Despite overwhelming evidence of the health benefits of physical activity, exercise interventions remain challenging for clinicians and patients alike—particularly diabetes patients who must contend with additional barriers because of their condition. Fortunately, research is revealing how to overcome some of these barriers and get patients moving.

Four researchers will discuss the latest findings in this area during the two-hour symposium Physical Activity and Diabetes—When, How Much, Insulin Adjustments, and More, which will begin at 2:15 p.m. CT Monday, June 15.

Jane E. Yardley, PhD, Assistant Professor at the University of Alberta in Camrose, Alberta, Canada, will review data on exercise timing and explain how patients can schedule activity to reduce the risk of hypoglycemia. She will talk specifically about fasting exercise among type 1 diabetes patients.

“Fasting exercise may actually be a better way to avoid hypoglycemia, which sounds counter intuitive but it’s something patients have known for a long time,” Dr. Yardley said. “One of the biggest causes of hypoglycemia for type 1 patients is having an excess of insulin in the system. If patients are exercising before breakfast, usually all they have is their basal insulin. Also, a lot of type 1 patients are prone to the dawn phenomenon, where there’s hyperglycemia. You can harness that to exercise and bring those glucose levels down.”

Dr. Yardley will also look at research indicating that fasting exercise in people without diabetes tends to promote higher growth hormone and cortisol levels. While studies haven’t measured these hormonal responses in type 1 diabetes patients, the responses would, in theory, promote fat as a fuel source over carbohydrates. “So that can also lead to more stable blood glucose during exercise,” she said.

Rémi Rabasa-Lhoret, MD, PhD, Professor at the University of Montreal and Montreal Clinical Research Institute, Quebec, Canada, will discuss how to adjust insulin dosing for exercise.

“I’m going to focus on insulin-treated patients—so all people with type 1 and a fraction of people living with type 2,” he said. “For those people, physical activity offers a lot of potential benefit. But still they are limited by the increased risk of glucose fluctuations, particularly hypoglycemia related to exercise.”

Dr. Rabasa-Lhoret will review recent data and provide practical strategies for advising patients about exercise.

“Data show clinicians are not well equipped to give practical advice to patients,” he said. “Should they reduce their insulin or take in more carbohydrates? If they reduce their insulin, how much and when? Is it different if they’re on injections or a pump? Is it different if it’s after a meal or fasting in the morning?”

Although the literature does not cover all exercises, intensities, and durations, Dr. Rabasa-Lhoret said he will try to answer these questions for the most common activities and will also give attendees 10 tips for adjusting insulin and/or carbohydrates to reduce exercise-induced hypoglycemia.

Also during the session, Normand G. Boulé, PhD, Professor, Faculty of Kinesiology, Sport, and Recreation at the University of Alberta, will examine exercise volume considerations for type 2 diabetes patients. And David G. Armstrong, DPM, MD, PhD, Professor of Clinical Surgery in the Keck School of Medicine at the University of Southern California, will discuss how new technologies can be used to manage activity for patients with diabetic feet.