Episode 216 - The Science of Exercise with T1 Diabetes – with Dr Sam Scott

The Science of Exercise with T1 Diabetes – with Dr Sam Scott

Managing type 1 diabetes as an endurance athlete can feel like solving a Rubik’s cube… while racing a triathlon.

In this episode, I’m joined by Dr Sam Scott – exercise physiologist, researcher, and former Head of Research for Team Novo Nordisk – to break down the science of exercising with T1 diabetes. Sam shares practical strategies for managing glucose, fuelling like a pro and using tech like CGMs and wearables to stay safe and perform at your best.

Whether you live with T1D, coach someone who does, or are just curious about high-performance sport with diabetes, this is a must-listen.

Links:

Dr Sam Scott’s book: The Science of Exercise with Type 1 Diabetes

Learn more about Enhanced

Check how well you’re doing when it comes to your nutrition with our 50 Step Checklist to Triathlon Nutrition Mastery

Start working on your nutrition now with my Triathlon Nutrition Kickstart course 

It’s for you if you’re a triathlete and you feel like you’ve got your training under control and you’re ready to layer in your nutrition. It's your warmup on the path to becoming a SUPERCHARGED triathlete – woohoo!

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Episode Transcription

Episode 216: The Science of Exercise with T1 Diabetes – with Dr Sam Scott

Welcome to the Triathlon Nutrition Academy podcast. The show designed to serve you up evidence-based sports nutrition advice from the experts. Hi, I'm your host Taryn, Accredited Practicing Dietitian, Advanced Sports Dietitian and founder of Dietitian Approved. Listen as I break down the latest evidence to give you practical, easy-to-digest strategies to train hard, recover faster and perform at your best. You have so much potential, and I want to help you unlock that with the power of nutrition. Let's get into it.

Taryn Richardson (00:00)
Today we are diving into a topic that is incredibly important for so many endurance athletes listening. Exercise is one of the best things we can do for our health, but for people living with type 1 diabetes it adds an extra layer of planning and complexity. Fueling, insulin, performance, safety, it is a lot. So I wanted to bring on somebody who has dedicated his entire career to helping athletes with diabetes stay active and perform at their best. Dr Sam Scott earned his PhD in exercise physiology from Liverpool John Moores University in the UK. He continued his research in Canada and Switzerland, focusing on how we can support people with diabetes to exercise more confidently and safely. He then spent around five years as Head of Research for Team Novo Nordisk, the world's first all-diabetes professional cycling team. How cool is that? Sam is also one of the authors of a new book called The Science of Exercise with Type 1 Diabetes. It pulls together research and lived experience to help people with diabetes navigate training and performance without feeling held back. Sam is now the CEO of Enhanced, a digital ecosystem designed to make exercise more accessible and engaging for people with diabetes through better data and better support. Today we are going to chat about where the biggest challenges sit for athletes with type 1 diabetes, what the latest science says about fueling and performance, and practical strategies you can implement into training. I am also going to take a peek at the future of diabetes tech in endurance sport. Sam, thank you so much for joining me on the podcast today.

Sam Scott (01:43)
Thanks for having me, it is great to be here.

Taryn Richardson (01:45)
You have worked with some seriously high-performing athletes in your career. What led you to specialise in diabetes and exercise?

Sam Scott (01:53)
I started interacting with more people living with the condition while I was doing my PhD, and that is what drew me into this area.

Taryn Richardson (02:04)
You were the Head of Research for Team Novo Nordisk for around five years. What did you learn from working with elite cyclists with type 1 diabetes?

Sam Scott (02:14)
I learned a huge amount. It was interesting to see what is possible in practice versus what is possible theoretically. These are professional athletes, not research subjects unless they choose to be, so trust mattered. Observing how they managed things day to day was incredibly valuable. They had each figured out individual solutions that worked for them. It would have been wrong to barge in with “the research says this” and disrupt systems that already worked. Their attitudes toward technology, their strategies, their motivations, all varied and all mattered.

Taryn Richardson (04:07)
That is what makes a good practitioner. You can have all the research, but you still have to apply it to the human in front of you.

Sam Scott (04:28)
Exactly. There are cultural differences, different levels of acceptance of technology, and different motivations for training. You have to understand why people do things the way they do and help them build systems they will actually engage with.

Taryn Richardson (05:24)
Before we go deeper, can you explain the difference between type 1 and type 2 diabetes?

Sam Scott (05:40)
Type 1 diabetes affects roughly 9 million people worldwide. It is an autoimmune condition where the immune system attacks insulin-producing beta cells in the pancreas. The body no longer makes insulin, so lifelong insulin therapy and glucose monitoring are essential. Type 2 diabetes affects around 550 million people worldwide. It is linked to factors such as inactivity, dietary patterns and genetics. Over time, the body becomes less responsive to insulin and eventually may not produce enough. People may transition to insulin therapy and glucose monitoring as well. Pre-diabetes affects another half a billion people and is a warning stage leading to type 2. Most of my work focuses on type 1.

Taryn Richardson (08:04)
Why is exercise one of the hardest parts of diabetes management?

Sam Scott (08:15)
Glucose responses vary with exercise type, duration and intensity. Add timing of insulin, timing of meals, heat, altitude and hormonal changes. Most people end up doing a lot of trial and error to work out what actually works for them.

Taryn Richardson (08:49)
What about people training at a high level, like triathletes doing 10 to 20 hours a week?

