Sports Medicine: Athletes and Physically Active People With Diabetes

Physical activity has many health benefits in people with type 1 and type 2 diabetes. Clinicians must be comfortable counseling patients with both types of diabetes on how to participate safely in various types of physical activity. According to the American Diabetes Association (ADA), most people with diabetes do not need further testing before initiation of low- to moderate-intensity exercise. Recommended physical activity for adults includes at least 150 min/week of moderate-intensity aerobic activity plus resistance training 2 to 3 times/week; for children and adolescents the recommendation is 60 min/day. Important steps to ensure safe participation in physical activity include modifying the insulin regimen and carbohydrate intake, as well as more frequent monitoring of blood glucose in the time periods surrounding exercise. For patients using multiple daily insulin injections, the preprandial bolus insulin dose typically should be decreased relative to the expected intensity and duration of aerobic exercise. For those using continuous subcutaneous insulin infusion pumps, the basal insulin rate should be reduced by 50% to 80% approximately 90 min before aerobic exercise. Continuous glucose monitoring provides an opportunity for more frequent glucose monitoring and tighter glycemic control during exercise participation.