Avis de non-responsabilité : Nous travaillons à la traduction de notre site dans d'autres langues. Si vous rencontrez des problèmes avec les traductions, veuillez nous envoyer un courriel à l'adresse suivante diabeteswise@stanford.edu.

Exercice

Special Considerations While Being Active with T1D and Using an AID System


New diabetes technology like Automated Insulin Delivery (AID) systems can help make exercise and T1D management a little bit easier. But some activities (like long workouts, swimming, or playing in hot or cold weather) can make glucose levels harder to manage1. We’ve got some tips to help you stay safe in these situations!

This section has been simplified from the AID and Exercise Position Statement by Moser & Zaharieva et al.  

Long Activities (Examples: Marathon running or long hike) Everything You Need for the Miles Ahead

Things to Know

  • Set higher glucose target 1-2 hours before activity to avoid lows, but doing this for a long time can also make glucose levels spike
  • Low insulin can increase risk of ketones, which are dangerous
  • Long activities use up a lot of energy, so glucose levels often drop
  • Stress or too little insulin can make glucose levels rise

Tips

  • Eat small carb snacks during activity
  • Don’t reduce insulin too much or for too long
  • Avoid large snacks without taking some insulin
  • Watch your CGM number and trend arrow closely and change alerts to catch lows and highs early

Taking Off Your Pump for a Long Time (over 2 hours) What to Know Before You Disconnect

Things to Know

  • Glucose levels can rise when pump hasn’t delivered insulin for a long period of time
  • No insulin for too long can also increase risk of ketones

Tips

  • If disconnecting AID system from your body, remember to suspend/stop insulin delivery so insulin delivery doesn’t continue when system is not connected to you
  • Consider reconnecting AID system every hour to give small insulin doses
  • Consider switching to manual mode so you have more control over insulin delivery
  • Consider “untethered” method (long-acting insulin plus pump) for activities where a pump doesn’t work well

More Information:

    • No Disadvantage to Insulin Pump Off vs Pump On During Intermittent High-Intensity Exercise in Adults With Type 1 Diabetes2
    • Flexible insulin therapy with a hybrid regimen of insulin degludec and continuous subcutaneous insulin infusion with pump suspension before exercise in physically active adults with type 1 diabetes (FIT Untethered): a single-centre, open-label, proof-of-concept, randomised crossover trial3
    • Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin4
    • The Effects of Basal Insulin Suspension at the Start of Exercise on Blood Glucose Levels During Continuous Versus Circuit-Based Exercise in Individuals with Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion5
Competition Stress (Examples: Sporting event or tournament) Understanding Your Body’s Response to High-Stress Moments

Things to Know

  • Stress hormones can raise your glucose levels even if you don’t eat
  • After the event, glucose levels may drop, even many hours later

Tips

  • Monitor how much active insulin (or insulin on board) is on your device before competition because AID system likely increasing insulin delivery with stress
  • Stay hydrated
  • Avoid setting higher glucose target 1-2 hours before competition
  • If glucose levels rise above 270 mg/dL (15.0 mmol/L) with competition stress, consider small insulin correction dose (around half of your usual correction)

More Information

  • The competitive athlete with type 1 diabetes6
  • Type 1 diabetes mellitus and exercise in competitive athletes7
  • Improved glycaemic variability and basal insulin dose reduction during a running competition in recreationally active adults with type 1 diabetes - A single-centre, prospective, controlled observational study8
Water Sports (Examples: Swimming or surfing) Splash Smart: Staying Safe in the Water

Things to Know

  • Devices (example: AID system and CGM) may not communicate well with each other in water, so monitor glucose levels more closely
  • Low glucose levels in water can be dangerous because it might not feel the same as it does on land

Tips

  • Check if AID system is approved for use in water
  • Try keeping AID and CGM devices close together so they can communicate
  • Avoid water sports if you have too much active insulin
  • Suspend insulin delivery and/or disconnect pump, where possible
  • If disconnecting AID system in water, consider reconnecting every hour to give small insulin dose
  • Keep fast-acting glucose snacks like juice or glucose tablets nearby

Contact Sports (Examples: Wrestling or football) Staying on Top of Your Game and Your Blood Sugar

Things to Know

  • Stress hormones can raise glucose levels even if you don’t eat
  • Devices (example: AID system and CGM) can fall off or get damaged
  • Wearing devices can sometimes feel uncomfortable

