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Blood Glucose Management for
Games & Interval Exercise
Othmar Moser
Post-Doctoral Researcher
A-STEM
(Diabetes Research Group)
Table of Content
• Games & Interval Exercise – different or the same?
• Safe for People with Type 1 diabetes?
• Therapy Management around Games & Interval Exercise
• Expected Glucose Responses
• New Technology/Insulin and Games & Interval Exercise
Games & Interval Exercise – different or the same?
Matthew et al., 2009
Cipryan et al., 2017
Gibala e al., 2012
Games & interval exercise describe physical exercise that is
characterised by brief, intermittent bursts of vigorous activity (O),
interspersed by periods of rest or low-intensity exercise (O).
Basketball Game Interval exercise
Random order Structured
Safe for People with Type 1 diabetes?
• Games and interval exercise can be associated with a
higher risk of nocturnal hypoglycaemia than continuous
aerobic exercise
• No data exist on increased risk of cardiovascular events
(e.g. myocardial infarction) during interval exercise in
people with type 1 diabetes
• Even in patients with coronary heart disease, an event rate
of 1 nonfatal heart attack per 23182 hours of interval
training it is reported
Moser et al., 2015
Riddell et al., 2017
Rognmo et al., 2012
YES!
1Low = fast walking, jogging (easily talking)
Moderate = fast jogging, moderate running (talking possible)
Heavy = fast running (talking demanding)
Intense = fast running (talking not possible)
Therapy Management around Games &
Interval Exercise
Riddell et al., 2017
Moser et al., 2017
Moser et al., 2015
Intensity 30 min exercise 60 min exercise
Low1 - 25% for bolus
insulin (60-90 min
prior exercise)
- 50%
Moderate - 50% - 75%
Heavy - 75% NA
Intense - 75% NA
Therapy Management around Games &
Interval Exercise
Starting blood glucose below 5 mmol/L (<90 mg/dL)
• Ingest 10–20 g of glucose before starting exercise; delay exercise
5–6.9 mmol/L (90–124 mg/dL)
• Games & interval Exercise can be started
7–10 mmol/L (126–180 mg/dL) & 10.1–15 mmol/L (182–270 mg/dL)
• Games & interval Exercise can be started; blood glucose could rise
Above 15 mmol/L (270 mg/dL)
• NO games & interval Exercise; check ketones!
Riddell et al., 2017
Expected Glucose Responses to Games
Game
Continuous
exercise
- 5.3 ± 0.4 mmol/L
- 1.1 ± 0.7 mmol/L
45 min
Campbell at al., 2014
Expected Glucose Responses to Interval
Exercise (20 sec Sprints)
Moser et al., 2015
No difference in blood glucose
decrease in comparison of continuous
exercise and interval exercise in blood
glucose response during exercise
and during 24 hrs after exercise for
different exercise intensities!
New Technology/Insulin for Games & Interval
Exercise
• Flash glucose monitoring
• Continuous glucose monitoring
• Basal-automatic artificial pancreas
• Ultra-long acting insulins
• Faster-short acting insulins
Exercise
studies
INT/Games
studies
Take Home Message
• Games & interval exercise are safe for people with type 1
diabetes
• Therapy adaptation is mainly based on exercise intensity
and duration
• Adequate reaction to starting blood glucose levels are
necessary
• Blood glucose response to games & interval exercise may
vary
Literature
1. Lukas Cipryan, et al. Acute and Post-Exercise Physiological Responses to High-Intensity Interval Training in Endurance and
Sprint Athletes. J Sports Sci Med. 2017 Jun;16(2):219-229.
2. Dionne Matthew, Anne Delextrat. Heart rate, blood lactate concentration, and time–motion analysis of female basketball players
during competition. Journal of Sports Sciences, June 2009; 27(8): 813–821.
3. Martin Gibala, et al. Physiological adaptations to low-volume, high-intensity interval training in health and disease. J Physiol
590.5 (2012) pp 1077–1084.
4. Othmar Moser, et al. Effects of High-Intensity Interval Exercise versus Moderate Continuous Exercise on Glucose Homeostasis
and Hormone Response in Patients with Type 1 Diabetes Mellitus Using Novel Ultra-Long-Acting Insulin. PLoS ONE 10(8):
e0136489. doi:10.1371/journal.pone.0136489.
5. Michael C Riddell, et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Endocrinology. 2017
http://dx.doi.org/10.1016/S2213-8587(17)30014-1.
6. Rognmo Ø, et al. Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients.
Circulation. 2012. 126(12):1436-40.
7. Othmar Moser, et al. Short-Acting Insulin Reduction Strategies for Continuous Cycle Ergometer Exercises in Patients with Type
1 Diabetes Mellitus. Asian J Sports Med. 2017 March; 8(1):e42160.
8. Campbell, et al. Simulated games activity vs continuous running exercise: A novel comparison of the glycemic and metabolic
responses in T1DM patients. Scand J Med Sci Sports 2014: doi: 10.1111/sms.12192
Dankeschön!
Othmar Moser
E-mail: [email protected]
Tel: +44 7757 062851
Web: researchgate.net/profile/Othmar_Moser
Twitter: @Othmar_moser