Strength And Hypertrophy Training With Type 1 Diabetes.

There is roughly 8.1-8.8 million people in the world with Type 1 Diabetes, roughly 8% of the population of the UK live with it.

Which brings me to this article, I recently had a reader reach out asking for some more information regarding training for strength and size while living with Type 1 Diabetes. It’s something which can have serious health consequences if not managed correctly.

In this article I aim to give a brief overview for those of you who may not be clued up on Type 1 Diabetes to help others, and bring you evidence based data regarding how to best approach your training.

What You'll Find Out

• 🤓 What Is Type 1 Diabetes?

• 👉 Resistance Training, General Fitness and Nutrition Guidelines

• Section

• ✍️ TL:DR - Key Takeaways & Practical Applications

BASIC UNDERSTANDING
WHAT IS TYPE 1 DIABETES?

Type 1 Diabetes is a condition where your body cannot produce a hormone called insulin. Insulin helps your body use glucose for energy. Without insulin the level of glucose in your blood becomes too high and your body cannot regulate properly.

Type 1 diabetes often starts in children and young adults but it can happen at any age, caused by a problem with your immune system (autoimmune condition) and there is currently no cure. It can however be managed by checking your blood glucose regularly, tracking what you eat and drink, and adjusting how much insulin you take.

There are two main problems that can arise from your bodies inability to produce insulin and regulate glucose:

• Hypoglycemia - Low blood sugar. This can be caused by strenuous long aerobic activity. Usually defined when levels drop below 70mg/dl. Hypoglycemia usually occurs one to two hours after exercise.

• Hyperglycemia - Rise in blood sugar above normal levels. This can be caused by intense bouts of exercise / anaerobic activities. Usually defined when blood sugar levels are above 130 mg/dl. This can also occur when carb or insulin intake exceeds utilisation needs.

A review by (Cavallo et al., 2024) states that extended-duration aerobic exercise typically leads to a decrease in blood glucose levels, whereas higher intensity aerobic and anaerobic activity, especially if carried out at high intensity for less than 10 minutes promotes an elevation in blood glucose levels.

The general guidelines by some governing bodies can be pretty vague, with the American Diabetes Association (ADA) recommending at least 150 minutes of moderate to vigorous aerobic exercise per week.

As for Anaerobic Training / Weightlifting the ADA have this to say:

RELEVANT DATA ON TYPE 1
Training & Nutrition

GENERAL FITNESS BENEFITS

A cross-sectional multicentre study involving 18,028 adults over the age of 18, by (Bohn et al., 2015) looked at the effects of physical activity on patients with Type 1 Diabetes, the physical activity was self reported by the subjects and were categorized into 3 groups - 0, 1-2 times per week, 2+ times per week.

The authors found significant reduction in glycated haemoglobin (HbA1c), daily insulin dosage, and Body Mass Index (BMI) for the group doing physical activity more than 2 times per week. With rates for severe hypoglycemic episodes, comas, and DKA were lower in the 2+ times per week group.

NUTRITIONAL GUIDELINES FOR T1 DIABETES

(Cavallo et al., 2024) outlines that Athletes affected by uncomplicated T1DM don’t have different nutritional requirements from those of non-diabetic athletes; regarding performance enhancement. They just need to modify their intake taking into consideration glucose levels, body weight, insulin therapy and specific exercise whether its aerobic or anaerobic.

• Lack of Insulin can hinder the body’s ability to store and utilize nutrients properly, effecting recovery, training adaptations and muscle growth.

• High blood glucose can hinder muscle protein synthesis

• Low blood glucose can affect performance and can make training more difficult.

To counter this, especially when trying to build muscle and strength analysis your blood glucose control. Do all you can to keep blood glucose levels in healthy range. Once you know how your body responds to each training variable you can adjust your carbohydrate intake and nutrition accordingly.

RESISTANCE TRAINING

A study by (Särnblad et al., 2021), which examined the glycaemic responses to non-fasted morning sessions of Resistance training, Aerobic training, Intermittent training and no exercise, with eight adolescent males with T1D. There were no significant blood glucose changes during exercise or 60 minutes post exercise in the resistance training group (Figure 1), as well as no hypoglycaemia reported 4 hours post recovery.

A randomised crossover study by (Toghi-Eshghi & Yardley, 2019), with 12 participants compared training in the morning (fasted) 7am or in the late afternoon 5pm, performing roughly ~ 40 minutes of RE (three sets of eight repetitions, seven exercises, at the individual's predetermined eight repetition maximum). 48 hours separated the 12 participants 7am and 5pm training.

There findings?

• Blood glucose rose during fasting morning exercise (9.5 ± 3.0 to 10.4 ± 3.0 mmol/L), however it declined with afternoon exercise (8.2 ± 2.5 to 7.4 ± 2.6 mmol/L)

• Sixty minutes post exercise, blood glucose concentration was significantly higher after fasting morning exercise than after afternoon exercise (10.9 ± 3.2 vs 7.9 ± 2.9 mmol/L)

• CMG data indicated more frequent hyperglycemia (12 events vs five events) after morning RE than after afternoon RE.

The potential for hyperglycaemia and reduced risk of hypoglycaemia presents during fasted morning resistance training where no insulin or carbohydrate adjustments are made, which is likely due to typically low circulating insulin levels at this time.

TL:DR
Key Takeaways & Practical Applications

Any type of physical activity should not be a barrier to someone with type 1 diabetes. Exercise brings health benefits to type 1 diabetics that include improved insulin sensitivity, improve glucose tolerance, healthy weight management and a decreased risk for heart disease and other diseases.

Plan ahead, know how your blood glucose (blood sugar) and body responds to exercise, this can help you keep your blood glucose from going too low or too high.

Different types of activity may affect you differently, you should check your blood glucose before, during and after an exercise session. Put a trial and error system into place.

As we have seen from the research even what time of the day can affect your blood glucose response, so monitor that going forward if you don’t already.

If you have any questions you’d like answered, topics you would like discussed, or perhaps some feedback, email them over to me at: [email protected]

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