Insulin adjustments
Pre-exercise	Timing of exercise	Action
MDI	≤90 min after meal	Reduce pre-meal insulin bolus, 25%–50% if<90 min exercise, 50% if>90 min exercise
	>90 min after meal	Do not adjust bolus, may need to consume extra Carbohydrate
Pump	≤90 min after meal	Reduce pre-exercise insulin dose or use temporary basal rate for 30–90 min pre-exercise
	>90 min after meal	Do not reduce bolus, temporary basal rate only
During exercise	MDI	Replenish with Carbohydrate as needed
During exercise	Pump	Use temporary basal rate, for example, 50%
After exercise	MDI	Reduce long-acting insulin dose
After exercise	Pump	Reduce basal rate for 4 hours from bedtime

bw, body weight;
Additional recommendations: If first-time exercise, there is a prolonged hypoglycaemia risk so the basal rate should be reduced for the entire night using temporary basal rate setting; if on MDI the long -acting dose should be reduced that day/night. Hypoglycaemia risk is also higher if exercise is carried out on sequential days, or there was a hypoglycaemic event on the day preceding exercise. Alcohol also increases the risk of hypoglycaemia. If hyperglycaemia is encountered post-exercise (especially likely if moderate-intensity/high -intensity exercise at the anaerobic/lactate threshold), a cool-down over 20–30 min will reduce the need to give a correction bolus. A 10 s sprint done before and/or during low/moderate -intensity exercise will elevate glucose levels and reduce the risk of hypoglycaemia during or after exercise.