EXTOD Healthcare Professionals National Conference

Therapies discussed: Exercise, diet, finger and continuous glucose monitors, insulin, insulin pumps and closed loop systems.

• Effect of different physiology
• Variability of glucose response to exercise.
• Effect of insulin levels
• Physiological changes post exercise
• Effect of diabetes complications

Two people who exercise will explain the problems they have with exercise and their solutions

This session will present clinical cases to highlight key medical questions to ask and important signs to look for during patient assessment. It will also cover the main contraindications to exercise. The session will conclude with a dedicated question-and-answer segment to allow for further discussion and clarification.

Topics covered:

• Macronutrients and Energy Balance: Understanding the role of carbohydrates, proteins, and fats in fuelling performance, recovery, and overall health.
• Hydration and Electrolyte Management: Importance of fluid balance before, during, and after exercise to optimise performance and prevent dehydration.
• Nutrient Timing: Strategies for fuelling around training and competition to enhance energy availability, performance, and recovery.
• Supplements: Overview of evidence-based supplements, their potential benefits, risks, and current guidelines for safe use

This workshop will be run in five parallel groups (two paediatric and three adult focused), with the same content. Each group will be run by two HCPs and a patient.

The following topics will be covered:

• Assessing Exercise Type and Intensity – Understanding how different forms of exercise influence glucose response and inform preparation.
• Pre-Exercise Insulin Adjustments – Evidence-based guidance on modifying basal and bolus insulin, as well as insulin pump and closed-loop settings, to minimise the risk of hypoglycaemia
• Carbohydrate Planning – Determining when and how much carbohydrate to consume before exercise, depending on timing, intensity, and recent insulin dosing.
• Glucose Targets and Monitoring – Recommended glucose thresholds before starting activity and how to interpret CGM data in preparation.
• Practical Tools– Using decision aids to support individualised pre-exercise planning.

Facilitators for the groups 

• Group 1 (Adult) Prof Rob Andrews & Monika Jakiel-Rusin
• Group 2 (Adult) Prof Parth Narendran & Claire Foster
• Group 3 (Adult) Dr Alistair Lumb & Manyee Li
• Group 4 (Paediatric) John Pemberton & Anne-Marie Frohock
• Group 5 (Paediatric) Giorgio Carrieri & Francesa Annan

In this session, delegates will be introduced to the exercise-specific features of commonly used insulin pump and closed-loop systems. Each system will be reviewed in detail, with practical guidance on how to optimise settings before, during, and after physical activity.

At the end of the session, all attendees will receive a summary sheet outlining the key features, advantages, and limitations of each system, along with recommendations on which systems may be most suitable for individuals with varying needs and activity levels.

Please return to your workshop group for this session.

Topics covered will be:

• Real-Time Glucose Monitoring – Interpreting CGM data to guide in-exercise decision-making.
• In-Exercise Carbohydrate Strategies – How to calculate and deliver appropriate carbohydrate intake during different types and durations of exercise.
• Insulin Management Mid-Exercise – Guidance on temporary basal rates, suspension features, and manual adjustments for those on pumps and closed-loop systems.
• Exercise intensity to manage glucose – using sprints to manage glucose during exercise

Topics covered will be:

• Post-Exercise Glucose Trends – Understanding delayed hypoglycaemia and how different types of exercise affect glucose levels in the hours following activity.
• Insulin Adjustments After Exercise – Evidence-based guidance on modifying bolus and basal insulin (including overnight settings) to reduce hypoglycaemia risk.
• Carbohydrate and Protein Requirements for Recovery – Role of macronutrients in glycogen replenishment, muscle repair, and maintaining glucose stability.
• Managing Nocturnal Hypoglycaemia – Prevention strategies for overnight lows, including food choices, insulin dosing, and CGM alerts

Peter Davies, a patient with Type 1 diabetes will share his experiences of managing Type 1 diabetes for almost 70 years.

At this point, anyone who did not attend the breakfast briefing can now enter the conference room ready for day 2 to start.

This talk will explore findings from the EXTOD-Immune trial, which looked at how a 12-week exercise programme affects immune cells linked to Type 1 Diabetes in adults recently diagnosed with the condition. It will also cover the role of exercise in preserving beta-cell function.

Topics covered:

• Understanding common sports injuries in people with type 1 diabetes and strategies to prevent them.
• Recognising how diabetes-specific factors (e.g. neuropathy, glycaemic variability) may affect injury risk and recovery.
• Clinician perspectives on managing injury while maintaining safe levels of physical activity.
• Practical guidance on rehabilitation, safe return to exercise, and maintaining glucose management during recovery

These workshops will be run twice in the morning, once from 10.50am until 11.45am and then again from 11.45am until 12.35pm. You can attend two different workshops from the following: 

Workshop 4a – Motivation and Safety: Supporting Someone Who is Overweight to Start and Maintain Exercise

• Strategies for initiating safe and achievable exercise plans for individuals living with obesity.
• Understanding psychological barriers and techniques to build motivation and confidence.
• Tailoring insulin and carbohydrate advice to minimise hypoglycaemia risk.
• Monitoring safety markers and promoting long-term adherence to physical activity.

