The Impact of Exercise on Blood Glucose. Jacqueline Shahar, MEd, RCEP, CDE Clinical Exercise Physiologist CerCfied Diabetes Educator

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1 The Impact f Exercise n Bld Glucse Jacqueline Shahar, MEd, RCEP, CDE Clinical Exercise Physilgist CerCfied Diabetes Educatr

2 In this sessin yu will learn Trends in glucse prduccn and uclizacn with exercise Research n exercise and impact n bld glucse Target bld glucse with exercise Tips and summary

3 Bld Glucse Trends During Aerbic Exercise Glucse uptake by muscles can increase by up t 20 fld during exercise and last hurs pst exercise Lw BG can ccur with ex,7-10 hurs arer ex, r ver night Ian Gallen, MD; RunSweet.cm

4 Bld Glucse Trends During Shrt Intense Exercise Ian Gallen, MD; RunSweet.cm

5 Mderate vs IntermiVent High Intensity Cycling 40% VO2 peak + 4 secs maximal sprint effrt perfrmed every 2min 30min cntinuus ex@ 40% f VO2 peak Epinephrine and nrepinephrine were high at the end f sessin that included sprints which caused increase in glucse prduccn IntermiVent high intensity cycling prevented further decline in BG (52±14mg/dl versus 79± 22mg/dl) fr 2 hurs pst exercise Guelfi et al., Diabetes Care, 2005

6 Resistance Ex Befre r ARer Aerbic Ex 180mg/dl Resistance befre aerbic 90mg/dl Aerbic befre resistance Aerbic befre resistance Resistance befre aerbic Yardley et al; Diabetes Care 2012

7 10 Secnds Maximal Sprint 90mg/dl BG increased by 18-25mg/dl arer 10 secnds sprint 10 secnds sprint causes sustained increase in BG and helps prevent lw BG when insulin at basal level: befre breakfast, late arer nn, at night Cme Fahey et al; J Clin End Metab, 2012

8 Effect f Different Cycling IntensiCes n Glucse Requirements Glucse prduc4n Glucse u4liza4n SheVy et al; J Clin End Metab, 2016

9 Glucse Replacement During Exercise Glucse replacement culd range between 10-20g carbs every 10-20min f ex t maintain perfrmance Cnsume up t 60g/hur f EX t avid GI discmfrt Use sprts drinks r dilute fruit juices - helps with hydracn 180mg/dl 90mg/dl 180mg/dl 90mg/dl Ian Gallen, MD RunSweet.cm

10 Type f Exercise and Impact n BG Michael Riddell, Yrk University, Canada

11 QuesCns t Cnsider D yu need t: Prevent lw BG? Treat lw BG? Manage high BG? What is yur target BG pre exercise? Maintaining BG at range mg/dl Which insulin is wrking during exercise? What snacks t carry? What t eat arer exercise? Hw t prevent lw BG arer exercise r ver night?

12 Target Bld Glucse with Exercise Exercise dura4n & intensity intensity mderate intensity 30-60min@ high intensity BG <100mg/ dl 15g carbs 15-20g carbs Add prteins/ fats BG mg/ dl N carbs needed 15g carbs (if BG N carbs needed if BG mg/ dl N carbs needed N carbs needed 30g carbs 15-20g carbs N carbs needed; % insulin crreccn BG abve 250mg/dl Check fr Ketnes D nt exercise if mderate t large ketnes present D light t mderate intensity >60min; high intensity 30-60g carbs/ hr f accvity 30-60g carbs/ hr f accvity 30-60g carbs/ hr/accvity % Insulin Hydrate

13 Insulin Adjustments with Exercise Reduce rapid accng insulin/blus by 25-75% depends n duracn and intensity if accvity is perfrmed at insulin peak Reduce lng accng insulin 10-20% reduccn at night befre exercise OR arer exercise if experience lw BG ver night Split lng accng insulin t equal tw dses and reduce either ne depends n Cme f exercise Pump: reduce basal rate by % depends n duracn and intensity Evaluate the effect arer every change yu make and keep in mind that Trial and Errr" is the principal methd Zaharieva and Riddell, NutriCn FYI, ADA 2015

fr me I was able t eat befre geqng lw and if need be switch t water befre my glucse wuld g high

14 CnCnuus Glucse Mnitring Q: What is the ne diabetes tl the team culd nt d withut? Phil: CGM. having the ability t see the numbers was gd, but mre imprtantly the direc4nal arrw what did it fr me I was able t eat befre geqng lw and if need be switch t water befre my glucse wuld g high Phil Sutherland, Team Type 1 Sensr lag Cme with exercise Zaharieva and Riddell, NutriCn FYI, ADA

15 Summary Tips Prs Cns Eat extra carbs with exercise Reduce blus insulin clse t exercise time 10 secnds sprint at the start r end f sessin Beneficial fr prlnged r unplanned exercise Prevent lw BG ver night with cmplex carbs after ex Increases muscle glycgen stres Decreases chance f lw BG with exercise Reduces carbs requirement Reduces chance f lw BG fllwing exercise Use Insulin pump Prvides mre flexibility f insulin adjustments with exercise Reduce pre-exercise basal insulin Reducing basal insulin pstexercise Decreases chance f lw BG with exercise Reduces carbs requirement Decreases chance fr lw BG ver night Use CGM Prvides a directinal arrw f BG with exercise Over cnsumptin f carbs culd lead t high BG Challenging t lse weight Requires planning in advance Difficult t be spntaneus w/ex May nt be safe fr everyne Nt practical fr cntact sprts (e.g., ftball, jud, rugby) Expensive Causes pre- and late pst-exercise high BG Mrning BG can be high Delay in getting real time glucse value

16 Team Type 1 Thank Yu

University College Hospital. Pump school Starting on an insulin pump. Children and Young People s Diabetes Service

University College Hospital. Pump school Starting on an insulin pump. Children and Young People s Diabetes Service University Cllege Hspital Pump schl Starting n an insulin pump Children and Yung Peple s Diabetes Service 2 If yu wuld like this dcument in anther language r frmat, r require the services f an interpreter,