News Article
Track Occurrence in Bid to Prevent Delayed-Onset Hypoglycemia in Diabetic Athletes
KEYSTONE, Colo. (EGMN) - Delayed-onset hypoglycemia can become a concern in patients with type 1 diabetes after high-intensity or prolonged exercise, according to diabetes counselor Gary Scheiner.
"This is something you have to watch out for," he said at a conference on the management of diabetes in youth. "It's due to a combination of the body's increased sensitivity to insulin caused by exercise and the muscles' need to replace their glycogen stores. It's not going to happen after a 45-minute treadmill walking session. You're going to have to really exhaust yourself." Mr. Scheiner is the owner and clinical director of Integrated Diabetes Services, Wynnewood, Pa.
An unprepared patient is easily caught off guard by this dangerous phenomenon, since the blood sugar fall typically doesn't occur until 6-12 hours after the end of a hard 2-hour-plus exercise session. Occasionally, it can happen up to the 24-hour mark.
"Somebody who has a really hard afternoon workout might drop during the early part of the night. That's typical to see," he said at the conference, which was sponsored by the Barbara Davis Center for Childhood Diabetes, the University of Colorado, and the Children's Diabetes Foundation at Denver.
The key to preventing delayed-onset hypoglycemia is to carefully track its occurrence pattern, both in terms of the preceding workouts and the carbohydrate snacks consumed during the exercise session.
"It might happen after lacrosse practice, for example, but not after an evening of volleyball. You base your preventive strategy on the record of the patterns," Mr. Scheiner continued.
An effective preventive measure is to reduce basal insulin by 20%-30% following a high-risk activity. Alternatively, the athlete can cut back on meal or snack insulin boluses up until the time the delayed-onset low is expected. During that at-risk period, the patient should make an effort to eat snacks composed of slow-acting, low-glycemic carbohydrates that don't require insulin boluses.
It is a good idea for the patient to check blood glucose levels following a high-risk workout more frequently than normal - say, every 2 hours during the at-risk period - and again at 3 a.m. on the night following the activity.
Mr. Scheiner is a consultant to Unomedical, CardioCom, and Byram Healthcare, serves on the speakers bureaus of Smith Medical, Sanofi-Aventis, and Medtronic, and has received research grants from NovoNordisk.
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