Continuous exercise (CON) and high-intensity interval exercise (HIIE) can be safely performed with type 1 diabetes mellitus (T1DM). Additionally, continuous glucose monitoring (CGM) systems may serve as a tool to reduce the risk of exercise-induced hypoglycemia. It is unclear if CGM is accurate during CON and HIIE at different mean workloads. Seven T1DM patients performed CON and HIIE at 5% below (L) and above (M) the first lactate turn point (LTP₁), and 5% below the second lactate turn point (LTP₂) (H) on a cycle ergometer. Glucose was measured via CGM and in capillary blood (BG). Differences were found in comparison of CGM vs. BG in three out of the six tests (p < 0.05). In CON, bias and levels of agreement for L, M, and H were found at: 0.85 (−3.44, 5.15) mmol·L⁻¹, −0.45 (−3.95, 3.05) mmol·L⁻¹, −0.31 (−8.83, 8.20) mmol·L⁻¹ and at 1.17 (−2.06, 4.40) mmol·L⁻¹, 0.11 (−5.79, 6.01) mmol·L⁻¹, 1.48 (−2.60, 5.57) mmol·L⁻¹ in HIIE for the same intensities. Clinically-acceptable results (except for CON H) were found. CGM estimated BG to be clinically acceptable, except for CON H. Additionally, using CGM may increase avoidance of exercise-induced hypoglycemia, but usual BG control should be performed during intense exercise.

To survey the need for an individualized exercise duration prescription, we investigated acute physiological responses during constant load exercise of maximal duration (tmax), and determined so-call...

Duration is a rarely investigated marker of exercise prescription. The aim of this study was to test the feasibility of the methodological approach, assessing effects of different duration constant-load exercise (CLE) on physiological responses (internal load) and recovery kinetics. Seven subjects performed an incremental exercise (IE) test, one maximal duration CLE at 77.6 ± 4.8% $\dot{\mathrm{V}}{\mathrm{O}}_{\mathrm{2}\mathrm{m}\mathrm{a}\mathrm{x}}$, and CLE’s at 20%, 40%, and 70% of maximum duration. Heart rate (HR), blood lactate (La), and glucose (Glu) concentrations were measured. Before, 4, 24, and 48 h after CLE’s, submaximal IE tests were performed. HR variability (HRV) was assessed in orthostatic tests (OT). Rating of perceived exertion (RPE) was obtained during all tests. CLE’s were performed at 182 ± 27 W. HR_peak, La_peak, $\dot{\mathrm{V}}{\mathrm{E}}_{\mathrm{peak}}$, and RPE_peak were significantly higher in CLE’s with longer duration. No significant differences were found between CLE’s for recovery kinetics for HR, La, and Glu in the submaximal IE and for HRV or OT. Despite no significant differences, recovery kinetics were found as expected, indicating the feasibility of the applied methods. Maximum tests and recovery tests closer to CLE’s termination are suggested to better display recovery kinetics. These findings are a first step to prescription of exercise by both intensity and duration on an individual basis.

Therapy must be adapted for people with type 1 diabetes to avoid exercise-induced hypoglycemia caused by increased exercise-related glucose uptake into muscles. Therefore, to avoid hypoglycemia, the preexercise short-acting insulin dose must be reduced for safety reasons. We report a case of a man with long-lasting type 1 diabetes in whom no blood glucose decrease during different types of exercise with varying exercise intensities and modes was found, despite physiological hormone responses. A Caucasian man diagnosed with type 1 diabetes for 24 years performed three different continuous high-intensity interval cycle ergometer exercises as part of a clinical trial (ClinicalTrials.gov identifier NCT02075567). Intensities for both modes of exercises were set at 5% below and 5% above the first lactate turn point and 5% below the second lactate turn point. Short-acting insulin doses were reduced by 25%, 50%, and 75%, respectively. Measurements taken included blood glucose, blood lactate, gas exchange, heart rate, adrenaline, noradrenaline, cortisol, glucagon, and insulin-like growth factor-1. Unexpectedly, no significant blood glucose decreases were observed during all exercise sessions (start versus end, 12.97 ± 2.12 versus 12.61 ± 2.66 mmol L−1, p = 0.259). All hormones showed the expected response, dependent on the different intensities and modes of exercises. People with type 1 diabetes typically experience a decrease in blood glucose levels, particularly during low- and moderate-intensity exercises. In our patient, we clearly found no decline in blood glucose, despite a normal hormone response and no history of any insulin insensitivity. This report indicates that there might be patients for whom the recommended preexercise therapy adaptation to avoid exercise-induced hypoglycemia needs to be questioned because this could increase the risk of severe hyperglycemia and ketosis.