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An international research team led by Prof. Dr. Othmar Moser, Professor of Exercise Physiology & Metabolism at the University of Bayreuth, has developed guidelines for glucose management around exercise. The recommendations published in the journals "Diabetologia" and "Pediatric Diabetes" aim to protect people with diabetes type 1 from hypo- and hyperglycaemia.
In fact, people living with type 1 diabetes can be physically active despite their health condition. However, they must take care of their blood sugar levels when they perform exercise. Because their pancreas is not able to produce endogenous insulin, and insulin must be injected to keep glucose levels stable, they must constantly consider an onset of hypoglycaemia. Unfortunately, insulin therapy, which aims to optimize blood sugar levels by artificial means, is not easy to handle around physical exertion. For this reason, an international expert team, coordinated by Prof. Dr. Othmar Moser, has developed new recommendations for exercise based on novel continuous glucose monitoring systems. These systems should enable people with type 1 diabetes to carry out physical activity safely, without the risk of dangerous blood sugar fluctuation.
The recommendations show in detail at which threshold of elevated glucose levels, insulin should be administered. They also lay out exactly how much carbohydrate depending on their glucose level should be taken. This management of blood glucose during exercise is to be facilitated by an app currently being developed in collaboration with King's College in London. The aim is to provide smart glucose management. "As with most chronic diseases, an active lifestyle is important to ensure a long and more-or-less healthy life. With our recommendations, we aim to help people with diabetes mellitus type 1 integrate physical activity and exercise as an essential part of their respective therapy plan", says Moser, who has held his professorship of Exercise Physiology & Metabolism in Bayreuth since 1 November 2020.
A central component of the guidelines is a new type of sugar measuring device (CGM), which makes current glucose values constantly available. The glucose concentration is measured constantly and non-invasively – i.e. without taking blood – using a tiny transmitter placed under the skin. A transmitter sends the current value to the receiver several times a day. "The guidelines exploit this medical-technical progress to enable the uncomplicated and truly reliable management of glucose level. To date, all therapy recommendations for sports and diabetes mellitus type 1 have been based on invasive blood glucose measurement from the fingertip," says Moser.
In earlier studies, he and his team already showed that in order to avoid life-threatening hypoglycaemia, it is necessary for people with type 1 diabetes to keep their glucose levels stable during exercise – either by reducing the insulin dose, depending on the duration and intensity of the exercise, or by supplementing it with additional carbohydrates.
Prof. Dr. Othmar Moser
Exercise Physiology and Metabolism
University of Bayreuth
Phone: +49 (0)921 / 55-3464
E-mail: othmar.moser@uni-bayreuth.de
Othmar Moser et al.: Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA). Diabetologia (2020). DOI: https://dx.doi.org/10.1007/s00125-020-05263-9
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