Situations & Solutions
QUESTION 6. When is your last meal or snack before exercising?
Q6 Rationale. The timing of the meal or snack in relation to the timing of the workout is important in determining what preventative action to take. It may be that he could just decrease his meal bolus if the meal is close to the time of exercise, for example. Also, if he takes a large bolus close to the time of exercise, the educator knows that high blood insulin levels block the release of glucose from glycogen stores and also the release of free fatty acids from fat stores.
QUESTION 7. Do you adjust your bolus or basal rate for exercise?
Q7 Rationale. Again, this is important for determining what preventative action to take. If he is already decreasing his basal rate, he may need to decrease it further, or start the decrease earlier, and/or maintain the decrease for a longer period.
QUESTION 8. What are your basal rates throughout the day?
Q8 Rationale. It might help to know if his basal rate at the time of exercise is actually increasing or decreasing. It is common for rates to be higher between dinner and bedtime, when many people do exercise. In that case, the temporary reduction may need to be greater than if the basal rate stays the same.
QUESTION 9. Where do you put your infusion sets?
Q9 Rationale. If an infusion set is located in a limb that will be exercised rather than in an area like the abdomen or hip, the insulin absorption and action will be increased with the exercise. This is important to keep in mind.
QUESTION 10. How often do you test your blood glucose?
Q10 Rationale. It may be that he was already hypoglycemic before starting the exercise or is not testing enough to be aware of blood glucose trends.