Amateur Sport in Adults With Type 1 Diabetes: Glycemic Challenges, Insulin Adjustment Strategies, and the Role of Modern Glucose Monitoring Technologies

Background: Regular physical activity in patients with type 1 diabetes (T1D) is associated with highly dynamic metabolic changes. Prolonged aerobic exercise carries the risk of rapid exercise-induced hypoglycemia, whereas anaerobic exercise and competitive stress can lead to paradoxical hyperglycemia. The growing population of adults with T1D engaging in amateur sports requires modern, evidence-based medical support. Aim: This paper aims to review the current literature on physiological challenges, periexercise insulin therapy strategies, and the application of modern technologies in adult amateur athletes. Material and methods: A review of the current literature was conducted using medical databases (PubMed, Scopus), focusing on the latest guidelines and clinical trials. The synthesis targeted adult patients with T1D, glycemic management during amateur sports, and modern diabetes technologies. Results: Optimal glycemic management requires preemptive basal insulin reduction (planned 60–90 minutes in advance of exercise), modification of mealtime boluses, and targeted carbohydrate supplementation. Delayed late-onset hypoglycemia (LOH), particularly during the night, remains a critical challenge. The use of continuous glucose monitoring (CGM) systems allows for proactive responses to glucose fluctuations based on trend arrows. Furthermore, the implementation of advanced hybrid closed-loop (AHCL) systems, through exercise modes and nocturnal auto-suspension, not only improves metabolic safety but also drastically reduces the cognitive burden and the fear of hypoglycemia (FoH). Conclusions: Safe and satisfying participation in amateur sports by adult patients with T1D is fully achievable by flexibly combining the latest therapeutic guidelines with advanced diabetes technology and thorough patient education.