Sport bei Typ-1-Diabetes: Strategien für ein optimales Glukose-Management

Sport verbessert die körperliche Fitness, beugt Herz-Kreislauf-Erkrankungen vor und steigert das psychische Wohlbefinden. Eine der größten Herausforderungen im Alltag von Menschen mit Typ-1-Diabetes ist es, den Glukosespiegel vor, während und nach dem Sport im physiologischen Bereich zu halten. In diesem Beitrag beschreiben wir, durch welche gezielten Maßnahmen Menschen mit Typ-1-Diabetes ihr Glukose-Management bei Sport verbessern können.

Kernaussagen

• Regelmäßige sportliche Betätigung hat zahlreiche positive Effekte für Menschen mit Typ-1-Diabetes, welche die Risiken überwiegen.

• Menschen mit Typ-1-Diabetes haben ein erhöhtes Risiko für akute und nächtliche Hypoglykämien durch Sport. Das Risiko lässt sich durch gute Vorbereitung, Überwachung und die Nutzung eines CGM-Systems (kontinuierliches Glukose-Monitoring) minimieren.

• Ein kontinuierliches Glukose-Monitoring (CGM) reduziert die Zeit in Hypoglykämie und den HbA_1c-Wert.

• Durch die kontinuierliche Überwachungsmöglichkeit und das Einstellen von Alarmgrenzen werden die Blutglukose-Überwachung während des Sports vereinfacht und das Sicherheitsgefühl erhöht.

• Der Blutglukose-Wert eines jeden Menschen reagiert unterschiedlich auf Sport.

• Orientierend gilt: Leichtes bis moderates Ausdauertraining senkt, Intervall-Training stabilisiert oder senkt und intensives anaerobes Training erhöht den Blutglukose-Spiegel.

• Ein Sport-Tagebuch ist ein gutes Hilfsmittel, um das individuelle Hypoglykämie-Risiko besser einschätzen zu können und die Therapie bestmöglich dem Sport anzupassen.

Schlüsselwörter

Diabetes mellitus - Training - Bewegungstherapie - Hypoglykämie - Ketoazidose

Keywords

Diabetes mellitus - training - exercise therapy - hypoglycemia - ketoacidosis

Publication History

Article published online:
21 July 2025

• Literatur

• 1 Muñoz-Pardeza J, López-Gil JF, Huerta-Uribe N. et al. Physical Fitness and Activity Levels as Predictors of Subjective Well-Being in Youths With Type 1 Diabetes Mellitus: A 2-Year Longitudinal Analysis of the Diactive-1 Cohort Study. Scand J Med Sci Sports 2025; 35: e70033
• 2 Roep BO, Thomaidou S, van Tienhoven R. et al. Type 1 diabetes mellitus as a disease of the β-cell (do not blame the immune system?). Nat Rev Endocrinol 2021; 17: 150-161
• 3 Danne T, Nimri R, Battelino T. et al. International consensus on use of continuous glucose monitoring. Diabetes Care 2017; 40: 1631-1640
• 4 Sylow L, Kleinert M, Richter EA. et al. Exercise-stimulated glucose uptake – regulation and implications for glycaemic control. Nat Rev Endocrinol 2017; 13: 133-148
• 5 Lascar N, Kennedy A, Hancock B. et al. Attitudes and barriers to exercise in adults with type 1 diabetes (T1DM) and how best to address them: a qualitative study. PLoS One 2014; 9: e108019
• 6 Pitt JP, McCarthy OM, Hoeg-Jensen T. et al. Factors influencing insulin absorption around exercise in type 1 diabetes. Front Endocrinol (Lausanne) 2020; 11: 573275
• 7 Jayawardene DC, McAuley SA, Horsburgh JC. et al. Closed-Loop Insulin Delivery for Adults with Type 1 Diabetes Undertaking High-Intensity Interval Exercise Versus Moderate-Intensity Exercise: A Randomized, Crossover Study. Diabetes Technol Ther 2017; 19: 340-348
• 8 Moser O, Tschakert G, Mueller A. et al. Effects of high-intensity interval exercise versus moderate continuous exercise on glucose homeostasis and hormone response in patients with type 1 diabetes mellitus using novel ultra-long-acting insulin. PLoS One 2015; 10: e0136489
• 9 Riddell MC, Gallen IW, Smart CE. et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol 2017; 5: 377-390
• 10 Moser O, Riddell MC, Eckstein ML. et al. Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA). Diabetologia 2020; 63: 2501-2520
• 11 Riddell MC, Peters AL. Exercise in adults with type 1 diabetes mellitus. Nat Rev Endocrinol 2023; 19: 98-111
• 12 Yardley JE. Reassessing the evidence: prandial state dictates glycaemic responses to exercise in individuals with type 1 diabetes to a greater extent than intensity. Diabetologia 2022; 65: 1994-1999
• 13 Toghi-Eshghi SR, Yardley JE. morning (fasting) vs afternoon resistance exercise in individuals with type 1 diabetes: A randomized crossover study. J Clin Endocrinol Metab 2019; 104: 5217-5224
• 14 Murillo S, Brugnara L, Servitja JM. et al. High intensity interval training reduces hypoglycemic events compared with continuous aerobic training in individuals with type 1 diabetes: HIIT and hypoglycemia in type 1 diabetes. Diabetes Metab 2022; 48: 101361
• 15 Chimen M, Kennedy A, Nirantharakumar K. et al. What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review. Diabetologia 2012; 55: 542-551
• 16 Gal JJ, Li Z, Willi SM. et al. Association between high levels of physical activity and improved glucose control on active days in youth with type 1 diabetes. Pediatr Diabetes 2022; 23: 1057-1063
• 17 Kennedy A, Nirantharakumar K, Chimen M. et al. Does exercise improve glycaemic control in type 1 diabetes? A systematic review and meta-analysis. PLoS One 2013; 8: e58861
• 18 Riddell MC, Turner LV, Patton SR. Is There an Optimal Time of Day for Exercise? A Commentary on When to Exercise for People Living With Type 1 or Type 2 Diabetes. Diabetes Spectr 2023; 36: 146-150
• 19 Adolfsson P, Riddell MC, Taplin CE. et al. ISPAD Clinical Practice Consensus Guidelines 2018: Exercise in children and adolescents with diabetes. Pediatr Diabetes 2018; 19: 205-226
• 20 Asgharzadeh A, Patel M, Connock M. et al. Hybrid closed-loop systems for managing blood glucose levels in type 1 diabetes: a systematic review and economic modelling. Health Technol Assess 2024; 28: 1-190
• 21 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: 255-280
• 22 van Bon AC, Blauw H, Jansen TJP. et al. Bihormonal fully closed-loop system for the treatment of type 1 diabetes: a real-world multicentre, prospective, single-arm trial in the Netherlands. Lancet Digit Health 2024; 6: e272-e280
• 23 Nimri R, Phillip M. Automated Insulin Delivery Systems for Treatment of Type 1 Diabetes: Strategies for Optimal Performance. Horm Res Paediatr 2025; 24: 1-13
• 24 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: 2065-2079
• 25 Moser O, Müller A, Aberer F. et al. Comparison of insulin glargine 300 u/ml and insulin degludec 100 u/ml around spontaneous exercise sessions in adults with type 1 diabetes: a randomized cross-over trial (ULTRAFLEXI-1 Study). Diabetes Technol Ther 2023;
• 26 MacDonald MJ. Postexercise late-onset hypoglycemia in insulindependent diabetic patients. Diabetes Care 1987; 10: 584-588