MANAGING MDI AND
EXERCISE FOR TYPE 1
DIABETES
Structured Education - Staying Ahead of the Game
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Learning Outcomes
1. To know the key questions to ask patients with Type 1 diabetes,
who require advise on exercise
2. To gain a basic understanding of the bodies physiological
response to and consequent effect on blood glucose levels, from
taking part in aerobic, anaerobic or mixed aerobic/anaerobic
activities
3. To know how to safely advise Type 1 patients on MDI (Multiple
Daily Injections) on adjustment of insulin dosage and taking in
extra carbohydrates required for aerobic, anaerobic and mixed
aerobic/anaerobic activities.
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Key Questions To Ask
Key questions to ask patients with Type
1 diabetes, who require advise on
exercise
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Key Questions To Ask
Questions about the person!
Questions about the persons diabetes!
Questions about the person & exercise!
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Key Questions To Ask
Feedback...!
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key questions to ask
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Questions About The Persons
Why do you want to start exercising?
What experience do you have with exercise?
What are your short, medium and long term
goals?
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Questions About The Persons
Diabetes
How long have you had diabetes?
Do you suffer any complications? (feet, eyes, blood pressure etc.,)
How is your general diabetes management? (good, sub-optimal
etc.,)
How often do you check your blood sugars?
What does your blood sugar profile look like now?
How much support do you currently get to managed your diabetes?
Have you had any structured diabetes training? (DAFNE etc)
Are you familiar with what happens to your blood sugar during and
after exercise?
Do you have any other medical conditions which could affect your
ability to exercise?
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Questions About The Exercise
Type,
Is it structured and planned
Frequency,
Duration,
Intensity,
Previous Experience,
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The Bodies Physiological Response
Basic understanding of the bodies
physiological response to and
consequent effect on blood glucose level
of aerobic, anaerobic and mixed
aerobic/anaerobic exercise.
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Physical Activity - Exercise
• Physical activity
• Exercise
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Physical Activity - Exercise
PHYSICAL ACTIVITY
Any bodily movement produced by skeletal
muscle that result in energy expenditure.
So that includes a broad spectrum of activities,
including occupational, leisure and routine
daily activities
Heart Disease and Diabetes 2003
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Physical Activity - Exercise
EXERCISE
This is a component of physical activity and
describes physical activity, which is planned
and structured and done to improve and or
maintain physical fitness
Heart Disease and Diabetes 2003
Structured Education - Staying Ahead of the Game
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The Bodies Physiological Response
Basic understanding of the bodies
physiological response to and
consequent effect on blood glucose level
of aerobic, anaerobic and mixed
aerobic/anaerobic exercise.
Structured Education - Staying Ahead of the Game
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The Bodies Physiological Response
Why use these terms; aerobic and
anaerobic?
As these are the two energy systems used during
physical activity and exercise.
www.teachpe.com/anatomy/energy_systems.php
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The Bodies Physiological Response
The terms aerobic and anaerobic?
Literally mean ‘with oxygen’ and ‘without oxygen’ respectively.
When describing exercise these terms were originally used at a time when it was believed that
your ability to continue exercising was related to the availability of oxygen. It is now understood
that the muscles always have plenty of oxygen, but its the intensity and duration of exercise that
dictates the percentage contribution from the various different energy systems.
So, marathon running is largely aerobic but still has a contribution from anaerobic sources whilst
100m sprinting is largely anaerobic but still has a contribution from aerobic sources. And theres a
large spectrum of activities which fall between these extremes. For example 400m running may
be 50% aerobic and 50% anaerobic.
Runsweet.com - Gallen, Ian W, - Godfrey, Richard
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The Bodies Physiological Response
The terms aerobic and anaerobic?
Literally mean ‘with oxygen’ and ‘without oxygen’
respectively.
Runsweet.com - Gallen, Ian W, - Godfrey, Richard
Structured Education - Staying Ahead of the Game
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The Bodies Physiological Response
The terms aerobic and anaerobic?
Literally mean ‘with oxygen’ and ‘without oxygen’ respectively.
When describing exercise these terms were originally used at a time when it was believed that
your ability to continue exercising was related to the availability of oxygen. It is now understood
that the muscles always have plenty of oxygen, but its the intensity and duration of exercise that
dictates the percentage contribution from the various different energy systems.
So, marathon running is largely aerobic but still has a contribution from anaerobic sources whilst
100m sprinting is largely anaerobic but still has a contribution from aerobic sources. And theres a
large spectrum of activities which fall between these extremes. For example 400m running may
be 50% aerobic and 50% anaerobic.
Runsweet.com - Gallen, Ian W, - Godfrey, Richard
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The Bodies Physiological Response
•
Aerobic energy system
•
In this context ‘aerobic’ refers to the fact that oxygen is
required in the process whereby carbohydrates and fats
are oxidised (burned) completely to make a compound
called ATP (which is the prime energy source of all
cells). Typically endurance sports require energy from
predominantly aerobic sources.
