Blood Glucose Management for

Games & Interval Exercise

Othmar Moser

Post-Doctoral Researcher

A-STEM

(Diabetes Research Group)

Table of Content

• Games & Interval Exercise – different or the same?

• Safe for People with Type 1 diabetes?

• Therapy Management around Games & Interval Exercise

• Expected Glucose Responses

• New Technology/Insulin and Games & Interval Exercise

Games & Interval Exercise – different or the same?

Matthew et al., 2009

Cipryan et al., 2017

Gibala e al., 2012

Games & interval exercise describe physical exercise that is

characterised by brief, intermittent bursts of vigorous activity (O),

interspersed by periods of rest or low-intensity exercise (O).

Basketball Game Interval exercise

Random order Structured

Safe for People with Type 1 diabetes?

• Games and interval exercise can be associated with a

higher risk of nocturnal hypoglycaemia than continuous

aerobic exercise

• No data exist on increased risk of cardiovascular events

(e.g. myocardial infarction) during interval exercise in

people with type 1 diabetes

• Even in patients with coronary heart disease, an event rate

of 1 nonfatal heart attack per 23182 hours of interval

training it is reported

Moser et al., 2015

Riddell et al., 2017

Rognmo et al., 2012

YES!

1Low = fast walking, jogging (easily talking)

Moderate = fast jogging, moderate running (talking possible)

Heavy = fast running (talking demanding)

Intense = fast running (talking not possible)

Therapy Management around Games &

Interval Exercise

Riddell et al., 2017

Moser et al., 2017

Moser et al., 2015

Intensity 30 min exercise 60 min exercise

Low1 - 25% for bolus

insulin (60-90 min

prior exercise)

- 50%

Moderate - 50% - 75%

Heavy - 75% NA

Intense - 75% NA

Therapy Management around Games &

Interval Exercise

Starting blood glucose below 5 mmol/L (<90 mg/dL)

• Ingest 10–20 g of glucose before starting exercise; delay exercise

5–6.9 mmol/L (90–124 mg/dL)

• Games & interval Exercise can be started

7–10 mmol/L (126–180 mg/dL) & 10.1–15 mmol/L (182–270 mg/dL)

• Games & interval Exercise can be started; blood glucose could rise

Above 15 mmol/L (270 mg/dL)

• NO games & interval Exercise; check ketones!

Riddell et al., 2017

Expected Glucose Responses to Games

Game

Continuous

exercise

- 5.3 ± 0.4 mmol/L

- 1.1 ± 0.7 mmol/L

45 min

Campbell at al., 2014

Expected Glucose Responses to Interval

Exercise (20 sec Sprints)

Moser et al., 2015

No difference in blood glucose

decrease in comparison of continuous

exercise and interval exercise in blood

glucose response during exercise

and during 24 hrs after exercise for

different exercise intensities!

New Technology/Insulin for Games & Interval

Exercise

• Flash glucose monitoring

• Continuous glucose monitoring

• Basal-automatic artificial pancreas

• Ultra-long acting insulins

• Faster-short acting insulins

Exercise

studies

INT/Games

studies

Reality around Games & Interval Exercise…

… but doable?

Take Home Message

• Games & interval exercise are safe for people with type 1

diabetes

• Therapy adaptation is mainly based on exercise intensity

and duration

• Adequate reaction to starting blood glucose levels are

necessary

• Blood glucose response to games & interval exercise may

vary

Literature

1. Lukas Cipryan, et al. Acute and Post-Exercise Physiological Responses to High-Intensity Interval Training in Endurance and

Sprint Athletes. J Sports Sci Med. 2017 Jun;16(2):219-229.

2. Dionne Matthew, Anne Delextrat. Heart rate, blood lactate concentration, and time–motion analysis of female basketball players

during competition. Journal of Sports Sciences, June 2009; 27(8): 813–821.

3. Martin Gibala, et al. Physiological adaptations to low-volume, high-intensity interval training in health and disease. J Physiol

590.5 (2012) pp 1077–1084.

4. Othmar Moser, 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 10(8):

e0136489. doi:10.1371/journal.pone.0136489.

5. Michael C Riddell, et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Endocrinology. 2017

http://dx.doi.org/10.1016/S2213-8587(17)30014-1.

6. Rognmo Ø, et al. Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients.

Circulation. 2012. 126(12):1436-40.

7. Othmar Moser, et al. Short-Acting Insulin Reduction Strategies for Continuous Cycle Ergometer Exercises in Patients with Type

1 Diabetes Mellitus. Asian J Sports Med. 2017 March; 8(1):e42160.

8. Campbell, et al. Simulated games activity vs continuous running exercise: A novel comparison of the glycemic and metabolic

responses in T1DM patients. Scand J Med Sci Sports 2014: doi: 10.1111/sms.12192

Dankeschön!

Othmar Moser

E-mail: othmar.moser@swansea.ac.uk

Tel: +44 7757 062851

Web: researchgate.net/profile/Othmar_Moser

Twitter: @Othmar_moser