European Journal of Applied Physiology

, Volume 115, Issue 12, pp 2599–2607 | Cite as

Evaluation of glucose control when a new strategy of increased carbohydrate supply is implemented during prolonged physical exercise in type 1 diabetes

  • Peter Adolfsson
  • Stig Mattsson
  • Johan Jendle
Original Article



In healthy individuals, high carbohydrate intake is recommended during prolonged exercise for maximum performance. In type 1 diabetes (T1D), this would alter the insulin requirements. The aim of the study was to evaluate the safety of high glucose supplementation during prolonged exercise and the glucose control when a novel strategy of increased carbohydrate supply was implemented during prolonged exercise in T1D.


Eight subjects with T1D participated in a sports camp including sessions of prolonged exercise and individualized feedback during three consecutive days. This was later followed by a 90 km cross-country skiing race. Large amounts of carbohydrates, 75 g/h, were supplied during exercise and the insulin requirements were registered. Glucose was measured before, during and after exercise aiming at euglycaemia, 4–8 mmol/L (72–144 mg/dL). During the race, continuous glucose monitoring (CGM) was used as an aspect of safety and to allow direct and individual adjustments.


Compared to ordinary carbohydrate supply during exercise, the high carbohydrate supplementation resulted in significantly increased insulin doses to maintain euglycaemia. During the cross-country skiing race, the participants succeeded to reach mean target glucose levels; 6.5 ± 1.9 mmol/L (117 ± 34 mg/dL) and 5.7 ± 1.5 mmol/L (103 ± 27 mg/dL) at the start and finish of the race, respectively. Episodes of documented hypoglycemia (<4 mmol/L/72 mg/dL) were rare. CGM was used for adjustments.


In this study, large carbohydrate supplementation in T1D individuals during prolonged aerobic exercise is safe and allows the subjects to maintain glycaemic control and indicates the feasibility of CGM under these conditions.


Blood glucose Carbohydrates CGM Diabetes mellitus type 1 Exercise Hypoglycemia Insulin 



Continuous glucose monitoring


Continuous subcutaneous insulin infusion


Plasma glucose


Physical exercise


Type 1 diabetes



This work was supported by unrestricted Grants from Novo Nordisk Scandinavia.

Compliance with ethical standards

Conflict of interest

Peter Adolfsson is one of the founders and a board member of Diasend.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Institute of Clinical SciencesThe Sahlgrenska Academy at University of GothenburgGothenburgSweden
  2. 2.Endocrine and Diabetes CenterThe hospital of Halland KungsbackaKungsbackaSweden
  3. 3.Faculty of Health Sciences and MedicineÖrebro University HospitalÖrebroSweden
  4. 4.Endocrine and Diabetes CenterFalun HospitalFalunSweden
  5. 5.Endocrine and Diabetes CenterKarlstad HospitalKarlstadSweden

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