In general, appropriate entry-level activities for most people that are unlikely to have adverse consequences beyond sore muscles are walking, yard work, and dancing. Additional time should be added to an exercise program as the fitness level improves, but patients should be advised to stop exercising if pain or discomfort is experienced and to seek medical attention if the pain fails to subside. Because elevated blood sugar levels can cause excess water to be lost via the urine, PWD are at increased risk for developing dehydration. In addition, thirst centers in the brain are not activated until a 1 percent body water loss has occurred. It is, therefore, necessary to assure that exercise be initiated in a hydrated state and that a fluid consumption schedule be established during exercise (S. Colberg, R. Sigal and B. Fernhall et al. 2010). Table 2.2 contains basic fluid guidelines for physical activity.
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Fueling the body prior to the activity and replenishing it after the activity are also crucial. Eating a meal or snack within two hours prior to exercise increases energy levels and results in an increased number of calories burned. Glycogen stores need to be replenished post-exercise, and the muscular microtears that occur with sustained activity need to be repaired within 30 minutes after exercise. During exercise lasting longer than 45 to 60 minutes, supplemental fluids and calories may be
After Activity 24 ounces for every pound of body weight lost during the activity Weigh before and after activity to ensure proper rehydration needed, as will more frequent blood sugar testing. When blood glucose remains within 70 to 150 mg/dL during exercise, muscle efficiency and performance are optimized (Dunford 2006), (Hinnen et al 2001), (Kundrat and Rockwell 2008), (Walsh and Roberts 2000). MNT should be individualized based on the type, amount, and intensity of the exercise performed.
Physical Activity with Type 1 Diabetes
Exercise is not reported to improve glycemic control in persons with type 1 diabetes; however, the same benefits from exercise that the non-diabetic population experiences, such as decreased risk of CVD and improved sense of well-being, still apply. Thus regular physical activity should be encouraged in individuals with type 1 diabetes (Franz et al. 2010). It is important to note that research regarding the benefits and risks of physical activity on this population is limited. Participation in exercise may pose challenges for a person with type 1 diabetes. If a person with type 1 diabetes has a minimal amount of insulin available due to inadequate insulin therapy, the secretion of catecholamines and glucagon can cause high blood glucose levels during exercise, and if untreated, can lead to the accumulation of ketone bodies and cause diabetic ketoacidosis. It is not necessary to postpone exercise based simply on hyperglycemia as long as the patient feels well and as long as urine and blood ketones are negative. On the opposite end of the spectrum, if the person with type 1 diabetes has excessive insulin onboard, severe hypoglycemia can occur during the activity (ADA, 2013), (S. Colberg, R. Sigal and B. Fernhall et al. 2010). For this reason, it is imperative that all people with type 1 diabetes check their blood sugar before activities and always carry some form of rapid acting glucose (e.g., glucose tablets, juice) to treat hypoglycemia.
It has been reported that participation in continuous moderate-intensity exercise (aerobic activity between 40 and 59 percent of maximum oxygen uptake or 55 to 69 percent maximal heart rate) causes an increase in the risk of hypoglycemia, both during and up to 31 hours following the cessation of an activity. Additionally, during sustained high-intensity exercise (approximately 15 minutes at >80 percent of maximum oxygen uptake), a progressive rise in blood glucose levels can occur (Franz et al. 2010). In this case, with high hyperglycemia caused by vigorous activity, additional insulin should only be added after the individual’s response to vigorous activity is studied on several occasions (Franz et al. 2010). A reduction in insulin dosage is the preferred method to prevent hypoglycemia when exercise is planned. For unplanned exercise, additional carbohydrate is generally required, such that a 70-kg person would need an additional 10 to 15 grams carbohydrate per hour of moderate intensity physical activity, and more if intense activity occurs (ADA, 2008).