Matias states that he would like to start exercising again as he is feeling better. He is used to playing tennis several times per week as well as cycling at least 2 days per week for over 20 miles each time

Question

Again, he expresses his concern regarding low blood sugar. How would you counsel Matias regarding physical activity, his diet, and his blood glucose monitoring?

Answer 1

• I would advise Matias to definitely keep snacks on him and to be able to recognize signs of mild hypoglycemia.
• I would explain how exercise can cause hypoglycemia and that hypoglycemia can occur up to 24 hours after strenuous exercise such as biking 20 miles.
• He should check his blood glucose prior to exercise to gauge how much insulin to give himself.
• He should also check his blood glucose for signs of hypoglycemia after exercise.
• If exercise is going to last longer than 30 minutes, a small snack is needed. Usually an additional 15 g of carbohydrates should be adequate for each hour of moderate physical activity.
• For more strenuous exercise, 30 g of carbs per hour may be required. This would likely be the case for his tennis and bicycling activities.
• Insulin will probably have to be reduced to potentially 1/3 to ½ of original dosage for periods of exercise lasting a longer duration.
• Adequate snacks will need to be consumed prior to exercise and insulin may not be needed to "cover" these snacks. Additional snacks may be needed post-exercise as well.
• Suggest him to bring a "kit" with carbohydrate replacements (such as gels, tablets, or paste), glucometer (and testing strips), insulin/syringes, and ketone testing strips with him when playing tennis and get a pouch to carry these on his bike
• Use medical ID.
• Matias should inform his exercise partners about how to identify the signs and treat him for hypoglycemia.