While it is widely accepted that exercise plays an important role in the management of diabetes, extensive teaching must occur before the patient initiates his exercise program

Question

Which statement below indicates that the patient who requires insulin needs further teaching regarding the implementation of an exercise regimen?
A) "I may need to decrease my insulin dosage, if it will peak during my workout session."
B) "It is important that I increase the intensity of my exercise when my blood glucose levels are over 250 mg/dL and I have ketones in my urine."
C) "I will make sure I have a snack such as crackers and cheese before I exercise."
D) "I will monitor my blood sugar before, during, and after long periods of exercise."

Answer 1

Ans: B
Feedback: Patients who have blood glucose levels exceeding 250 mg/dL and who have ketones in their urine should not begin exercising until the urine test results are negative for ketones, and the blood glucose level is closer to normal. Exercising with elevated blood glucose levels increases the secretion of glucagons, growth hormone, and catecholamines. The liver then releases more glucose, and the result is an increase in the blood glucose level. Patients who require insulin should be taught to eat a 15-g carbohydrate snack or a snack of a complex carbohydrate with a protein (such as crackers and cheese) before engaging in moderate exercise to prevent unexpected hypoglycemia. This snack is important because the decrease in circulating insulin that normally occurs with exercise cannot occur in patients treated with insulin. It may also be necessary to patients to reduce the dosage of insulin that peaks at the time of exercise to prevent postexercise hypoglycemia. Monitoring for hypoglycemia includes blood glucose monitoring before, during, and after exercise and the consumption of a snack after the exercise session. The patient who exercises should increase the frequency of blood glucose monitoring.