Regular exercise is important for health, fitness and longevity in people living with type 1 diabetes, and many individuals seek to train and compete while living with the condition. Muscle, liver and glycogen metabolism can be normal in athletes with diabetes with good overall glucose management, and exercise performance can be facilitated by modifications to insulin dose and nutrition. However, maintaining normal glucose levels during training, travel and competition can be a major challenge for athletes living with type 1 diabetes. Some athletes have low-to-moderate levels of carbohydrate intake during training and rest days but tend to benefit, from both a glucose and performance perspective, from high rates of carbohydrate feeding during long-distance events. This review highlights the unique metabolic responses to various types of exercise in athletes living with type 1 diabetes.

Introduction: The COVID‐19 pandemic has forced rapid reconsideration as to the way in which health care is delivered. One potential means to provide care while avoiding unnecessary person‐to‐person contact is to offer remote services (telemedicine). This study aimed to (1) gather real‐time information on the use and perception of telemedicine in people living with type 1 diabetes and (2) assess the challenges, such as restricted access to health care and/or medical supplies.Methods: An anonymous questionnaire was widely distributed between 24 March and 5 May 2020 using an open‐access web‐based platform. Data were analysed descriptively, and results were stratified according to age, sex and HbA_1c.Results: There were 7477 survey responses from individuals in 89 countries. Globally, 30% reported that the pandemic had affected their healthcare access due to cancelled physical appointments with their healthcare providers. Thirty‐two per cent reported no fundamental change in their medical follow‐up during this period, with 9% stating that no personal contact was established with their doctors over the duration of the study. Twenty‐eight per cent received remote care through telephone (72%) or video‐calls (28%). Of these, 86% found remote appointments useful and 75% plan to have remote appointments in the future. Glucose control, indicated by HbA_1c, was positively associated with positive perception of telemedicine. In males, 45% of respondents with an HbA_1c > 9% rated telemedicine not useful compared to those with lower HbA_1c, while 20% of females with an HbA_1c > 9% rated it not useful (χ² = 14.2, P = .0016).Conclusion: Remote appointments have largely been perceived as positive in people with type 1 diabetes with the majority (75%) stating that they would consider remote appointments beyond the pandemic. Age and level of education do not appear to influence perception of telemedicine, whereas poor glucose control, particularly in males, seems to negatively affect perception.

AIMS To investigate whether 1) six weeks of high-intensity interval training (HIT) induces similar improvements in cardio-metabolic health markers as moderate-intensity continuous training (MICT) in people with type 1 diabetes, and 2) whether HIT abolishes acute reductions in plasma glucose observed following MICT sessions. METHODS Fourteen sedentary individuals with type 1 diabetes (n=7 per group) completed six weeks of HIT or MICT 3 times per week. Pre- and post-training measurements were made of 24h interstitial glucose profiles (using continuous glucose monitors (CGMS)) and cardio-metabolic health markers ($V˙$O_2peak, blood lipid profile and aortic pulse wave velocity; aPWV). Capillary blood glucose concentrations were assessed before and after exercise sessions throughout the training programme to investigate changes in blood glucose during exercise in the fed state. RESULTS Six weeks of HIT or MICT increased $V˙$O_2peak by 14% and 15%, respectively (P<0.001), and aPWV by 12% (P0.05). In the fed state, the mean change in capillary blood glucose concentration during the HIT sessions was -0.2±0.5 mmol/L, whereas blood glucose change was -5.5±0.4 mmol/L during MICT. CONCLUSIONS Six weeks of HIT improved $V˙$O_2peak and aortic PWV to a similar extent as MICT. The finding that blood glucose remained stable during HIT in the fed state, but consistently fell during MICT, suggests that HIT may be the preferred training mode for some people with type 1 diabetes.

Around 80% of individuals with Type 1 diabetes (T1D) in the United States do not achieve glycaemic targets and the prevalence of comorbidities suggests that novel therapeutic strategies, including lifestyle modification, are needed. Current nutrition guidelines suggest a flexible approach to carbohydrate intake matched with intensive insulin therapy. These guidelines are designed to facilitate greater freedom around nutritional choices but they may lead to higher caloric intakes and potentially unhealthy eating patterns that are contributing to the high prevalence of obesity and metabolic syndrome in people with T1D. Low carbohydrate diets (LCD; <130 g/day) may represent a means to improve glycaemic control and metabolic health in people with T1D. Regular recreational exercise or achieving a high level of athletic performance is important for many living with T1D. Research conducted on people without T1D suggests that training with reduced carbohydrate availability (often termed “train low”) enhances metabolic adaptation compared to training with normal or high carbohydrate availability. However, these “train low” practices have not been tested in athletes with T1D. This review aims to investigate the known pros and cons of LCDs as a potentially effective, achievable, and safe therapy to improve glycaemic control and metabolic health in people with T1D. Secondly, we discuss the potential for low, restricted, or periodised carbohydrate diets in athletes with T1D.

Aims To compare the effect of a bout of high-intensity interval training (HIT) with a bout of moderate-intensity continuous training (MICT) on glucose concentrations over the subsequent 24h period. METHODS Fourteen people with type 1 diabetes (duration of type 1 diabetes 8.2±1.4 years), all on basal-bolus regimen, completed a randomised, counterbalanced, crossover study. Continuous glucose monitoring was used to assess glycaemic control following a single bout of HIT (6 x 1min intervals) and 30 mins of moderate-intensity continuous training (MICT) on separate days, compared to a non-exercise control day (CON). Exercise was undertaken following an overnight fast with omission of short-acting insulin. Capillary blood glucose samples were recorded pre and post-exercise to assess the acute changes in glycaemia during HIT and MICT. RESULTS There was no difference in the incidence of or percentage time spent in hypoglycaemia, hyperglycaemia or target glucose range over the 24h and nocturnal period (24:00-06:00h) between CON, HIT and MICT (P>0.05). Blood glucose concentrations were not significantly (P=0.49) different from pre to post-exercise with HIT (+0.39±0.42 mmol/L) or MICT (-0.39±0.66 mmol/L), with no difference between exercise modes (P=1.00). CONCLUSIONS HIT or 30 mins of MICT can be carried out after an overnight fast with no increased risk of hypoglycaemia or hyperglycaemia, and provided the pre-exercise glucose concentration is 7-14 mmol/L, no additional carbohydrate ingestion is necessary to undertake these exercises. As HIT is a time-efficient form of exercise, the efficacy and safety of long-term HIT should now be explored.