Post-exercise Glucose Management in Type 1 Diabetes: Comparing Carbohydrate Intake and Insulin Reduction Strategies

This study aimed to compare 2 post-exercise glucose management approaches in type 1 diabetes patients using continuous subcutaneous insulin infusion.

A group of 46 adults and adolescents underwent a 60-minute ergocycling session at 60% of their VO_2peak at 4 pm After the exercise, participants were randomly assigned to post-exercise glucose management strategies: The first strategy involved a 20% reduction in basal insulin infusion rate for 10 h, along with a 20% reduction in the dinner insulin bolus. The second strategy consisted of consuming a post-exercise snack with 50% of their usual insulin bolus, followed by an evening snack without insulin bolus.

During the 13-hours of recovery (5 PM to 6 AM post-exercise), there were no significant differences between the 2 strategies in terms of time spent within blood glucose levels of 4.0-10.0 mmol/l (54.4 ± 26.2 vs 57.7 ± 25.9%) and time spent below 4.0 mmol/l (1.8 ± 5.9 vs 5.5 ± 9.2%), this difference did not reach statistical significance, likely due to high interindividual variability as reflected by the large standard deviations. However, the time to first hypoglycemic event (eg, time from exercise end to first interstitial glucose <4.0 mmol/L) was significantly longer with the basal insulin reduction strategy (140 vs 83 min, P= .04), indicating a clinically meaningful advantage in delaying post-exercise hypoglycemia.

Both strategies were comparably effective in maintaining similar blood glucose stability during the 13-hours recovery period post-exercise. However, the basal insulin reduction strategy significantly delayed the onset of the first hypoglycemic episode, suggesting a potential advantage for post-exercise hypoglycemia management.