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For my wife (type 1 diabetic), physical activity is the big one that throws off her calculations as a walk in a hilly area makes her blood sugar drop like a rock. Of course she always has something with sugar with her but then she has to figure out how much to consume.

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Hill walks are particularly challenging for me too. I can do rowing or weightlifting with my sugars staying fairly stable or rising if it's really intense, but something about walking steadily up a gentle slope makes it drop massively. There was some interesting research a couple of years back on how exercising the calf muscle is particularly effective at lowering BG, perhaps that has something to do with it https://pmc.ncbi.nlm.nih.gov/articles/PMC9404652/

Yea, as a T1D myself the amount of insulin I need is massively different from days I'm arguing on the internet compared to days I'm up doing physical exercise. Things get concerning really quick when you're a distance from anything and your glucose starts dropping.

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