Preventing exercise-induced hypoglycaemia in insulin-dependent diabetes

Excerpt

To the Editor: As a practising internist on insulin for type 2 diabetes, I found the article by Thabit and Leelarathna, on exercise-induced hypoglycaemia, of much professional and personal interest [1]. In the last four years, I have personally visited the emergency department twice for severe hypoglycaemia reactions, with glucose values as low as 0.78 mmol/l. One of these occurred when I did not eat for 8 h (14:00 to 22:00) and the other was 3 h after a 10 min bout of resistance activity before my daily aerobic exercise. No doubt, exercise-induced hypoglycaemia is a constant challenge for patients on insulin. Of the options for preventing exercise-induced hypoglycaemia listed in the article, the easiest is insulin dose reduction using an insulin pump. Continuous glucose monitoring is also helpful. Most people with type 1 diabetes, however, do not have these hi-tech options. Carbohydrate supplementation and provoking hepatic glucose output using a high energy/resistance exercise before aerobic activity may interfere with weight management and blood glucose regulation, unless the patient is extra vigilant. This letter points to a simpler exercise option for management of hyperglycaemia with minimal risk for hypoglycaemia. The key is in the timing. …