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Brian D. Tran and Pietro Galassetti

The beneficial effects of exercise, including reduction of cardiovascular risk, are especially important in children with type 1 diabetes (T1DM), in whom incidence of lifetime cardiovascular complications remains elevated despite good glycemic control. Being able to exercise safely is therefore a paramount concern. Dysregulated metabolism in T1DM however, causes frequent occurrence of both hypo- and hyperglycemia, the former typically associated with prolonged, moderate exercise, the latter with higher intensity, if shorter, challenges. While very few absolute contraindications to exercising exist in these children, exercise should not be started with glycemia outside the 80–250 mg/dl range. Within this glycemic range, careful adjustments in insulin administration (reduction or infusion rate via insulin pumps, or overall reduction of dosage of multiple injections) should be combined with carbohydrate ingestion before/during exercise, based on prior, individual experience with specific exercise formats. Unfamiliar exercise should always be tackled with exceeding caution, based on known responses to other exercise formats. Finally, gaining a deep understanding of other complex exercise responses, such as the modulation of inflammatory status, which is a major determinant of the cardio-protective effects of exercise, can help determine which exercise formats and which individual metabolic conditions can lead to maximally beneficial health effects.

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Michael C. Riddell, Oded Bar-Or, Beatriz V. Ayub, Randolph E. Calvert and George J.F. Heigenhauser

There are currently no guidelines regarding the carbohydrate (CHO) dosage required to prevent exercise-induced hypoglycemia in children with insulin-dependent diabetes mellitus (IDDM). To prevent hypoglycemia by matching glucose ingestion with total-CHO utilization, 20 adolescents with IDDM attended 2 trials: control (CT; drinking water) and glucose (GT; drinking 6-8% glucose). Participants performed 60 min of moderate-intensity cycling 100 min after insulin injection and breakfast. CT's total-CHO utilization during exercise was determined using indirect calorimetry. In GT, participants ingested glucose in the amount equal to total CHO utilization in the CT. A total of 9 participants had BG <4.0 mmol/L in CT compared to 3 in GT (p < .05). In conclusion, glucose ingestion equal to total-CHO utilization attenuates the drop in blood glucose and reduces the likelihood of hypoglycemia during exercise in adolescents with IDDM.

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(0.4[0.2–1.0]) ( P  = .008) and between PR2 (0.4[0.2–1.0]) and the marathon (0.1[0–0.3]) ( P  = .008). There was no severe hypoglycemia or hyperglycemia with ketosis at any time before, during and after the PRs and Marathon. Conclusions.— To avoid exercise-induced hypoglycemia, it is necessary to reduce usual doses

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Andrzej Gawrecki, Aleksandra Araszkiewicz, Agnieszka Szadkowska, Grzegorz Biegański, Jan Konarski, Katarzyna Domaszewska, Arkadiusz Michalak, Bogda Skowrońska, Anna Adamska, Dariusz Naskręt, Przemysława Jarosz-Chobot, Agnieszka Szypowska, Tomasz Klupa and Dorota Zozulińska-Ziółkiewicz

-8587(17)30014-1 28126459 29. Riddell MC , Milliken J . Preventing exercise-induced hypoglycemia in type 1 diabetes using real-time continuous glucose monitoring and a new carbohydrate intake algorithm: an observational field study . Diabetes Technol Ther . 2011 ; 13 : 819 – 25 . PubMed ID: 21599515 doi:10.1089/dia