Regular exercise for people with type 1 diabetes (T1D) should be encouraged and supported by healthcare professionals despite the challenges of managing exercise in these individuals, according to a new consensus statement co-authored by Australian experts and just published in the Lancet Diabetes Endocrinology.

There are a number of barriers to exercise, some of which are common to those without diabetes, but T1D presents additional barriers, the authors say, including fear of hypoglycaemia, loss of glycaemic control, and inadequate knowledge around exercise management.

The difficulties in managing blood glucose levels around exercise arise from the fact that many factors can influence the glycaemic response to exercise including: the location of insulin delivery, the amount of circulating insulin, the blood glucose level prior to exercise, the timing and composition of the last meal or snack, and the intensity, duration and type of exercise performed.

But after reviewing the latest evidence, the authors, including Dr Carmel Smart, a clinical research fellow and Senior Diabetes and Endocrine Dietitian at John Hunter Children’s Hospital, give practical information and tips, including glucose targets for safe and effective exercise, and nutrition and insulin dose adjustments to help with preventing exercise-related glucose excursions in different situations.

Speaking to the limbic co-author Dr Carmel Smart,  said the guidelines came out of the JDRF PEAK program, designed to provide education for healthcare professionals on how to better support people with T1D who want to participate in physical activity.

She said the key message in the guidance was to consider the individual’s goals for exercise before making decisions about diabetes management during exercise.

“For example, are you discussing strategies with someone exercising at an elite level who wants to improve their sports performance or someone who wants to exercise to lose weight? The manipulation of nutrition and insulin doses would be quite different in these two cases”.

“Some of the traditional recommendations given to people with T1D by their health professionals are not evidence-based”, she added.

While acknowledging that more research is needed in some areas, the paper summarises the expert panel’s consensus on the strategies available to help incorporate exercise safely into the daily management plan for adults who exercise regularly, including those participating in sports and competitive events.