Truly a game-changer.
If you want the research and rationale behind this approach, listen to Episode 8: Activity Snacking to Increase Time in Range for T1D.
The tactics on this page have changed my diabetes life permanently.
I’m confident they can do the same for you.
GAME is about using FAST movers of glucose between meals to deal with highs quickly and cleanly.
Remember this graph?
And remember how much smoother Christmas Day became once I swapped insulin corrections for high knees?
Here’s what we’ve been building towards.
How does GAME work?
Everything you need was covered in the Foundations.
Grace: “Daddy, surely you’re the only one mad enough to do this?”
Not even close. Let me show you a few young people who’ve used GAME and smashed it.
Example 1: eight-year-old on injections
This lad was on injections using a Dexcom. He was sitting around 60% time in range with a predicted HbA1c of 7.3% — pretty decent — but he was stuck on the glucose rollercoaster and didn’t know how to get off.
After learning GAME, the family set the high alert at 11.0 mmol/L (200 mg/dL). When the alarm sounded, they used 15 minutes of jogging on the spot (high knees).
The result: one burst a day on average. Glucose dropped below 11.0 within about half an hour. Overnight corrections stayed insulin-based.
Time in range jumped from 60% to 75% almost immediately, with lows kept under 4%.
Example 2: fewer hypos, more range
This young woman had a strong baseline TIR of 73%, but she was hammering correction insulin between meals. The insulin stacking was brutal: more than 13% of the time hypo.
She swapped corrections for 5–10 minute bursts of skipping or jogging on the spot whenever the alert hit 9.0 mmol/L (160 mg/dL). Straight away: 85% time in range and hypos under 4%.
Example 3: the penthouse run
This one makes me smile. She was already dominating: consistently >80% time in range with <4% low. But she wanted to go for the penthouse.
She chose 5–10 minutes of star jumps when glucose reached 8.0 mmol/L (145 mg/dL). On average she needed two short bursts per day — 20 minutes total of flapping arms and legs.
BOOM: 98.8% time in range with virtually no lows. Only 0.2% off my record.
“This sounds like a lot of exercise… what if I can’t do it?”
Totally fair. We start with baby steps.
Grace and Jude, for you we’ll set the high alert at 12.0 mmol/L (215 mg/dL) and keep it there until you’re about six. After that, we’ll gradually slide it down towards 10.0 mmol/L (180 mg/dL) — only if it feels sensible and sustainable.
If you run SET properly, you usually need just one short burst a day. If you eat ultra-processed chaos, expect to need more.
Also, for plain old health you need at least three lots of twenty minutes of vigorous activity per week. GAME often ends up being your minimum effective dose. Anything beyond that is a bonus.
Will GAME cause hypos?
Yes — at first, almost certainly.
GAME is more art than science. To become Picasso, you need trial and error with continual tinkering, and one rule above all:
Early on, I often over-did it — ten minutes of high knees when five would have done. You learn quickly by watching your CGM.
The timings are guides. Your job is to adapt them to your body, your life, and your rhythms.
Does it have to be jogging on the spot?
Nope. Any movement that uses most of your body will work.
My favourites: high knees, rowing, running (sometimes literally around the city centre at work), and jumping jacks.
Others I’ve helped use cycling, trampolining, burpees, skipping — whatever fits your environment and your joints.
No rules. Whatever works, works. The CGM will tell you.
Should I ever use correction insulin?
Absolutely.
Overnight, I’ll still correct highs with insulin. Not even I am doing high knees at 4 a.m.
School is trickier. If staff are comfortable supporting GAME, we use it. If not, insulin corrections at school are fine.
By secondary school, you’ll decide what’s practical. In lessons you might prefer insulin. At break, you might hammer a few high knees anywhere — or do them in a loo cubicle if you fancy being stealthy.
I’m fairly sure I hold the world record for high knees in toilet cubicles. Someone call Guinness.
As your skill grows, you may experiment with a split approach: half-correction plus a short activity burst for stubborn highs. Pizza is my usual trigger for this combo.
GAME isn’t all-or-nothing. The more you use it, the better your time in range. But you can flex it to fit real life.
What if I can’t exercise at all?
Two solid options:
- AID systems
- Sugar Surfing — a brilliant approach to proactive micro-corrections without stacking insulin. Worth reading, full stop.
GAME done.
Next step: SET.
