Many people with type 1 diabetes are keen to exercise and play sport. Different types of exercise cause different problems with glycaemic control and require different management strategies. Physiological problems and possible management solutions in type 1 diabetes are considered for three types of exercise using case scenarios. Moderate intensity exercise is linked with hypoglycaemia and so insulin dose reductions and carbohydrate supplementation are discussed. Similar strategies for dealing with post-exercise hypoglycaemia are also considered. High intensity-exercise is linked with hyperglycaemia, with insulin dose increases a possible solution. Intermittent high-intensity exercise is linked with an attenuated reduction in blood glucose during exercise, and a reduction in the risk of immediate post-exercise hypoglycaemia. The potential benefits of continuous subcutaneous insulin infusion in managing diabetes in the context of exercise are discussed. Given the need to keep patients with type 1 diabetes healthy, training in this area is becoming increasingly important for professionals caring for this group of patients.
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