Runsweet.com - Gallen, Ian W, - Godfrey, Richard
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The Bodies Physiological Response
• Anaerobic energy system
•
This system provides energy in the absence of Oxygen.
•
This system is used in the first few minutes of all
exercise, before there is sufficient oxygen available
at the muscles for aerobic metabolism to kick in.
It’s also used for fast, powerful bursts of energy, for
which the aerobic system is insufficient
Runsweet.com - Gallen, Ian W, - Godfrey, Richard
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The Bodies Physiological Response
• Aerobic/Anaerobic energy system
•
As the intensity of exercise increases there is an
increasing contribution from anaerobic sources and a
decreasing contribution from aerobic sources.
Runsweet.com - Gallen, Ian W, - Godfrey, Richard
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The Bodies Physiological Response
• Recap - Aerobic/Anaerobic energy systems
•
The aerobic system produces the largest amounts of
energy, although at the lowest intensity.
•
At the start of exercise the body cannot deliver
oxygen to the muscles fast enough to initiate a
complex chemical reaction required during aerobic
metabolism. Therefore the body relies on
anaerobic processes for the first couple of minutes.
www.teachpe.com/anatomy/energy_systems.php
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Exercise And Diabetes, What
Happens?
•
During exercise, your blood glucose goes up and down,
depending upon the type of exercise;
•
During short periods of anaerobic exercise, or exercise
with short explosive bursts of activity, your glucose
levels may rise;
•
In contrast, glucose levels generally fall with prolonged
aerobic exercise. Hypoglycaemia after exercise can
also be a problem.
Runsweet.com - Gallen, Ian W, - Godfrey, Richard
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Key Questions To Ask
Know how to safely advise Type 1
patients on MDI on adjustment of insulin
dosage, taking on extra carbohydrate
required for aerobic, anaerobic and
mixed aerobic/anaerobic activities.
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To know How To Safely Advise Type 1
Patients On MDI
Metabolic Control Before Exercise
Start exercise blood glucose levels should be
between 7-12mml.
Consider consuming extra carbohydrate at the start if
levels are <7.
For levels >12mml without ketosis delay glucose
replacement during exercise until glucose has fallen.
• Avoid exercise if ketosis is present.
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To know How To Safely Advise Type 1
Patients On MDI
Food Intake
Consume additional carbohydrate as needed to avoid
hypoglycaemia. As a general guide for moderate intensity
endurance activities high glycaemic index carbohydrate should be
consumed after 20minutes of exercise at a rate of up to
approximately 1g/kg/hr. Lower intensity activities or intermittent high
intensity activities are likely to require smaller rates of carbohydrate
supplementation.
Carbohydrate-based foods with a high glycaemic index should be
readily available during and after exercise.
Adequate hydration is essential.
Runsweet.com - Gallen, Ian W, - Godfrey, Richard
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To Know How To Safely Advise Type 1
Patients On MDI
Blood Glucose Monitoring Before, During
and After Exercise
Measure blood glucose before, every 30minutes
during and at the end of exercise.
Identify when changes in insulin or food intake are
necessary, where possible sudden unaccustomed
changes should be avoided e.g. if a reduction in
insulin is thought to be required trial a 20% reduction
insulin first don’t jump straight to a 75% reduction.
Runsweet.com - Gallen, Ian W, - Godfrey, Richard
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To Know How To Safely Advise Type 1
Patients On MDI
General Safety
Where possible avoid exercising alone and alert others to
potential signs of hypoglycaemia.
Extra care should be taken when exercising after a recent
hypoglycaemic episode as risk of hypoglycaemia during
exercise is increased.
Runsweet.com - Gallen, Ian W, - Godfrey, Richard
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Live Web-Surfing
REPs - Register of Exercise Professionals
www.exerciseregister.org
www.runsweet.com
www.brianmac.co.uk
www.teachpe.com
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Live Web-Surfing
REPs - Register of Exercise Professionals
www.exerciseregister.org
Structured Education - Staying Ahead of the Game
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Structured Education - Staying Ahead of the Game
Structured Education - Staying Ahead of the Game
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Structured Education - Staying Ahead of the Game
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Structured Education - Staying Ahead of the Game
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Structured Education - Staying Ahead of the Game
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Structured Education - Staying Ahead of the Game
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Structured Education - Staying Ahead of the Game
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Structured Education - Staying Ahead of the Game
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Structured Education - Staying Ahead of the Game
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Live web-surfing
www.runsweet.com
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Live web-surfing
www.brianmac.co.uk
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Live web-surfing
www.teachpe.com
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Live Web-Surfing
Can three minutes of exercise a week help make
you fit?
www.bbc.co.uk/news/health-17177251
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about me!
Structured Education - Staying Ahead of the Game
S. Roberts