TL;DR
New international guidance is now available on how to exercise safely with type 1 diabetes when using Automated Insulin Delivery (AID) systems.
- The EASD–ISPAD consensus statement summarises the current evidence base on AID, exercise, and glucose management.
- Key levers for safer exercise: adjust glucose targets, manage carbohydrate around activity, minimise insulin on board, and use each system’s specific activity or exercise modes.
- Downloadable graphics are available in both mmol/L and mg/dL, plus one-page TL;DR guides for major commercial systems.
- This page provides information, not individual medical advice. Always discuss changes with your own diabetes team.
The simple version
It’s finally landed.
The Automated Insulin Delivery (AID) and Exercise Consensus Statement pulls together what we currently know about exercising safely with type 1 diabetes when using AID systems.
You can download all the key graphics here:
mmol/L graphics (PowerPoint)
and
mg/dL graphics (PDF).
Short, system-specific TL;DR guides are available here:
This page walks through the core ideas, some system-specific nuance, and practical actions you can discuss with your team and test in real life.
The medium version
As a member of the writing group for the European Association for the Study of Diabetes (EASD) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) position statement, I am honoured to have contributed to this guidance.
The consensus document consolidates current evidence and clinical practice into a single resource aimed at people with type 1 diabetes, families, and healthcare professionals. The goal is simple: safer, more enjoyable movement with AID systems, using practical tools that can be implemented in day-to-day life.
Here are the people to thank, with special appreciation to Othmar and Dessi who drove the consensus process (and were probably driven slightly mad in the process).
A little background
Exercise is one of the most powerful tools for managing type 1 diabetes, improving cardiovascular health, insulin sensitivity, mental health, and quality of life. Yet, when you add an AID system into the mix, things can get complicated.
AID systems adjust insulin frequently in the background. This is brilliant for overnight and day-to-day living, but during exercise it means you start each session with different “insulin conditions”, even when your starting glucose looks the same. That makes trial-and-error hard and repeatability low.
This consensus statement lays out a framework for thinking about exercise with AID: how to shape insulin delivery before, during, and after activity; how to use system-specific tools; and how to make the whole process safer and more predictable.
If you are completely new to exercise and type 1 diabetes, here is a starter guide that covers the basics before you add AID into the picture.
Core principles for safe exercise with AID systems
The consensus outlines key strategies that address the main moving parts of physical activity and glucose management with AID systems.
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Planned physical activity
When you expect glucose to fall, increasing the glucose target 1–2 hours before exercise is usually helpful. For activities that tend to raise glucose (e.g. short, very high-intensity work), keeping regular or even slightly lower targets may be more appropriate.If exercise starts within 2 hours of a meal, reducing the carbohydrate amount entered into the AID system by around 25–33% is one pragmatic option. This reduces bolus insulin and lowers hypoglycaemia risk, even if glucose temporarily runs a little higher. The key point: the reduction in carbohydrate means a net reduction in insulin; the algorithm cannot “recreate” the insulin you never gave.
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Unplanned physical activity
For sudden activity (e.g. a spontaneous game, unexpected walk), adjust in real time by setting a higher glucose target and using small amounts of rapid-acting carbohydrate if glucose is below about 7.0 mmol/L (126 mg/dL) and trending down. -
Carbohydrate management
Balanced carbohydrate intake around exercise aims to prevent hypoglycaemia without causing prolonged hyperglycaemia afterwards. A useful starting point is to begin supplementing with carbohydrate below 7.0 mmol/L (126 mg/dL), using roughly 3–20 g every 20–30 minutes. The exact amount depends on trend arrows and what you expect your glucose to do during the session.The consensus includes one of my favourite graphics of this kind, which helps you think about likely glucose behaviour during exercise.
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Timing and insulin on board (IOB)
Exercising with less active insulin on board reduces hypoglycaemia risk. A pragmatic “three-hour rule” is to avoid starting planned exercise within three hours of your last significant bolus if possible, or to specifically reduce that bolus if you will be active.Planning activity before meals or during fasting windows is often safer and more predictable.
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