If you have type 2 diabetes and are treated with oral medications that cause insulin to be released from the pancreas (insulin releasing pills):
The goal of your checklist and FAQs is to help ensure more predictable blood sugar results and to prevent low blood sugars if you are treated with pills that cause insulin to be released from the pancreas (Insulin Secretagogues).
- Know your blood sugar before starting any significant activity or exercise. If you are low, you need to eat a rapidly acting carbohydrate snack.
- Check your blood sugar level as needed throughout exercise.
- Be prepared to snack. It may be necessary to eat a carbohydrate-containing snack to prevent a low blood sugar.
- Will exercise cause a low blood sugar?
- When should your insulin secretagogue dose be adjusted?
- What kind of food should I take to prevent or treat a low blood sugar during exercise?
- Does the time of day of the exercise matter?
- Is your exercise predictable?
- Have you been drinking alcohol while exercising?
- Are you sick or stressed?
- How long does the blood sugar lowering effect of exercise last?
- Is your blood sugar unexpectedly high following exercise?
- Are you trying to lose weight?
In general, the longer, more vigorous, and more intense the exercise, the more likely that the exercise will lower the blood sugar. You may need to lower the dose of your insulin secretagogue pills, and eat more carbohydrates to prevent a low blood sugar related to exercise. The converse also is true – brief, non-strenuous exercise may not require any medication dose or diet adjustment.
Because exercise generally increases insulin sensitivity, a lower dose of your insulin secretagogue pills may be needed. Exercising every day may require an overall reduction in you diabetes medication dose. Exercising every once in a while may require a dose reduction just on the day of your intermittent exercise. Check with your health care provider for specific dose adjustment recommendations.
It may be necessary to eat a carbohydrate-containing snack to prevent a low blood sugar especially if the exercise is unplanned or prolonged. Ideally, the snack should be a liquid or readily absorbed form of simple carbohydrate. Remember that complex carbohydrate takes a longer time to digest. If the food is high fat or oily, the stomach will empty more slowly and the absorption of the sugar is delayed. High-fat or complex carbohydrate containing snacks may increase the risk of exercise-related low blood sugars.
This change in insulin sensitivity throughout the day is important to understand, because if you exercise when you are more insulin sensitive, you may be at greater risk for a low blood sugar. To prevent low blood sugars, you may need to lower the dose of your insulin secretagogue pills, eat more carbohydrate or both. Check with your medical provider for specific recommendations. The converse also is true. Exercising during periods of insulin resistance may have less blood glucose-lowering effects, so fewer adjustments to medication dose and carbohydrate intake may be needed.
Try to exercise at the same time of day, for the same amount of time and at the same level of exertion. This will ensure the most predictable blood glucose response. Whenever you exercise, you have to match the duration and intensity of exercise with other factors such as natural body rhythms or changes in insulin sensitivity that occur throughout the day, peak medication effect and the content of meals.
Remember! Alcohol alone can reduce the amount of glucose produced by the liver, and can put you at risk for a low blood sugar.
Alcohol and exercise in combination increase the risk of a low blood sugar.
At first this may sound odd. Who would drink alcohol while running or swimming? However, consider if you are both drinking and dancing. Both activities promote low blood sugar, and this can lead to such severe lows that you pass out. Should that happen, it might be difficult to know whether you have had too much to drink or are suffering from low blood sugar.
Understand what happens when you’re sick, stressed, or fatigued.
Any sort of stress will make you less sensitive to insulin. If you are sick or stressed or exceptionally fatigued, you will release more glucose counter-regulatory hormone. As a result, the exercise may have less of a glucose-lowering effect.
The blood-sugar lowering effect of exercise can vary in duration. Depending upon your level of physical training, and the intensity and duration of exercise, you may be more sensitive to insulin for hours or even into the next day after exercise. When you exercise every day, you body becomes overall more sensitive. However, if you stop exercising, in a few days the increased sensitivity will wear off as well.
Here are some points to keep in mind:
- People who work out or are physically active on a daily basis may need to lower the dose of their insulin secretagogue pill medications.
- For people who exercise more sporadically, the acute effect of exercise on insulin sensitivity may last hours to half-a-day.
- Unusually prolonged or vigorous activity may result in a decrease in insulin secretagogue pill dose requirements, overnight and even into the next day.
When the blood sugar is unexpectedly high after exercise, think about why. Generally, exercise will lower your blood sugar. If the post- exercise blood sugar reading is unexpectedly high, you may need to consider if your blood sugar dropped so low during the activity that your body re-regulated itself by releasing counter-regulatory hormones. If so, the subsequent rebound can cause a high blood sugar reading. Other considerations might be overestimating the impact of the exercise, engaging in a stressful kind of exercise (such as weight lifting) and eating too much carbohydrate beforehand.
Try to optimize your dose of insulin secretagogue pills so that you can avoid exercise related low blood sugar reactions and the need for extra exercise-related snacks. Fewer snacks mean fewer calories!
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