{"id":6552,"date":"2015-11-28T18:37:33","date_gmt":"2015-11-28T17:37:33","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bjsm\/?p=6552"},"modified":"2015-11-28T18:46:44","modified_gmt":"2015-11-28T17:46:44","slug":"6552","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bjsm\/2015\/11\/28\/6552\/","title":{"rendered":"Fear of hypoglycaemia is the greatest barrier to exercise in type 1 diabetics: What health professionals need to know"},"content":{"rendered":"<p><strong><em><span style=\"color: #008000\">Undergraduate perspective on Sports &amp; Exercise Medicine<\/span> <span style=\"color: #ff6600\">&#8211;<\/span><\/em><\/strong><span style=\"color: #ff6600\"><strong>\u00a0<em>a BJSM blog series<\/em><\/strong><\/span><\/p>\n<p><strong>By <\/strong><strong>Manroy Sahni (<\/strong><a href=\"https:\/\/twitter.com\/manroysahni\"><strong><u>@manroysahni<\/u><\/strong><\/a><strong>)<\/strong><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-6553\" src=\"https:\/\/stg-blogs.bmj.com\/bjsm\/files\/2015\/11\/diabtes.jpg\" alt=\"diabtes\" width=\"217\" height=\"173\" \/>A plethora of health benefits are associated with physical activity in Type 1 Diabetes Mellitus (T1DM) (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22189486\">Chimen et al., 2012<\/a>). Thus, it is important to encourage exercise in T1DM as, just like the general population, <strong>the majority of these patients are insufficiently active!<\/strong> (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16888470\">Plotnikoff et al., 2006<\/a>). T1DM is associated with a 10-fold increase in cardiovascular disease compared to non-diabetics (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12774166\">Laing et al., 2003<\/a>), therefore the benefits of physical activity in promoting cardiorespiratory health are particularly pertinent in this patient group. However, in this population group we must be <strong>mindful of the risks<\/strong>.<\/p>\n<p>Following exercise, people with T1DM will need to replenish their energy levels, correct any hyperglycaemia and guard against low blood sugars. This can be extremely difficult for type 1 diabetics (who may be young) that are trying to keep fit and healthy. <strong>Many diabetics worry about hypoglycaemic episodes following exercise<\/strong>. However, with careful monitoring and the <strong>right advice these people can excel in whatever sport they choose<\/strong>. This is highlighted by the numerous examples of high profile elite diabetic athletes. <strong>Diabetes should not prevent people from exercising<\/strong>. It is the duty of health care professionals to encourage exercise and allow it to be achieved in a safe capacity. Here are some insights from leaders in the feild:<\/p>\n<p><span style=\"color: #008000\"><strong>Highlights of the 2nd National Exercise and Type 1 Diabetes (T1DM) Conference<\/strong><\/span><\/p>\n<p><strong><em><span style=\"color: #800080\">Normal endocrine and metabolic responses to exercise<\/span> <span style=\"color: #800080\">&#8211;<\/span><\/em><\/strong><span style=\"color: #800080\"><em> Professor Anton Wagenmakers<\/em><\/span><\/p>\n<ul>\n<li>During high intensity aerobic exercise muscle glycogen is the main fuel whereas at lower intensities the proportion of fat usage increases<\/li>\n<li>The main metabolic and endocrine regulation mechanisms were also discussed including the roles of insulin, glucagon, cortisol, growth hormone and adrenalin<\/li>\n<li>A salient message was that <strong>improved glucose homeostasis is an immediate benefit for all following exercise<\/strong><\/li>\n<\/ul>\n<p><span style=\"color: #800080\"><strong><em>The impact of T1DM on endocrine and metabolic responses to exercise <\/em><\/strong><em>&#8211; Professor Michael Riddell<\/em><\/span><\/p>\n<ul>\n<li><strong>Type 1 diabetics can do any form of exercise extremely well<\/strong>\u2026 but typically have some levels of dysglycaemia<\/li>\n<li>During exercise <strong>type 1 diabetics utilise fuels slightly differently<\/strong>, they tend to be better fat burners and may use more muscle glycogen and less plasma glucose<\/li>\n<li>A range of factors contribute to the altered blood glucose levels during exercise;\n<ul>\n<li>Type of exercise: High-intensity, short duration, anaerobic exercise such as weight-lifting and sprinting tends to cause <strong>hyperglycaemia<\/strong> whereas low-intensity, longer duration aerobic exercise such as jogging predisposes <strong>hypoglycaemia <\/strong><\/li>\n<li><strong>Nutrition <\/strong>is also a key factor<\/li>\n<li>The impact of <strong>emotions and environmental factors<\/strong> should not be underestimated<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"color: #800080\"><strong><em>Nutrition for patients with T1DM who are exercising <\/em><\/strong><em>&#8211; Mrs Janet Gordon<\/em><\/span><\/p>\n<ul>\n<li>When exercising the carbohydrate requirements are dependent upon body mass, exercise intensity and duration<\/li>\n<li>It is essential that people with T1DM receive adequate nutrition <strong>before, during and after<\/strong> exercise to prevent hypoglycaemia<\/li>\n<li>Regarding recovery, protein and carbohydrate together improve glycogen storage post-exercise<\/li>\n<\/ul>\n<p><span style=\"color: #800080\"><strong><em>Management strategies before and during exercise <\/em><\/strong><em>&#8211; Dr Richard Bracken<\/em><\/span><\/p>\n<ul>\n<li>It is important to remember that each individual patient will be different and that the same patient may even react differently to the same treatment in different situations.