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Summary Type 1 diabetes is a challenging condition to manage for various physiological and behavioural reasons. Regular exercise is important, but management of different forms of physical activity is particularly difficult for both the individual with type 1 diabetes and the health-care provider. People with type 1 diabetes tend to be at least as inactive as the general population, with a large percentage of individuals not maintaining a healthy body mass nor achieving the minimum amount of moderate to vigorous aerobic activity per week. Regular exercise can improve health and wellbeing, and can help individuals to achieve their target lipid profile, body composition, and fitness and glycaemic goals. However, several additional barriers to exercise can exist for a person with diabetes, including fear of hypoglycaemia, loss of glycaemic control, and inadequate knowledge around exercise management. This Review provides an up-to-date consensus on exercise management for individuals with type 1 diabetes who exercise regularly, including glucose targets for safe and effective exercise, and nutritional and insulin dose adjustments to protect against exercise-related glucose excursions.

ISPAD Clinical Practice Consensus Guidelines 2018 : Management and support of children and adolescents with type 1 diabetes in school

Recent developments in the understanding of the impact of dietary quality and meal composition are driving changes in the education provided to children and young people about nutrition and lifestyle management of Type 1 Diabetes (T1D). Nutrition education is moving beyond carbohydrate counting and insulin adjustment to acknowledging the influence of whole food choices on glycemic outcomes.

Physical activity is an important part of childhood. It is important for normal childhood development, to maintain healthy bones and body composition, and is useful in developing and maintaining social contacts. Physical activity is no less important for children and young people with diabetes. It is actively encouraged but presents significant challenges for diabetes management for the child, family, and the diabetes team. Physical activity can lead to fluctuations in blood glucose levels that can be difficult to manage or to avoid. In this chapter, we will provide some background to the developmental aspects of physical activity in children and young people and suggest some strategies for managing type I diabetes during periods of physical activity.