Abstract Practical guidelines for exercise in insulin treated diabetics – a prospective cohort series of insulin treated diabetics using a simple questionnaire and continuous glucose monitoring to assess the influence of specific guidelines on blood sugar levels before, during and after exercise.
Background Scientific literature suggests that if a diabetic on insulin can achieve euglycaemia during exercise the metabolic response to exercise is normalised. Problems occur both during and post exercise due to swings in blood sugar that are aggravated by the diabetic’s response to these swings.
Objectives The principle objective was to establish practical exercise guidelines for insulin treated diabetics that could be used as a safe reference by diabetics themselves and sports physicians/general practitioners. The guidelines were set to minimise the swings into hyperglycaemia and hypoglycaemia commonly seen in diabetics during exercise. A secondary objective was to assess whether use of the guidelines could approximate the blood sugar of the diabetic during exercise to that of the non-diabetic during exercise.
Design Using a cohort of insulin treated diabetics the efficacy of practical exercise guidelines were assessed before, during and after exercise using a simple questionnaire and continuous interstitial glucose monitoring.
Subjects Nine insulin treated diabetics were recruited from a diabetic sports clinic in the Buckinghamshire Hospitals NHS Trust, which took referrals from anywhere in England. Two non-diabetic, elite athletes were recruited for comparison.
Results On questioning 86% of subjects reported a reduction in exercise associated hypoglycaemia and 28% reported an improvement in exercise performance when using the guidelines. There was a narrowing of the glucose oscillations in 85% of the subjects studied however the difference in the recording of interstitial glucose outside the range of 4–10 mmol/l before and after using the exercise guidelines was statistically not significant p>0.05 (p=0.058).
Conclusions The outcomes of this study suggest that these guidelines are effective clinically in reducing blood sugar oscillations during exercise in insulin treated diabetics; however the outcomes were not statistically significant probably as a result of the small sample size. Further study with a larger sample size is merited to validate these guidelines further.
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