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Techniques for Exercise Preparation and Management in Adults with Type 1 Diabetes

      Abstract

      Objectives

      People with type 1 diabetes are at risk for early- and late-onset hypoglycemia following exercise. Reducing this risk may be possible with strategic modifications in carbohydrate intake and insulin use. We examined the exercise preparations and management techniques used by individuals with type 1 diabetes before and after physical activity and sought to determine whether use of differing diabetes technologies affects these health-related behaviours.

      Methods

      We studied 502 adults from the Type 1 Diabetes Exchange's online patient community, Glu, who had completed an online survey focused on diabetes self-management and exercise.

      Results

      Many respondents reported increasing carbohydrate intake before (79%) and after (66%) exercise as well as decreasing their meal boluses before (53%) and after (46%) exercise. Most reported adhering to a target glucose level before starting exercise (77%). Despite these accommodations, the majority reported low blood glucose (BG) levels after exercise (70%). The majority of users of both insulin pump therapy (CSII) and continuous glucose monitoring (CGM) (Combined) reported reducing basal insulin around exercise (55%), with fewer participants adjusting basal insulin when using other devices (SMBG only = 20%; CGM = 34%; CSII = 42%; p<0.001). However, CSII and Combined users reported that exercise makes their BG levels harder to control (p<0.05) and makes them feel less able to predict their BG levels while exercising (p<0.001); they show agreement that fear of low BG levels keeps them from exercising (p<0.01).

      Conclusions

      These findings highlight the need for exercise-management strategies tailored to individuals' overall diabetes management, for despite making exercise-specific adjustments for care, many people with type 1 diabetes still report significant difficulties with BG control when it comes to exercise.

      Résumé

      Objectifs

      Les personnes atteintes de diabète de type 1 sont à risque de développer une hypoglycémie avec un déclenchement précoce et tardif après l'exercice. La réduction de ce risque peut être possible par des modifications stratégiques dans l'apport en glucides et dans l'usage de l'insuline. Nous avons examiné les préparatifs de l'exercice et les techniques de gestion utilisées par les individus atteints de diabète de type 1 avant et après l'activité physique, et avons cherché à déterminer si l'utilisation de différentes techniques de traitement du diabète affecte ces comportements liés à la santé.

      Méthodes

      Nous avons étudié 502 adultes issus de la communauté d'échange en ligne de patients atteints de diabète de type 1, Glu, qui avaient complété un sondage en ligne axé sur l'autogestion du diabète et l'exercice.

      Résultats

      De nombreux répondants ont rapporté augmenter l'apport en glucides avant (79%) et après (66%) l'exercice, et aussi réduire leurs bols alimentaires avant (53%) et après (46%) l'exercice. La plupart ont rapporté se baser sur un niveau cible de glucose avant de commencer l'exercice (77%). En dépit de ces ajustements, la majorité a rapporté de faibles taux de glucose sanguin (BG) après l'exercice (70%). Lamajorité des utilisateurs à la fois de la thérapie par pompe à insuline (CSII) et de la surveillance continue du glucose (CGM) (Combiné) a rapporté réduire l'insuline basale jouxtant l'exercice (55%), avec moins de participants ajustant l'insuline basale lors de l'utilisation d'autres appareils (autosurveillance de la glycémie (SMBG) seulement=20%; CGM=34%; CSII=42%; p<0,001). Cependant, les utilisateurs de la CSII et les utilisateurs combinés ont rapporté que l'exercice rend leurs niveaux de glycémie plus difficiles à contrôler (p<0,05), et les fait se sentir moins capables de prédire leurs niveaux de glycémie pendant l'exercice (p<0,001); ils se montrent d'accord sur le fait qu'une crainte de niveaux faibles de glycémie les empêchent de faire de l'exercice (p<0,01).

      Conclusions

      Ces résultats mettent en évidence la nécessité de développer des stratégies de gestion de l'exercice ajustées à la gestion d'ensemble du diabète des individualités, car malgré des ajustements spécifiques à l'exercice dans un but curatif, beaucoup de personnes avec un diabète de type 1 rapportent encore des difficultés importantes dans le contrôle de la glycémie pour ce qui a trait à l'activité physique.

      Keywords

      Mots clés

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