Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Département de Nutrition, Faculté de Médicine, Université de Montréal, Montréal, Québec, Canada.
Institut de recherches cliniques de Montréal, Montréal, Québec, Canada; Département de Nutrition, Faculté de Médicine, Université de Montréal, Montréal, Québec, Canada; Département des Sciences Biomédicales, Faculté de Médicine, Université de Montréal, Montréal, Québec, Canada; Division of Endocrinology, McGill University, Montreal, Québec, Canada; Endocrinology Division, Montreal Diabetes Research Center, Montreal, Québec, Canada.
Can J Diabetes. 2021 Oct;45(7):666-676. doi: 10.1016/j.jcjd.2021.01.003. Epub 2021 Jan 20.
Physical activity (PA) is important for individuals living with type 1 diabetes (T1D) due to its various health benefits. Nonetheless, maintaining adequate glycemic control around PA remains a challenge for many individuals living with T1D because of the difficulty in properly managing circulating insulin levels around PA. Although the most common problem is increased incidence of hypoglycemia during and after most types of PA, hyperglycemia can also occur. Accordingly, a large proportion of people living with T1D are sedentary partly due to the fear of PA-associated hypoglycemia. Continuous subcutaneous insulin infusion (CSII) offers a higher precision and flexibility to adjust insulin basal rates and boluses according to the individual's specific needs around PA practice. Indeed, for physically active patients with T1D, CSII can be a preferred option to facilitate glucose regulation. To our knowledge, there are no guidelines to manage exercise-induced hypoglycemia during PA, specifically for individuals living with T1D and using CSII. In this review, we highlight the current state of knowledge on exercise-related glucose variations, especially hypoglycemic risk and its underlying physiology. We also detail the current recommendations for insulin modulations according to the different PA modalities (type, intensity, duration, frequency) in individuals living with T1D using CSII.
身体活动（PA）对 1 型糖尿病（T1D）患者很重要，因为它有许多健康益处。尽管如此，由于在 PA 期间和之后正确管理循环胰岛素水平的难度，许多 T1D 患者仍然难以维持足够的血糖控制。虽然最常见的问题是在大多数类型的 PA 期间和之后发生低血糖的发生率增加，但也可能发生高血糖。因此，由于担心与 PA 相关的低血糖，很大一部分 T1D 患者久坐不动。连续皮下胰岛素输注（CSII）为根据 PA 实践中个体的特定需求调整胰岛素基础率和推注提供了更高的精度和灵活性。事实上，对于活跃的 T1D 患者，CSII 可以作为一种便利血糖调节的首选方案。据我们所知，目前尚无针对使用 CSII 的 T1D 患者在 PA 期间管理运动引起的低血糖的指南。在这篇综述中，我们重点介绍了与运动相关的血糖变化的现有知识状况，特别是低血糖风险及其潜在生理学。我们还详细介绍了根据使用 CSII 的 T1D 患者的不同 PA 模式（类型、强度、持续时间、频率）对胰岛素进行调节的当前建议。
