Resources & References

Where our content comes from

About the content and sources

This content has been developed within the Sports&Diabetes and DiaPS project, combining existing scientific knowledge, expert input, and real-life experiences from the diabetes and sport community.

All materials have been reviewed and adapted by our medical writers to ensure they are clear, practical, and understandable for a broad audience. While the information is based on reliable sources, it is not intended to replace professional medical advice.

Main contributors include:

• Maja Cigrovski Berković, M.D. Associate Professor at Faculty of Kinesiology, Lead medical expert
• Felice Strollo, M.D. Professor, Lead medical expert
• Margaret Nicholls, medical writer
• Natasha Kuhfuß, Master of science in Sport science
• Cameron Keighron, PhD
• Antonia Precalli, M.D.

Supporting Experts: 

• Sabine Dupont, IDF Europe
• Christina Petrut, mag. psych.
• Tihana Šadek, mag. nutr.
• Alena Tatarević, mag. pharm.
• Ines Jakopanec, patient expert
• Dunja Bračun, coach experience in diabetes and sport

List of Sources and References

• ADA Standards of Medical Care in Diabetes – 2021. 13. Children and Adolescents.American Diabetes Association. Diabetes Care. 44(Suppl. 1): S180-S199, 2021.
• Achten J et al. Exogenous oxidation of isomaltulose is lower than that of sucrose during exercise in men. J Nutr. 137: 1143–1148, 2007.
• Adolfsson P et al. Evaluation of glucose control when a new strategy of increased carbohydrate supply is implemented during prolonged physical exercise in type 1 diabetes. Eur J Appl Physiol 115:2599–2607, 2015.
• Allen N, Gupta A. Current Diabetes Technology: Striving for the Artificial Pancreas. Diagnostics (Basel) 2019;9(1):31.
• Atkinson FS et al. International tables of glycemic index and glycemic load values: 2008.Diabetes Care. 2008 Dec;31(12):2281-3.
• Baker LB et al. Acute effects of carbohydrate supplementation on intermittent sports performance. Nutrients 7:5733–5763, 2015.
• Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care 2019;42:1593–1603.
• Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kroger J, Weitgasser R. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Lancet 2016;388:2254–2263.
• Carter MR et al. Impairments in Local Heat Loss in Type 1 Diabetes during Exercise in the Heat. Med. Sci. Sports Exerc., Vol. 46, No. 12, pp. 2224–2233, 2014.
• Coggan AR et al. Glucose kinetics during high-intensity exercise in endurance-trained and untrained humans. J Appl Physiol (1985). 1995 Mar;78(3):1203-7.
• Colberg SR, Laan R, Dassau E, Kerr D. Physical activity and type 1 diabetes: time for a rewire? J Diabetes Sci Technol 2015;9(3):609-18.
• Colberg SR et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care 39:2065–2079, 2016.
• Dubé MC, Lavoie C, Weisnagel SJ. Glucose or Intermittent High-Intensity Exercise in Glargine/Glulisine Users with T1DM. Med Sci Sports Exerc.;45:3-7, 2013.
• Durak, E. P.; Jovanovic-Peterson, L.; Peterson, C. M. (1990): Randomized crossover study of effect of resistance training on glycemic control, muscular strength, and cholesterol in type I diabetic men. In: Diabetes care 13 (10). DOI: 10.2337/diacare.13.10.1039.
• Esefeld, Katrin; Kress, Stephan; Behrens, Meinolf; Zimmer, Peter; Stumvoll, Michael; Thurm, Ulrike et al. (2020): Diabetes, Sports and Exercise. In: Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association. DOI: 10.1055/a-1284-6097.
• Fleming GA, Petrie JR, Bergenstal RM, Holl RW, Peters AL, Heinemann L. Diabetes Digital App Technology: Benefits, Challenges, and Recommendations. A Consensus Report by the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) Diabetes Technology Working Group. Diabetes Care 2020;43(1):250-260.
• Franc S, Daoudi A, Pochat A, Petit MH, Randazzo C, Petit C, Duclos M, Penfornis A, Pussard E, Not D, Heyman E, Koukoui F, Simon C, Charpentier G. Insulin-based strategies to prevent hypoglycaemia during and after exercise in adult patients with type 1 diabetes on pump therapy: the DIABRASPORT randomized study. Diabetes Obes Metab 2015;17(12):1150-7.
• Francescato MP et al. Prolonged exercise in type 1 diabetes: performance of a customizable algorithm to estimate the carbohydrate supplements to minimize glycemic imbalances. PLoS One 2015;10:e0125220. doi: 10.1371/journal.pone.0125220. eCollection 2015.
