Managing blood glucose during and after exercise in Type 1 diabetes: reproducibility of glucose response and a trial of a structured algorithm adjusting insulin and carbohydrate intake

Managing training and competition with type 1 diabetes is complicated, but not impossible. Athletes, and their diabetes care providers, should be aware of everything that might impact blood glucose responses to exercise. These factors include the type, timing, intensity and duration of exercise, as well as the timing and size of insulin dosage adjustments and carbohydrate intake. Due to differences in physiology (age, sex, fitness levels, etc.) there is no “one size fits all” solution, however, with careful planning and record-keeping, athletes with type 1 diabetes have the same opportunities for success in their sport as everyone else.

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Body Mass Index Effect on Differing Responses to Psychological Stress in Blood Glucose Dynamics in Patients With Type 1 Diabetes

Journal of Diabetes Science and Technology ◽

10.1177/1932296818758103 ◽

2018 ◽

Vol 12 (3) ◽

pp. 657-664 ◽

Cited By ~ 1

Author(s):

Basak Ozaslan ◽

Stephen D. Patek ◽

Jesse H. Grabman ◽

Jaclyn A. Shepard ◽

Eyal Dassau ◽

...

Keyword(s):

Body Mass Index ◽

Type 1 Diabetes ◽

Blood Glucose ◽

Psychological Stress ◽

Body Mass ◽

Carbohydrate Intake ◽

Mixed Effect ◽

Stress Levels ◽

Effectiveness Index

Objective: The objective was to investigate the relationship of body mass index (BMI) to differing glycemic responses to psychological stress in patients with type 1 diabetes. Methods: Continuous blood glucose monitor (CGM) data were collected for 1 week from a total of 37 patients with BMI ranging from 21.5-39.4 kg/m2 (mean = 28.2 ± 4.9). Patients reported daily stress levels (5-point Likert-type scale, 0 = none, 4 = extreme), physical activity, carbohydrate intake, insulin boluses and basal rates. Daily reported carbohydrates, total insulin bolus, and average blood glucose (BG from CGM) were compared among patients based on their BMI levels on days with different stress levels. In addition, daily averages of a model-based “effectiveness index” (quantifying the combined impact of insulin and carbohydrate on glucose levels) were defined and compared across stress levels to capture meal and insulin independent glycemic changes. Results: Analyses showed that patient BMI likely moderated stress related glycemic changes. Linear mixed effect model results were significant for the stress-BMI interaction on both behavioral and behavior-independent glycemic changes. Across participants, under stress, an increase was observed in daily carbohydrate intake and effectiveness index at higher BMI. There was no significant interactive effect on daily insulin or average BG. Conclusion: Findings suggest that (1) stress has both behavioral and nonbehavioral glycemic effects on T1D patients and (2) the direction and magnitude of these effects are potentially influenced by level of stress and patient BMI. Possibly responsible for these observed effects are T1D/BMI related alterations in endocrine response.

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