How does physical activity affect blood glucose levels? Rachel is a soccer player and usually plays daily. What recommendations will you make to Rachel to assist with managing her glucose during exercise and athletic events?

Question

What will be an ideal response?

Answer 1

Physical activity can greatly affect blood glucose levels. The benefits of exercise far exceed the risks. For example, exercise can improve Hgb A1c percentages, improve blood lipid levels and blood pressure, reduce the risk of developing cardiovascular disease, and improve one's ability to cope with stress.
However, both hypoglycemia and hyperglycemia are acute risks of exercise. Exercise naturally lowers blood glucose levels, especially during unusually strenuous, sporadic, or prolonged exercise (greater than 1 hour). If the diabetic poorly controls her/his blood sugar, exercise can actually cause hyperglycemia and the production of ketones. When insulin is not available, counter-regulatory hormones that increase during exercise cause an increase in hepatic glucose production and free fatty acids from fat metabolism.
Because of this, blood glucose should be monitored before, during, and after the exercise to identify how blood sugar levels change. For moderate exercise lasting less than 30 minutes, additional carbohydrate or insulin adjustment is not needed. In some cases, carbohydrate could be administered without insulin coverage. A small snack (15 grams of carbohydrates) can be eaten if the exercise will last longer than 30 minutes. This should be adequate for each hour of moderate physical activity. For each hour of strenuous exercise, a 30-gram snack of carbohydrate is needed. Also, insulin adjustments might be needed. For most, a 20% or greater decrease in insulin during the period of exercise is necessary.