Do youth with type 1 diabetes exercise safely? A focus on patient practices and glycemic outcomes

Abstract

Despite several studies showing the frequency of hypoglycemia during and after exercise, many youth are not adjusting insulin for exercise. A tool designed to capture patient practices and provide clinicians with a framework for patient education may lead to improved safety around exercise in youth with T1D.

Mini-Dose Glucagon as a Novel Approach to Prevent Exercise-Induced Hypoglycemia in Type 1 Diabetes

“…In line with this possibility, even if basal insulin suspension occurs at the time of exercise onset, insulin levels can rise in circulation once the exercise starts (13). We chose a 50% reduction in basal insulin delivery 5 min prior to exercise as this is commonly recommended in practice (22). This basal insulin reduction strategy near exercise onset had no effect in preventing exercise-induced hypoglycemia relative to no intervention, thus supporting a greater reduction (i.e., 80-100% basal rate reduction), perhaps well in advance of the activity, which has recently been recommended (23) but not yet formally tested.…”

ISPAD Clinical Practice Consensus Guidelines 2018: The delivery of ambulatory diabetes care to children and adolescents with diabetes

“…The family and school staff should have access to glucagon and know how to use it in case of severe hypoglycemia. The diabetes team should be familiar with recent guidelines, and reinforce safe practices . This is important to reinforce especially in families where girls are not allowed much physical activity, if diabetes is perceived as a disease (the “ill” child should not be “tired out”), or if school staff are fearful of assisting the child during exercise or activities outside the classroom.…”

Patterns of Physical Activity Adherence by Adolescents With Diabetes or Obesity Enrolled in a Personalized Community-Based Intervention

“…Reasons for the lower levels of activity may be related to poor aerobic capacity, a lack of incentives at key timepoints (ie, obese adolescents and those with T2DM may have expected to see evidence of weight loss), a greater perception of barriers to exercise in those with T2DM, limited family support, and fear of hypoglycemia in adolescents with T1DM. Roberts et al 58 noted the absence of insulin adjustment and an increased frequency of blood glucose testing in relation to exercise in youth with T1DM. Further study is warranted to provide best evidence for clinicians to become more proficient in providing instructions on monitoring self-management practices for balancing blood glucose checks, insulin regime (if prescribed), and food intake related to exercise and prescribing exercise aligned to personal profiles of adolescents with diabetes or obesity that have known risks for future health disparities in cardiovascular outcomes.…”