Date of Award

January 2014

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Catherine W. Yeckel



Objective: Exercise training and sport activity are important for good health among those with type 1 diabetes mellitus (T1DM); however, fear of hypoglycemia is a clear barrier to participation. We examined both the main demographic and exercise training risk profiles for exercise-associated and nocturnal hypoglycemia, including indicators of unawareness. Mode of insulin delivery, whether multiple daily injections (MDI) via pen or continuous subcutaneous insulin infusion (CSII) via pump, was an important consideration.

Research Design: Our study was based on data from an internet-based survey in the Netherlands that attracted T1DM participants who engage in routine exercise or sport activity.

Results: The majority of survey participants reported experiencing hypoglycemia either "sometimes" (67.9%) or "regularly" (18.5%) during or after exercise, while 74% reported experience of nocturnal hypoglycemia. In contrast, only a very small number of survey participants reported complete unawareness surrounding symptom severity (< 4%). Overall, regular exercise-associated hypoglycemia predicted the report of nocturnal hypoglycemia (OR= 14.44; P < 0.001). Significant demographic predictors specific for exercise-associated hypoglycemia were sex, age, and number of years of exercise with T1DM (P <0.05). Nocturnal hypoglycemia was influenced by duration of diagnosis and daily basal insulin dose requirements (P < 0.05). Mode of insulin delivery (pen/pump) significantly influenced both exercise-associated (P= 0.002) and nocturnal (P= 0.042) hypoglycemic outcomes, depending on exercise type (endurance/non-endurance). Specifically, pump use, in the context of non-endurance exercise, was associated with high risk for both forms of hypoglycemia.

Conclusions: While hypoglycemia is prevalent in individuals with T1DM who exercise regularly, hypoglycemia unawareness is not. Given that baseline insulin requirements were broadly tied to the above risk profiles, we conclude that exercise regimens to improve overall insulin sensitivity may be crucial to mitigating risk for hypoglycemic outcomes.


This is an Open Access Thesis.

Open Access

This Article is Open Access