Empowering Exercise in T1D: Insights from Clinical Experts

Guest Blogger
Category: Optimisation

Helping people with type 1 diabetes (T1D) stay active has long been a balancing act. Exercise can improve metabolic health and quality of life but also increases the risk of glycaemic variability and hypoglycaemia.1,2

In the recent webinar “Practical Implementation of AID and Exercise Guidance,” experts Dr. Dessi Zaharieva (Stanford University, USA) and Dr. Michael Riddell (York University, Canada) discussed how automated insulin delivery (AID) systems like Omnipod® 5 can help healthcare providers (HCPs) and people with diabetes navigate these challenges more effectively.

 

Dr. Dessi Zaharieva Dr. Dessi Zaharieva

Dr. Dessi Zaharieva, PhD. CEP, CDCES
Stanford University, USA

Dr. Michael Riddell Dr. Michael Riddell

Dr. Michael Riddell, PhD
York University, Canada

Watch full webinar

What Makes Exercise Complex in T1D?

Even with advanced diabetes technologies, the physiological impact of exercise remains difficult to predict.2 As Dr. Zaharieva explained, insulin absorption accelerates during activity, and insulin on board (IOB) can heighten the risk of hypoglycaemia, particularly during spontaneous movement.3

Dr. Riddell highlighted several variables that influence individual responses to physical activity3:

  • Type and intensity of exercise
  • Time of day and pre-exercise blood glucose
  • Stress levels (especially in competition)
  • Environmental factors, including heat, cold, or altitude

While continuous glucose monitors (CGMs) are essential tools, factors like dehydration or intense motion can reduce sensor accuracy.3 For HCPs, understanding these nuances is crucial to tailoring safe, personalised exercise guidance.

Omnipod 5 Helps Support Safe Physical Activity

Omnipod 5 helps address these challenges through features designed specifically with active users in mind:

  • Activity Feature: Temporarily raises the target glucose to 8.3 mmol/L (150 mg/dL) and reduces insulin delivery. Most effective when activated 60 to 120 minutes prior to planned exercise. Once expired or canceled, SmartAdjust™ resumes regular insulin adjustments.
  • SmartAdjust™ Omnipod 5 Algorithm: The insulin dosing algorithm is built into the Pod itself, allowing insulin delivery to continue even when the controller is not nearby.*
  • Tubeless, waterproof† Pod: The Pod can be submerged up to 7.6 meters for 60 minutes.

 

Planned vs. Unplanned Exercise: Distinct Strategies for Omnipod 5 Users

One key message came through: the need to approach planned and spontaneous activity differently.

For planned exercise, the experts recommend3:

  • Activate the Activity Feature 1–2 hours beforehand
  • Adjust carbohydrate intake proactively
  • Monitor glucose closely throughout activity

For spontaneous activity, the experts recommend3: 

  • Promptly increase the glucose target
  • Consume more carbohydrates to compensate for elevated IOB
  • Be aware of CGM lag during rapid glucose changes

Real-world scenarios demand tailored planning, such as competitive stress, water-based† activities, extreme environments, and long-duration events. To explore these strategies in more detail, watch the full webinar.

Spotlight: A Young Athlete’s Diabetes Story with Omnipod 5

The story of a 10-year-old girl living with T1D who uses Omnipod 5 in combination with Dexcom G6 illustrates how Omnipod 5 can support active lifestyles. Her weekly routine includes basketball, dance, and horse riding,—a physically demanding schedule for any child.

Despite this high level of activity, her data reflected strong glycaemic control:

  • GMI: 7.3%
  • Mean glucose: 9.2 ± 3.1 mmol/L (165 ± 56 mg/dL)

This case underscores how thoughtful planning can help even the youngest users stay active with confidence. It’s a clear demonstration of how Omnipod 5 supports clinical outcomes and simplifies life with diabetes for children and their families.

Clinician FAQs

What are the primary risks of unplanned or spontaneous exercise with an AID system?

What’s the role of carbohydrate intake before and during exercise for patients using Omnipod 5?

What makes Omnipod 5 ideal for physically active people, especially children or adolescents with T1D?

*It is recommended to keep the controller nearby to address important alerts/alarms.

†The Pod has an IP28 rating for up to 7.6 metres (25 feet) for up to 60 minutes. The Controller is not waterproof. Please consult sensor manufacturer user guide for sensor waterproof rating.

The Omnipod 5 Automated Insulin Delivery System is a single hormone insulin delivery system intended to deliver U-100 insulin subcutaneously for the management of type 1 diabetes in persons aged 2 and older requiring insulin. The Omnipod 5 System is intended for single patient use. The Omnipod 5 System is indicated for use with NovoLog®/NovoRapid®, Humalog®, Trurapi®/Truvelog®/Insulin aspart Sanofi®, Kirsty®, and Admelog/Insulin lispro Sanofi U-100 insulin. Refer to the Omnipod® 5 Automated Insulin Delivery System User Guide and www.omnipod.com/safety for complete safety information including indications, contraindications, warnings, cautions, and instructions.

References: 

1. Colberg SR, Sigal RJ, Yardley JE, et al. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065-2079. 

2. Riddell MC, Gallen IW, Smart CE, et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol. 2017;5(5):377-390. 3. Moser O, Zaharieva DP, Adolfsson P, et al. The use of automated insulin delivery around physical activity and exercise in type 1 diabetes: a position statement of the European Association for the Study of Diabetes (EASD) and the International Society for Pediatric and Adolescent Diabetes (ISPAD). Diabetologia. 2025;68(2):255-280.