Download Exercise and Blood Sugar

Joan Plummer RD LMNT CDE
[email protected]
Why Exercise
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Exercise can assist your heart and lungs to function better
Exercise can help you to lose or maintain your weight
Exercise can help to relieve stress and tension
Exercise help to control blood sugars by making cells more
sensitive to insulin and removes glucose from the blood
Exercise helps to reduce risk factors associated with heart
disease
Exercise lowers blood pressure and cholesterol
Exercise strengthens your muscles and bones
Exercise keeps joints flexible and improves balance
Exercise helps you to sleep better
Diabetes physiology and activity
 Muscle contraction, increased blood flow and increased
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body temperature cause the body to be more responsive or
sensitive to insulin
Low blood glucose may result with activity because too
much insulin is circulation.
The pancreas is not able to slow down the amount of
insulin to be released
The liver and pancreas do not respond quickly enough to
raise the blood glucose- hypoglycemia may result.
Without adequate insulin, muscles will be forced to rely
on fat as fuel and eventually this can lead to an increase in
ketone bodies
When to test blood glucose
 Before exercise- lets you know if you should exercise and or
if you need to treat a low blood glucose. If below 120 take
15 grams of carbohydrate; if greater than 250 or spilling
ketones, do not do strenuous exercise. Exercise will lead to
more stress on the body and will increase blood glucose
even more.
 Post exercise – lets you know if blood glucose has dropped
 1-2 hours post exercise- checks the effect of exercise on
blood glucose
 Trial and error during exercise – to see effect on blood
glucose before, during and after activity
Hypoglycemia
 Condition characterized by abnormally low blood
glucose levels usually less than 70 mg/dl
 May also be referred as an insulin reaction or insulin
shock
 Check blood glucose if have any symptoms
 If unable to check blood glucose for any reason, treat
the hypoglycemia
Hypoglycemia symptoms
 Shakiness
 Nervousness or anxiety
 Sweating, chills and clamminess
 Irritability or impatience
 Confusion
 Rapid/ fast heartbeat
 Lightheadedness or dizziness
 Hunger and nausea
 Sleepiness
Hypoglycemia symptoms (cont.)
 Blurred/ impaired vision
 Tingling or numbness in the lips or tongue
 Headaches
 Weakness or fatigue
 Anger, stubbornness or sadness
 Lack of coordination
 Nightmares or crying out during sleep
 Seizures
 Unconsciousness
Hypoglycemia treatment
 Consume 15-20 grams of glucose or simple
carbohydrate
 Recheck your blood glucose after 15 minutes
 If hypoglycemia is not above 70, repeat with 15 grams
carbohydrate
 Once glucose returns to normal, eat a small snack if
your next planned meal or snack is more than an hour
or two away
15 grams of simple carbohydrate
 3-4 glucose tablets
 Gel tube equal to 15 grams of carbohydrate
 2 tablespoons of raisins
 4 oz (1/2 cup) of juice or regular soda(not diet)
 1 tablespoon sugar, honey, syrup or frosting
 8 oz. of skim or 1% milk
 Hard candies, jellybeans, skittles, or gumdrops equal
in portion to 15 grams of carbohydrate( read label)
If become unconscious:
 Call 911
 Inject glucagon into the individual’s buttock, arm or
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thigh, following manufacturers instructions
When the individual regains consciousness( usually in
5-15 minutes), they may experience nausea and
vomiting
Do not inject insulin (will lower blood sugar even
more)
Do not provide food or fluids( individual can choke)
Do not put hands in mouth(individual can choke)
Preventing Low Blood Sugars
Your blood glucose response to exercise will vary
depending on:
 Your blood glucose level before starting activity
 The intensity of the activity
 The length of time you are active
 Changes you have made to your insulin dose
 Trial and error for increased activity – may need to
lower insulin dose or eat extra carbohydrate
Preventing low blood sugars
 If blood glucose is below 120 before exercise:
 For mild/moderate activity(walking, biking)for 30
minutes or less take food equaling 15 grams of
carbohydrate before activity
 For intensive activity(soccer, rollerblading) for 30-60
minutes, take food equaling 30 grams of carbohydrate
before activity
 For extensive activity( sports/ cross country) for 2 or
more hours take food equaling 30 grams of
carbohydrate and check blood glucose after 1 hour and
repeat food if <120 mg/dl
Preventing hypoglycemia
 Exercise may lower blood gluc0se for 6-24 hours after
exercise
 Try to avoid giving insulin into the muscles that will be
used during exercise. For example, do not give the
insulin into the legs if the exercise involves walking or
biking
 Avoid exercise at insulin peak times
 Avoid exercising in the morning before eating without
talking to your physician
When not to exercise
 When your blood sugar is above 250 mg/dl- exercise
may increase the blood sugars even more- should not
do strenuous exercise
 When spilling ketones
 If the blood glucose is high and there are ketones, the
body is under stress and adding the stress of exercise
will raise the blood sugar and cause more ketones
 If you are sick
Guidelines for the athlete
 Eat a balanced meal 1-3 hours before the activity, this
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gives the body energy
May choose to decrease the amount of insulin
depending on the type and timing of the exercise
May need a snack just before the activity, depending
on what you ate
May need a snack at half way point
Check blood sugars frequently
Guidelines for the Athlete
 Eat a balanced meal before the activity(1-3 hours)
 Include grains and protein
 Protein will bind with the carbohydrate and slow
digestion
 This will lengthen the amount of time the food is
affecting the blood sugar
 Always drink plenty of water before the activity for
hydration
 ALWAYS carry some form of glucose with you
Other factors to consider
 Pre-exercise insulin dose needs to be reduced when
exercise is longer than 30 minutes
 Long exercise (hiking, biking ) that begins in the
morning or after lunch, may need to decrease the premeal insulin by up to 50%
 The risk of nocturnal hypoglycemia is particularly high
if exercise is performed in the evening. A decrease in
up to 50% of the evening insulin dose may be required
 If on an insulin pump, may need to lower the basal
insulin rate before and during the activity
Hyperglycemia caused by exercise
 Blood glucose usually goes down
 Sometimes exercise causes an increase in the blood
glucose right after exercise.
 Do not treat with insulin but let the body relax. If give
insulin may have hypoglycemia
 This is caused by the release of stress hormones during
exercise.
Conclusion
 Activity is important for blood glucose control.
 Be careful of hypoglycemia with activity.
 Test! Test! Test!