title: Techniques for Exercise Preparation and Management in Adults with Type 1 Diabetes.
abstract: OBJECTIVE
  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.
authors.affiliation: William Sansum Diabetes Center, Santa Barbara, California, United States.
authors.forename: Jordan E
authors.initials: JE
authors.lastname: Pinsker
authors.affiliation: Type 1 Diabetes Exchange, Boston, Massachusetts, United States.
authors.forename: Amy
authors.initials: A
authors.lastname: Kraus
authors.affiliation: Type 1 Diabetes Exchange, Boston, Massachusetts, United States.
authors.forename: Danielle
authors.initials: D
authors.lastname: Gianferante
authors.affiliation: William Sansum Diabetes Center, Santa Barbara, California, United States.
authors.forename: Benjamen E
authors.initials: BE
authors.lastname: Schoenberg
authors.affiliation: Department of Medicine, Santa Barbara Cottage Hospital, Santa Barbara, California, United States.
authors.forename: Satbir K
authors.initials: SK
authors.lastname: Singh
authors.affiliation: University of California Santa Barbara, Santa Barbara, California, United States.
authors.forename: Hallie
authors.initials: H
authors.lastname: Ortiz
authors.affiliation: William Sansum Diabetes Center, Santa Barbara, California, United States; Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, United States.
authors.forename: Eyal
authors.initials: E
authors.lastname: Dassau
authors.affiliation: William Sansum Diabetes Center, Santa Barbara, California, United States. Electronic address: dkerr@sansum.org.
authors.forename: David
authors.initials: D
authors.lastname: Kerr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation*; D003922:Diabetes Mellitus, Type 1 / Q000517:prevention & control*; D019468:Disease Management; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012648:Self Care; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose
keywords: continuous glucose monitoring; diabète de type 1; exercice physique; exercise; hypoglycemia; hypoglycémie; technologie; technology; type 1 diabetes