Download PDF
Diabetologie und Stoffwechsel 2023; 18(05): 352-364
DOI: 10.1055/a-2014-7799
CME-Fortbildung

Typ-1-Diabetes und Sport: Was ist zu berücksichtigen?

Type 1 Diabetes and Sports: What to Consider?
Johanna Kramme
,
Othmar Moser
,
Tim Heise
,
Dominik Pesta
› Further Information
Also available at
    Permissions and Reprints

Sport verbessert die körperliche Fitness, beugt Herz-Kreislauf-Erkrankungen vor und steigert das psychische Wohlbefinden. Eine der größten Herausforderungen im Alltag von Menschen mit Typ-1-Diabetes ist es, den Glukosespiegel vor, während und nach dem Sport im physiologischen Bereich zu halten. In diesem Beitrag beschreiben wir, durch welche gezielten Maßnahmen Menschen mit Typ-1-Diabetes ihr Glukosemanagement bei Sport verbessern können.

Abstract

For many people with type 1 diabetes, sport is a central part of their lives. Sport improves physical fitness, prevents cardiovascular diseases and increases the psychological well-being of persons with type 1 diabetes. In addition, exercise increases insulin sensitivity. However, one of the biggest challenges in the daily life of individuals with type 1 diabetes is to maintain glucose levels in the physiological range before, during and after exercise. In addition, the fear of hypoglycemia discourages many people with type 1 diabetes from exercising. In this article, we show what targeted measures persons with type 1 diabetes can use to improve their glucose management during exercise. A better understanding of management options can encourage people with type 1 diabetes to increase their physical activity.

Kernaussagen

  • Menschen mit Typ-1-Diabetes sollten Sport treiben, da die positiven Effekte die Risiken überwiegen.

  • Menschen mit Typ-1-Diabetes haben ein erhöhtes Risiko für akute und nächtliche Hypoglykämien durch Sport. Das Risiko lässt sich durch gute Vorbereitung, Überwachung und die Nutzung von kontinuierliches Glukosemonitoring (CGM) minimieren.

  • Kontinuierliches Glukosemonitoring (CGM) reduziert die Zeit in Hypoglykämie und den HbA1c-Wert.

  • Durch die kontinuierliche Überwachungsmöglichkeit und das Einstellen von Alarmgrenzen werden die Blutglukoseüberwachung während des Sports vereinfacht und das Sicherheitsgefühl erhöht.

  • Der Blutglukosewert jeder Person reagiert unterschiedlich auf Sport.

  • Orientierend gilt: Leichtes bis moderates Ausdauertraining senkt, Intervalltraining stabilisiert oder senkt und intensives anaerobes Training erhöht den Blutglukosespiegel.

  • Ein Sporttagebuch ist ein gutes Hilfsmittel, um das individuelle Hypoglykämierisiko besser einzuschätzen und die Therapie bestmöglich dem Sport anzupassen.

