Exercise and the Development of the Artificial Pancreas: One of the More Difficult Series of Hurdles

J Diabetes Sci Technol. 2015 Oct 1;9(6):1217-26. doi: 10.1177/1932296815609370.


Regular physical activity (PA) promotes numerous health benefits for people living with type 1 diabetes (T1D). However, PA also complicates blood glucose control. Factors affecting blood glucose fluctuations during PA include activity type, intensity and duration as well as the amount of insulin and food in the body at the time of the activity. To maintain equilibrium with blood glucose concentrations during PA, the rate of glucose appearance (Ra) to disappearance (Rd) in the bloodstream must be balanced. In nondiabetics, there is a rise in glucagon and a reduction in insulin release at the onset of mild to moderate aerobic PA. During intense aerobic -anaerobic work, insulin release first decreases and then rises rapidly in early recovery to offset a more dramatic increase in counterregulatory hormones and metabolites. An "exercise smart" artificial pancreas (AP) must be capable of sensing glucose and perhaps other physiological responses to various types and intensities of PA. The emergence of this new technology may benefit active persons with T1D who are prone to hypo and hyperglycemia.

Keywords: artificial pancreas; exercise; insulin; metabolism.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Actigraphy / instrumentation*
  • Algorithms
  • Biomarkers / blood
  • Blood Glucose / drug effects*
  • Blood Glucose / metabolism
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / diagnosis
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / physiopathology
  • Diffusion of Innovation
  • Energy Metabolism / drug effects
  • Equipment Design
  • Exercise*
  • Glucagon / blood
  • Humans
  • Hypoglycemic Agents / administration & dosage*
  • Insulin / administration & dosage*
  • Insulin Infusion Systems
  • Motor Activity*
  • Pancreas, Artificial*
  • Predictive Value of Tests
  • Signal Processing, Computer-Assisted
  • Time Factors
  • Treatment Outcome


  • Biomarkers
  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin
  • Glucagon