Tips

    • Place devices in safe spots on body, where they are less likely to get bumped off
    • Use extra adhesive or overlay tape to keep devices on
    • If disconnecting AID system from your body, remember to suspend/stop insulin delivery so insulin delivery doesn’t continue when system is not connected to your body
    • May avoid setting a higher glucose target 1-2 hours before exercise if your glucose levels usually rise during contact sports

Hot Weather (Examples: Hiking in heat) Hot Days, Smart Plays: Diabetes Tips for the Heat

Things to Know

  • Sweat can make devices fall off
  • Heat can make insulin be absorbed faster, which can lower glucose levels
  • Your body works harder to stay cool, using more energy and this can cause quick or unexpected drops in glucose levels
  • Hot weather can sometimes make CGM readings less accurate

Tips

More Information

  • Environmental effects of ambient temperature and relative humidity on insulin pharmacodynamics in adults with type 1 diabetes mellitus9
  • Factors Influencing Insulin Absorption Around Exercise in Type 1 Diabetes10
  • Impairments in local heat loss in type 1 diabetes during exercise in the heat11
  • Impaired whole-body heat loss in type 1 diabetes during exercise in the heat: a cause for concern?12
  • Update on Management of Type 1 Diabetes and Type 2 Diabetes in Athletes13
Cold Weather (Example: Skiing) Layer Up, Check In: Cold Weather Tips with Diabetes

Things to Know

  • Cold weather can change how your body absorbs insulin
  • Glucose levels might go high or low depending on activity and how cold you get
  • Cold weather can cause insulin in AID system and also glucose gels to freeze
  • Loss of signal is possible with glucose meter and/or CGM

Tips

  • Keep insulin and glucose gels close to your body to stay warm
  • Use glucose tablets instead of gels or other treatments that can freeze
  • Warm up devices before using
  • Consider setting higher CGM alert, where possible

High Altitude (Example: Hiking in mountains) High Elevation, High Awareness: Managing Diabetes Up High

Things to Know

  • Less oxygen can make it hard to think clearly
  • Glucose levels might go high or low depending on activity and altitude
  • Fingerstick glucose meter might not be as accurate at high altitude

Tips

  • Monitor glucose levels closely on CGM
  • Stay hydrated
  • For short periods at high altitude, body may be more insulin resistant, but this usually improves after a few days at altitude
  • Above 5000 m, more stress hormones produced, and this may increase risk of high glucose levels

More Information

  • Increased insulin requirements during exercise at very high altitude in type 1 diabetes14
  • Diabetes, trekking and high altitude: recognizing and preparing for the risks15
  • Personal Insulin Pump With Predictive Low Glucose Management Technology at High Altitude16
  • Physiological Characteristics of Type 1 Diabetes Patients during High Mountain Trekking17
  • Extreme altitude mountaineering and Type 1 diabetes; the Diabetes Federation of Ireland Kilimanjaro Expedition18
  • Effects of Simulated High Altitude on Blood Glucose Levels During Exercise in Individuals With Type 1 Diabetes19

References:

1. Moser O, Zaharieva DP, Adolfsson P, et al. The use of automated insulin delivery around physical activity and exercise in type 1 diabetes: a position statement of the European Association for the Study of Diabetes (EASD) and the International Society for Pediatric and Adolescent Diabetes (ISPAD). Diabetologia. 2025 Feb;68(2):255–280. doi:10.1007/s00125-024-06308-z 

2. Zaharieva DP, Cinar A, Yavelberg L, Jamnik V, Riddell MC. No Disadvantage to Insulin Pump Off vs Pump On During Intermittent High-Intensity Exercise in Adults With Type 1 Diabetes. Can J Diabetes. 2020;44(2):162-168. doi:10.1016/j.jcjd.2019.05.015

3. Aronson R, Li A, Brown RE, McGaugh S, Riddell MC. Flexible insulin therapy with a hybrid regimen of insulin degludec and continuous subcutaneous insulin infusion with pump suspension before exercise in physically active adults with type 1 diabetes (FIT Untethered): a single-centre, open-label, proof-of-concept, randomised crossover trial. Lancet Diabetes Endocrinol. 2020;8(6):511-523. doi:10.1016/S2213-8587(20)30114-5

