Type post exercise to prevent hypoglycaemia [6-9]. The

Type 1 diabetes
is a life long metabolic disorder, which manifests when the pancreas stops
producing insulin; as a result type 1 patients are dependant on insulin for
survival 1-2.
However, regular physical activity for type 1 diabetes
comprises with various health and cardiovascular benefits including: increased
insulin sensitivity, maintaining persistent glycaemic control by energizing
muscle glucose uptake and promotes good quality of life with diabetes 3-5. Thus,
it would be advised to the client to consider adhering to regular physical
activity post marathon due to the health benefits with diabetes and improved
insulin sensitivity.


Blood glucose Monitoring & Exercise

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Before starting
any training regimen, It’s essential to be aware of balancing type of physical
activity levels, insulin dosing and tailored nutritional intake, in order to
maintain normal blood glucose levels: pre, during and post exercise to prevent
hypoglycaemia 6-9. The American College of Sports Medicine guidelines suggest
people living with type 1 diabetes participating in physical activity should
aim to keep glucose levels prior, during and after exercise predominantly over
5.5 mmol/L and essentially lesser than 13.8-16.7 mmol/L to prevent
hypoglycaemia episodes 10. This can be achieved by monitoring glucose 30
minutes prior to exercise, every 30 minutes during exercise and following
exercise; this can help enhance metabolic control when exercising 7. If these
glucose levels aren’t achieved, it’s important to postponement exercise to
establish if ketones are present; if glucose levels are below 5mmol/L consume
quick-acting carbohydrates approximately 15-20 grams and recheck glucose levels
to determine if exercise can be started 5.


Training Session Consent & Preparations


Running a marathon consists of running the
distance of 26 miles 11 and preparing for marathon training sessions is a
challenging task especially for type 1 patients, which compromises of vast
effort and constant practice 11. It’s not recognised if the client is a
regular exerciser or has any other medical conditions that may restrict her
from exercise (e.g. hypertension, blocked arteries etc.). Thus, before starting
any form of exercise, it’s vital she obtains consent from her doctor to determine
if she’s fully physical to fulfil both short and long duration and low and high
intensity training sessions and the marathon itself before adhering to nutritional
and medication advise discussed below 12.


Important Considerations During initial Training Sessions


When starting
initial training sessions it’s important to start off with lighter exercises, as
non-regular exercises don’t have reduced glucose-controlling reaction to hypoglycaemia,
only type 1 athletes or regular exercisers would have these physiological
benefits 13.  Thus, consider setting
realistic goals by starting with low intensity shorter runs covering shorter
distances and making way up steadily, this way the body would become accustomed
to the exercise intensity, improve insulin sensitivity, which would help reduce
the risk of hypoglycaemia 14.


Insulin Adjusting
& Exercise


Most challenging scenarios of exercising
with type 1 diabetes is adjusting correction insulin dose with nutrition and
exercise, in order to prevent hypoglycaemia 15. Several aspects could affect
glucose reactions to exercise such as: glucose levels prior to exercise,
timing, type and intensity of exercise, timing of insulin injections and last
meal consumed prior to exercise 15. Taking vast amount of insulin prior to
exercise can cause hypoglycaemia, as it diminishes the amount of glucose that adds
to the blood from the liver and taking smaller amount of insulin would
predispose to hyperglycaemia 16. Thus, it’s vital to reduce the dose of
insulin with meals prior to exercise, which will again depend on the duration,
time and intensity of the exercise session 16.


The client is currently taking ‘Novorapid’
insulin with meals. If the client decides to exercise after a meal Diabetes UK
guidelines for insulin adjusting prior to exercise intensity 17 suggest: if
exercising within 30 minutes of short duration of mild exercise, its advised to
reduce 25% of rapid-acting insulin. If exercising for at least 60 minutes of
moderate to high intensity exercise, a reduction of 50-75% of rapid-acting
insulin reduction is recommended and exercising for over 90 minutes reduction
of rapid-acting insulin from 25 to 75% is advised. If exercising before
breakfast consume minimal sugary fluids during exercise and take normal insulin
dose with breakfast post-exercise. If exercising after breakfast, reduce
novo-rapid by 25% and consume lower calorie breakfast with usual insulin dose
for lunch and dinner 18.

In regards to Lantus insulin taken at night; if
exercising couple days per week the dose of this long-acting insulin can be
split meaning it can be taken twice a day, which can allow the meal insulin
dose to be reduced prior to exercise 19. If exercising everyday Lantus
insulin can be reduced by 20-25% at night, which would help prevent
hypoglycaemia episodes the following morning 19. 



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