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At time intervals, the following variables were measured: concentration of blood glucose and plasma insulin, skin blood flow, skin temperature and rate of carbohydrate and fat oxidation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Blood glucose concentration did not change in response to cycling while immersed in cool or thermoneutral water (<jats:italic>p<\/jats:italic>&gt;0.05) but decreased during cycling on land (<jats:italic>p<\/jats:italic>&lt;0.05). The concentration of plasma insulin decreased during and early after cycling in cool water (<jats:italic>p<\/jats:italic>&lt;0.05). During 60 min of on-land recovery (at 24\u00b0C) after cycling in cool water, blood glucose concentration increased significantly (~2 mmol\/l, <jats:italic>p<\/jats:italic>&lt;0.05), but not after cycling in thermoneutral water or on-land.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\/interpretation<\/jats:title>\n            <jats:p>Exercise at 40% <jats:inline-formula>\n                <jats:alternatives>\n                  <jats:tex-math>$$\\dot{V}{\\text{O}}_{\\text{2peak}}$$<\/jats:tex-math>\n                  <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                    <mml:mrow>\n                      <mml:mover>\n                        <mml:mi>V<\/mml:mi>\n                        <mml:mo>\u02d9<\/mml:mo>\n                      <\/mml:mover>\n                      <mml:msub>\n                        <mml:mtext>O<\/mml:mtext>\n                        <mml:mtext>2peak<\/mml:mtext>\n                      <\/mml:msub>\n                    <\/mml:mrow>\n                  <\/mml:math>\n                <\/jats:alternatives>\n              <\/jats:inline-formula> performed in a basal insulinaemic state in cool water in people with type 1 diabetes does not cause a greater decrease in blood glucose concentration than in thermoneutral water or on land, but blood glucose increases early during on-land recovery, probably as a result of a transient fall in plasma insulin.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s00125-025-06456-w","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T06:47:50Z","timestamp":1750229270000},"page":"2011-2022","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Does exercise in cool water cause a higher risk of hypoglycaemia than in thermoneutral conditions in type 1 diabetes?"],"prefix":"10.1007","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8736-2327","authenticated-orcid":false,"given":"Kristina J.","family":"Abramoff","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shane K.","family":"Maloney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy W.","family":"Jones","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth A.","family":"Davis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul A.","family":"Fournier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"issue":"11","key":"6456_CR1","doi-asserted-by":"publisher","first-page":"937","DOI":"10.2165\/00007256-200737110-00002","volume":"37","author":"KJ Guelfi","year":"2007","unstructured":"Guelfi KJ, Jones TW, Fournier PA (2007) New insights into managing the risk of hypoglycaemia associated with intermittent high-intensity exercise in individuals with type 1 diabetes mellitus. 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Some of the data were presented as an abstract at the American Diabetes Association Scientific Session in June 2024.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Acknowledgements"}},{"value":"Some or all of the datasets generated during and\/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"Open Access funding enabled and organized by CAUL and its Member Institutions. This research has received financial support from the JDRF Global Centre of Excellence in Diabetes Research combined with a Research Matching Fund from the University of Western Australia (CRE \u2013 NHMRC\/JDRF APP107190). Funding was provided from a Children\u2019s Diabetes Centre Seeding Grant.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"KJA made substantial contributions to the conception and design of the research, the acquisition of data and the analysis and interpretation of data, and drafted the manuscript. PAF supervised all aspects of the research, including the design and analysis of data, and contributed critically to the drafting and revision of the manuscript. SKM contributed to the study design and acquisition of data, and played an active role in critically reviewing and editing the manuscript. TWJ and EAD provided some input to the study design and played an active role in revising the manuscript critically for important intellectual content. All authors approved the final version of the manuscript. KJA is the guarantor.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}