Approach to the Patient: Type 1 Diabetes Management With Exercise-Prepare, Perform, Stabilize, and Study

Management of type 1 diabetes during physical activity and exercise remains challenging despite advancements in diabetes technology, including continuous glucose monitoring and automated insulin delivery systems. The approach to the patient as a healthcare provider involves careful consideration of numerous patient-specific goals and factors including a patient's motivations for regular physical activity and exercise, their baseline characteristics and exercise self-management knowledge base, features of the activity types being planned and/or performed, the timing of the various activities in relation to meals and insulin dosing, and the type of insulin therapy and other medications that may be used. Here we present a novel systematic approach to the patient and guidelines for clinical consultation using a "Who, What, When, Where, Why, and How" approach and consideration of the 4 key phases of exercise management: before, during, after, and between episodes-described here as prepare, perform, stabilize, and study. We offer this information using a case-based approach to illustrate these important considerations.