• Fuchsjäger-Mayrl, Gabriele; Pleiner, Johannes; Wiesinger, Günther F.; Sieder, Anna E.; Quittan, Michael; Nuhr, Martin J. et al. (2002): Exercise training improves vascular endothelial function in patients with type 1 diabetes. In: Diabetes care 25 (10), S. 1795–1801. DOI: 10.2337/diacare.25.10.1795.
• Gawrecki A. et al. Physical workload and glycemia changes during football matches in adolescents with type 1 diabetes can be comparable. Acta Diabetologica 56:1191–1198, 2019.
• Gilbertson HR et al. The effect of flexible low glycemic index dietary advise versus measured carbohydrate diets on glycemic control in children with type 1 diabetes. Diabetes Care. 34:1137–1143, 2001.
• Gunther S, Heymann H. Di- and oligosaccharide substrate specificitiesand subsite binding energies of pig intestinal glucoamylase–maltase. Arch Biochem Biophys. 354:111–6, 1998.
• Hohendorff J et al. Risk factors of hypoglycaemia in type 1 diabetes individuals during intensive sport exercise—Data from the SPORTGIVECHANCE event. Int J Clin Pract. 2019;73:e13411. https://doi.org/10.1111/ijcp.13411
• Jeukendrup. A step towards personalized sports nutrition: carbohydrate intake during exercise. Sports Med 44(Suppl.1): S25–S33, 2014.
• Kordonouri O, Riddell MC. Use of apps for physical activity in type 1 diabetes: current status and requirements for future development. Ther Adv Endocrinol Metab 2019;10:2042018819839298.
• Kovatchev BP et al. Episodes of Severe Hypoglycemia in Type 1 Diabetes Are Preceded and Followed within 48 Hours by Measurable Disturbances in Blood Glucose. J Clin Endocrinol Metab. 2000 Nov;85(11):4287-92.
• Landt, K. W.; Campaigne, B. N.; James, F. W.; Sperling, M. A. (1985): Effects of exercise training on insulin sensitivity in adolescents with type I diabetes. In: Diabetes care 8 (5), S. 461–465. DOI: 10.2337/diacare.8.5.461.
• Lou G,  Larramona G,  Montaner  T, Barbed S.  Effect of CGM in the HbA1c and Coefficient of Variation of glucose in a pediatric sample. Prim Care Diabetes. 2020 Oct 29;S1751-9918(20)30290-4.  Doi: 10.1016/j.pcd.2020.10.005. Online ahead of print.
• Malik FS, Taplin CE. Insulin therapy in children and adolescents with type 1 diabetes. Paediatr Drugs. 2014 Apr;16(2):141-50.
• McAuley SA et al. Insulin pump basal adjustment for exercise in type 1 diabetes: a randomized crossover study. Diabetologia. 2016 Aug;59(8):1636-44.
• McGinn R et al. Does type 1 diabetes alter post-exercise thermoregulatory and cardiovascular function in young adults? Scand J Med Sci Sports 2015: 25: e504–e514 doi: 10.1111/sms.12344.
• Messer L, McFann K, Chase HP, Fiallo-Scharer R. Preventing post-exercise nocturnal hypoglycemia in children with type 1 diabetes. J Pediatr 2010;157(5):784-8.e1.
• Moser O, Yardley JE, Bracken RM. Interstitial Glucose and Physical Exercise in Type 1 Diabetes: Integrative Physiology, Technology, and the Gap In-Between. Nutrients 2018;10(1):93.
• Moser O, Eckstein ML, Mueller A, Birnbaumer P, Aberer F, Koehler G, Sourij C, Kojzar H, Holler P, Simi H, Pferschy P, Dietz P, Bracken RM, Hofmann P, Sourij H. Impact of physical exercise on sensor performance of the FreeStyle Libre intermittently viewed continuous glucose monitoring system in people with Type 1 diabetes: a randomized crossover trial. Diabet Med 2019;36(5):606-611.
• Moser O, Riddell MC, Eckstein ML, Adolfsson P, Rabasa-Lhoret R, van den Boom L, Gillard P, Nørgaard K, Oliver NS, Zaharieva DP, Battelino T, de Beaufort C, Bergenstal RM, Buckingham B, Cengiz E, Deeb A, Heise T, Heller S, Kowalski AJ, Leelarathna L, Mathieu C, Stettler C, Tauschmann M, Thabit H, Wilmot EG, Sourij H, Smart CE, Jacobs PG, Bracken RM, Mader JK. 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 Dec;63(12):2501-2520.
• Nansel TR et al. Effect of varying glycemic index meals on blood glucose control assessed with continuous glucose monitoring in youth with type 1 diabetes on basal-bolus insulin regimens. Diabetes Care. 31:695–697, 2008.
• Oskarsson P, Antuna R, Geelhoed-Duijvestijn P, Krӧger J, Weitgasser R, Bolinder J. Impact of flash glucose monitoring on hypoglycaemia in adults with type 1 diabetes managed with multiple daily injection therapy: a pre-specified subgroup analysis of the IMPACT randomised controlled trial. Diabetologia 2018;61:539–550.
