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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.
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CHO intake
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- Variation in CHO quantity (including inaccuracy to evaluate intake) and type will impact glycaemic
excursions.
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Self-monitored capillary glucose measurements and CGM
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- 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
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Medications/ alcohol
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- Insulin sensitivity may be impacted as might glucose monitoring tools
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Physiological cycles
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- Diurnal endocrine variation, menstrual cycle and pregnancy impact insulin sensitivity and impact glycaemic patterns during rest and perhaps during
exercise
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Changes in work and sleep patterns
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- Require changes in timing of insulin basal dose administration
- Timing of PA should be considered relative to insulin sensitivity and nocturnal hypoglycaemia risk
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Intercurrence illness and stress
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- May require changes in both basal and bolus insulin dose
- Vigorous exercise contraindicated
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Starting blood glucose and ketone testing
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Starting blood glucose concentrations
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General Recommendations*
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Below Target
(<5 mmol/l)
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- Ingest 10–20 g of glucose before starting exercise
- Delay exercise until blood glucose > 5mmol/L (90 mg/dL) and monitor closely for hypoglycaemia
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Near target
(5-6.9mmol/l)
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- Ingest 10 g of glucose before starting aerobic exercise
- Anaerobic exercise and IHIE can be started
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Target
(7-10mmol/l)
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- Aerobic exercise can be started
- Anaerobic exercise and IHIE can be started but glucose levels may rise
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Slightly above target
10.1-15.0 mmol/l)
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- Aerobic exercise can be started
- Anaerobic exercise can be started but glucose levels may rise
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Above target
(>15 mmol/l)
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- 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.
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Guidelines on food intake
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Situation
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Macronutrient Needs for Endurance Performance
(Athletes with and without diabetes)
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Macronutrient needs for Hypoglycaemia Prevention
(Under basal insulin conditions)
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Macronutrient needs for Hypoglycaemia Prevention
(Under hyperinsulinaemic conditions)
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Pre-exercise meal
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A minimum of 1g CHO/kg BW +/- protein according to exercise intensity and type
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A minimum of 1g CHO/kg BW +/- protein +/- adjusted bolus insulin dose
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A minimum of 1g CHO/kg BW +/- protein with reduced bolus insulin dose
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Immediately pre-exercise
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No CHO required
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If BG < 5mmol/l ingest 10-20g CHO
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If BG < 5mmol/L ingest 10-20g CHO
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Up to 30 min duration
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No CHO required
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If BG < 5mmol/l ingest 10-20g CHO
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May require up to 15-30g CHO to prevent hypoglycaemia
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30- 60 min duration
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Small amounts of CHO (10-15 g/hr) may be helpful according to the exercise intensity
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Low- moderate intensity:
Small amounts of CHO (10-15 g/hr) depending on the exercise intensity and BGL
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May require up to 15-30g CHO/30 min to prevent hypoglycaemia
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High intensity:
No CHO required during exercise unless blood glucose is < 5 mmol/l. Replace CHO post-
exercise.
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60- 150 min duration
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30-60g CHO/hr
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CHO intake according to BG.
Follow sports nutrition guidelines, as CHO may be needed for fuel and performance
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May require up to
30-60g CHO/hr to prevent hypoglycaemia
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> 150 min duration
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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)
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CHO intake according to BG to prevent hypoglycaemia.
Follow sports nutrition guidelines with appropriate insulin adjustment for glycaemic
management
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Post- exercise meal
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1-1.2g CHO/kg body BW and 20-30g protein
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Follow sports nutrition guidelines to maximise recovery with appropriate insulin adjustment for
glycaemic management
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Making changes in Insulin dose and food intake
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Adjustment
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Prolonged endurance exercise (predominantly
aerobic)
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Brief intense exercise (aerobic and
anaerobic)
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Pre- exercise meal bolus dose insulin
reduction
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Advised when exercise occurs within ~120min of bolus dose
The magnitude of reduction vary according to timing, type, duration and intensity of
exercise
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Bolus reduction not advised
May require additional conservative bolus dose correction if hyperglycaemia develops
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Pre-exercise basal insulin dose reduction in with multiple
injections
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May also be useful if on twice daily intermediate insulin
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Basal reduction not advised
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Basal nocturnal insulin dose reduction (MDI & CSII)
following exercise by ~20% to reduce nocturnal hypoglycaemia
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Particularly important if the exercise occurred in the afternoon or early evening
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Useful for helping limiting post-exercise hypoglycaemia after intermittent high intensity
exercise
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Temporary basal rate change (CSII)
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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
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Increased basal rate may be needed to help prevent/treat hyperglycaemia either during or
immediately after exercise
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Pre-exercise CHO intake
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Not usually needed
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Intra-exercise CHO intake
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Typically 1g/kg/hr exercise up to 60g/h if no insulin dose adjustments have been made
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Not usually needed
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Pre-exercise or post-exercise
sprint
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May help reduce hypoglycaemia risk
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May increase hyperglycaemia risk
Consider a prolonged aerobic cool down
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Post exercise CHO intake
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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)
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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)
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Things to consider before exercise
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