Sam Scott (09:03)
There are many endurance athletes with type 1 diabetes. The training itself is similar to athletes without diabetes. The extra layer is constant glucose management.

Taryn Richardson (09:56)
In some ways the complexity might make them smarter, more in tune athletes.

Sam Scott (10:26)
Many people say they become more aware of their body. But the burden is huge. They are constantly thinking about how training, insulin and fueling will affect glucose. There are also logistical issues like travel and backups for backups.

Taryn Richardson (11:48)
What are some of the biggest misconceptions about athletes and diabetes?

Sam Scott (12:10)
That they cannot train fasted. That they cannot have large amounts of carbohydrate. Early on, many were significantly under-fueling. They were consuming far fewer carbs than athletes without type 1 diabetes. Fueling needs are very similar between the two groups.

Taryn Richardson (13:31)
So many athletes are carb-phobic, so I am glad you said that.

Sam Scott (13:50)
Studies on professional cyclists show that their carbohydrate needs are nearly identical to athletes without type 1 diabetes.

Taryn Richardson (14:16)
Do you have one simple principle for fueling during training if you have type 1 diabetes?

Sam Scott (14:34)
Individualisation is key. Understand your goal for the session and fuel accordingly, while managing glucose. Fast-acting carbs are used to maintain blood glucose, and you layer that onto performance fueling.

Taryn Richardson (15:00)
Many people with diabetes hesitate to carb load. Any advice?

Sam Scott (15:09)
If you want to compete with athletes without diabetes, you need to find a way to incorporate carbohydrate loading. Start with standard protocols and adapt your insulin and glucose management around it. Working with a diabetes educator and a qualified sports nutrition professional is ideal.

Taryn Richardson (16:24)
Thank you for clarifying “nutrition coach”.

Sam Scott (16:26)
Yes, someone qualified in nutrition and diabetes.

Taryn Richardson (16:34)
What does good glucose control look like during exercise?

Sam Scott (16:53)
Avoid terms like good and bad. Glucose varies day to day even with the same protocol. Generally, people aim to start exercise between 7 and 12 millimoles per litre to reduce hypoglycaemia risk. During events, they try to stay within that range. Training may allow slightly lower levels, but it is individual.

Taryn Richardson (18:51)
CGMs have changed the game for monitoring. How have they helped athletes?

Sam Scott (19:33)
CGMs remove constant finger-prick testing and provide continuous data, trend arrows and retrospective insights. Athletes can see what happens during and after exercise and adjust strategies. They can also view glucose data live during longer events. It makes decision making much easier.

Taryn Richardson (22:41)
What is the highest carb intake per hour you have seen?

Sam Scott (22:55)
Around 90 to 100 grams per hour in professional cyclists.

Taryn Richardson (23:03)
I expected higher.

Sam Scott (23:05)
Management strategies make it safe and effective. It is very similar to athletes without diabetes.

Taryn Richardson (23:25)
How long does it take someone to build to that?

Sam Scott (23:57)
It varies. It depends on when they were diagnosed and how experienced they are. Some were athletes before diagnosis and only had to add diabetes management. Others grew up with diabetes and sport together.

Taryn Richardson (25:11)
Do you think technology will eventually make most of the decisions?

Sam Scott (25:27)
Yes. Cycling already uses heavy data-driven decision making. AI powered individualised coaching is already progressing.

Taryn Richardson (26:24)
Tell us about Enhanced.

Sam Scott (26:34)
Enhanced aims to merge glucose, wearable, nutrition and insulin data into one platform, then use personalised algorithms to guide training and recovery based on your individual responses. The goal is to reduce the decision-making burden and help people focus on their sport.

Taryn Richardson (28:05)
It looks clean, simple and genuinely helpful.

Sam Scott (28:23)
We wanted it to feel user friendly, not purely medical. Something people enjoy using.

Taryn Richardson (29:12)
Any final advice?

Sam Scott (29:17)
Living with type 1 diabetes is complex, even before you add sport. But sport represents possibility. I have seen newly diagnosed people told not to exercise, which sends the message that they also cannot do anything else. Showing people what is possible is powerful. If you can manage sport, you can manage university, family, career and whatever else you want to do.

Taryn Richardson (30:35)
You can do hard things.

Sam Scott (30:36)
Yes.

Taryn Richardson (30:37)
Sam, thank you so much for joining me. If you want to dive deeper into the science and strategies we talked about today, grab a copy of Sam’s book The Science of Exercise with Type 1 Diabetes. For Triathlon Nutrition Academy athletes, we have an exclusive masterclass with Sam inside the Academy Library where we go deeper into practical strategies for triathletes. If you are interested in the tech side, check out Enhanced. Links to the book and Enhanced are in the show notes. And if you need help creating a nutrition strategy that supports your training and performance goals, that is what we do at Dietitian Approved. You can learn more at dietitianapproved.com. Thanks again for joining me, Sam.

Sam Scott (32:11)
Thank you.

Taryn Richardson (32:13)
See you all next week.

Thanks for joining me for this episode of the Triathlon Nutrition Academy podcast. I would love to hear from you. If you have any questions or want to share with me what you've learned, email me at [email protected]. You can also spread the word by leaving me a review and taking a screenshot of you listening to the show. Don't forget to tag me on social media, @dietitian.approved, so I can give you a shout out, too. If you want to learn more about what we do, head to dietitianapproved.com. And if you want to learn more about the Triathlon Nutrition Academy program, head to dietitianapproved.com/academy. Thanks for joining me and I look forward to helping you smashed in the fourth leg - nutrition!