How should exercise be managed for a person with type 1 diabetes on insulin therapy?

How should exercise be managed for a person with type 1 diabetes on insulin therapy?

• A. Monitor glucose; consider reducing bolus or basal insulin pre-exercise and/or carry fast-acting carbs; check glucose before, during, after.
• B. Stop insulin completely before exercise.
• C. Increase basal insulin only.
• D. Avoid carrying carbohydrates.

Answer: (A)

Exercise changes how insulin and glucose work together, so planning around activity helps prevent lows while still keeping glucose in a safe range. When someone with type 1 diabetes on insulin exercises, muscles take up glucose more readily and insulin sensitivity increases, which can cause blood glucose to drop during and after the activity. The safest approach is active glucose monitoring and ready adjustments to insulin and carbohydrate intake based on what you plan to do. Check glucose before starting to know where you’re at and to decide if you need to tweak your plan. If you’re about to engage in prolonged or intense activity, you may need to reduce the amount of rapid-acting insulin you’d normally take with meals or modestly adjust basal insulin for the duration of the exercise. Carry fast-acting carbohydrates so you can promptly treat any drop in glucose during or after exercise. It’s also important to recheck glucose after exercise because lows can occur hours later due to continued increased insulin sensitivity and depleted glycogen stores. Stopping insulin completely isn’t appropriate because it risks dangerous hyperglycemia and ketoacidosis. Increasing basal insulin alone without considering food intake and activity can heighten the risk of hypoglycemia during exercise. Avoiding carbohydrates removes a key tool for preventing and treating lows during and after activity.

Exercise changes how insulin and glucose work together, so planning around activity helps prevent lows while still keeping glucose in a safe range. When someone with type 1 diabetes on insulin exercises, muscles take up glucose more readily and insulin sensitivity increases, which can cause blood glucose to drop during and after the activity. The safest approach is active glucose monitoring and ready adjustments to insulin and carbohydrate intake based on what you plan to do.

Check glucose before starting to know where you’re at and to decide if you need to tweak your plan. If you’re about to engage in prolonged or intense activity, you may need to reduce the amount of rapid-acting insulin you’d normally take with meals or modestly adjust basal insulin for the duration of the exercise. Carry fast-acting carbohydrates so you can promptly treat any drop in glucose during or after exercise. It’s also important to recheck glucose after exercise because lows can occur hours later due to continued increased insulin sensitivity and depleted glycogen stores.

Stopping insulin completely isn’t appropriate because it risks dangerous hyperglycemia and ketoacidosis. Increasing basal insulin alone without considering food intake and activity can heighten the risk of hypoglycemia during exercise. Avoiding carbohydrates removes a key tool for preventing and treating lows during and after activity.