Background and Aims

Regular exercise is an important part of healthy lifestyle for people with diabetes (PWD). However, the complexities around adjusting insulin doses and food intake to maintain glucose control during exercise are major barriers. Current paper-based guidelines are difficult to apply in practice and provide limited individualisation of recommendations, and there is an unmet need for software-based clinical decision support tools. Here we describe an application (app), which we have developed, to provide personalised proactive guidance with the goal of facilitating improved glucose control around exercise.

Methods

In the software development process, the decision tree from the current international consensus guidelines (Riddell et al.) was deconstructed and expanded from 8 branches in total to 3 separate decision trees for aerobic, mixed and anaerobic exercise with 20, 20 and 6 pathways, respectively. The app provides recommendations for insulin dose adjustments throughout the day and weight-based carbohydrate supplements, as well as pre-emptive bedtime guidance to prevent nocturnal hypoglycaemia following exercise. Guidance is customised based on insulin delivery modality (pump vs injection therapy), insulin-on-board status and includes specific exercise suggestions based on current glucose levels and hypoglycaemia risk. This latter functionality, specifically recommendations for mixed or anaerobic exercise activity to minimise carbohydrate supplementation requirements, could facilitate the use of exercise to support weight management goals in PWD on insulin.

Results

Not applicable

Conclusions

This personalised exercise advisor app addresses an important therapeutic need for a tool to facilitate exercise in PWD on insulin.

Reference:

Riddell et al. Lancet Diabetes Endocrinol. 2017;5:377-390.

Background and Aims / Part 1

Exercise comes in a variety of forms and intensities and is important for health and fitness in diabetes . however, in people with diabetes, short term alterations in glucose homeostasis is often caused by increased exercise levels. The aimof this presentation is to highlight the general glycemic patters caused by the different types of exercise in people lving with diabetes who are taking insulin. The technical challenges to simulate the normal neuroendocrine responses to exercise in diabetes are also highlighted.

Methods / Part 2

An overview of normal and abnormal physiology is examined

Results / Part 3

Prolonged aerobic exercise increases insulin stimulated and non-insulin stimulated glucose disposal and hypoglycemia develops. With intensive and competaive exercise events, particularly in the morning, stress hormones levels rise and hyperglycemia ensues.

Conclusions / Part 4

Insulin delivery strategies for prolonged exercise and for short intense activities are needed to manage glycemia in patients living with diabetes