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[IP] Exercise

I have received several e-mails regarding exercise. I will respond
initially with some rather generic guidelines that I feel are
appropriate to all Type I diabetics. I will address your individual
concerns regarding your specific programs soon.

First, let me emphasize that there is no clearly documented evidence
that exercise improves glycemic control in IDDM; however, it is clear
that regular exercise does diminish insulin resistance, improve glucose
metabolism, improve lipid profile, improve body composition, improve
blood pressure if initially elevated, improve self-esteem and sense of
well-being, and reduce cardiovasular disease risk. Exercise adds another
variable into the big "BALANCE" equation. Pumpers, who in general are
more "in tune" with their bodies and take a more active role in their
management are probably the best equipped to handle exercise (even high
intensity or long duration exercise).

If you are just beginning an exercise program, the American College of
Sports Medicine (ACSM) recommends that anyone with known metabolic
disease, OR, those with 2 or more cardiovascular (CV) risk factors who
plan on engaging in vigorous exercise (>60% VO2max), OR, anyone with 1
or more signs or symptoms of CV disease engaging in moderate to vigorous
exercise (>40% VO2max), OR any man >40 or woman >50 should first undergo
and graded exercise test. This test can not only be diagnostic for
underlying CV disease (which we diabetics have a greater risk for), but
he can provide very useful information for the exercise prescription.

Close glucose monitoring is a must for diabetics beginning an exercise
program, and for those more experienced exercisers who want to improve
performance. Maintain BG and insulin levels close to phyiologic norms
will improve overall athletic performance. With the evolution of
Humalog, the BG response to exercise should be more predictable. I use
to have to "pad" my pre-exercise, or pre-race blood sugars well above
200, so that I wouldn't crash during the run. This is even with
disconnecting from the pump and consuming CHO during the run. The
effects of the Velosulin that I used before would linger and have a
profound effect on my BG. With Humalog, I can keep the pump on and begin
my runs with my BG within the normal range and by simply using a reduced
temorary basal rate, maintain them during the 15-20 mile training runs. 

A common question is: How much CHO do I consume during exercise. It is
difficult to give precise information because of wide individual
variations; however, estimates of energy requirements can be based on
the intensity and duration of the activity. For example, 30 min of
moderate intensity exercise requires approx 15-30 g of CHO. These
guidelines are only approximate and actual CHO requirements depend on
many factors: exercise intensity and duration, preceeding meal makeup,
circulating insulin levels, individual fitness levels, biomechanical
efficiency, and the need for exogenous CHO for maintenance of BG in the
normal range. Hence, exercise is just another variable in the big
"BALANCE" equation. I must go, work is calling. If there is any more
interest in exercise, I'll be happy to contribute my humble two cents

Insulin-Pumpers website   http://www.bizsystems.com/Diabetes/