Training Guide: Carbohydrate intake around exercise for people with type 1 diabetes

Carbohydrate consumption is a critical factor in both fueling physical activity and regulating blood glucose levels, particularly for individuals managing type 1 diabetes. Achieving the right balance is essential to sustain energy levels during exercise while preventing episodes of low blood glucose (hypoglycemia). However, effectively managing carbohydrate intake during physical activity poses certain complexities and potential risks.

By familiarizing yourself with and implementing appropriate strategies, individuals with type 1 diabetes can enhance their exercise performance and ensure stable blood glucose levels. It's important to emphasize the necessity of personalized approaches, as individual requirements may vary significantly.

This blog serves as a summary of scientific research surrounding the influence of carbohydrate quantity, timing, and type on exercise outcomes for individuals with type 1 diabetes.

Understanding the effects of exercise on blood glucose levels in individuals with type 1 diabetes is crucial for optimizing health outcomes

Regular physical activity is strongly recommended for people living with type 1 diabetes due to its multifaceted benefits, including improvements in cardiovascular health, body composition, and psychological well-being. However, the relationship between exercise and glucose levels is intricate and warrants careful consideration.

Despite advancements in insulin therapy and diabetes management technology, navigating exercise remains a formidable challenge for many individuals with type 1 diabetes. The fear of experiencing hypoglycemia, a potentially dangerous drop in blood glucose levels, often acts as a significant deterrent to engaging in physical activity.

Guidelines currently advise adjusting insulin dosages and/or consuming additional carbohydrates to mitigate the risk of exercise-induced hypoglycemia. While insulin adjustment and carbohydrate intake are closely intertwined in managing blood glucose levels during exercise, our focus in this article will be specifically on the timing, type and quantity of carbohydrates consumed in relation to physical activity.

Exercise presents a complex metabolic stressor affected by various individual and environmental factors, all influencing how blood glucose levels respond. For individuals with type 1 diabetes, determining the appropriate amount, timing, and type of carbohydrates to consume presents numerous challenges.

Effective strategies for glycemic management during exercise necessitate consideration of factors such as pre-exercise blood glucose levels, insulin sensitivity, and the anticipated impact of different exercise types and intensities on blood glucose levels.

Furthermore, the choice of carbohydrates consumed and their composition—whether consumed alone or in combination with other macronutrients like fats or proteins—can significantly influence glycemic response and insulin requirements. While the primary goal of carbohydrate consumption around exercise for individuals with type 1 diabetes is to prevent hypoglycemia, other factors such as optimizing performance, managing weight, and long-term glycemic management must also be taken into account.

Moreover, it's crucial to consider the enjoyment of food to minimize the risk of developing eating disorders or unhealthy fixation on dietary practices. Overall, a nuanced understanding of the interplay between exercise, carbohydrate intake, and blood glucose management is essential for individuals with type 1 diabetes to effectively incorporate physical activity into their lifestyles while safeguarding their health.

How much carbohydrate should you be consuming around exercise? The importance of quantity

Determining the appropriate carbohydrate intake surrounding exercise involves balancing glycemia and providing fuel for the physical activity. The ideal amount of carbohydrates consumed before, during, and after exercise depends on factors such as blood glucose levels, the type and intensity of the exercise, and the insulin level in the body.

For individuals with type 1 diabetes, starting exercise with a stable blood glucose level between 7 and 14 mmol/L (126-250 mg/dl) and low ketone levels is recommended. If glucose levels are below 5.0 mmol/L (90 mg/dl), it's advisable to consume 10–20 g of glucose before starting exercise, while 10 g of carbohydrate is sufficient if glucose levels range between 5.0 and 6.9 mmol/L (90-126 mg/dl).

Generally, for moderate-intensity exercise sessions lasting up to 30 minutes and under stable blood sugar conditions, a modest amount of carbohydrates (10–20 g/h) suffice.

As exercise duration and intensity increase, higher carbohydrate intake becomes necessary, with recommendations ranging from 75 to 90 g/h for sessions exceeding one hour. However, research indicates the importance of adjusting insulin dosage to avoid excessive carbohydrate consumption, as it may lead to unintended weight gain, particularly in prolonged endurance exercises.

Moreover, during prolonged and intense exercise, the maximum capacity for gut absorption of carbohydrates (1.2–1.7 g/min for glucose) becomes a limiting factor. In such cases, relying solely on glucose for fueling may lead to gastrointestinal discomfort and an energy deficit, potentially causing hypoglycemia in individuals with type 1 diabetes. Exploring alternative carbohydrate sources with different absorption rates and kinetics could be beneficial in these scenarios. We will touch on this later in the article.

