PA and diabetes

Question 1

what is a sliding scale

Answer 1

it is a scale where you determine the BG and then give a certain amount of insulin after the fact. it is not proactive but reactive.
can be seen with geriatric population or for those that cant do carb counting

Question 2

what is the dawn phenomenon?

Answer 2

abnormal rise of BG in the morning between 4and 8 am.

most common in type 1

Question 3

why does the dawn phenomenon happen?

Answer 3

fasting glucose levels rise because of an increase in hepatic glucose production and could be due to midnight surge in growth hormone

Question 4

how would you correct the dawn phenomemon?

Answer 4

you would tell the person to take a breakfast with carbs and insulin in the morning to correct the hyper.

Question 5

what is the somogyi phenomenon?

how do we treat it?

Answer 5

it is known as rebound hyperglycemia or post hypo hyperglycemia.
pattern that happens because of the counterregulatory hormones that stimulate the making of glucose.

in order to treat the high in the morning, we need to treat the low at night and to do that we need to make sure there is a good snack before bed.

Question 6

what are some symptoms of somogyi ?

Answer 6

nightmares, sweating, difficulty waking up, morning headaches

Question 7

in the elder, what medication type will we go for and what should we be careful with

Answer 7

prefer DPP4i over sulfonyread

do not use sulfonyreas or thialidinediones (hypos)

Question 8

fasting and ramadan: what is the very high risk :MUST NOT category

Answer 8

recent DKA, recent HHS, acute illness, poor controlled T1DM, advanced CV complications,
pregnancy or GDM

Question 9

fasting and ramadan: high risk SHOULD NOT

Answer 9

T2Dm with poor glycemic control 
pregnant with T2DM or GDM controlled by diet only 
T2DM on MDI or mixed insulin 
CKD stage 3 
well controlled T1DM

Question 10

fasting and ramadan: moderate llow risk, CAN fast

Answer 10

well controlled diabetes

trx with lifestyle alone or with metformingGPP4i OR glp1rRA, SU, SGLT2I, TZD, basal insulin

Question 11

what are PA recommendations with diabetes

Answer 11

ADULT: 150 min/ week with no more than 2 days off in a row and strength 2-3x/week
KID: 60 min/day

Question 12

name three challenges to exercise and why it is

Answer 12

1) injury
2) impact on overall A1C varies. the attempt to avoid hypos makes the minor A1C drop not as beneficial since fear
3) hypoglycemia is the first reported barrier. they can get it right after PA or after at night. there is the lag effect that can occur 6-15 hours later overnight.

Question 13

What is the BG effect on aerobic exercise

Answer 13

the PA is using oxygen and so the report is hypos.

Question 14

what is the BG effect on mixed exercise?

Answer 14

this one is hard to predict, can be up or down.

Question 15

what is the BG effect on anaerobic exercise

Answer 15

this one is hyperglycemia predicted because it is powerful, short term activity.

Question 16

why is there a risk of nocturnal hypo ?

Answer 16

there are increased glucose needs so increased insulin sensitivity and glycogen restoration
there is impaired counterregulation
relative excessive insulin circulating
absence of carb intake at night

Question 17

why does hypo happen with PA ?

Answer 17

the glut 4 transporter is not needed when going into the cell membrane with PA. your body stops the release of insulin.
with T1DM, you already do not have the stop of the release of insulin, so this is adding hypo possibility.

Question 18

why does glucose uptake remain high post-exercise?

Answer 18

it needs to replenish muscle glycogen stores

Question 19

what is the variable drop of glucose if there is no insulin adjusted?

Answer 19

around 3.6 mmol/L.

40% become hypo.

Question 20

why does training improve insulin sensitivity and lipid use? (ADD MORE

Answer 20

lipid use increase with PA duration.

Question 21

how does training affect ISF and total daily insulin

Answer 21

it increases the ISF and lowers the needs

Question 22

how does anaerobic PA cause hyperglycaemia?

Answer 22

it stimulates the liver to create glucose and so it increases the needs during recovery

Question 23

what is one way to prevent hypoglycemia post exercise?

Answer 23

do a single short spring 20 min before end of PA

Question 24

what are some warm up and cool down recommendations?

Answer 24

warm up: if hyper and ketotic, bc of insulin deficiency, dont exercise until hyper and ketons are restored with insulin.
if milk hyper (8-14) do a 10-15 min milk aerobic warm up

cool down: always cool down for 20 min – easy intensity.
consider conservation insulin correction if remaining hyper.

Question 25

what is the recommendations before PA for bolus insulin?

Answer 25

reduction :
mild aerobic: 30 min = 25%, 60 min= 50%
moderate aerobic: 30 min= 50%, 60 min= 75%
heavy aerobic: 30 min= 75% , 60min= NA(not for typical people)
intense aerobic or anaerobic = no reduction recommended.

Question 26

what is the dose adjustment for basal insulin before aerobic PA for patients with MDI or CSII

Answer 26

patients on MDI: adjustment not recommended
if on BID, could consider reducing 1 or both by 20
for CSII: basal reduce by 60-80 for PA over 45-60 min. dose could be reduced up to 90 min before PA.

Question 27

what is the dose adjustment for basal insulin AFTER PA.

Answer 27

for MDI : reduce night time dose by 20. encourage Carb consumption to prevent hypo. test BG at night
for pump: reduce by 20 to 3 am. encourage carb consumption. test BG at night.

Question 28

what BG should t1dm aim to start exercise with?

Answer 28

between 5 and 7.

Question 29

what is the recommendation for rule of thumb eating if BG is less than 5

Answer 29

ingest 10-20 g of glucose before PA and delay until above 5

Question 30

what is the recommendation for rule of thumb eating if BG is between 5- 6.9

Answer 30

ingest 10 g of glucose

anaerobic and high intensity can be started

Question 31

what is the recommendation for rule of thumb eating if BG is 7-15

Answer 31

aerobic and anaerobic and interval high intensity can be started

Question 32

what is the recommendation for rule of thumb eating if BG is above 15

Answer 32

check blood ketons and do low intensity PA or give small dose of correction.
no PA if ketons are above 1.5