Page 605 - fbkCardioDiabetes_2017

Cardio Diabetes Medicine 2017 581

Exercise is extreme cold or heat to be avoided
Inspection of feet before and after exercise is necessary

TABLE 5 : SPECIFIC CONSIDERATIONS FOR EXERCISE IN T1DM and T2DM
Specific considerations for exercise in Type T1DM
Avoid hypoglycemia during exercise by :
 Avoiding heavy exercise during peak insulin action

 Using non-exercising areas for insulin injection
 Reducing pre-exercise insulin dosages by 20 – 50%, if multiple daily injections are used, using an insu-
lin pump and also decreasing the basal before exercise. These are individualistic based on blood glucose
monitoring.
 Monitor glycemia before, during and after as necessary.
 Taking extra carbohydrate before and hourly during exercise. This also to be individualized and based
on blood glucose monitoring.
 After prolonged exercise, monitor glycemia and take extra carbohydrate to avoid delayed hypoglycemia.
 Use extra caution in monitoring glycemia if exercise is being performed within 24 hrs of a hypoglycemic
episode.
Specific considerations for exercise in Type T2DM

 Hypoglycemia is less common in T2DM during exercise then in T1DM and extra carbohydrate usually
unnecessary.
 Patients on insulin or sulphonylureas may need to reduce the doses during exercise day guided by
glucose monitoring

Recommendations : Adults with diabetes should engage in 2–3 sessions/
Pre-exercise medical clearance is generally unneces- week of resistance exercise on nonconsecutive days.
sary for asymptomatic individuals prior to beginning Flexibility training and balance training are recom-
low- or moderate-intensity physical activity not ex- mended 2–3 times/week for older adults with diabe-
ceeding the demands of brisk walking or everyday tes. Yoga and tai chi may be included based on in-
living. dividual preferences to increase flexibility, muscular
Most adults with diabetes should engage in 150 min strength, and balance.
or more of moderate-to-vigorous intensity activi- Individuals with diabetes or pre diabetes are en-
ty weekly, spread over at least 3 days/week, with couraged to increase their total daily incidental (non
no more than 2 consecutive days without activity. exercise) physical activity to gain additional health
Shorter durations (minimum 75 min/week) of vigor- benefits.
ous intensity or interval training may be sufficient for
younger and more physically fit individuals. To gain more health benefits from physical activity
programs, participation in supervised training is rec-
Children and adolescents with type 1 or type 2 dia- ommended over non supervised programs. (Table 6)
betes should engage in 60 min/day or more of mod-
erate or vigorous intensity aerobic activity, with vigor-
ous, muscle-strengthening, and bone-strengthening
activities included at least 3 days/week.

Cardio Diabetes Medicine