Carbohydrate Requirement for Exercise in Type 1 Diabetes: Effects of Insulin Concentration

Abstract

Physical activity is a keystone of a healthy lifestyle as well as of management of patients with type 1 diabetes. The risk of exercise-induced hypoglycemia, however, is a great challenge for these patients. The glycemic response to exercise depends upon several factors concerning the patient him/herself (eg, therapy, glycemic control, training level) and the characteristics of the exercise performed. Only in-depth knowledge of these factors will allow to develop individualized strategies minimizing the risk of hypoglycemia. The main factors affecting the exercise-induced hypoglycemia in patients with T1D have been analyzed, including the effects of insulin concentration. A model is discussed, which has the potential to become the basis for providing patients with individualized suggestions to keep constant glucose levels on each exercise occasion.

Personalized Approach for the Management of Exercise-Related Glycemic Imbalances in Type 1 Diabetes: Comparison with Reference Method

“…The ECRES algorithm, based on a series of models and relations described previously, 13,14,19,23 estimates in a personalized manner the amount of carbohydrates supplement (reqCHO) needed to avoid exercise-related glycemic imbalances. The algorithm is summarized in Figure 1.…”

“…12 To the best of our knowledge, this is one of the rare approaches accounting for a few important parameters. Nevertheless, other crucial factors such as patient’s insulin sensitivity and the state of the patient’s physical conditioning are additional factors that require consideration, 13-15 as well as the time distance from the last insulin administration. 16…”

“…12 To the best of our knowledge, this is one of the rare approaches accounting for a few important parameters. Nevertheless, other crucial factors such as patient's insulin sensitivity and the state of the patient's physical conditioning are additional factors that require consideration, [13][14][15] as well as the time distance from the last insulin administration. 16 A personalized technology for patients affected by chronic conditions, such as T1D, might enhance self-management and improve patients' lifestyle and well-being.…”

“…16 A personalized technology for patients affected by chronic conditions, such as T1D, might enhance self-management and improve patients' lifestyle and well-being. 13,17 In this context, a patient-tailored and exercise-specific method able to estimate the amount of glucose supplement required to maintain safe blood glucose levels during physical activity was proposed and preliminarily tested during short 18,19 and prolonged exercise. 20,21 The Exercise Carbohydrate Requirement Estimation System (ECRES) algorithm is based on patient's habitual therapy and diet and accounts for his/her insulin sensitivity.…”

Exercise Management for Young People With Type 1 Diabetes: A Structured Approach to the Exercise Consultation

“…When insulin levels are close to basal levels, such as when exercise is performed before breakfast, the risk of hypoglycemia is minimal (50) and carbohydrate supplementation may not be required (51, 52). Given that categorizing carbohydrate requirements in a dichotomous manner (high vs. low insulin levels) is a simplified approach that does not take into account all the factors influencing glucose requirements, Francesco et al have developed an algorithm that estimates an individuals' glucose requirement during activity based on personalized situation specific information including insulin concentration (53).…”