4. Diabetes Research in Children Network (DirecNet) Study Group, Tsalikian E, Kollman C, et al. Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin. Diabetes Care. 2006;29(10):2200-2204. doi:10.2337/dc06-0495

5. Zaharieva D, Yavelberg L, Jamnik V, Cinar A, Turksoy K, Riddell MC. The Effects of Basal Insulin Suspension at the Start of Exercise on Blood Glucose Levels During Continuous Versus Circuit-Based Exercise in Individuals with Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion. Diabetes Technol Ther. 2017;19(6):370-378. doi:10.1089/dia.2017.0010

6. Riddell MC, Scott SN, Fournier PA, et al. The competitive athlete with type 1 diabetes. Diabetologia. 2020;63(8):1475-1490. doi:10.1007/s00125-020-05183-8

7. Ratjen I, Weber KS, Roden M, Herrmann ME, Müssig K. Type 1 diabetes mellitus and exercise in competitive athletes. Exp Clin Endocrinol Diabetes. 2015;123(7):419-422. doi:10.1055/s-0035-1545344

8. Moser O, Mueller A, Eckstein ML, et al. Improved glycaemic variability and basal insulin dose reduction during a running competition in recreationally active adults with type 1 diabetes-A single-centre, prospective, controlled observational study. PLoS One. 2020;15(9):e0239091. doi:10.1371/journal.pone.0239091

9. Al-Qaissi A, Papageorgiou M, Javed Z, et al. Environmental effects of ambient temperature and relative humidity on insulin pharmacodynamics in adults with type 1 diabetes mellitus. Diabetes Obes Metab. 2019;21(3):569-574. doi:10.1111/dom.13555

10. Pitt JP, McCarthy OM, Hoeg-Jensen T, Wellman BM, Bracken RM. Factors Influencing Insulin Absorption Around Exercise in Type 1 Diabetes. Front Endocrinol (Lausanne). 2020;11:573275. doi:10.3389/fendo.2020.573275

11. Carter MR, McGinn R, Barrera-Ramirez J, Sigal RJ, Kenny GP. Impairments in local heat loss in type 1 diabetes during exercise in the heat. Med Sci Sports Exerc. 2014;46(12):2224-2233. doi:10.1249/MSS.0000000000000350

12. Notley SR, Poirier MP, Yardley JE, Sigal RJ, Kenny GP. Impaired whole-body heat loss in type 1 diabetes during exercise in the heat: a cause for concern? Diabetologia. 2019;62(6):1087-1089. doi:10.1007/s00125-019-4858-5

13. Yardley JE, Colberg SR. Update on Management of Type 1 Diabetes and Type 2 Diabetes in Athletes. Current Sports Medicine Reports. 2017;16(1):38. doi:10.1249/JSR.0000000000000327

14. de Mol P, de Vries ST, de Koning EJP, Gans ROB, Tack CJ, Bilo HJG. Increased insulin requirements during exercise at very high altitude in type 1 diabetes. Diabetes Care. 2011;34(3):591-595. doi:10.2337/dc10-2015

15. Mohajeri S, Perkins BA, Brubaker PL, Riddell MC. Diabetes, trekking and high altitude: recognizing and preparing for the risks. Diabet Med. 2015;32(11):1425-1437. doi:10.1111/dme.12795

16. Matejko B, Benbenek-Klupa T, Malecki MT, Klupa T. Personal Insulin Pump With Predictive Low Glucose Management Technology at High Altitude. J Diabetes Sci Technol. 2017;11(1):176-177. doi:10.1177/1932296816649973

17. Matejko B, Gawrecki A, Wróbel M, et al. Physiological Characteristics of Type 1 Diabetes Patients during High Mountain Trekking. J Diabetes Res. 2020;2020:8068710. doi:10.1155/2020/8068710

18. Moore K, Vizzard N, Coleman C, McMahon J, Hayes R, Thompson CJ. Extreme altitude mountaineering and Type 1 diabetes; the Diabetes Federation of Ireland Kilimanjaro Expedition. Diabet Med. 2001;18(9):749-755. doi:10.1046/j.0742-3071.2001.00568.x

19. Dugan CW, Maloney SK, Abramoff KJ, et al. Effects of Simulated High Altitude on Blood Glucose Levels During Exercise in Individuals With Type 1 Diabetes. J Clin Endocrinol Metab. 2022;107(5):1375-1382. doi:10.1210/clinem/dgab881