Avoiding hypoglycemia during protracted physical exercise by utilizing modern technology

This case study describes a 40-year-old lady with long-standing type 1 diabetes for 37 years. Despite a history of recurrent hypoglycemia, impaired hypoglycemia awareness and an eating disorder, by changing to continuous subcutaneous insulin infusion therapy with an insulin pump, in combination with carbohydrate counting, she restored her hypoglycemia awareness and reduced blood glucose variability. This gave her the confidence to register to run in a marathon but during training experienced wide fluctuations in blood glucose with frequent hypoglycemia. With continuous glucose monitoring using a glucose sensor, she was able to undertake a strenuous training programme and subsequently manage her glucose to avoid hypoglycemia and maintain good control for the duration of the marathon. For some people with type 1 diabetes, technological advances have provided the capacity to reduce hypoglycemia risk, improve their quality of life, and enable them to participate in demanding physical activities.