PA and diabetes Flashcards
what is a sliding scale
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
what is the dawn phenomenon?
abnormal rise of BG in the morning between 4and 8 am.
most common in type 1
why does the dawn phenomenon happen?
fasting glucose levels rise because of an increase in hepatic glucose production and could be due to midnight surge in growth hormone
how would you correct the dawn phenomemon?
you would tell the person to take a breakfast with carbs and insulin in the morning to correct the hyper.
what is the somogyi phenomenon?
how do we treat it?
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.
what are some symptoms of somogyi ?
nightmares, sweating, difficulty waking up, morning headaches
in the elder, what medication type will we go for and what should we be careful with
prefer DPP4i over sulfonyread
do not use sulfonyreas or thialidinediones (hypos)
fasting and ramadan: what is the very high risk :MUST NOT category
recent DKA, recent HHS, acute illness, poor controlled T1DM, advanced CV complications,
pregnancy or GDM
fasting and ramadan: high risk SHOULD NOT
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
fasting and ramadan: moderate llow risk, CAN fast
well controlled diabetes
trx with lifestyle alone or with metformingGPP4i OR glp1rRA, SU, SGLT2I, TZD, basal insulin
what are PA recommendations with diabetes
ADULT: 150 min/ week with no more than 2 days off in a row and strength 2-3x/week
KID: 60 min/day
name three challenges to exercise and why it is
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.
What is the BG effect on aerobic exercise
the PA is using oxygen and so the report is hypos.
what is the BG effect on mixed exercise?
this one is hard to predict, can be up or down.
what is the BG effect on anaerobic exercise
this one is hyperglycemia predicted because it is powerful, short term activity.
why is there a risk of nocturnal hypo ?
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
why does hypo happen with PA ?
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.
why does glucose uptake remain high post-exercise?
it needs to replenish muscle glycogen stores
what is the variable drop of glucose if there is no insulin adjusted?
around 3.6 mmol/L.
40% become hypo.
why does training improve insulin sensitivity and lipid use? (ADD MORE
lipid use increase with PA duration.
how does training affect ISF and total daily insulin
it increases the ISF and lowers the needs
how does anaerobic PA cause hyperglycaemia?
it stimulates the liver to create glucose and so it increases the needs during recovery
what is one way to prevent hypoglycemia post exercise?
do a single short spring 20 min before end of PA
what are some warm up and cool down recommendations?
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.
what is the recommendations before PA for bolus insulin?
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.
what is the dose adjustment for basal insulin before aerobic PA for patients with MDI or CSII
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.
what is the dose adjustment for basal insulin AFTER PA.
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.
what BG should t1dm aim to start exercise with?
between 5 and 7.
what is the recommendation for rule of thumb eating if BG is less than 5
ingest 10-20 g of glucose before PA and delay until above 5
what is the recommendation for rule of thumb eating if BG is between 5- 6.9
ingest 10 g of glucose
anaerobic and high intensity can be started
what is the recommendation for rule of thumb eating if BG is 7-15
aerobic and anaerobic and interval high intensity can be started
what is the recommendation for rule of thumb eating if BG is above 15
check blood ketons and do low intensity PA or give small dose of correction.
no PA if ketons are above 1.5
