Do you have questions men's health related?
Please send them!
If you have a question related to men's health, please fill the form bellow.
1. It is a must to provide a valid email, unless you want your questions to be ignored.
We won't make your email public, but we like to talk with live persons.
2. To protect
your identity, take care the name you fill. We make public your name exactly as it is.
|
Public release date: 09 April 2008
[
]
Exercise, insulin, and type 2 diabetes
Question
Is there a guide for reducing the insulin dose during exercise for people with type 2 diabetes who are on basal/bolus insulin therapy?
Response from Teresa L. Pearson, MS, RN, CDE
Director, Diabetes Care, Fairview Health Services, Minneapolis, Minnesota
Exercise is a key component of a healthy diabetes treatment regimen, but when insulin is involved -- even in a person with type 2 diabetes -- precautions should be taken. Before embarking on an exercise program, the American Diabetes Association (ADA) emphasizes that a person with type 2 diabetes should be evaluated for cardiovascular disease or other conditions that might contraindicate certain types of exercise. It is important that the exercise program be individualized on the basis of findings of the evaluation as well as the therapy regimen.
There are other variables that need to be considered: How often does the person currently exercise? If he or she is not very active, the likelihood of hypoglycemia is greater. The length of time the person is active and the level of intensity will affect blood glucose response as well. Other medications, such as sulfonylureas or pramlintide, need to be considered.
Basically, if the person is on a basal/bolus insulin regimen, the primary concern is the prevention of hypoglycemia. The ADA recommends checking blood glucose before, after, and then several hours after exercise because hypoglycemia can occur hours after exercise. For exercise that continues for 30 minutes or more, carbohydrate (CHO) intake or the rapid-acting or short-acting insulin may need to be adjusted. If the blood glucose level is less than 100 mg/dL, the person should take 15 g of CHO before starting the activity. If the person is planning to exercise for 1 hour or longer, blood glucose should be checked during exercise. If blood glucose is below 100 mg/dL, 15 g of CHO may need to be added.
If the exercise is planned, the rapid-acting (or short-acting) insulin dose should be reduced 30% to 50%. It is better to be conservative at first. The short- or rapid-acting insulin dose given within an hour following the exercise may need to be reduced. It is important to keep good records of all blood glucose values, the duration and intensity of the activity, and CHO intake, and to use the information to guide adjustments in the future. The response will be different for everyone on the basis of the level of insulin resistance and physical fitness.
If the exercise is not planned and it has been more than 2 hours since the last meal, it is recommended that the person take an additional 15-20 g of CHO within 15 minutes of initiating the exercise for every 30 minutes of exercise. Again, this is a conservative recommendation that should be adjusted on the basis of response. In overweight individuals, this approach should be used only for unplanned activity; the preferred approach would be to reduce the insulin in order to avoid additional caloric intake.
Gradually increasing exercise and keeping good records will help keep everything in balance. Remember, it is important to consider activities that patients may not think of as exercise, such as shoveling snow, mowing the lawn, or gardening. Additional recommendations that can help your patients reduce the incidence of hypoglycemia include:
- Don't exercise when insulin is peaking;
- Avoid injecting into the arms or legs; use the abdomen to ensure more even absorption of insulin;
- If exercising late in the day, have a snack before bedtime to avoid a delayed hypoglycemic reaction during the night; and
- Don't forget hydration; fluids should be replenished during exercise, especially when exercise lasts for more than 1 hour and there is significant perspiration.
All in all, the best rule of thumb is to be proactive and prevent problems before they occur.
|
|
