Regular physical activity is highly recommended in subjects with type 1 diabetes (T1D) because of its beneficial impact on body composition, cardiovascular disease risk profile, glucose control and psychological wellbeing. However, exercise is challenging for many individuals with T1D, particularly due to the fear of hypoglycaemia, loss of glycaemic control and lack of motivation. The aim of this commentary is to briefly summarize the patterns of dysregulation of glucose homeostasis during and after exercise in subjects with T1D. In addition, we focus on carbohydrate intake and adjustment of insulin dosing as the main strategies used in clinical settings to optimize glucose control and prevent hypoglycaemia before, during and after exercise.