The competitive athlete with type 1 diabetes

Abstract

Regular exercise is important for health, fitness and longevity in people living with type 1 diabetes, and many individuals seek to train and compete while living with the condition. Muscle, liver and glycogen metabolism can be normal in athletes with diabetes with good overall glucose management, and exercise performance can be facilitated by modifications to insulin dose and nutrition. However, maintaining normal glucose levels during training, travel and competition can be a major challenge for athletes living with type 1 diabetes. Some athletes have low-to-moderate levels of carbohydrate intake during training and rest days but tend to benefit, from both a glucose and performance perspective, from high rates of carbohydrate feeding during longdistance events. This review highlights the unique metabolic responses to various types of exercise in athletes living with type 1 diabetes.

Improved glycaemic variability and basal insulin dose reduction during a running competition in recreationally active adults with type 1 diabetes—A single-centre, prospective, controlled observational study

“…The lower TIR seen in our study might be due to the real life set-up of a running competition, since it is more difficult to manage glucose as tightly as under lab conditions [ 24 – 26 ], hence under lab [ 24 – 26 ] and training conditions [ 15 ], TIR in range was found to be between 68–81%. An optimal TIR of >80% during exercise or a competition [ 27 ] might only be achieved if glucose levels are monitored tightly (~5 minutely) and respective adjustments are made to either the insulin dosing or the carbohydrate consumption [ 24 ]; however, this is not feasible during a running competition. Notable, during the running competition, participants with T1D did not show any TBR 1 or TBR 2 as also seen in the healthy group, which might be due to the safe but elevated mean glucose levels, as also confirmed by a TAR 1 of ~20% and TAR 2 of ~9%.…”

Comparing two treatment approaches for patients with type 1 diabetes during aerobic exercise: a randomised, crossover study

“…Only limited studies have evaluated the effects of both reducing insulin and eating carbohydrates without the usual insulin bolus on glycaemic control and performance with aerobic exercise [7,[9][10][11]. Here we compare these two recommendations and demonstrate that reducing insulin prior to exercising is the best strategy for maintaining normoglycaemia and likely the better strategy for optimising aerobic performance in patients with T1D.…”

“…However, whilst research does indicate that both strategies can independently support glycaemic control during exercise [8]. Knowledge of whether one strategy is better than the other is lacking, and only limited peer-reviewed studies have compared both approaches during exercise within the same experimental design [9][10][11]. Thus, the aim of the current study was to evaluate the effects of these two approaches on glycaemic control (time in normo-, hypo-and hyper-glycaemia) and performance in a single bout of aerobic exercise.…”

Artificial Pancreas Control Strategies Used for Type 1 Diabetes Control and Treatment: A Comprehensive Analysis

“…Tagougui et al [207] discussed in detail the development of AP systems over time, how they work, and the glucose control regulation during the physical activities. Riddell et al [208] claimed that recently approved HCL devices/systems are appropriate for the prolonged aerobic exercise if a temporary (higher level) glucose target is set well before the start of the exercise (i.e., 45-90 min before the exercise starting time). The comprehensive description, functionalities, examples, and working methodologies of the HCL systems can be found in several recent studies [209][210][211][212][213].…”