Exercise and Managing Blood Glucose
Case Study
Gregoire is a 20 year old university student living with type 1 diabetes for 10 years. He has been taught how to match his pre-meal (rapid-acting analogue) insulin dose to his carbohydrate intake. His A1C is 6.8% and he has minimal hypoglycemia. His meals are typically at 7 am, noon and 5:30 pm. He also takes a long-acting insulin analogue at bedtime, typically 10 pm.
He plans to join a soccer league with 1 hour games, 2 or 3 evenings per week. He discusses this with his diabetes educator. The plan is for Gregoire to check blood sugars more frequently for the first few weeks – before, during and after the game. As well Gregoire has agreed to try to eat 30 extra grams of carbohydrate before each game.
Gregoire comes back to see his diabetes educator 3 weeks later. His blood sugar records show he is having lows at 5AM or 6AM in the morning after most of his games.
Question 1: Which ONE of the following would NOT likely be contributing to Gregoire’s post-exercise hypoglycemia?
Drinking 3 beers with his team after the games. |
Incorrect. For people with type 1 diabetes, moderate consumption of alcohol with, or 2 or 3 hours after, an evening meal may result in delayed hypoglycemia overnight, the next morning or as late as 24 hours after alcohol consumption. |
The dose of his pre-supper rapid-acting insulin analogue. |
CORRECT. The timing of the hypoglycemic episodes falls outside of the time when the rapid-acting insulin analogue would be working. For a full discussion of physical activity and diabetes see: Chapter 10: Physical Activity and Diabetes. |
The dose of his basal insulin. |
Incorrect. Exercise performed late in the day or in the evening can be associated with increased risk of overnight hypoglycemia in people with type 1 diabetes. To reduce this risk, one can reduce bedtime intermediate or long-acting injected insulin dose, or reduce overnight basal insulin infusion rates by approximately 20% from bedtime to 3 am for insulin pump users. |
The inability to eat his prescribed pre-exercise snack because he is still full after his supper. |
Incorrect. The risk of hypoglycemia during exercise is of concern for people with type 1 diabetes. If pre-exercise blood glucose levels are < 5.5 mmol/L, approximately 15 to 30 g carbohydrate should be ingested before exercise. But Gregoire’s hypoglycemia is not occurring during exercise; rather, it’s occurring many hours later making it unlikely that the snack would be protective. |
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