Timing of Carbohydrate Intake in the Context of Exercise

Timing carbohydrate intake correctly is vital for managing blood glucose levels during exercise, particularly for individuals with type 1 diabetes. Understanding how our body's functions fluctuate over a 24-hour period, known as circadian variation, underscores the significance of timing in this context. This section delves into the impact of circadian factors on carbohydrate needs during exercise, elucidates why timing carbohydrate consumption around physical activity is crucial, and offers practical strategies for effective blood glucose management.

Circadian variation refers to the natural rhythm of bodily processes across the day-night cycle, influencing glucose metabolism and insulin sensitivity. Consequently, considering the timing of carbohydrate intake becomes pivotal. Studies have highlighted differences in glucose metabolism between morning and evening, with heightened insulin resistance observed later in the day. Hence, individuals with type 1 diabetes may require tailored carbohydrate amounts at different times to stabilize blood glucose levels during exercise.

Strategically timing carbohydrate intake before, during, and after exercise serves to avert hypoglycemia and enhance performance. Pre-exercise carbohydrate consumption furnishes the body with fuel for sustained activity and guards against blood glucose dips. At the same time, ingesting carbohydrates during exercise aids in glucose maintenance and fuels working muscles. Post-exercise, carbohydrates aid in replenishing glycogen stores and facilitating muscle recovery. Customizing carbohydrate intake according to exercise demands and individual requirements is crucial.

To optimize blood glucose management during exercise, consider these practical guidelines for timing carbohydrate intake:

• Before Exercise: Consume a carbohydrate-rich snack or meal 1-2 hours before commencing exercise, allowing for digestion and steady energy release.

• During Exercise: Depending on exercise duration and intensity, opt for carbohydrates in the form of sports drinks, gels, or easily digestible foods, aiming for 30-60 grams per hour to sustain blood glucose levels.

• After Exercise: Consume a carbohydrate and protein-rich snack or meal within 30 minutes to 2 hours post-exercise to replenish glycogen stores and facilitate muscle recovery.

Seeking guidance from healthcare professionals or registered dietitians is essential for tailoring carbohydrate intake to individual goals, exercise routines, and blood glucose management. They can offer personalized advice and can fine-tune strategies to optimize blood glucose control during exercise. Additionally, utilizing tools like the Enhance-d mobile app and dashboard aids in monitoring nutritional intake before, during, and after exercise, facilitating informed decision-making.

The Impact of Carbohydrate type on Blood Glucose Levels During Exercise

Carbohydrates play a crucial role in providing fuel for exercise and maintaining stable blood glucose levels, especially for individuals with type 1 diabetes. However, not all carbohydrates are created equal. The quality or type of the ingested carbohydrates can impact glycemic response. Let's dive into the factors that influence the quality of ingested carbohydrates and how they can affect blood glucose levels during exercise.

Types of Carbohydrates and Glycemic Response

• Some carbohydrates, like those found in sugary drinks and processed foods, are quickly digested and absorbed, leading to a rapid spike in blood glucose levels.

• Carbohydrates with a lower glycemic index, such as whole grains, fruits, and vegetables, are digested and absorbed more slowly, resulting in a more gradual and sustained release of glucose into the bloodstream.

The Role of Fiber and Other Macronutrients

Fiber, found in foods like whole grains, legumes, and vegetables, slows down the digestion and absorption of carbohydrates, helping to prevent rapid fluctuations in blood glucose levels. Additionally, consuming carbohydrates alongside protein and healthy fats can further slow down digestion and promote stable blood glucose levels during exercise.

Choosing High-Quality Carbohydrates

To choose high-quality carbohydrates that promote stable blood glucose levels, it's important to focus on whole, unprocessed foods. Opt for complex carbohydrates like whole grains, fruits, vegetables, and legumes, which provide a steady release of glucose into the bloodstream. Avoid sugary drinks, processed foods, and refined grains, which can cause rapid blood glucose spikes.

The quality of ingested carbohydrates, including the types of carbohydrates and the context within a meal, can significantly impact glycemic response during exercise. Choosing high-quality carbohydrates, such as whole grains, fruits, and vegetables, along with incorporating fiber and other macronutrients, can help maintain stable blood glucose levels. For individuals with type 1 diabetes, it is essential to monitor blood glucose levels closely and work with healthcare professionals to develop personalized carbohydrate intake strategies that suit individual needs and exercise requirements. By making informed choices about carbohydrate quality, individuals with type 1 diabetes can optimize their exercise performance and maintain better glycemic control.

Athletes with Type 1 Diabetes: Managing Carbohydrate Intake

Athletes with type 1 diabetes face unique challenges when it comes to managing their blood glucose levels during exercise. One of the key considerations for these athletes is individualized carbohydrate intake. The amount of carbohydrates ingested should be tailored to meet the demands of exercise and avoid hypoglycemia, while also providing enough fuel to sustain performance.

