Dr. Jaiwant Rangi explains why type 1 diabetes increases hypoglycemia risk during exercise and how to prevent it. Take 15-30g carbs before activity and every 30-45 minutes during, reduce insulin pump basal rates by 50% beforehand, or cut mealtime bolus by half if on injections. Monitor glucose constantly with finger sticks or CGM.
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Foreign. Why is it difficult to manage type 1 diabetes while exercising? Type 1 diabetes is difficult enough already and matching carbs to insulin and accounting for stress etc. Can be a bit too much. It's a fear of hypoglycemia that is the greatest barrier to exercise in people with type 1 diabetes. In a normal person who does not have diabetes, there are counter regulatory hormones that help to respond to hypoglycemia and prevent severe hypoglycemia. For example, when the blood glucose values drop less than 90, the counter regulatory hormones start working and less than 80 we have suppression of insulin secretion and less than 70 there's glucagon and epinephrine increase and less than 60 we get autonomic symptoms like sweating, shaking, etc. Less than 50 there are neuroglycopenic symptoms like confusion, difficulty concentrating, etc. Now why does exercise induced hypoglycemia and diabetes happen? It happens because individuals with type 1 diabetes the counter regulatory hormone response is diminished. Insulin is not shut off appropriately with exercise and the glucagon production is suppressed. The net effect is there's less glucose production and there's more glucose utilization. So it's very important to recognize that either there's a pre workout carb intake or there's lowering or the shutting off of insulin during exercise, which is possible only if you are on insulin pump. If you are not on an insulin pump and you're taking a long and a short acting insulin in the form of multiple daily injections, it can be challenging. Let's try to understand how the carbohydrate intake helps. Carbohydrate intake decreases the body's need to break down glycogen to produce or create glucose. So if you are very low, take simple carbohydrates. To prevent low blood sugars, you can try more complex carbohydrates. Now take extra carbohydrates if the blood glucose value is less than 150 before exercise. Take 15 to 30 grams of carbohydrates before you start or you may need more and 15 to 30 every 30 to 45 minutes while exercising. The alternative is to decrease insulin. The idea is to minimize the insulin on board and monitor the trends prior to exercise. Some strategies for insulin pump users. You can decrease your basal insulin by 50% starting an hour prior to exercise, which is expected to last for an hour. Now you can also stop or remove the pump completely prior to a brief exercise and put it back on afterwards. If you're on subcutaneous insulin injections then lower the mealtime bolus by 50%. The trend prior to exercise is extremely important and dropping blood sugar can feel just as bad as as low blood sugar itself. Therefore, we suggest monitor your blood sugar before exercise more frequently during exercise and we strongly recommend you using continuous glucose monitors. I hope you found this helpful. This is not for individual patients or person, but this is a general recommendation or suggestion and ideas. You've got to talk to your doctor about your personal needs.