<\/li>\n<li>Consequently, <strong>it is impossible to develop a one-size-fits-all protocol<\/strong> for the management of type 1 diabetic patients undertaking exercise<\/li>\n<li>Broadly, additional carbohydrate may be required and insulin levels adjusted<\/li>\n<\/ul>\n<p>For aerobic exercise consider:<\/p>\n<ul>\n<li>A reduction in rapid-acting insulin before exercise<\/li>\n<li>Eating low glycaemic index carbohydrates before activity (as recommended by health professional)<\/li>\n<\/ul>\n<p>For strength\/ resistance exercise consider:<\/p>\n<ul>\n<li>Avoiding an insulin bolus before exercise if it\u2019s a morning session<\/li>\n<li>Having recovery carbohydrate handy if the session is longer than 30 minutes<\/li>\n<li>Administering an insulin bolus after the session if it is less than 30 minutes to avoid hyperglycaemia<\/li>\n<\/ul>\n<p>For further information (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23897688\">Galassetti et al., 2013<\/a> AND <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21154013\">West et al., 2011<\/a>)<\/p>\n<p><span style=\"color: #800080\"><strong><em>Post-exercise management <\/em><\/strong><em>&#8211; Dr Ian Gallen <\/em><\/span><\/p>\n<ul>\n<li>After activity, it is essential to <strong>replenish fuel stores<\/strong>, <strong>control post-exercise glycaemia<\/strong> and <strong>limit late hypoglycaemia<\/strong><\/li>\n<li><strong>Fear of hypoglycaemia is the most significant barrier to exercise in type 1 diabetics<\/strong> (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18689694\">Brazeau et al., 2008<\/a>)<\/li>\n<li>A hypoglycaemic episode following exercise can have a <strong>devastating impact<\/strong> on a type 1 diabetic and it is the role of health care professionals to help prevent this<\/li>\n<li>Different forms of activity (type, intensity, duration) have different influences on post-exercise blood glucose levels<\/li>\n<li>Therefore <strong>the risk of nocturnal hypoglycaemia varies depending on the form of exercise<\/strong><\/li>\n<li>Aerobic exercise later in the day is more likely to cause nocturnal hypoglycaemia than resistance exercise<\/li>\n<\/ul>\n<p>For further information on the avoidance of nocturnal hypoglycaemia read <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20650471\">Taplin et al., 2010<\/a>.<\/p>\n<p>********************<\/p>\n<p><strong> #Type1uncut<\/strong> is a resource for young adults with T1DM run by Diabetes UK. They provide useful information targeted at young people with diabetes using social media platforms, YouTube and Google+ hangouts. They produce a series of factsheets including information on exercising with T1DM. (<a href=\"https:\/\/www.diabetes.org.uk\/Guide-to-diabetes\/Type-1-Uncut-for-young-adults\/\">Diabetes UK<\/a>)<\/p>\n<p><strong><em>Mr. Manroy Sahni<\/em><\/strong> (<a href=\"https:\/\/twitter.com\/manroysahni\">@manroysahni<\/a>) is a medical student at Birmingham University, UK. He has a keen interest in Sport &amp; Exercise Medicine and is the current Vice-President of the Birmingham Undergraduate SEM Society.<\/p>\n<p><strong><em>Dr. Liam West<\/em><\/strong><em>\u00a0 (<\/em><a href=\"https:\/\/twitter.com\/liam_west\">@Liam_West<\/a><em>) coordinates the \u201cUndergraduate Perspective on Sports &amp; Exercise Medicine\u201d Blog Series.<\/em><\/p>\n<p><em>If you would like to contribute to the \u201cUndergraduate Perspective on Sports &amp; Exercise Medicine\u201d Blog Series please email <\/em><a href=\"mailto:liamwestsem@hotmail.co.uk\">LIAMWESTSEM@HOTMAIL.CO.UK<\/a><em> for further information.<\/em><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Undergraduate perspective on Sports &amp; Exercise Medicine &#8211;\u00a0a BJSM blog series By Manroy Sahni (@manroysahni) A plethora of health benefits are associated with physical activity in Type 1 Diabetes Mellitus (T1DM) (Chimen et al., 2012). Thus, it is important to encourage exercise in T1DM as, just like the general population, the majority of these patients [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bjsm\/2015\/11\/28\/6552\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[297,2905],"class_list":["post-6552","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-diabetes","tag-undergraduate-perspective"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts\/6552","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/comments?post=6552"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/posts\/6552\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/media?parent=6552"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/categories?post=6552"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bjsm\/wp-json\/wp\/v2\/tags?post=6552"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}