Major obstacles in blood sugar management for people with type 1 diabetes include hypoglycaemia, loss of glycaemic control, and insufficient knowledge regarding exercise management. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. [1]

Need for physical activity in type 1 diabetes

As may be expected with a chronic disease that primarily affects middle-aged and older individuals, type 2 diabetes is usually complicated by other medical conditions. In the 1999-2004 cohort of the National Health and Nutrition Examination Survey (NHANES), only 14% of patients with type 2 diabetes had no other comorbidities. [2]

In type 1 diabetes, it is important to maintain a balance between your insulin doses, the food you eat, and the activity you do including your housework.

Alterations in blood glucose levels to exercise will be heavily influenced by:

  • Your blood glucose levels before you start activity
  • Intensity of the activity
  • The duration of the activity
  • And the modifications in insulin doses [3]

Exercise guidelines for patients with type 1 diabetes

A recent set of guidelines [4] have been published by a team of 21 researchers to educate and help people perform type 1 diabetes exercise safely without constant fluctuations in blood sugar. New guidelines regarding glucose targets, nutritional and insulin adjustments to prevent exercise related changes in blood sugar have been mentioned.

New guidelines in this report state the following:

  • A minimum of 150 minutes of accumulated physical activity per week. Regular physical activity can reduce the risk of both diabetic eye disease and kidney disease [4]
  • There should be not more than two consecutive days of no activity
  • Resistance activity is also recommended two to three times a week
  • For pediatric patients and young people with type 1 diabetes, new guidelines advise at least 60 minutes of physical exercise a day
  • This report also includes recommendations for glucose targets, adjustments in insulin doses and nutritional management around exercise
  • Studies showed that aerobic exercise such as walking, light cycling, or jogging can reduce glucose levels, while anaerobic exercises like sprinting, heavy weight lifting are known to increase blood glucose temporarily. Thus, more clarity on the type of exercise and its impact on blood glucose levels can help achieve a better glycemic control.
  • For aerobic exercises, reductions in basal or bolus insulin or both before the onset of physical activity can reduce episodes of hypoglycemia or even an increase of intake of carbohydrate to 60 grams per hour or so.
  • For anaerobic exercises, certain conservative insulin dose modifications maybe required. Although if performed in the later part of the day, it can pose a risk of nocturnal hypoglycemia.
  • Regular exercise ensures a better control over glycated hemoglobin levels, blood pressure levels, and healthier body mass index.

Conclusion

These guidelines will help patients with type 1 diabetes overcome certain challenges regarding glucose control and exercise. It will help them achieve the several health benefits that come with regular exercising. However, regular glucose monitoring before and after exercise is important [5]. Management of glucose levels needs a complete understanding of the physiology of the different types of exercise and their effects on the blood glucose levels.

Credit: Dr. Rachita on behalf of Borderless Access

Copyright © 2017 BorderlessAccess

 References

  1. American Diabetes Association. Standards of Medical Care in Diabetes—2009. Diabetes Care2009;32:S13-61
  2. Suh DC, Choi IS, Plauschinat C, Kwon J, Baron M. Impact of comorbid conditions and race/ethnicity on glycemic control among the US population with type 2 diabetes, 1988-1994 to 1999-2004.
  3. American Diabetes Association
  4. Michael C Riddell, Ian W Gallen, et al. Exercise management in type 1 diabetes: a consensus statement. The Lancet Diabetes & Endocrinology, 2017
  5. Centers for Disease Control. The power of prevention