Statement outlines strategies for recovery after exercise in type 1 diabetes
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Adults with type 1 diabetes should take several key steps to optimize recovery after exercise, such as adjusting insulin dosing and protein and carbohydrate intake, and carefully monitoring blood glucose, according to a consensus statement.
The statement, developed by the working group for the study of integrative biology of exercise in diabetes and published in The Lancet Diabetes & Endocrinology, also highlights strategies for caffeine intake, cool-down routines based on glucose level and how to help ensure proper sleep. The working group noted that the recovery routine after exercise for adults with type 1 diabetes has received little attention in scientific literature, with most of the focus placed on insulin or nutritional adaptations to manage glycemia before and during the exercise bout.
“The post-exercise recovery period presents an opportunity for maximizing training adaption and recovery, and the clinical management of glycemia through the rest of the day and overnight,” Sam N. Scott, PhD, a research fellow at the University of Bern in Switzerland and head of research for Team Novo Nordisk Pro Cycling, and colleagues wrote. “The absence of clear guidance for the post-exercise period means that people with type 1 diabetes should either develop their own recovery strategies on the basis of individual trial and error or adhere to guidelines that have been developed for people without diabetes.”
Unique concerns when exercising
For athletes with type 1 diabetes, the challenge of managing glycemia makes recovery after exercise more difficult, the researchers wrote. These athletes must also consider the effects of altered insulin sensitivity, hyperglycemia after exercise, depleted glycogen stores, dehydration, impaired glucose counter-regulatory responses, insulin doses, abrupt changes in the rate of muscle glucose uptake due to a halt in muscle contraction, and the effect of nutritional selection on blood glucose concentration.
“The quantity of post-exercise carbohydrate intake will depend on the type, duration and intensity of the exercise done, as well as blood glucose concentration and the circulating amount of insulin,” the researchers wrote. “If maximizing the rate of muscle glycogen resynthesis is the primary aim (which is common for endurance or ultra-endurance athletes that compete multiple times within a short time span), post-exercise carbohydrate ingestion is the most important factor establishing the rate of muscle glycogen synthesis.”
The authors make several recommendations to optimize recovery after exercise in type 1 diabetes:
- Check glucose immediately after exercise and at regular, 15-minute intervals; be alert for hyperglycemia or hypoglycemia.
- Insulin adjustments can vary depending on circumstances; however, consider reducing insulin dose before exercise and reduce the first basal dose during the recovery period, particularly if the exercise session lasted 30 to 60 minutes. Reduce bolus insulin dose with recovery meal.
- Initiate carbohydrates when glucose is less than 144 mg/dL, particularly if glucose is decreasing.
- When rapid recovery from a long period of exercise is the objective and peak performance is required within 24 hours, aim to consume 1 g to 1.3 g of carbohydrates per kilogram per hour for the first 4 hours of recovery, starting as soon as possible after exercise, with frequent feeding intervals thereafter — every 30 minutes.
- Daily protein recommendations are 1.6 to 1.8 g per kg per day for endurance athletes. Protein added to carbohydrate immediately after exercise might speed up recovery.
- Be aware of the effects of drinks containing high amounts of carbohydrate on blood glucose concentration. Hydrate with carbohydrate-free drinks if blood glucose concentration is greater than 180 mg/dL.
- Be aware of hot or humid conditions.
- Approximately 200 mg to 300 mg of caffeine might reduce the risk for hypoglycemia during and after exercise; this can be consumed alongside glucose.
- Avoid high amounts of caffeine consumption late in the day, which can negatively affect sleep.
- If blood glucose is greater than 180 mg/dL during the last 10 minutes of exercise, consider a more prolonged, low-intensity cool down. If during the last 10 minutes of exercise the blood glucose concentration is between 90 mg/dL and 180 mg/dL, reduce the length of the cool down.
‘Greater planning’ needed
Researchers noted that rapid developments in technologies, such as continuous glucose monitoring sensors, smart devices or wearables, and closed-loop insulin delivery systems, all contribute to the possibility of an increased time in range around exercise with less input from the user. Hybrid closed-loop systems offer benefits for improved time in the glycemic target range overnight, even under demanding environmental and unplanned conditions, they wrote, and future advances in machine learning will likely increase decision support.
“Regardless of the athlete’s sport or competition level, it is clear that many different behaviors will have an effect on short-term and long-term recovery, and thus affect the subsequent performance, training adaptation and time in the target glycemic range,” the researchers wrote. “Athletes with type 1 diabetes should always prioritize blood glucose 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 greater planning and attention is needed to optimize nutrition and insulin strategies for glycogen resynthesis.”
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