Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-101

ACTIVITY/EXERCISE

General principle See Chapter 5: Treatment Modalities: Lifestyle for general exercise guidelines. Knowledge of the effects of exercise on BG levels is mandatory for someone with type 1 diabetes. A list of general principles regarding the addition of activity/exercise to a regimen includes the following (164): • Adequate fuel and fluids are necessary to ensure safe and effective periods of activity. • The longer the period of activity, the greater the necessary reduction of insulin dose. • When activity is spontaneous and not preplanned, supplemental carbohydrate before and during the activity can be used to balance the effects of ambient (previously injected) insulin, if the activity lasts longer than 30 minutes. Carbohydrate requirements for exercise/activity Maintaining high carbohydrate availability can improve exercise performance, while decrease in carbohydrate availability can lead to fatigue, resulting in impaired skill and concentration, increased perceived exertion and poor performance. People who exercise at a moderate intensity for approximately one hour each day may benefit from a carbohydrate intake of 5 to 7 g carbohydrate/kg body weight/day (165). Total glycogen stores affect an athlete’s endurance. Insufficient carbohydrate intake may lead to depletion of muscle and liver glycogen stores and problems with chronic fatigue. For the person with diabetes, BG control is essential to achieve desirable muscle and hepatic glycogen stores, not only to maximize athletic performance, but, more importantly, to decrease the risk of hypoglycemia. People who train one to three hours/day may require 6-10 g carbohydrate/kg body weight/day (165). Pre-, inter- and post-exercise/activity carbohydrate intake Recommendations for the amount of carbohydrate to be ingested before, during and after exercise should be individualized based on BG levels and exercise intensity and duration. If insulin doses are decreased, only 15-20 g of carbohydrate may be required to prevent hypoglycemia. However, this amount of carbohydrate may be insufficient to promote performance; intake of 30-75 g of carbohydrate for activities longer than one hour is