Exercise induced hypoglycaemia in type 1 diabetes.

NEW FINDINGS What is the topic of this review? Hypoglycaemia is a commonly cited barrier to exercise in T1D. Knowledge of approaches to prevent or manage exercise induced hypoglycaemia can support patients to exercise and help clinicians to give advice. This review presents a number of evidence-based strategies to prevent exercise induced hypoglycaemia in T1D. What advances does it highlight? This review highlights a number of approaches which can be used before, during and after exercise which can mitigate the risk of hypoglycaemia. Approaches include: timing of exercise; type of exercise; adjustments to insulin and carbohydrate; use of novel technology; and education ABSTRACT: Exercise is a key component for the management of type 1 diabetes (T1D) and is associated with reduced risk of cardiovascular disease, decreased daily insulin requirements and improved quality of life. Because of these benefits people with T1D are recommended to undertake regular physical activity, 150 minutes per week for adults and 60 minutes per day for children and adolescents. Despite recommendations, many do not meet these targets. One of the commonly cited barriers to exercise is fear of hypoglycaemia along with limited knowledge of effective preventative strategies. Hypoglycaemia can be difficult to predict, and symptoms are often masked during exercise or stress of competition. For athletes with T1D hypoglycaemia can also limit sporting success. Hypoglycaemia prior to an event increases the risks of hypoglycaemia during competition and can reduce performance. To avoid hypoglycaemia, people with T1D may avoid exercise altogether, or consume excessive amounts of carbohydrates, which mitigates many of the health benefits of exercise. Increased understanding of approaches to prevent or manage hypoglycaemia are therefore important to help increase levels of physical activity in people with T1D, as well as supporting athletes with T1D to compete at the highest level. This review outlines the prevalence of exercise related hypoglycaemia, its underlying physiology as well as the strategies that can be used to prevent and manage exercise induced hypoglycaemia in T1D. The hope of the authors is that this knowledge will be used by people with T1D and their clinicians to find individual approaches to manage exercise related hypoglycaemia. This article is protected by copyright. All rights reserved