The Connected in Motion (CIM) team was fortunate enough to participate in the 83rd Scientific Sessions of the American Diabetes Association, one of the world’s premier platforms dedicated to advancing diabetes research and care. We’re excited to share with you the insights and knowledge gained from these thought-provoking sessions. Our aim is to ensure that the diabetes community in Canada benefits from these global discussions, helping all of us better understand the disease, manage it more effectively, and enhance our overall health and quality of life.
Presented by Dessi Zaharieva, Ph.D., CEP, CDCES, from Stanford University, the session titled “How to Get the Best of AID during Exercise” at the 83rd Scientific Sessions of the American Diabetes Association, shared valuable learnings from real-world experiences on managing blood glucose levels while using automated insulin delivery (AID) during physical activities.
Exercise Targets
Setting an elevated exercise target on an AID system can help prevent hypoglycemia during activity. This target is generally higher than your regular target to allow for the increased glucose utilization during exercise. The level at which you set your exercise target will be dependent on individual factors such as your body’s sensitivity to insulin, the type of exercise you are doing, its duration, and its intensity. This is where the personalized nature of diabetes management comes into play.
Understanding Exercise Intensity
The Borg scale is a simple way of rating perceived exertion (RPE), developed by Swedish psychologist Gunnar Borg. The scale typically goes from 6 to 20, but a modified version, ranging from 0 (nothing at all) to 10 (very, very heavy), can also be used. Understanding this scale can help you predict how your body might respond to different types of exercise. Higher intensity exercises, corresponding to 9-10 on the scale, can sometimes cause blood sugars to rise due to increased adrenaline release, requiring more insulin. In contrast, lower intensity activities might cause a drop in blood glucose levels, necessitating a reduction in insulin or an increase in carb intake.
Mealtime Bolus Adjustment
The amount of insulin you take with meals before exercise might need to be adjusted to avoid exercise-induced hypoglycemia. Generally, you might need to reduce your mealtime bolus insulin before engaging in physical activity. The exact reduction will depend on the duration and intensity of the exercise, as well as your individual insulin sensitivity. It’s essential to monitor blood glucose levels during and after exercise to understand how to adjust insulin doses optimally.
Hypoglycemia Prevention and Treatment
Hypoglycemia, or low blood sugar, can be a common issue during and after exercise for people with diabetes. By reducing bolus insulin, setting higher exercise targets, and having a small carbohydrate snack before exercise, you can help prevent hypoglycemia. If it does occur, the automated nature of AID systems can reduce insulin delivery to help bring blood glucose levels back to the target range. Carrying glucose tablets or other quick-acting carbohydrate sources is also a good practice for immediate treatment of hypoglycemia.
Individualized Approach
Each person’s body reacts differently to insulin and exercise, meaning strategies must be tailored to the individual. This involves monitoring and understanding your own blood glucose trends during different types of exercises and at different times of the day, and using this knowledge to adjust insulin delivery and carbohydrate intake as needed.
Backup Supplies
Physical activities, particularly contact sports or intensive workouts, can sometimes interfere with the functioning of an AID system. For instance, the cannula can get dislodged or blocked. Always carrying backup supplies, like an extra infusion set and insulin, can ensure you are prepared to handle such situations.
One Change at a Time
When trying to find the best strategy for managing exercise, it’s important to make only one change at a time. This could mean altering the exercise target, adjusting the bolus insulin, or modifying carbohydrate intake. By doing this, you can observe how each individual change impacts your blood glucose levels, allowing for more precise management.
Remember, these are general tips. Always consult with a healthcare provider before making significant changes to your diabetes management strategies, especially when it comes to insulin dosing and exercise.
Dessi Zaharieva’s presentation at the ADA Scientific Sessions 2023 offered invaluable insights on navigating the challenges of managing blood glucose levels during exercise. As evidenced by the real-world case studies, individualized approaches, backup planning, stress management, and preemptive planning play crucial roles in leveraging automated insulin delivery systems during physical activities. As our knowledge continues to evolve, we’re better equipped to manage these factors and improve the quality of life for individuals living with diabetes.