• Phillip M, Battelino T, Atlas E, Kordonouri O, Bratina N, Miller S, Biester T, Stefanija MA, Muller I, Nimri R, Danne T. Nocturnal glucose control with an artificial pancreas at a diabetes camp. N Engl J Med 2013;368(9):824-33.
• Rabasa-Lhoret R et al. Guidelines for premeal insulin dose reduction for postprandial exercise of different intensities and durations in type 1 diabetic subjects treated intensively with a basal-bolus insulin regimen (ultralente-lispro). Diabetes Care. 2001 Apr;24(4):625-30.
• Rickels MR, Dubose SN, Toschi E, Beck RW, VerdejoAS, et al. Mini-dose glucagon as a novel approach to prevent exercise-induced hypoglycemia in type 1 diabe‐ tes. Diabetes Care 2018;41: 1909–1916.
• Riddell MC, Gallen IW, Smart CE, Taplin CE, Adolfsson P, Lumb AN, Kowalski A, Rabasa-Lhoret R, McCrimmon RJ, Hume C, Annan F, Fournier PA, Graham C, Bode B, Galassetti P, Jones TW, Millán IS, Heise T, Peters AL, Petz A, Laffel LM. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol 2017;5(5):377-390.
• Riddell MC, Milliken J. Preventing exercise-induced hypoglycemia in type 1 diabetes using real-time continuous glucose monitoring and a new carbohydrate intake algorithm: an observational field study. Diabetes Technol Ther. 13:819–825, 2011.
• Shalitin S, Chase HP Diabetes technology and treatments in the pediatric age group. Int J Clin Pract Suppl. 2011 Feb;(170):76-82.
• Sigal RJ et al Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med 147:357-69, 2007.
• Southgate DAT. Digestion and metabolism of sugars. Am J Clin Nutr. 62(suppl):203s–11s, 1995.
• Standards of Care, American Diabetes Association. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes—2021 Diabetes Care 2021 Jan; 44(Supplement 1): S53-S72.
• Stevenson EJ et al. Influence of high-carbohydrate mixed meals with different glycemic indexes on substrate utilisation during subsequent exercise in women. Am J Clin Nutr. 84: 354–360, 2006.
• Tagougui S, Taleb N, Molvau J, Nguyen É, Raffray M, Rabasa-Lhoret R. Artificial Pancreas Systems and Physical Activity in Patients with Type 1 Diabetes: Challenges, Adopted Approaches, and Future Perspectives. J Diabetes Sci Technol 2019;13(6):1077-1090.
• Taplin CE et al. Preventing post-exercise nocturnal hypoglycemia in children with type 1 diabetes. J Pediatr. 2010;157:784–788.e1 https://doi.org/10.1016/j.jpeds.2010.06.004
• Thomas DE et al. Low glycemic index or low glycemic load diets for overweight and obesity. Cochrane Databse Syst Rev. 18:1–38,2007.
• Tsalikian E et al; Diabetes Research in Children Network (DirecNet) Study Group. Prevention of hypoglycemia during exercise in children with type 1 diabetes by suspending basal insulin. Diabetes Care 29:2200–2204, 2006.
• Van Can JG et al. Reduced glycaemic and insulinaemic responses following isomaltulose ingestion: implications for post-prandial substrate use. Br J Nutr. 11:1–6.,2009.
• U.S. Department of Health and Human Services. Physical activity guidelines for Americans, 2nd ed., 2018. https://health.gov/our-work/physical-activity/current-guidelines Accessed February 20, 2021.
• Wallberg-Henriksson, H.; Gunnarsson, R.; Rössner, S.; Wahren, J. (1986): Long-term physical training in female type 1 (insulin-dependent) diabetic patients: absence of significant effect on glycaemic control and lipoprotein levels. In: Diabetologia 29 (1), S. 53–57. DOI: 10.1007/BF02427281.
• West DJ et al. Isomaltulose Improves Postexercise Glycemia by Reducing CHO Oxidation in T1DM. Med. Sci. Sports Exerc., 43: 204–210, 2011.
• Yardley JE, Sigal RJ. Exercise strategies for hypoglycemia prevention in individuals with type 1 diabetes. Diabetes Spectr. 2015 Jan;28(1):32-8.
• Yardley JE, Iscoe KE, Sigal RJ, Kenny GP, Perkins BA, Riddell MC. Insulin pump therapy is associated with less post-exercise hyperglycemia than multiple daily injections: an observational study of physically active type 1 diabetes patients. Diabetes Technol Ther 2013;15(1):84-8; Taplin CE, Cobry E,
• Yki-Järvinen, H.; DeFronzo, R. A.; Koivisto, V. A. (1984): Normalization of insulin sensitivity in type I diabetic subjects by physical training during insulin pump therapy. In: Diabetes care 7 (6), S. 520–527. DOI: 10.2337/diacare.7.6.520.