| Summary: | Regular physical exercise is beneficial for the person with insulin-dependent diabetes
mellitus (IDDM). Participation in regular physical exercise, however, adds extra challenges that
must be overcome in order to maintain acceptable metabolic control with each exercise session.
Research in the area of diabetes and exercise has focused on the potential for exercise to improve
overall metabolic control. As a result of this research, a wide range of recommendations for
modifying diet and insulin for exercise in this population have been developed. There is a
paucity of research on what steps an already active person with IDDM makes in order to
maintain metabolic control before, during, and after exercise. The purpose of this study was to
use a self-administered, mailed questionnaire to obtain information on the adjustments in insulin
and diet currently used for exercise in active people with IDDM. A total of 137 members of the
International Diabetes Athletes Association with IDDM qualified to participate in this study.
The insulin administered prior to planned exercise was significantly lower than the
amount of insulin administered on a non-exercise day. For subjects who injected their insulin,
there was a significant decrease in the short acting insulin (p < 0.001), intermediate acting insulin
(p = 0.006), long acting insulin (p = 0.042), and total insulin (p < 0.001) used prior to planned
exercise. The insulin adjustments represented a 28.4 % reduction in short acting insulin, a
38.4 % reduction in intermediate acting insulin, a 9.7 % reduction in long acting insulin, and a
17.7 % reduction in total insulin injected. For subjects who used an insulin pump, there was a
significant decrease in the basal insulin infused (p = 0.024), the bolus insulin administered
(p < 0.001), and the total insulin (p < 0.001) used prior to planned exercise. The insulin adjustments represented a 6.4 % reduction in basal insulin, a 12.0 % reduction in bolus insulin,
and a 6.3 % reduction in total insulin used.
The amount of carbohydrate (CHO) consumed on an exercising day was significantly
greater (p < 0.001) than the amount of CHO consumed on a non-exercising day, by an average of
56.8 grams. In addition, there were weak positive correlations between the amount of CHO
consumed and the duration of exercise for CHO consumption before exercise (r = 0.42;
p < 0.001), during exercise (r = 0.19; p = 0.046), or a combination of before and during exercise
(r = 0.35; p < 0.001). Linear regression estimated that for every 60 minutes of exercise there was
a mean increase of 9.6 grams CHO consumed before exercise, 5.4 grams CHO consumed during
exercise, while 15.0 grams CHO were consumed both before and during exercise. There was,
however, no significant correlation between the CHO consumed after exercise (r = 0.017;
p = 0.859) and the duration of the exercise session.
Additional information related to IDDM and exercise determined that the signs and
symptoms of hypoglycemia recognized during exercise were different than those recognized at
rest, blood glucose was measured an average of 1.7 times during exercise, and a majority of
subjects (73.9 %) reported that their metabolic control was better as a result of an active lifestyle.
The results of this study suggest that a decrease in insulin administered prior to planned
exercise was required to prevent hypoglycemia during and after exercise. In addition, an increase
in CHO intake was required to provide an energy substrate during exercise and to maintain
euglycemia. Insulin and dietary adjustments are required for exercise in active persons with
IDDM in order to maintain metabolic control before, during, and after exercise. Further research
is required to provide specific recommendations in the adjustments to dietary intake and insulin
administration for exercise in already active people with IDDM. === Education, Faculty of === Kinesiology, School of === Graduate
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