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Question:

From New York, USA:

My 10 year old daughter was diagnosed 6 months ago with Type 1 diabetes. When she participates in certain activities, her glucose levels go up, not down as we were told they would. Could adrenaline be raising her sugar? Cheerleading and downhill skiing have both raised her glucose when she had no food intake during the activity. Her pediatric endocrinologist does not believe this is possible.

Answer:

Several things influence how your (or your daughter's) blood glucose levels respond to exercise. These include the type of exercise you choose, the intensity with which you exercise, and the length of time you spend exercising. If you exercise long and hard, you will probably deplete your glycogen stores in the muscles and liver that will be replaced by taking glucose from your blood. When and what you last ate at your recent meal or snack and your level of fitness also influences what happens to your blood glucose level while you exercise.

Short, high intensity exercise (such as sprinting, basketball, cheerleading and downhill skiing) may raise blood glucose levels in individuals with diabetes. This type of exercise usually lasts for 20 minutes or has periods of high-intensity activity interspersed with low intensity activity. These short term, stressful forms of exercise may lead to transient phases of hyperglycemia especially so in less well-trained individuals.

Blood glucose can also become elevated after exercise as a result of insulin deficiency. Insulin deficiency also results in an excess of counterregulatory "stress" hormones (glucagon, epinephrine also known as adrenaline, cortisol and growth hormone). This combination of not enough insulin and too much of the "stress" hormones causes the liver to produce two to three times more glucose than normal, leading to higher blood glucose levels.

You really need to check your daughter's blood glucose levels before and after exercise. If your daughter is engaging in an activity for the first time, it is equally important that you check her blood glucose level thirty minutes into the activity. Here are some general guidelines: If pre-exercise blood glucose is less than or equal to 100 mg/dl, eat a snack and recheck blood glucose 20 to 30 minutes after the snack. If pre-exercise blood glucose is over 100mg/dl to 250 mg/dl, go ahead and exercise. If pre-exercise blood glucose is over 250 mg/dl, check for ketones. If ketones are present, do not exercise. In the presence of ketones, exercise can worsen blood glucose control. If pre-exercise blood glucose is over 300 mg/dl, whether ketones are present or not, do not exercise.

PL

Original posting 5 Apr 1998
Posted to Exercise and Sports

  
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Last Updated: Tuesday April 06, 2010 15:08:58
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