Moving More, Managing Better

For people living with type 1 diabetes, managing blood sugar is rarely simple. It’s a daily balancing act involving insulin, food, physical activity, technology and a constant stream of decisions. Now, researchers are taking a closer look at another factor that may shape metabolic health in people with Type 1 diabetes: metabolic flexibility. It’s not a term most people hear in everyday diabetes conversations, but it describes something important: how efficiently the body switches between using carbohydrates and fat for energy.

New research from the AdventHealth Translational Research Institute (TRI) suggests that for people with Type 1 diabetes, that system may not always work as smoothly as it should. The encouraging part? Physical activity may help.

“Metabolic flexibility is the body’s ability to switch between using fat and carbohydrates for energy,” said Daria Igudesman, PhD, RD, postdoctoral fellow at the AdventHealth Translational Research Institute. “That ability matters throughout the day—when you’re exercising, after eating a meal, and even while you’re sleeping overnight.”

Dr. Igudesman’s work focuses on practical ways to help people with Type 1 diabetes better manage blood sugar and weight, with a particular emphasis on nutrition, movement, and long-term metabolic health.

What Exactly Is Metabolic Flexibility?

A simple way to think about metabolic flexibility is as the body’s fuel-switching system. After a meal, your body should use glucose (i.e. carbohydrates) for energy. Later, while sleeping, fasting, or during prolonged activity, it should shift toward burning fat instead.

“If you haven’t eaten in eight hours, your body needs to be able to switch to burning fat and eventually ketones for energy so your muscles, brain, and other tissues can continue functioning properly,” Igudesman explained.

When that switching process becomes less efficient, the body may have a harder time adapting to changing energy demands. Scientists are still working to understand exactly how metabolic flexibility affects long-term health, but many believe it may be an important marker of metabolic function with potential implications for blood glucose regulation, weight management, and even insulin delivery algorithms.

Why It Matters in Type 1 Diabetes

Metabolic inflexibility has already been documented in Type 2 diabetes. What researchers didn’t know was whether something similar might also be happening in Type 1 diabetes.

“Because insulin resistance can also be a feature of Type 1 diabetes and is one of the metabolic underpinnings of metabolic inflexibility, we suspected this concept could be relevant for Type 1 diabetes management,” Igudesman said. “Secondly, Dr. Elvis Carnero and Dr. Lauren Sparks have shown that an exercise intervention improves metabolic flexibility in Type 2 diabetes, but we wanted to begin to understand whether that is also the case in people with Type 1 diabetes who tend to exercise less than their peers without diabetes.”

That matters because metabolism in Type 1 diabetes is uniquely complicated. Unlike people without diabetes, those living with Type 1 rely on externally delivered insulin instead of the body’s own insulin production. Even with insulin pumps and continuous glucose monitors, matching insulin to meals, movement, stress, and everyday life is still far from exact. In addition, liver clearance of insulin is much lower in Type 1 diabetes than in someone who makes insulin internally, which leads to higher levels of circulating insulin throughout the body and can lead to insulin resistance.

“When someone with Type 1 diabetes consumes carbohydrates, they need to dose insulin appropriately,” Igudesman said. “If metabolic flexibility influences how efficiently the body uses those carbohydrates, that could have implications for blood sugar management.”

Researchers also believe a better understanding of metabolic flexibility could eventually help improve automated insulin delivery systems.

Why Movement Matters

The TRI team wanted to know whether physical activity might help explain some of the metabolic differences they were seeing. That question is especially relevant because exercise can feel complicated for people with Type 1 diabetes. For many, the fear of hypoglycemia, or dangerously low blood sugar, is enough to make movement feel stressful instead of empowering for some.

Dr. Igudesman’s findings are the first to suggest that physical activity may matter for metabolic flexibility in Type 1 diabetes. The adults with Type 1 diabetes in the study showed measurable impairments in metabolic flexibility compared with peers without diabetes. But when physical activity levels were modeled upward, some of those differences largely disappeared.

That doesn’t mean exercise directly reverses metabolic inflexibility. More research is still needed. But it does suggest movement may play a meaningful role.

“This still needs to be confirmed in experimental studies,” Igudesman noted. “But we think helping people with Type 1 diabetes increase physical activity could potentially improve metabolic flexibility, blood sugar management, and possibly longer-term health outcomes.”

Good News: It Doesn’t Have to Be Intense

If hearing the word exercise makes you think of punishing gym sessions or long-distance runs, this research offers a much more approachable perspective.

Some of the most promising findings involved light physical activity, the kind of movement many people already do every day, whether that’s taking a walk, gardening, doing household chores, choosing the stairs, playing with kids, or walking the dog.

“What was especially encouraging is that when we modeled increasing light physical activity, we actually saw that this was associated more strongly with greater metabolic flexibility than with moderate to vigorous exercise was,” Igudesman said.

That’s an important message for anyone who feels intimidated by traditional fitness advice.

“You don’t necessarily have to jump into intense workouts,” she said. “Increasing overall movement throughout the day may still be beneficial.”

Or, as she puts it, “The best type of exercise is often the type you’ll actually do.”

Moving Safely with Type 1 Diabetes

Of course, movement in Type 1 diabetes comes with important safety considerations. Exercise can push blood sugar up or down depending on timing, insulin levels, food intake, and activity intensity.

“One of the most important things to consider with exercise in Type 1 diabetes is safety,” Igudesman said.

If your insulin pump includes an exercise mode, activating it 30 minutes to two hours before planned activity may help reduce the risk of hypoglycemia. If movement is unplanned, checking blood sugar first becomes even more important.

“Standardized guidance can help determine whether blood sugar is in an appropriate range to begin exercise,” she said.

Depending on where glucose levels are, that may mean reducing insulin, consuming carbohydrates, or waiting until levels stabilize. And perhaps most importantly, movement doesn’t have to be formal.

“We don’t always have to think about exercise as something structured or planned,” Igudesman said. “Movement can include chores, gardening, playing with kids, or walking the dog.”

The Bottom Line

People with Type 1 diabetes face challenges that extend beyond blood sugar alone. This research suggests accessible, everyday movement may help support metabolic health in ways researchers are only beginning to understand.

And perhaps the most reassuring message is this: better health doesn’t have to start with perfection. Sometimes it starts with simply getting up and moving.