Utilizing Devices for Exercise

Pumps are often designed with physical activity and exercise in mind. Many of these smart devices can track insulin on board (IOB) to prevent concerns like low glucose or overlapping doses. Many insulin pumps also have an "activity" or "exercise" mode built-in to increase your glucose target during exercise. Below, we provide some information on how to use these systems around activity.

Tips for Physical Activity with AID Systems:

For planned physical activity, generally recommended to set higher glucose target 1-2 hours before activity if decrease in glucose expected during activity
If rise in glucose expected during activity, consider keeping standard glucose target (may not need higher glucose target)
For unplanned physical activity, generally recommended to set higher glucose target as soon as possible if decrease in glucose is expected
If planning physical activity within 2 hours of meal, consider setting higher glucose target first, then reducing bolus insulin by around 25-33% if decrease in glucose expected
Whenever possible, plan to exercise when insulin on board (IOB) is low
Tubed pumps may be good option for contact sports since they can be disconnected during activity
Patch pump or tubeless pumps may be good option for water sports since they can typically remain connected during activity
Some sports, like contact sports, may require more frequent site changes (every 1-2 days) to prevent site failures
Auto-Soft infusion sets may be preferred in contact sports
With AID systems, generally recommended to treat with fewer carbohydrates (around 3-20 grams every 20 mins). Visit our Nutrition for Physical Activity page for more tips.
Adhesives and overlay tapes can help devices stay on during physical activity. Visit our Exercise Tips and Adhesives page for specific types of adhesive, overlay tape, and even clothing products to help keep your devices safe and in place during activity.
To learn more about consensus guidelines for physical activity and AID, as well as more specific device recommendations during activity, check out this article (https://link.springer.com/article/10.1007/s00125-024-06308-z#Tab1) and our Guidelines for Exercise page.

Automated Insulin Delivery Systems

Automated insulin delivery (AID) systems can improve glucose management, but often require users to adjust certain pump settings in advance of exercise. The table below highlights physical activity features of various types of AID systems. For more information on physical activity guidance for each device, click the link on the device name.

Device	Standard Glucose Target	Exercise Setting Terminology	Exercise Target	AID Features for Exercise:
Tandem t:slim X2 with Control IQ	112-160 mg/dL	Exercise mode	140-160 mg/dL	Can run Exercise mode for 30 minutes to 8 hours, or leave it on until turned off manually Up to 6 personal profiles can be created to accommodate for different types of activity Still delivers automatic correction boluses, even with exercise mode on
Tandem Mobi with Control IQ	112-160 mg/dL	Exercise mode	140-160 mg/dL	Can run exercise mode for 30 minutes to 8 hours, or leave it on until turned off manually Up to 6 personal profiles can be created to accommodate for different types of activity Still delivers automatic correction boluses, even with exercise mode on. Same AID algorithm as t:slim, but has a smaller footprint and is controlled from phone
Insulet Omnipod 5	110-150 mg/dL	Activity feature	150 mg/dL	Up to 8 different targets can be programmed, flexibility around glucose Can run Activity feature for up to 24 hours
Medtronic MiniMed 780G	110-120 mg/dL	Temp Target	150 mg/dL	Can run Temp Target for 30 minutes to 24 hours in 30-minute increments Prevents automatic correction boluses when Temp Target is active
Beta Bionics iLet Bionic Pancreas	110 mg/dL (lower), 120 mg/dL (usual), 130 mg/dL (higher)	No exercise setting (currently)	N/A	Although currently no specific higher glucose target setting for exercise, users can consider adjusting standard target manually (e.g., from 110 to 130 mg/dL) before exercise, but should remember to return glucose target back after exercise
CamDiab mylife CamAPS FX	80-198 mg/dL	“Ease-off” mode or “Boost” mode	150 mg/dL	Use “Ease-off” mode and/or increasing glucose target 1-2 hours before exercise to reduce risk of hypoglycemia Use “Boost” mode if an increase in glucose is expected during exercise Both modes can be pre-programmed to automatically start and end at a predefined time
Diabeloop Generation 1 (DBLG1)	110 mg/dL (default), adjustable between 100-130 mg/dL	Physical Activity mode	Glucose target and hypoglycemia threshold are increased by 70 mg/dL (reduces aggressiveness of insulin delivery)	When Physical Activity mode is used, intensity can be set to low, moderate or intense and planned duration can be manually set Automatically reduces basal rate insulin delivery for 16 hours after activity to reduce risk of post-exercise hypoglycemia
OpenAPS, Android APS, FreeAPS X, Loop	Customizable	Ability to change/scale all insulin delivery parameters (aggressiveness of automation) and targets	Customizable	Program for duration of time or schedule for specific time; will automatically deactivate at the end of the programmed or scheduled time APS works with Android devices and Loop works with Apple devices

Consensus Guidelines Rights and Permissions

This article is licensed under a Creative Commons Attribution 4.0 International License - no changes were made to the figures.

Moser O and Zaharieva DP et al. (2024) Diabetologia DOI 10.1007/s00125-024-06308-z

© The International Society of Pediatric and Adolescent Diabetes and the European Association for the Study of Diabetes 2024. Distributed under the terms of the CC BY 4.0 Attribution License (http://creativecommons.org/licenses/by/4.0/).

Utilizing Devices for Exercise

References