Physical activity and insulin calculation Flashcards

Question

Which exercise type results in a more stable glucose profile in T1DM

Answer 1

Resistance Exercise Results in a More Stable Glucose Profile Aerobic exercise leads to a drop in blood glucose

Answer 2

Before Exercise: • If hyperglycemic (≥14 mmol/L or ≥252 mg/dL) and ketotic (≥1.5 mmol/L plasma ketones) because of insulin deficiency, don’t exercise until hyperglycemia and ketones restored with insulin • If mildly hyperglycemic (8-14 mmol/L or 144-252 mg/dL) do a 10-15 min mild aerobic warm-up After Exercise: • Always cool down for ~20 mins - aerobic, easy intensity • Consider conservative insulin correction if remain hyperglycemic (≥ 12.2 mmol/L or ≥220 mg/dL)

Answer 3

The longer the exercise the more you need to decrease the insulin dose Mild aerobic exercise 30 min: ~25% 60 min: ~50% Moderate aerobic exercise (~50% VO2max) 30 min: ~50% 60 min: ~75% Heavy aerobic exercise (70–75% VO2max) 30 min: ~75% 60 min: NA Intense aerobic or anaerobic exercise 30 min: No reduction recommended 60 min: NA

Answer 4

When someone uses a pump he/she needs to disconnected or suspended the pump at least 30 minutes before exercise; preferably an hour before

Answer 5

• Set alarms to check blood glucose levels during the night • Advise household members on signs of severe hypoglycemia, and on appropriate use of glucose gels or glucagon • Avoid alcohol following exercise • We suggest that continuous glucose monitoring (CGM) should be used, with the benefits of: - Alerts in case of hypoglycemia - No alerts if no hypoglycemia is detected

Answer 6

CGM is slightly less precise at the moment of exercise then when someone is at rest When someone is exercising there's a rapid change in glucose so CGM does not pick up the level of glucose that the person is really at arrows of tendency are very useful at this moment

Answer 7

Self-treated hypoglycemia within 1 hour of planned activity - In case of exercise, treat hypoglycemia to stabilise blood glucose before activity - If glucose level increases, it is okay to exercise; monitoring is necessary - May need to retreat as hypoglycemia is more likely to occur Severe hypoglycemia within 24 hours of planned activity - Ideally, exercise should not be undertaken - Patients should not exercise, and alert others of the potential for hypoglycemia Hypoglycemia during exercise - Discontinue the activity and treat hypoglycemia

Answer 8

<5 mmol/L - Ingest 10-20 g of glucose before exercise - Delay exercise until blood glucose >5 mmol/L 5 – 6.9 mmol/L - Ingest 10 g of glucose - Anaerobic and Interval high intensity exercise can be started 7 –15 mmol/L - Aerobic, anaerobic, and interval high intensity exercise can be started >15 mmol/L - Check blood ketones and perform low intensity exercise, or give small corrective dose of insulin - Low intensity exercise may be okay if blood ketones are <1.4 mmol/L. consider small corrective dose of insulin. No exercise if >1.5 mmol/L exercise is not recommended as there is a high risk of DKA as their insulin levels is likely v low

Answer 9

Increased CHO needs: - Blood glucose below 5 mmol/L - Aerobic exercise - New sport/ unfamiliar activity Decreased CHO needs: - Anaerobic exercise - Short duration - Insulin adjusted with meal prior to exercise Can both decreases and increase: - Fasting exercise - Training Phase of athlete - Competition

Answer 10

Before: - reduce insulin bolus - reduce basal insulin - CHO snack right before the exercise During - reduce basal insulin - have a snack at the end (especially in athletes to increase glycogen reserves) - supra-maximal exercise at the end (Physical activity that alternates short bursts of energy with periods of rest) After: - resume basal insulin before bed - reduce insulin bolus - CHO snack before bed - Reduce basal insulin before bed

Answer 11

Basal insulin added to non-insulin antihyperglycemic agents: 1- Start with 10 un/day (= 1 injection at bedtime) 2- Add 1 un per day until target is reached (except Degludec: 2 units every 3-4 days or 4 units per week)

Answer 12

* How much total daily insulin (TDD) will you suggest: TDD = 0.5 X 80 = 40 un per day * How much will be given with a long-acting insulin (e.g., Glargine 300)? Long acting: 16 un. * How much will be given via rapid-acting insulin (e.g., Glulisine)? * Breakfast: 8 un * Lunch: 8 un * Diner: 8 un

Answer 13

* Insulin (Glulisine and Glargine 300) : 8-10-7-19 * What is the TDD? * 500/TDDà500/44=1un:11.4gCHO * (5.7 X (weightkg) )/TDD=5.7X80/44=10.4gCHO

Answer 14

ISF = 100/TDD In our case: ISF = 100/44 = 2.3 How much insulin should our patient give himself if his BG is at 13 mmol/L and he want to go down to 6 mmol/L: àDifference in BG / ISFà7 / 2.3 = 3 units

Answer 15

* TDD on MDI= 44un * What is the estimated TDD on Pump= 0.75 of TDD on MDI=33un * 80kg X 0.53= 42.4un * Average both: (33 +40 )/2= 37.7 un = 37.5