Aim. To summarise the current state of knowledge regarding how physical activity may stimulate counter-regulatory responses in type 1 diabetics and which clinical features can enhance the risk of either hyper- or hypoglycaemia. Data from the literature. A literature review of all relevant PubMed-indexed literature from 2022-2026 was conducted, in addition to a review of the references cited in the identified literature and current clinical practice guidelines. In type 1 diabetes, persistent exogenous insulin action and attenuated glucagon and sympathoadrenal responses increase susceptibility to exercise-related hypoglycaemia. The clinical relevance of most diabetes-related modifiers is based on how long ago insulin was administered (insulin on board), when the patient's last bolus for a meal occurred, what their blood glucose levels were before an exercise session and whether they had been trending upward or downward recently, the type of activity being performed by the patient and their specific responses to these activities. Typically, aerobic forms of physical activity will result in larger decreases in blood glucose compared with resistance training and/or high intensity activity. Conclusions. Type 1 diabetes exercise management should be tailored to the individual and the nature of the exercise, as well as the patient's level of insulin exposure at that time and the dynamic blood glucose levels. Continuous glucose monitoring (CGM) and automated insulin delivery (AID) may provide enhanced safety for individuals. However, as with all technology, it is likely that this technology will have most benefit when used in conjunction with structured educational programs.