Hypoglycemia

Exercise and hypoglycemia

• When adequate insulin levels are present, muscular activity lowers BG during, immediately after, and/or several hours after exercise
• The BG-lowering effect is extremely variable and its severity depends on many factors
• When BG levels are high because of inadequate insulin levels, exercise may lead to a further rise in BG
• Recommendations for individuals can only be made on the basis of their age, size, individual experience and ‘trial and error’

Light or brief exercise

• A small intake of rapidly absorbed carbohydrate is usually recommended prior to exercise

Intensive, strenuous or prolonged exercise

• Careful monitoring of BG levels is recommended to help in matching insulin and food to the intensity of exercise
• Reduction of insulin should be considered
• Extra slowly absorbed complex carbohydrate will be necessary especially at bedtime following strenuous exercise in the afternoon or evening
  [The bedtime snack also containing fat and protein may help to prevent nocturnal hypoglycemia]

High-risk and/or high-activity exercise or sport when hypoglycemia would be potentially dangerous

• BG monitoring is extremely valuable
• BG targets for near-normoglycemia may be temporarily relaxed
• Extra rapidly absorbed carbohydrate must be available throughout the period of strenuous exercise
• Reduction of insulin dose should be considered
• Delayed and nocturnal hypoglycemia may be prevented by special attention to increased snacks especially before sleep

BG monitoring should be performed to provide information about glycemic levels during and after exercise or sport to enable individual algorithms to be devised Young people with diabetes should perform strenuous exercise in the presence of a companion or supervisor familiar with the recognition and treatment of hypoglycemia and with an immediate supply of rapidly absorbed carbohydrate