• Posted June 16, 2023

Why Exercise Is Often a Challenge for Folks With Type 1 Diabetes

It can be challenging for people with type 1 diabetes to exercise safely while controlling their blood sugar.

People with the condition often struggle with this balance, according to a new study based on a survey conducted through social media groups restricted to adults with type 1 diabetes who run, jog or walk for exercise. The survey findings were presented Thursday at a meeting of the Endocrine Society, in Chicago.

“Managing high and low blood sugar levels before, during and after aerobic exercise remains one of the greatest challenges for people living with type 1 diabetes,” said lead researcher Dr. Joseph Henske, an endocrinologist at the University of Arkansas for Medical Sciences in Little Rock.

“This study provides a number of key insights into the degree to which published guidelines and recommendations surrounding exercise with type 1 diabetes are understood and implemented in the real world," he said in a meeting news release.

In all, 102 adults with type 1 diabetes responded to the survey. Of those, 68% said they exercised four or more days per week, with weekly average of 23 miles.

Nearly all (97%) said they used continuous glucose monitors. About 75% used insulin pumps.

The respondents had a self-reported average HbA1C of 7.1%, indicating their diabetes was well-controlled. HbA1C is a measure of average blood sugar levels over the past three months. The goal for most people with diabetes is 7% or less.

Most respondents said they had learned about diabetes and exercise on their own.

About 80% reported learning mostly by “trial and error.” About 46% learned from social media; 32% from their medical team, and 28% through online searches. Some used multiple methods to figure out how to manage diabetes and exercise.

Hypoglycemia -- a condition in which blood sugar levels drop to unhealthy levels -- was a concern. In all, 27% of respondents reported an ongoing fear of hypoglycemia as a significant barrier to exercise. About 36% said they noticed increased variability in blood sugar levels because of exercise.

About 19% of respondents said they have hypoglycemia unawareness. That's when a person with diabetes does not experience the usual early warning symptoms of low blood sugar such as sweating, trembling, butterflies in the stomach, tingling, numbness and rapid pulse.

About 73% of those surveyed said they exercised even if they had severe hypoglycemia in the last 24 hours, which is not consistent with published guidelines.

About 74% did not perform testing for diabetic ketoacidosis (DKA), a serious and potentially deadly complication of diabetes. This included respondents who had very high and unexplained blood sugar prior to exercise. About 49% did not wear their diabetes identification during exercise.

“This survey demonstrated that many people who live with type 1 diabetes, despite being tech-savvy and engaged, passionate about exercise, and seemingly well-controlled based on hemoglobin A1C, are still struggling to exercise safely without high and low blood sugar,” Henske said. “We hope to increase awareness of published guidelines regarding exercising with diabetes and help create better practical educational tools.”

Findings presented at medical meetings are considered preliminary until published in a peer-reviewed journal.

More information

The American Diabetes Association has more on exercise and type 1 diabetes.

SOURCE: Endocrine Society, news release, June 15, 2023