Various strategies, activities prevent glycemic extremes in type 1 diabetes during exercise

Issue: September 2015

NEW ORLEANS — People with type 1 diabetes who want to be physically active can optimize their performance by choosing a strategy suited to their specific activity and goal, according to a presenter at the American Association of Diabetes Educators Annual Meeting.

Perspective from Anastasia Albanese-O’Neill, PhD, APRN, CDE

“Not all types of exercise are equal when it comes to blood glucose response,” Sheri R. Colberg, PhD, FACSM, professor of exercise science at Old Dominion University in Norfolk, Virginia, told Endocrine Today.

Sheri R. Colberg

Although preventing hypoglycemia is the primary concern of exercisers with type 1 diabetes, hyperglycemia can occur as well.

“Any time you have a big release of glucose-raising hormones, adrenaline being one of those, you might actually have your glucose go up instead of down while you’re exercising,” Colberg said.

Sports that involve sprinting, adrenaline-based activities and competitive or otherwise stressful events can raise blood glucose levels quickly. According to Colberg, this response to sprinting can be a tool for preventing hypoglycemia during physical activity.

Colberg suggests that people attempt to maintain a blood glucose level between 80 mg/dL and 180 mg/dL while physically active.

“If it’s much higher than 180 mg/dL, you get to the point where you could get dehydrated or you feel a bit sluggish, and below 80 mg/dL you can get into the realm of hypoglycemia,” she said.

Colberg emphasized the importance of avoiding hypoglycemia. In type 1 diabetes, a hypoglycemic event — particularly an extreme low — can predispose a person to another event. “Hypoglycemia begets hypoglycemia,” she said.

Glycemic levels can be controlled by decreasing bolus insulin doses before exercising — from a 25% reduction for low-intensity activities to 50% for high-intensity activities; no reduction may be needed for short-duration high-intensity activities. Reducing basal doses is another strategy. Exercise duration and intensity should be considered when snacking is used to control blood glucose levels, as well, Colberg said.

The goal of exercise can also suggest which strategy for hypoglycemia prevention one should adopt, according to Colberg.

“If the goal is weight loss, I would focus more on reducing insulin and less on trying to increase food intake,” she said. – by Jill Rollet

Reference:

Colberg SR. F16. Presented at: The American Association of Diabetes Educators Annual Meeting; Aug. 5-8, 2015; New Orleans.

Disclosure: Colberg reports no relevant financial disclosures.

Perspective

Anastasia Albanese-O’Neill, PhD, APRN, CDE

What I heard in the talk was similar to the recommendations we make in clinic, especially choosing strategies depending on what the overall goal is. What I thought was particularly interesting was if the person was exercising to lose weight, then reducing insulin intake really is the best strategy; but if its an athlete, then maybe adding carbohydrates is the better strategy. I thought setting out the end goal first and arriving at what strategy you were going to use was an interesting point. The other thing I learned today was the use of sprints to reduce post-exercise or mid-exercise lows. Thats not something I was familiar with, so thats my take-away: use of short sprints during prolonged exercise to reduce the risk of hypoglycemia during exercise. Something I would be interested in as we get more tools and technology is more research in this area: How do elite athletes take type 1 off the table during exercise, to the extent thats possible, to really optimize the athletic experience?

Anastasia Albanese-O’Neill, PhD, APRN, CDE

University of Florida College of Nursing

Disclosures: Albanese-O’Neill reports no relevant financial disclosures.