Interpretation and management of hyperglycemia and exercise

Hyperglycemia and exercise

In some circumstances, high blood sugar may indicate medical problems, such as insulin deficiency. People with type 1 diabetes are more likely to have insulin deficiency because they are virtually unable to produce insulin; therefore, they should be instructed on why and when to check for ketones (1). This is especially important if the person is using an insulin pump. If ketones are present, higher blood glucose levels are the result of insulin deficiency, and corrective action should be taken immediately.

People with type 2 diabetes may have hyperglycemia resulting from a combination of insulin resistance and insufficient insulin secretion; in their case, extremely high blood glucose levels badociated with severe dehydration may result in hyperosmolar hyperglycemia, which may be aggravated by other extenuating health variables, such as severe illness and infections (2). These people do not usually produce ketones; if ketones exist, they may be due to dietary restriction, as opposed to insulin deficiency.

Most diabetes specialists teach people with type 1 diabetes to check for ketones when their blood glucose is consistently above 300 mg / dL (16.7 mmol / L). However, they should check for unexplained hyperglycemia (≥ 200 mg / dL or 11.1 mmol / L) that persists for more than 2 hours. Exercise should be delayed or suspended if ketone levels in the blood are high (≥ 1.5 mmol / L or 8.7 mg / dL), which is equivalent to moderate to large urinary ketones, because Glycemia and ketones can increase with even moderate activity (3).

Insulin dosing regimens badociated with frequent glycemic control significantly reduce the risk of developing insulin deficiency, and high levels of ketones are rarely detected during blood or urine tests. In most cases, a slightly elevated blood glucose level should not interfere with physical performance. However, some people report headaches, blurred vision, or lack of energy with even mild hyperglycemia, which may be reason enough to avoid physical activity until the person gets better. glucose level. The health care facilitator must consider the individual's ability to perform glucose and ketone tests and to understand the complexity of the information.

In other situations, physical activity itself may increase the normal blood glucose level when it is performed at high intensity (4). The response of catecholamines to a very intense activity results in exaggerated hepatic glucose production for the fuel and, once the activity is stopped, insulin requirements can double during the post-activity period. If the insulin dose is not corrected in insulin users, this hyperglycemia may last for several hours before lowering or not decreasing without additional insulin (5).

Those who use the insulin pump can administer a small amount of insulin to meet this physiological need. If you inject insulin to the syringe, you can also administer an extra dose of fast-acting or fast-acting insulin. The timing and amount of insulin administered should be carefully examined and monitored to obtain the desired blood glucose result. Individuals should consider the remaining insulin from their last injection or bolus for subsequent dose adjustment and take into account the residual effects of the last activity on blood glucose use (ie. Reinforced action of insulin after exercise). Regardless of the method of administration used, this additional dose of insulin may result in hypoglycemia and may not be desirable in all cases.

References for the interpretation and management of hyperglycemia and exercise:

1. Kamata Y, Takano K, Kishihara E, Watanabe M, Ichikawa R, Shichiri M. Distinct Clinical Features and Therapeutic Modalities of Diabetic Ketoacidosis in Type 1 and Type 2 Diabetes Mellitus. J Diabetes Complications 2017; 31: 468-72. doi: 10.1016 / j.jdiacomp.2016.06.023.
2. Umpierrez G, Korytkowski M. Diabetic emergencies – ketoacidosis, hyperglycemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol 2016; 12: 222-32. doi: 10.1038 / nrendo.2016.15.
3. Riddell TM, Gallen IW, Smart CE, et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol 2017; 5: 377-90. doi: 10.1016 / S2213-8587 (17) 30014-1.
4. Fahey AJ, Paramalingam N, Davey RJ, Davis EA, Jones TW, Fournier PA. The effect of a short sprint on the production and utilization rates of whole body glucose after exercise in people with type 1 diabetes J Clin Endocrinol Metab 2012; 97: 4193-200.
5. Xie J, Wang Q. Optimal correction factor of insulin in post-intense intensity intensity hyperglycemia in adults with type 1 diabetes: The study FIT. J Biomech Eng 2019; 141 (1) .2703963. doi: 10.1115 / 1.4041522.

Sheri R. Colberg, PhD, is the author of Diabetes Athlete Guide: Expert Advice for 165 Sports and Activities (the last edition of Diabetic Athlete's Manual), which is now available via Human Kinetics (https://us.humankinetics.com/products/athlete-s-guide-to-diabetes-the), Amazon (https://amzn.to/2IkVpYx), Barnes & Noble and elsewhere. She is also the author of Diabetes and stay fit for dummies. Emeritus Professor of Exercise Science at Old Dominion University and internationally renowned diabetes movement expert, she is the author of 12 books, 28 book chapters and more than 415 articles. She has received the 2016 Outstanding Diabetes Educator Award from the American Diabetes Association. Contact her through her websites (SheriColberg.com and DiabetesMotion.com).