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Exercise and Blood Glucose Management

  • Importance of Exercise

    • Exercise increases glucose utilization in the body.

    • Muscles require energy primarily derived from glucose.

    • The influence of exercise on blood glucose levels can last for about two days.

    • Monitoring blood glucose levels is critical before and during exercise, particularly for individuals with diabetes.

  • Pre-Exercise Considerations

    • Individuals may need to have a snack before exercising, especially if they have low initial blood glucose levels.

    • Discussing exercise plans with healthcare providers is essential for individuals with diabetes or chronic diseases.

    • Historical activity levels (sedentary vs active) should be assessed to tailor the exercise program.

  • Benefits of Exercise

    • Regular exercise can aid individuals with type 2 diabetes in managing their weight and possibly decreasing reliance on medications.

    • Exercise contributes positively to lipid profiles by lowering bad cholesterol and increasing good cholesterol (high-density lipoprotein).

  • Exercise Recommendations

    • Aim for 30 minutes of moderate exercise at least five days a week.

    • Avoid intense exercise sessions that are too strenuous, such as one hour of high-intensity workouts for only three days a week.

    • Avoid exercising during ketosis (burning fat rather than glucose).

    • Self-Monitoring: Urine tests for ketones can indicate ketosis status.

  • Guidelines for Blood Glucose Before Exercise

    • Blood Glucose < 90 mg/dL: Consume a substantial snack, not just a small treat like candy bars.

    • Fast Sugars: It's vital to carry quick-sugar options such as lifesavers, mini boxes of raisins, or non-diet sodas (regular juice or pop).

  • Additional Exercise Considerations

    • Prolonged sitting should be avoided.

    • Incorporating resistance training can enhance muscle function and overall fitness.

Insulin Types and Administration

  • Categories of Insulin

    • Insulin can be classified into four categories: rapid-acting, short-acting, intermediate, and long-acting.

1. Rapid-Acting Insulin

  • Onset: Begins to work within 15 minutes.

  • Examples: Humalog, Novolog.

2. Short-Acting Insulin

  • Onset: Begins to work within 30 minutes.

  • Examples: Humulin R, Novalin R.

3. Intermediate-Acting Insulin

  • Onset: Begins to work within 2 to 4 hours.

  • Examples: NPH insulins (Humulin N, Novalin N).

4. Long-Acting Insulin

  • Onset: Begins to work within 1 to 2 hours; no peak, continuous effect.

  • Examples: Lantus, Levemir.

    • Administration Routes

  • Insulin is typically administered subcutaneously (under the skin).

  • Intravenous Administration: Only short-acting insulins (regular insulin) can be administered IV.

  • Insulin Pumps: Provide continuous and bolus doses based on food intake.

  • Emphasis on site rotation for subcutaneous insulin administration to improve absorption and avoid tissue damage.

    • Insulin Storage and Preparation

  • Unopened insulin should be stored in the refrigerator.

  • NPH insulins must be rolled prior to use to mix.

  • For mixing insulins, the order of drawing up into the syringe should be clear before cloudy (clear into cloudy).

    • Monitoring for Low Blood Sugar

  • Knowing the peaks of different insulins is critical to preventing hypoglycemia.

  • Risk for low blood sugar usually occurs in the middle of insulin peak action timeframe.

  • Snack Timing: Tracking when medications are taken versus meals is vital for maintaining stable blood glucose levels.

Oral Hypoglycemics

  • Types of Oral Medications

    • Non-insulin medications work through various mechanisms to lower blood glucose.

1. Sulfonylureas

  • Examples: Glipizide, Glimepiride.

  • Mechanism: Stimulates pancreas to increase insulin production and enhances tissue sensitivity to insulin.

  • Side Effects: Possible photosensitivity, weight gain, headaches, and heartburn. Recommended to avoid alcohol.

  • Administration: Typically taken in the morning at least 30 minutes before breakfast.

2. Biguanides (Metformin)

  • Mechanism: Decreases glucose production by the liver and decreases glucose absorption in the intestines.

  • Side Effects: Commonly includes gastrointestinal issues such as nausea, vomiting, diarrhea, and potential risk for lactic acidosis.

  • Caution is necessary if kidney function is compromised; re-evaluating kidney function before resuming use is advisable after any interruptions.

    • GLP-1 Agonists

  • Examples include Ozempic and Wegovy.

  • Function: Increases insulin release and decreases glucagon levels (which converts stored glucose into blood glucose).

  • Use in Weight Management: Sometimes prescribed for weight loss in non-diabetic individuals.

Summary and Conclusion

  • Managing diabetes effectively involves integrating exercise, appropriate medication, and continuous monitoring of blood glucose levels. Understanding the various insulin types, their action timings, side effects of oral medications, and practical application in patient care is essential for providing optimal care to individuals with diabetes.