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Managing type 1 diabetes in the active population
  1. Nicola Keay1,
  2. Richard M Bracken2
  1. 1 Department of Sport and Exercise Sciences, Durham University, Durham, UK
  2. 2 Applied Sport, Technology, Exercise and Medicine Research Centre (A-STEM), Swansea University, Swansea, UK
  1. Correspondence to Dr Nicola Keay, Department of Sport and Exercise Sciences, 42 Old Elvet, Durham, DH1 3HN, Durham University, Durham, DH1 3HN, UK; nickykeayfrancis{at}

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Many high-profile athletes participate across a wide range of sports with type 1 diabetes. Team Type 1 encourages and supports those with type 1 diabetes to participate in physical activity, with professional cycling’s Team Novo Nordisk composed entirely of individuals with type 1 diabetes. Type 1 diabetes is likely to present early in an athlete’s career, a time when athletes may present with fatigue due to increased training loads. All physicians need to distinguish between possible causes of fatigue in these athletes.

Type 1 diabetes is an autoimmune condition with T-cell-mediated destruction of the pancreatic β cells of the islets of Langerhans, resulting in failure to produce sufficient insulin. The clinical outcome is an inability to adequately control glucose metabolism. Effective glucose metabolism is crucial in long-duration and high-intensity exercise. Self-administered exogenous insulin is required as a treatment to manage blood glucose.

The physiological response to exercise is a progressive decrease in insulin and increase in the pancreatic α-cell-derived antagonist hormone glucagon, while exercise also increases insulin sensitivity (increased ‘sensitivity’ means that for a given dose, there is a more pronounced effect—insulin does its job ‘better’). In addition, there is an exercise-induced rise in sympathoadrenal hormones …

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  • Collaborators Amber Medley, Executive Director of the Team Type 1 Foundation, and Jake Lane, Durham University.

  • Contributors NK was commissioned by a Senior Associate Editor BJSM to write this educational article. NK invited RNB, AM and JL to contribute and comment on the initial draft written by NK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.