Introduction: Continuous glucose monitoring (CGM) reveals the impact of physical activity to influence glycaemic fluctuations during high intensity and endurance sport activities.  The glucose changes associated with insulin-treated diabetes during physical load are theoretically determined. However, in real life significant inter-individual differences are observed. Thatsway analysis of CGM curves, recorded  during sport activities in diabetes type 1 patients (T1D), may substantially improve the  efficacy of their treatment.
	Aims: To obtain and analyse glycaemic curves in people with DM1 during various sporting activities (jogging, Ice hockey, skiing, marathon running, mixed martial arts (MMA)), and to design treatment regimen best suited to avoid undesirable glycaemic variability as the consequence of the physical activity.
	Methods:  From 29 adults with T1D  with  realised CGM (aged 19- 65 years) with HbA1c 7.4- 8.8 % DCCT, diabetes duration 3-30 years, treated by intensive insuline treatment (IIT) ;  2 men (M) and 3 women (W) provided CGM recordings. We used CGM systems: Guardian™ Connect, Guardian™ 2 Link, FreeStyle Libre. All participants practised their sport regularly and during CGM they also recorded  insulin  dosage (I),  saccharides (SJ) consumed and exercise duration.   Individual data were analysedand each participant was advised on adjustment of therapy.   
	Results:  From 29  CGM monitored DM1 patients  three typical glycaemic patterns were identified that developed as a consequence of physical activity (PA): (1) decline of glycaemia after physical activity;  (2) a glycaemic rise during physical activity;  (3) elevation of glycaemia after PA . Examples are: 1. Jogging in an IIT-treated patient led to nocturnal hypoglycaemia, eliminated after CGM based therapy adjustment.   2.  Unexpected elevation of glycaemia during a marathon in a young man on IIT was evoked by stress during sporting performance, while in another patient the same activity provoked hypoglycaemia.  3. Glycaemic elevation was observed after fhinishing PA in patient performing MMA, accompanied with high glucose variability.
             Conclusion : Glycaemic fluctuations  in people with T1D during sport are influenced by several factors:  type, duration and intensity of physical activity, inappropriate therapeutic adjustments by the individual, stress and others. The nowadays CGMS technology allows glucose monitoring during high intensity  and endurance sporting activities.  It enables glycaemic fluctuations in people with type 1 diabetes to be identified during physical exerciseand to be  and counteracted by appropriate therapeutic adjustments.

International Diabetes Federation Congress 2019