Along with medical nutritional therapy and insulin, exercise is the third component to successfully treating diabetes. Exercise, like insulin, lowers blood glucose levels, assists in maintaining normal lipid levels, and increases circulation. For most individuals, consistent and individualized exercise helps reduce the therapeutic dose of insulin.
Diabetics should be forewarned that they should never perform exercise during the time that their insulin level is at its peak. The ideal time for a diabetic to exercise is when their blood glucose level is between 100 to 200 mg/dl or about thirty to sixty minutes after meals. They should also avoid exercising when their blood glucose is above 250 mg/dl and ketones are present in the urine.
There are metabolic effects that occur with exercise that type 1 and type 2 diabetics should be aware of. In the case of type 1 diabetes, glucose control can be compromised if proper adjustments are not made in food intake or insulin administration. People with type 2 diabetes who take oral hypoglycemic medications may be at risk of post-exercise hypoglycemia.
Here are some general guidelines that may assist in regulating the glycemic response to exercise in persons with type 1 diabetes.
1. Metabolic control before exercise: Avoid exercise if fasting glucose levels are greater than 250 mg/dl and ketosis is present. Eat added carbohydrates if glucose levels are less than 100 mg/dl.
2. Blood glucose monitoring before and after exercise: identify when changes in insulin of food intake are necessary. Learn the blood glucose response to different exercise conditions.
3. Food intake: Consume added carbohydrates as needed to avoid hypoglycemia. Carbohydrate-based foods should be readily available during and after exercise.
People with type 1 diabetes who do not have complications and are in good blood glucose control can perform all levels of exercise, including leisure activities, recreational sports, and competitive sports. To do this safely, the diabetic must posses the ability to collect self monitored blood glucose data while exercising and use this data to adjust their insulin and nutritional therapy.
Exercise can increase the risk for hypoglycemia in people with type 1 diabetes. Hypoglycemia during exercise of forty minutes or less is rare. Onset of hypoglycemia is more likely to occur after exercise, often four to ten hours after. Blood glucose levels should be monitored at one to two hour intervals after exercise to assess response to the exercise and allow for adjustments in insulin and food intake.
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