25 Facts to Know on Exercise on Type 1 Diabetes

A team of international researchers release new guidelines based on the accumulation of research on the subject.



This past month, researchers from more than a dozen leading diabetes and exercise research teams published guidelines on how to exercise with Type 1 diabetes. These guidelines, published in the Lancet, represent the current international consensus of the best methods for maintaining blood sugar control with exercise.

From the report, we’ve pulled out 25 important findings:

Why You Really Should Exercise

1. Some 60 percent of people with Type 1 diabetes are overweight or obese

2. Some 40 percent of people with Type 1 have hypertension, and 60 percent have dyslipidemia, a condition which increases the chance of clogged arteries, heart attacks, and strokes.

Read “JDRF Rolls Out its PEAK Program on Exercise and Type 1.”

3. Children and young people with Type 1 all see improved cardiorespiratory fitness and blood lipid levels with regular physical activity.

4. Adults with Type 1 diabetes who are physically active had lower rates of retinopathy

Read “5 Tips for Exercise and Type 1.”

5. Regular exercise decreases total daily insulin needs.

How Much Exercise Should You Do

6. Adults with diabetes should aim for a total of 150 minutes of accumulated physical activity each week.

7. Resistance exercise is recommended two to three times a week.

What Happens to Your Blood Sugar Levels During Exercise

8. During aerobic exercise, insulin secretion decreases and glucagon secretion increases.

9. During anaerobic activities and high-intensity interval training, circulating insulin levels do not decrease as much as they do in aerobic activities.

10. Trained athletes with Type 1 diabetes experience greater drops in blood sugar levels during aerobic exercise than do those who aren’t that physically fit.

11. Resistance exercise can provide better blood sugar stability than continuous moderate-intensity aerobic exercise.

12. Aggressive reductions in insulin intake or skipped doses can lead to hyperglycemia and a heightened risk of ketosis.

13. For at least 24 hours after exercise, you have a greater risk of hypoglycemia, especially at night..

How to Manage Your Blood Sugar Levels for Exercise

14. Researchers recommend that your blood sugar levels be between 126 mg/dL and 180 mg/dL before starting aerobic exercise.

15. For anaerobic exercise, you can start out a bit lower at 90 mg/dL to 126 mg/dL.

16. It’s not recommended that you exercise if you have had a bout of severe hypoglycemia (with levels below 50 mg/dL) in the last 24 hours.

17. You need to eat carbs after a workout to restock your internal glucose supplies.

18. Mixing protein with that carb intake will help your body build muscle.

19. You can reduce your bolus insulin dose the meal before you exercise to avoid hypoglycemia during prolonged exercise.

20. Such reductions require advance planning, however, and should only be done when you plan to do an exercise with a predictable level of effort within two to three hours after a meal.

21. For those on multiple daily injections, reducing basal insulin concentrations before exercise can also reduce the risk of hypoglycemia during and after the activity, but it might up the risk of hyperglycemia. Therefore, it’s not often recommended.

22. Pump users have more flexibility to tinker with basal delivery rates one to two hours before an activity.

23. However, suspending basal insulin delivery altogether an hour before an activity can up your risk of hyperglycemia. Reduce, don’t suspend, your basal rates an hour or an hour and a half before exercise.

24. To deal with increased insulin sensitivity after exercise, think about reducing your bolus dose by about 50 percent for your first post-exercise meal, and have a low-glycemic snack before bedtime.

25. Of course, every individual’s blood sugar levels react differently to exercise. Also, more research is needed, especially on pump use and exercise, before researchers can ever hope to provide ironclad, always-going-to-work guidelines. Therefore, it’s best to monitor your blood sugar levels frequently around exercise, and treat fluctuations accordingly.

What do you think? Do these guidelines match your experience of exercise with Type 1 diabetes? If you have a story to share of exercise and Type 1, please email me at cidlebrook@epscomm.com.

This study was sent to Insulin Nation by JDRF, which was involved in this research and has created an educational program on exercise and Type 1 diabetes. You can learn more about JDRF’s PEAK program at typeonenation.org/peak.

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Craig Idlebrook is a past editor for Insulin Nation, Type 2 Nation, and Información Sobre Diabetes. He is now the community engagement and content manager for T1D Exchange.