Exercise, Sleep, and Type 1 Diabetes

There is a complex relationship between sleep, exercise, and glucose control in people with type 1 diabetes. People with type 1 diabetes do not produce sufficient insulin to maintain energy balance and maintain normal glucose levels. They require exogenous insulin to be delivered either through a needle injection, a pump, or more recently through automated insulin delivery or the so-called artificial pancreas. Sleep is known to impact insulin sensitivity. Shorter duration sleep is known to cause insulin resistance on days following restricted sleep and impact counterregulatory hormones released by the body in response to hypoglycemia episodes. Exercise can further complicate the problem as exercise also impacts insulin sensitivity and glucose utilization. People with type 1 diabetes tend to sleep less than people without diabetes and have a high incidence of sleep-related disorders including obstructive sleep apnea. People with type 1 diabetes also find exercise challenging because of the risk of acute and longer term hypoglycemia. This chapter will explore the relationship of sleep, exercise, and type 1 diabetes and provide ideas on how future automated glucose management systems may better integrate exercise and sleep metrics.