Abstract：
Challenges and fears related to managing glucose levels around planned and spontaneous exercise affect outcomes and quality of life in people living with type 1 diabetes. Advances in technology, including continuous glucose monitoring, open-loop insulin pump therapy and hybrid closed-loop (HCL) systems for exercise management in type 1 diabetes, address some of these challenges. In this review, three research or clinical experts, each living with type 1 diabetes, leverage published literature and clinical and personal experiences to translate research findings into simplified, patient-centred strategies. With an understanding of limitations in insulin pharmacokinetics, variable intra-individual responses to aerobic and anaerobic exercise, and the features of the technologies, six steps are proposed to guide clinicians in efficiently communicating simplified actions more effectively to individuals with type 1 diabetes. Fundamentally, the six steps centre on two aspects. First, regardless of insulin therapy type, and especially needed for spontaneous exercise, we provide an estimate of glucose disposal into active muscle meant to be consumed as extra carbohydrates for exercise (\'ExCarbs\'; a common example is 0.5 g/kg body mass per hour for adults and 1.0 g/kg body mass per hour for youth). Second, for planned exercise using open-loop pump therapy or HCL systems, we additionally recommend pre-emptive basal insulin reduction or using HCL exercise modes initiated 90 min (1-2 h) before the start of exercise until the end of exercise. Modifications for aerobic- and anaerobic-type exercise are discussed. The burden of pre-emptive basal insulin reductions and consumption of ExCarbs are the limitations of HCL systems, which may be overcome by future innovations but are unquestionably required for currently available systems.
摘要：
与围绕计划和自发运动管理葡萄糖水平相关的挑战和恐惧会影响1型糖尿病患者的结果和生活质量。技术的进步，包括连续血糖监测,用于1型糖尿病运动管理的开环胰岛素泵治疗和混合闭环（HCL）系统，解决其中一些挑战。在这次审查中,三名研究或临床专家，每个人都患有1型糖尿病，利用已发表的文献、临床和个人经验，将研究结果转化为简化，以患者为中心的战略。了解胰岛素药代动力学的局限性，个体对有氧运动和无氧运动的不同反应，以及技术的特点，提出了六个步骤来指导临床医生有效地将简化的操作更有效地传达给1型糖尿病患者.从根本上说,六个步骤集中在两个方面。首先,无论胰岛素治疗类型，特别是自发运动所需要的，我们提供了葡萄糖进入活动肌肉的估计值，这些活动肌肉打算作为额外的碳水化合物消耗用于运动（\'ExCarbs\';一个常见的例子是成人每小时0.5g/kg体重，青年每小时1.0g/kg体重）。第二,对于使用开环泵治疗或HCL系统的计划锻炼，我们还建议在运动开始前90分钟(1-2小时)开始使用先发制人的基础胰岛素减少或使用HCL运动模式,直至运动结束.讨论了有氧运动和无氧运动的修改。先发制人的基础胰岛素减少和ExCarbs消耗的负担是HCL系统的局限性，这可能会被未来的创新所克服，但无疑是当前可用系统所必需的。
