The Role of Newer Technologies (CSII and CGM) and Novel Strategies in the Management of Type 1 Diabetes for Sport and Exercise

  • Alistair N. Lumb


Long-acting insulin analogues (insulin glargine (Lantus), sanofi-aventis; insulin detemir (Levemir), Novo Nordisk) are now used to provide basal insulin therapy for the majority of people using multiple daily injection (MDI) treatment regimens for type 1 diabetes. These insulins have provided significant benefit in terms of greater stability of circulating insulin levels [1, 2], which in turn has led to more stable blood glucose levels and a reduction in rates of hypoglycemia, particularly nocturnal hypoglycemia [3, 4]. However, as has been explained elsewhere in this volume, circulating insulin levels can vary considerably during sport and exercise in those without diabetes. An unfortunate consequence of stabilizing insulin levels in those with type 1 diabetes is, therefore, a significant risk of dysglycemia during exercise. For example, during endurance exercise in those without diabetes, such as prolonged running or cycling, insulin levels fall [5] to allow the mobilization of carbohydrate and lipid fuel sources [6], with insulin secretion falling to below fasting levels [7]. These fuel sources provide the energy required by exercising muscle and allow blood glucose levels to be maintained within a tight range. In people with diabetes using MDI therapy, insulin levels remain reasonably stable during exercise [5]. This limits the body’s ability to mobilize the required fuel sources and therefore results in a significant risk of hypoglycemia. The (somewhat inelegant) solution to this problem is usually the ingestion of carbohydrate, which can be problematic to maintain in some sports and also reduces the benefit of exercise if weight control is one of the intended outcomes.


Insulin Glargine Basal Insulin Continuous Glucose Monitoring Insulin Detemir Continuous Subcutaneous Insulin Infusion 
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Copyright information

© Springer-Verlag London 2012

Authors and Affiliations

  1. 1.Diabetes CentreWycombe Hospital, Buckinghamshire Healthcare NHS TrustHigh Wycombe, BuckinghamshireUK

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