LWD - Chapter G

G2: Exercise and diabetes

Types of activity

Aiming for glucose levels in range during activity and exercise can help you perform at your best, as well as optimising your concentration levels. To help keep your glucose in range it will help to understand about different types of activity, how they affect your glucose levels, the amount of insulin working in your body and how long you will be active for.

The body stores glucose in the liver and muscles for times when extra fuel is needed, like exercise. During activity these stores usually last about 45 minutes. However, the body struggles to use this stored glucose efficiently if there is too much or too little insulin in the body and may result in hypos or the development of ketones.

It is not recommended to exercise if glucose is less than 4 mmol/l. You should treat the hypo with your usual fast acting glucose treatment and delay activity. Be mindful that your risk of having a hypo during activity is increased following a hypo.

Do not exercise if you have ketones. Please follow the sick day guidelines for ketones above 0.6mmol/l and correct high glucose and ketones before being active.

To support children and young people to take part in activity, reducing insulin and eating some extra carbohydrates may be needed. Checking glucose levels before exercise, every 20 minutes during exercise and at the end of the exercise is helpful. After vigorous/hard or long bouts of exercise you may even need to check glucose overnight.

Multiple daily injections (MDI)

• If eating up to 90 mins before activity reduce your food bolus by 50%.
• Aim for a glucose ≥7mmol/l prior to starting exercise. If glucose <7mmol/l have a 10g carbohydrate snack without insulin.
• Check your glucose every 20 minutes or so to review the need for additional snacks.

Automated Insulin Delivery systems (AIDs)

• Turn on exercise mode 1-2 hours before planned activity.
• For short duration activities like PE, exercise mode may be enough to keep glucose levels stable.
• Consider the need for extra carbohydrates without insulin if glucose is trending low but not <4mmol/l, see the 5-7g carbohydrate snack list.
• Have a 5-7g carbohydrate snack without insulin every 20 mins as needed.

Drinks for Sport

It is important to keep hydrated when you are being active, water or sugar-free dilute squash are good choices. If you wear a sensor keeping hydrated is really important for the accuracy of the glucose readings. Check the colour of your urine to help you know if you need to drink more, aim for a urine that is colourless or pale yellow.

After exercise

Include a cool down of 10-15 minutes after exercise as this helps reduce lactic acid and adrenaline levels in the body which affects post glucose rises. If after 30 minutes your glucose remains out of range, please give 50% of the normal suggested correction.

The body can remain sensitive to insulin for some hours after exercise, so consider reducing the insulin with your food by 25% if eating soon after exercise. We recommend eating foods with both carbohydrates and protein to help replace muscle glucose stores and repair muscle tissue.

If you have been active in the later afternoon or evening, we recommend you have a carbohydrate and protein containing snack before bed.

Bedtime/ refuelling snack ideas

• ½ an apple with peanut butter.
• Glass of milk.
• Beans on toast.
• Cracker and cheese.
• Tuna/cheese/peanut butter sandwich.
• Cereal (cereal bar) and milk.

If you are training regularly and require some personalised advice about how to eat to improve your performance, please contact the diabetes team.

G3: Sleep

Sleep is really important for the body. A lack of sleep can affect wellness, glucose levels and mental health.

Here are some of the reasons why prioritising sleep is important:

• Helps maintain a healthy weight.
• Heals and repairs heart and blood vessels.
• Consolidates learning.
• Helps creativity.
• Helps reduce stress.
• Releases growth hormones.
• Improves our mental health.
• Help us to solve problems.
• Help us to make decisions.
• Helps improve low mood and depression.

How much sleep do I need?

The average person spends around a third of their life asleep. The amount of sleep you need depends on your age, sex, health and other elements. Sleep cycles change with age. Screen time can have a major impact on sleep cycles.

Find out how much sleep you need, using the list below:

• 1-12 months old - 14-15 hours per day.
• 1-3 years old - 12-14 hours per day.
• 3-6 years old - 10-12 hours per day.
• 7-12 years old - 10-11 hours per day.
• 12-18 years old - 8-9 hours per day.
• 18-65 years old - 7-9 hours per day.
• 65+ - 7-8 hours per day.