Schlüsselwörter

Diabetes mellitus - Training - Bewegungstherapie - Hypoglykämie - Ketoazidose

Keywords

Diabetes mellitus - training - exercise therapy - hypoglycemia - ketoacidosis


Publication History

Article published online:
12 October 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Roep BO, Thomaidou S, van Tienhoven R. et al. Type 1 diabetes mellitus as a disease of the β-cell (do not blame the immune system?). Nat Rev Endocrinol 2021; 17: 150-161
    CrossrefPubMedSearch in Google Scholar
  • 2 Danne T, Nimri R, Battelino T. et al. International consensus on use of continuous glucose monitoring. Diabetes Care 2017; 40: 1631-1640
    CrossrefPubMedSearch in Google Scholar
  • 3 Sylow L, Kleinert M, Richter EA. et al. Exercise-stimulated glucose uptake – regulation and implications for glycaemic control. Nat Rev Endocrinol 2017; 13: 133-148
    CrossrefPubMedSearch in Google Scholar
  • 4 Lascar N, Kennedy A, Hancock B. et al. Attitudes and barriers to exercise in adults with type 1 diabetes (T1DM) and how best to address them: a qualitative study. PLoS One 2014; 9: e108019
    CrossrefPubMedSearch in Google Scholar
  • 5 Jayawardene DC, McAuley SA, Horsburgh JC. et al. Closed-Loop Insulin Delivery for Adults with Type 1 Diabetes Undertaking High-Intensity Interval Exercise Versus Moderate-Intensity Exercise: A Randomized, Crossover Study. Diabetes Technol Ther 2017; 19: 340-348
    CrossrefPubMedSearch in Google Scholar
  • 6 Pitt JP, McCarthy OM, Hoeg-Jensen T. et al. Factors influencing insulin absorption around exercise in type 1 diabetes. Front Endocrinol (Lausanne) 2020; 11: 573275
    CrossrefPubMedSearch in Google Scholar
  • 7 Moser O, Tschakert G, Mueller A. 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 2015; 10: e0136489
    CrossrefPubMedSearch in Google Scholar
  • 8 Riddell MC, Gallen IW, Smart CE. et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol 2017; 5: 377-390
    CrossrefPubMedSearch in Google Scholar
  • 9 Moser O, Riddell MC, Eckstein ML. et al. Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA). Diabetologia 2020; 63: 2501-2520
    CrossrefPubMedSearch in Google Scholar
  • 10 Riddell MC, Peters AL. Exercise in adults with type 1 diabetes mellitus. Nat Rev Endocrinol 2023; 19: 98-111
    CrossrefPubMedSearch in Google Scholar
  • 11 Yardley JE. Reassessing the evidence: prandial state dictates glycaemic responses to exercise in individuals with type 1 diabetes to a greater extent than intensity. Diabetologia 2022; 65: 1994-1999
    CrossrefPubMedSearch in Google Scholar
  • 12 Toghi-Eshghi SR, Yardley JE. morning (fasting) vs afternoon resistance exercise in individuals with type 1 diabetes: A randomized crossover study. J Clin Endocrinol Metab 2019; 104: 5217-5224
    CrossrefPubMedSearch in Google Scholar
  • 13 Murillo S, Brugnara L, Servitja JM. et al. High intensity interval training reduces hypoglycemic events compared with continuous aerobic training in individuals with type 1 diabetes: HIIT and hypoglycemia in type 1 diabetes. Diabetes Metab 2022; 48: 101361
    CrossrefPubMedSearch in Google Scholar
  • 14 Chimen M, Kennedy A, Nirantharakumar K. et al. What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review. Diabetologia 2012; 55: 542-551
    CrossrefPubMedSearch in Google Scholar
  • 15 Gal JJ, Li Z, Willi SM. et al. Association between high levels of physical activity and improved glucose control on active days in youth with type 1 diabetes. Pediatr Diabetes 2022; 23: 1057-1063
    CrossrefPubMedSearch in Google Scholar
  • 16 Kennedy A, Nirantharakumar K, Chimen M. et al. Does exercise improve glycaemic control in type 1 diabetes? A systematic review and meta-analysis. PLoS One 2013; 8: e58861
    CrossrefPubMedSearch in Google Scholar
  • 17 Adolfsson P, Riddell MC, Taplin CE. et al. ISPAD Clinical Practice Consensus Guidelines 2018: Exercise in children and adolescents with diabetes. Pediatr Diabetes 2018; 19: 205-226
    CrossrefPubMedSearch in Google Scholar
  • 18 Colberg SR, Sigal RJ, Yardley JE. et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care 2016; 39: 2065-2079
    CrossrefPubMedSearch in Google Scholar
  • 19 Moser O, Müller A, Aberer F. et al. Comparison of insulin glargine 300 u/ml and insulin degludec 100 u/ml around spontaneous exercise sessions in adults with type 1 diabetes: a randomized cross-over trial (ULTRAFLEXI-1 Study). Diabetes Technol Ther 2023;
    CrossrefPubMedSearch in Google Scholar
  • 20 MacDonald MJ. Postexercise late-onset hypoglycemia in insulin-dependent diabetic patients. Diabetes Care 1987; 10: 584-588
    CrossrefPubMedSearch in Google Scholar