T1D And Exercise

Question 1

Define T1D

Answer 1

An autoimmune disease that causes insulin secreting B-cells in the pancreas to be destroyed, so the body cannot produce enough insulin to regulate blood glucose levels.
‘Absolute insulin deficiency’

Question 2

What is HbA1c?

Answer 2

Glycated Hb (glucose sticks to RBC’s), often used as a marker for diagnosing diabetes.

Question 3

Why is a high HbA1c bad?

Answer 3

More likely to develop diabetes complications,

can damage blood vessels

Question 4

What are T1 diabetics dependant on?

Answer 4

Exogenous insulin - bolus, basal & pump

Question 5

What is the common response in hormones to falling glucose?

Answer 5

First response at ~ 4.15mmol/L : Increase insulin,
Decrease glucagon,
Increase adrenaline,
Increase growth hormone,
Last response at ~ 2.9mmol/L : Increase cortisol

Question 6

Why can’t T1 diabetics regulate glucose at all?

Answer 6

As well as an insulin deficiency, B-cells also affect a-cells secretion, affecting glucagon.

Question 7

What is a major risk for T1 diabetics, especially when exercising?

Answer 7

Hypoglycaemia, as blood glucose may drop without the host knowing. They have to rely on really good monitoring and appropriate exogenous insulin input.

Question 8

What hormonal response happens when T1 diabetics exercise that leads to hypoglycaemia?

Answer 8

There is no suppression of insulin (as insulin injection/pump),
No increase in glucagon.
This means patients experience increased glucose uptake, suppression of hepatic and adipocyte tissue and increased CHO combustion, ultimately leading to hypoglycaemia

Question 9

Why Is exercise good for T1D?

Answer 9

• lower bp
• lower cholesterol
• better BMI
• increased body sensitivity to insulin
• good for CV health
• morbidity link between T1D and obesity
• helps improves sleep

Question 10

Why is exercising difficult for T1D?

Answer 10

Hypoglycaemia risk (during and post),
Difficulty managing insulin dose,
Glucose variability,
HbA1c could potentially get worse,
Competitive sports can cause blood sugar levels to rise up to cortisol from nerves and stress (glucose control more difficult),
Timing of exercising - too soon after a meal still have rapid acting insulin dose in system so greater risk of hypo.

Question 11

T1D varies between each individual, some patients may have residual B-cell function and experience improved glucose control during exercise, where as those without see a detonation in glucose control. Personalised medicine??

Answer 11

Fact

Question 12

What is the recommendations for diff blood sugar levels before exercising?

Answer 12

Good level (to increase performance and good health)- 5-8mmol/L - ingest 10g of glucose pre exercise. 
Any lower - detrimental to the body - ingest glucose and wait until BG is >5
Any higher - low Int exercise and possible correction dose.

Question 13

Why is regular exercise important for glucose management?

Answer 13

Exercise increases insulin sensitivity so patients require less insulin for the same amount of CHO. It also helps lower post-meal blood glucose spikes - better regulation.

Question 14

T1D Recommendations for exercise and nutrition

Answer 14

30 mins x5 p/w of MOD intensity (slow drop in insulin),
Monitor bg levels pre, during and post ex,
Hydration,
Carb meal pre exercise and before bed,
Any meals should be eaten 3 hours prior ( rapid acting insulin 3-4hrs action),
Be careful for late onset hypoglycaemia - reduce basal insulin dose