Background: The risk of hypoglycemia is increased with moderate-intensity exercise in patients with type 1-diabetes (T1D), and strategies to prevent hypoglycemia during or after exercise typically involve adjustment of insulin dosing and/or Carbohydrate (CHO). In case of hypoglycemia during unplanned exercise, international guidelines consider treatment as for standard hypoglycemia correction.
The aim of this review was to provide an up to date summary of the available evidence on amount and type of carbohydrate to correct hypoglycemia during exercise, in children and adolescents with T1D.
Methods: following a literature search on hypoglycemia treatment during exercise in T1D, in subjects 0-18 years, without Predictive Low Glucose Suspend (PLGS) augmented insulin pumps, or Predictive Low Glucose Management (PLGM) or Hybrid Closed Loop (HCL) systems, and limited to the last 15 years was performed. A total of 131 studies were identified and 5 studies were included in the review.
Results: The studies we analysed in the review are concordant with current international guidelines to use the calculation 0.3 g/Kg to estimate the quantity of rapid acting CHO for treating hypoglycemia in the pediatric population during exercise. In the context of moderate intensity exercise, forms of glucose and sucrose can perform similar efficacy that could be lower for fructose. Few studies suggest considering repeated treatment or a snack in particular in case of unplanned exercise.
Conclusion: This review collected available evidence on hypoglycemia treatment in the particular context of exercise; more data comparing different strategies in children and adolescents are necessary.