For athletes living with type 1 diabetes, managing their glucose levels and treatment regimens can be a challenge. An Ask the Expert session featured insight into the glycemic impact of different forms of exercise and the clinical management of these athletes.

“We have learned so much from competitive athletes with type 1 diabetes over the years who are competing at really high levels. Diabetes can certainly negatively impact metabolism and physiology and, while it’s not easy with this disease to be in athletic competition, it is achievable,” said Michael Riddell, PhD.

Dr. Riddell, Professor in the School of Kinesiology and Health Science and Senior Scientist at the Muscle Health Research Centre at York University in Toronto, Canada, discussed the physiology, metabolism, and training behaviors of the competitive athlete living with type 1 diabetes in Management of the Athlete with Diabetes.

The session can be viewed on-demand by registered meeting participants at ADA2023.org. If you haven’t registered for the 83rd Scientific Sessions, register today to access the valuable meeting content through August 28.

“An athlete is someone who is engaged in training in sports aiming to improve or sustain his or her performance results,” Dr. Riddell said. “An individual who is engaged in this kind of sport training and competition, their major focus is their sport of interest and, for most of them, it is their full-time job, so these are unique patients that you might have in your care.”

Athletes with type 1 diabetes exist at all ages, ranging from newly diagnosed young athletes learning to live with diabetes to older athletes who may have been managing their diabetes for decades, he noted.

Advances in diabetes technologies have helped athletes with type 1 diabetes achieve their competitive goals, but he said continued research is needed to better understand the metabolic impact of exercise in this unique set of patients.

“We could have faster insulins, for example, and we could have different ways of delivering insulin, such as inhaled insulin,” Dr. Riddell explained. “We need to continue to explore these things and develop individualized glycemic management strategies for these patients.”

Lori M. Laffel, MD, MPH, Professor of Pediatrics and Chief of the Pediatric, Adolescent and Young Adult Section at the Joslin Diabetes Center, discussed clinical considerations and strategies to help diabetes care providers best support their patient-athletes with type 1 diabetes.

“First, it is important to understand exactly the nature of the exercise—the type of exercise, duration, and intensity,” Dr. Laffel said. “Different forms of exercise have different effects on glycemia, and different physiologic mechanisms are in play for people with and without diabetes.”

For people with type 1 diabetes, she said clinicians need to pay attention to both insulin and glucose, including the delayed effects of exercise on glucose levels overnight, a common concern for people living with diabetes.

“You need to know in fundamental ways how much insulin is on board when you start exercising, and luckily we have a lot of automated systems now and even smart pens that will tell us how much active insulin there is,” Dr. Laffel said. “We also have to know in essence how much carbohydrate there is on board, particularly in pediatric patients, and if there is carbohydrate on board, you need to pay attention to how that may impact exercise.”

She also pointed out that insulin sensitivity increases with fitness. “So, if people are going on an exercise plan, you may need to actually reduce their overall insulin doses down the road,” Dr. Laffel said.