Facilitators - Florence Kinnafick & Dr Katie Hesketh

Workshop 4b – Refining Your Advice for Children and Young People

• Physiological differences in glucose response to exercise in children and adolescents.
• Age-appropriate insulin adjustments, carbohydrate strategies, and safety considerations.
• Supporting young people’s autonomy and confidence in self-management during sport.
• Managing school and extracurricular activities.

Facilitators - Francesa Annan & Giorgio Carrieri

Workshop 4c – Managing Exercise and Pregnancy: Maintaining Exercise Levels, Targets, and Safety

• Safe exercise recommendations across different stages of pregnancy for women with type 1 diabetes.
• Adjusting insulin and carbohydrate advice to accommodate pregnancy-related glucose variability.
• Understanding changing exercise targets and clinical markers of safety.
• Providing supportive, individualised advice to encourage safe physical activity throughout pregnancy.

Facilitators - Claire Foster & Prof Rob Andrews

Workshop 4d – Dealing with All-Day / Multi-Day Events

• Planning insulin, carbohydrate intake, and hydration strategies for prolonged physical activity.
• Managing cumulative fatigue, changing insulin sensitivity, and glucose fluctuations over time.
• Practical approaches to meal planning, recovery periods, and overnight management.
• Supporting patients in event preparation, including risk assessment and contingency planning.

Facilitators - Anne-Marie Frohock & Prof Parth Narendran

Workshop 4e – Advanced Technology and Exercise - FULLY BOOKED

• Optimising the use of insulin pumps, CGM, and closed-loop systems during exercise.
• Troubleshooting common issues with sensor lag, auto-correction, and exercise modes.
• Understanding technology-specific settings (e.g. temporary targets, exercise modes) and how to tailor them.

Facilitators - Manyee Li & Dr Alistair Lumb

At this point, please join your second-choice workshop for the morning, as indicated on your badge.

Topics that will be covered:

• Exploring physiological differences in females and their impact on glucose control, performance, and weight management.
• Understanding carbohydrate needs and glucose responses during exercise across different phases of the menstrual cycle.
• Sharing research findings and clinical experience in supporting female athletes with type 1 diabetes, and strategies for personalised care.
• Highlighting key tools, resources, and research papers to guide healthcare professionals in optimising management for this population.

These workshops will be run twice in the morning, once from 2.25pm until 3.15pm and then again from 3.30pm until 4.30pm. You can attend two different workshops from the following:

Workshop 5a – Activity Snacks: Using Exercise to Improve Time in Range- FULLY BOOKED

• Understanding the concept of “activity snacks” and their impact on glucose stability.
• Practical strategies for prescribing short bouts of exercise to enhance time in range.
• Real-world case examples and troubleshooting common challenges.

Facilitators - John Pemberton & Dr Katie Hesketh

Workshop 5b – Psychology of Exercise

• Understanding psychological barriers and motivators influencing exercise engagement in people with type 1 diabetes.
• Strategies to build exercise confidence, resilience, and long-term behaviour change.
• Recognising the emotional impact of exercise challenges, including fear of hypoglycaemia.
• Practical tools to support patient motivation, goal setting, and self-efficacy.

Facilitator - Florence Kinnafick

Workshop 5d – Adjusting for Events Abroad (e.g. Time Differences and Travel Arrangements)

• Managing insulin dosing and glucose monitoring across time zone changes and long-haul travel.
• Planning for food, hydration, and exercise during transit and upon arrival.
• Practical advice for adapting closed-loop systems, CGMs, and pump settings abroad.
• Preparing patients for environmental challenges (e.g. temperature, altitude) that affect glucose management.

Facilitators - Manyee Li & Giorgio Carrieri

Workshop 5e – Dealing with Different Training Regimes - FULLY BOOKED 

• Adapting glucose management strategies for endurance, strength, and interval training.
• Insulin and carbohydrate adjustments tailored to varied training intensities and schedules.
• Monitoring and responding to cumulative training effects on glucose control and insulin sensitivity.
• Educating patients on recognising when training patterns require clinical re-assessment.

Facilitator - Anne-Marie Frohock & Prof Rob Andrews

At this point, please join your second-choice workshop for the afternoon, as indicated on your badge.

The EXTOD Fellowship Lecture represents the highest honour awarded by EXTOD. It is presented to an individual who has made an outstanding contribution to the field of type 1 diabetes and exercise. The recipient is invited to deliver a 30-minute lecture, sharing their expertise, research, and insights with conference delegates.