testing

Starting blood glucose concentrations

General Recommendations*

Below Target

(<5 mmol/l)

  • Ingest 10–20 g of glucose before starting exercise
  • Delay exercise until blood glucose > 5mmol/L (90 mg/dL) and monitor closely for hypoglycaemia

Near target

(5-6.9mmol/l)

  • Ingest 10 g of glucose before starting aerobic exercise
  • Anaerobic exercise and IHIE can be started

Target

(7-10mmol/l)

  • Aerobic exercise can be started
  • Anaerobic exercise and IHIE can be started but glucose levels may rise

Slightly above target

10.1-15.0 mmol/l)

  • Aerobic exercise can be started
  • Anaerobic exercise can be started but glucose levels may rise

Above target

(>15 mmol/l)

  • If the hyperglycaemia is unexplained (not associated with a recent meal), check blood ketones. If ketones are modestly elevated (up to 1.4 mmol/l), a small corrective insulin dose should be given before exercise. If blood ketones are severely elevated (≥1.5mmol/l), don’t..
  • Mild to moderate aerobic exercise may be started if blood ketones are low (<0.6 mmol/l) or if urine ketones are less than 2+. Blood glucose levels should be monitored during exercise to help notify if glucose is rising further.
  • Intense exercise should be initiated only with caution as it may promote a further rise in glycaemia.

Guidelines on food intake

Situation

Macronutrient Needs for Endurance Performance

(Athletes with and without diabetes)

 

Macronutrient needs for Hypoglycaemia Prevention

(Under basal insulin conditions)

 

Macronutrient needs for Hypoglycaemia Prevention

(Under hyperinsulinaemic conditions)

 

Pre-exercise meal

A minimum of 1g CHO/kg BW +/- protein according to exercise intensity and type

A minimum of 1g CHO/kg BW +/- protein +/- adjusted bolus insulin dose

A minimum of 1g CHO/kg BW +/- protein with reduced bolus insulin dose

Immediately pre-exercise

No CHO required

If BG < 5mmol/l ingest 10-20g CHO

If BG < 5mmol/L ingest 10-20g CHO

Up to 30 min duration

No CHO required

If BG < 5mmol/l ingest 10-20g CHO

May require up to 15-30g CHO to prevent hypoglycaemia

30- 60 min duration

Small amounts of CHO (10-15 g/hr) may be helpful according to the exercise intensity

Low- moderate intensity:

Small amounts of CHO (10-15 g/hr) depending on the exercise intensity and BGL

 

May require up to 15-30g CHO/30 min to prevent hypoglycaemia

High intensity:

No CHO required during exercise unless blood glucose is < 5 mmol/l. Replace CHO post- exercise.

60- 150 min duration

30-60g CHO/hr

CHO intake according to BG.

Follow sports nutrition guidelines, as CHO may be needed for fuel and performance

May require up to

 30-60g CHO/hr to prevent hypoglycaemia

> 150 min duration

60-90g CHO/hr spread across the activity (e.g. 20-30g CHO/20 min)

 

Use CHO sources that utilize different gut transporters (e.g. glucose and fructose)

 

CHO intake according to BG to prevent hypoglycaemia.

 

Follow sports nutrition guidelines with appropriate insulin adjustment for glycaemic management

Post- exercise meal

1-1.2g CHO/kg body BW and 20-30g protein

Follow sports nutrition guidelines to maximise recovery with appropriate insulin adjustment for glycaemic management

 

Making changes in Insulin dose and food intake

Adjustment

Prolonged endurance exercise (predominantly aerobic)

Brief intense exercise (aerobic and anaerobic)

Pre- exercise meal bolus dose insulin reduction

Advised when exercise occurs within ~120min of bolus dose

The magnitude of reduction vary according to timing, type, duration and intensity of exercise

Bolus reduction not advised

May require additional conservative bolus dose correction if hyperglycaemia develops

Pre-exercise basal insulin dose reduction in with multiple injections

May also be useful if on twice daily intermediate insulin

Basal reduction not advised

Basal nocturnal insulin dose reduction (MDI & CSII) following exercise by ~20% to reduce nocturnal hypoglycaemia

Particularly important if the exercise occurred in the afternoon or early evening

Useful for helping limiting post-exercise hypoglycaemia after intermittent high intensity exercise

 

Temporary basal rate change (CSII)

Reduce basal rate to as low as total suspension of normal basal during exercise

To take into account rapid acting insulin pharmacokinetics, this basal rate reduction should ideally occur well before exercise start (up to 90 minutes before)

Normal basal rates can be resumed either at the end of exercise, or later in recovery depending on glucose trends

Increased basal rate may be needed to help prevent/treat hyperglycaemia either during or immediately after exercise

Pre-exercise CHO intake

 

Not usually needed

Intra-exercise CHO intake

Typically 1g/kg/hr exercise up to 60g/h if no insulin dose adjustments have been made

Not usually needed

Pre-exercise or post-exercise sprint

May help reduce hypoglycaemia risk

May increase hyperglycaemia risk

Consider a prolonged aerobic cool down

Post exercise CHO intake

Useful to reduce risk of hypoglycaemia and enhance recovery (see Nutritional Management section)

May need a specified insulin bolus depending on length and intensity of exercise (may need a reduced insulin to CHO ratio)

Useful to reduce risk of hypoglycaemia and enhance recovery but should be delayed if hyperglycaemia is initially observed (see Nutritional management section)

May need a specified insulin bolus strategy (e.g. may need a reduced insulin to CHO ratio)

Contact us

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+44 118 3227969+44 118 3227969

 

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