A 25-year-old male with history of type I diabetes presented wanting aid in managing his blood glucose levels. History and exam showed a healthy individual who was initially diagnosed with diabetes at the age of 19, who exercised 3 times per week, and looking to gain tighter control over his blood glucose levels. He had a good understanding of the disease, however he found that in the evening blood glucose levels would increase to >200mg/dL with tighter control attained during the day. Upon review of his medications, diet and fitness goals, the patient’s plan would consist of usage of pre-meal insulin to more tightly control postprandial glucose spikes and an adopted diet where he would limit carb consumption past 6pm.

For type I diabetics, regular exercise has been shown to improve their physiologic well-being through reduction of comorbidities, and improving their psychological well-being. Among the greatest of concerns while exercising is development of exercise-induced hypoglycemia. This issue is compounded by the fact that glycemic control can vary in the exercise based off the type, quality, and quantity of carb ingested to prevent exercise-induced hypoglycemia, when they are ingested in relation to the length and intensity of the bout of exercise, and their individual insulin load at the start of the workout.

To combat the wide range of factors that can make the prevention of exercise-induced hypoglycemia difficult in athletes with type I diabetes, recent studies have recommended the development of a customizable algorithm to help more accurately estimate the individual carb need for the athlete per bout of exercise. The ECRES algorithm is one such example that estimates carb requirements during exercise based on the athlete’s insulin load, their level of fitness, expected heart rate, the duration of exercise, and usual carb intake throughout the day.

References: Scott S, Etal Carbohydrate Intake in the Context of Exercise in People with Type 1 Diabetes. Nutrients. 2019;11(12):3017. Published 2019 Dec 10.