<p>The Athlete with Type 1 Diabetes: Transition from Case Reports to General Therapy Recommendations</p>

Abstract

Fear of hypoglycemia is a common barrier to exercise and physical activity for individuals with type 1 diabetes. While some of the earliest studies in this area involved only one or two participants, the link between exercise, exogenous insulin, and hypoglycemia was already clear, with the only suggested management strategies being to decrease insulin dosage and/or consume carbohydrates before and after exercise. Over the past 50 years, a great deal of knowledge has been developed around the impact of different types and intensities of exercise on blood glucose levels in this population. Recent decades have also seen the development of technologies such as continuous glucose monitors, faster-acting insulins and commercially available insulin pumps to allow for the real-time observation of interstitial glucose levels, and more precise adjustments to insulin dosage before, during and after activity. As such, there are now evidence-based exercise and physical activity guidelines for individuals with type 1 diabetes. While the risk of hypoglycemia has not been completely eliminated, therapy recommendations have evolved considerably. This review discusses the evolution of the knowledge and the technology related to type 1 diabetes and exercise that have allowed this evolution to take place.

ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes

“…Of note, many of the new data were derived from adult, rather than pediatric populations. This guideline incorporates a new theme focused on strategies for glucose management for athletes living with T1D based in part on a randomized controlled trial (RCT) 7 of the impact of acute hyperglycemia. General therapy recommendations for athletes 8 were described, and later a review regarding competitive athletes with T1D was published (Sections 6 and 9). 9 Several, technological developments since the last guideline in 2018 have been incorporated into these new guidelines (Section 8).…”

“…This guideline incorporates a new theme focused on strategies for glucose management for athletes living with T1D based in part on a randomized controlled trial (RCT) 7 of the impact of acute hyperglycemia. General therapy recommendations for athletes 8 were described, and later a review regarding competitive athletes with T1D was published (Sections 6 and 9 ). 9 …”

Type 1 diabetes management in a competitive athlete: A five‐year case report

“…with moderate (1–3 sets of 15 repetitions) to vigorous (6–8 repetitions per 6–8 sets) intensity and 8–10 exercises for a minimum of two nonconsecutive days‐a weeks; it is further possible to add flexibility and balance training (Standard Medical Care in Diabetes, 2012 ; Colberg et al, 2016 ; Jaggers et al, 2016 ). On the contrary, these recommendations are not consistently implemented due to a fear of hypoglycemia during physical activity (Riddell et al, 2017 ; Yardley, 2019 ). The effects of regular physical activity on diabetes management are now well established.…”

Knowledge and Awareness about Diabetes of Recently Retired Athletes

“…Individuals with type I diabetes can improve their exercise and physical activity safety by better understanding and monitoring blood glucose changes during and after exercise as well as a higher knowledge about the importance of exercise and physical activity are also helpful in the prevention and controlling of diabetes complications [17]. The lack of understanding and awareness of diabetes symptoms can make it difficult to diagnose the condition early on [18].…”