Strategies for Balancing Energy Requirements and Glycemic Control

Balancing energy requirements with glycemic control during prolonged endurance exercise is another important strategy for athletes with type 1 diabetes. Endurance exercise can lead to increased energy expenditure and changes in insulin sensitivity, making it crucial for athletes to carefully manage their carbohydrate intake to maintain stable blood glucose levels. Timing of carbohydrate intake is also important, both before, during, and after exercise, as well as considering circadian factors. By strategically timing their carbohydrate intake, athletes can optimize glycemic control and fuel their performance effectively.

Managing Carbohydrate Intake During Competition

Competition stress can have a significant impact on carbohydrate requirements for athletes with type 1 diabetes. The stress and adrenaline associated with competition can lead to higher blood glucose levels, requiring athletes to adjust their carbohydrate intake accordingly. Effective management of competition stress involves closely monitoring blood glucose levels and making adjustments to carbohydrate intake as needed to maintain stable glycemic control.

The Importance of Individualized Approaches of carbohydrate intake for athletes with type 1 diabetes

In order to effectively manage their carbohydrate intake, athletes with type 1 diabetes should take an individualized approach. This means working closely with healthcare professionals to develop a plan that takes into account their specific needs and goals. Factors such as insulin adaptation and the presence of other macronutrients can also affect carbohydrate intake and glycemic response, further highlighting the importance of personalized strategies.

By considering these specific considerations and implementing individualized carbohydrate intake strategies, athletes with type 1 diabetes can effectively manage their blood glucose levels during exercise and optimize their athletic performance. It's important for these athletes to work closely with healthcare professionals to develop a plan that meets their unique needs and to regularly monitor and adjust their carbohydrate intake as necessary. With the right approach, athletes with type 1 diabetes can excel in their sport while maintaining safe glucose levels.

Additional factors to keep in mind around exercise and carbohydrate intake

When it comes to managing blood glucose levels during exercise, there are several modifying and additional factors that can affect carbohydrate intake and glycemic response in people with type 1 diabetes.

• Sex hormones: One important factor to consider is the influence of sex hormones on fuel metabolism and counter-regulation during exercise. Research has shown that sex hormones, such as estrogen and testosterone, can impact how the body uses and regulates fuel during physical activity. For example, studies have found that estrogen can increase insulin sensitivity and enhance glucose uptake in skeletal muscles, while testosterone can stimulate glycogen synthesis and promote fat oxidation.

• Eating disorders and anxiety related to food: Another factor that can have a significant impact on carbohydrate intake and blood glucose control is the potential presence of eating disorders or anxiety related to food. People with type 1 diabetes may develop disordered eating patterns or develop anxiety around food due to the need to constantly monitor and manage their blood glucose levels. This can lead to restrictive eating habits or excessive exercise, which can disrupt carbohydrate intake and result in poor glycemic control. It is crucial for healthcare professionals to address these psychological factors and provide appropriate support and guidance to ensure a healthy relationship with food and exercise.

An Individualized Approach to Carbohydrate Intake

Taking an individualized approach to carbohydrate intake is of utmost importance for people with type 1 diabetes. Each person's circumstances and needs are unique, and their carbohydrate intake should be tailored accordingly. Factors such as age, weight, insulin sensitivity, physical activity levels, and personal goals should be taken into account when determining the appropriate amount and timing of carbohydrate intake.

It may be necessary to work closely with a healthcare professional, such as a registered dietitian or diabetes educator, to develop a personalized carbohydrate management plan that optimizes blood glucose control during and after exercise.

It is crucial to take an individualized approach to carbohydrate intake based on personal circumstances and to work closely with healthcare professionals to ensure optimal blood glucose control. By addressing these factors and tailoring carbohydrate intake, individuals with type 1 diabetes can effectively manage their blood glucose levels during and after exercise, allowing them to safely participate in physical activity and achieve their fitness goals.

Athletes with type 1 diabetes have specific considerations when it comes to carbohydrate intake during exercise. Additional factors, such as insulin dosing and the presence of other macronutrients, can affect carbohydrate intake and glycemic response. Taking an individualized approach to carbohydrate intake is important for managing blood glucose levels during and after exercise in people with type 1 diabetes.

Conclusion

Managing carbohydrate intake plays a significant role in achieving optimal blood glucose management and overall well-being for individuals with type 1 diabetes during exercise. By understanding the quantity, timing, and quality of carbohydrates, and taking an individualized approach, people with type 1 diabetes can effectively fuel their workouts and prevent hypoglycemia. It is important to emphasize the importance of personalized carbohydrate intake and the need for ongoing collaboration with healthcare professionals to ensure the best possible outcomes. If you have type 1 diabetes and engage in exercise, make sure to pay attention to your carbohydrate intake for a healthier and more balanced lifestyle.