1. Joan Plummer RD LMNT CDE jlplummer@columbushosp.org

2. Why Exercise 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

3. Diabetes physiology and activity Muscle contraction, increased blood flow and increased 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

4. 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

5. 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

6. Hypoglycemia symptoms Shakiness Nervousness or anxiety Sweating, chills and clamminess Irritability or impatience Confusion Rapid/ fast heartbeat Lightheadedness or dizziness Hunger and nausea Sleepiness

7. 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

8. 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

9. 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)

10. If become unconscious: Call 911 Inject glucagon into the individual’s buttock, arm or 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)

11. 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

12. 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

13. 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

14. 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

15. Guidelines for the athlete Eat a balanced meal 1-3 hours before the activity, this 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

16. 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

17. 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 pre- meal 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

18. 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.

19. Conclusion Activity is important for blood glucose control. Be careful of hypoglycemia with activity. Test! Test! Test!