Statement describes post-exercise recovery strategies in type 1 diabetes

Adults with type 1 diabetes need to take several key steps to optimize recovery after exercise, such as adjusting insulin dosage and protein and carbohydrate intake, and careful monitoring of blood sugar levels. , according to a consensus statement.

The statement, developed by the Task Force for the Study of Integrative Exercise Biology in Diabetes and published in The Lancet Diabetes & Endocrinology, also highlights strategies for caffeine consumption, recovery routines based on glucose level and how to help ensure good sleep. The working group noted that the post-exercise recovery routine for adults with type 1 diabetes has received little attention in the scientific literature, with the main focus being on insulin or nutritional adaptations for it. manage blood sugar before and during exercise.

“The post-exercise recovery period provides an opportunity to maximize training adaptation and recovery, as well as clinical blood sugar management throughout the rest of the day and night.” Sam N. Scott, PhD, a researcher at the University of Bern in Switzerland and head of research for the Novo Nordisk Pro Cycling team, and his colleagues wrote. “The lack of clear guidelines for the post-exercise period means that people with type 1 diabetes must either develop their own recovery strategies based on individual trial and error, or adhere to the guidelines that have been developed for. people without diabetes. “

Unique concerns when exercising

For athletes with type 1 diabetes, the challenge of blood sugar management makes recovery after exercise more difficult, the researchers wrote. These athletes should also consider the effects of altered insulin sensitivity, post-exercise hyperglycemia, depleted glycogen stores, dehydration, altered blood counter-regulatory responses. glucose, insulin doses, abrupt changes in the rate of muscle glucose uptake due to cessation of muscle contraction, and the effect of nutritional selection on blood glucose concentration.

“The amount of carbohydrate after exercise will depend on the type, duration and intensity of the exercise performed, as well as the concentration of glucose in the blood and the amount of insulin circulating,” wrote Researchers. “While maximizing the rate of muscle glycogen resynthesis is the primary goal (which is common for endurance or ultra-endurance athletes who compete multiple times in a short period of time), after exercise is the most important factor in establishing the rate of muscle glycogen synthesis.

The authors make several recommendations to optimize recovery after exercise in type 1 diabetes:

• Check blood sugar immediately after exercise and at regular 15-minute intervals; be careful with hyperglycemia or hypoglycemia.
• Insulin adjustments may vary depending on the circumstances; however, consider reducing the insulin dose before exercise and reducing the first basal dose during the recovery period, especially if the exercise session has lasted 30 to 60 minutes. Reduce the bolus insulin dose with the recovery meal.
• Initiate carbohydrates when glucose is below 144 mg / dL, especially if glucose is dropping.
• When rapid recovery from a long period of exercise is the goal and peak performance is required within 24 hours, aim to consume 1g to 1.3g of carbohydrate per kilogram per hour for the first 4 hours of exercise. recovery, starting as soon as possible after exercise, with frequent feeding intervals thereafter – every 30 minutes.
• The daily protein recommendations are 1.6-1.8g per kg per day for endurance athletes. Protein added to carbohydrates immediately after exercise can speed up recovery.
• Be aware of the effects of drinks containing large amounts of carbohydrate on the level of glucose in the blood. Hydrate with non-carbohydrate drinks if your blood sugar is above 180 mg / dL.
• Be aware of hot or humid conditions.
• About 200 mg to 300 mg of caffeine could reduce the risk of hypoglycemia during and after exercise; it can be eaten with glucose.
• Avoid consuming large amounts of caffeine at the end of the day, which can interfere with sleep.
• If blood sugar is above 180 mg / dL in the last 10 minutes of exercise, consider more prolonged, lower intensity recovery. If during the last 10 minutes of exercise the blood glucose concentration is between 90 mg / dL and 180 mg / dL, reduce the duration of recovery.

Need “more planning”

The researchers noted that rapid developments in technologies, such as continuous glucose monitoring sensors, smart devices or portable devices, and closed-loop insulin delivery systems, all contribute to the possibility of a increased exercise time with less user intervention. Hybrid closed-loop systems offer benefits for improving time in the glycemic target range overnight, even under demanding and unforeseen environmental conditions, they wrote, and future advances in machine learning will likely increase the rate. help with the decision.

“Regardless of the athlete’s level of sport or competition, it is clear that many different behaviors will have an effect on short-term and long-term recovery, and thus affect subsequent performance, adaptation to workout and time within the target glycemic range, ”the researchers wrote. “Athletes with type 1 diabetes should always prioritize blood sugar management, which is essential for overall health and to optimize aspects of recovery. However, the unique ability of people living with type 1 diabetes to influence their insulin concentration through exogenous administration suggests that increased planning and attention is needed to optimize nutrition and insulin strategies for resynthesis. glycogen.