Situations & Solutions
QUESTION 11. How do you determine your bolus doses?
Q11 Rationale. The educator needs to know if he is doing carbohydrate counting or fixed insulin doses, etc, in order to help him make adjustments.
QUESTION 12. Do you eat or drink anything during your workout?
Q12 Rationale. This information is important to take into account when deciding on preventive recommendations.
Based on the responses to each of the above questions, the educator can come up with an assessment and plan. The right plan will have to be based upon trial and error, and close monitoring and record keeping by the patient.
Some of the possible recommendations the educator could make include:
Alternative 1: Decrease the pre-meal bolus, even in half, if exercise
is within an hour or so of the previous meal.
Alternative 2: Leave
the basal rate as is, but have him eat, for example, 30 grams of carbohydrate
for every 30 minutes of intense exercise.
Alternative 3: Reduce the
basal rate by 20-50% or more beginning 30 minutes to an hour before exercise
begins and continue the decrease for 2 times the duration of the workout.
Alternative
4: Omit the pre-meal bolus if the meal is within an hour of the time of
exercise.
Alternative 5: Make sure his infusion set is in his
abdomen on the days he exercises.
Alternative 6: Ask him to monitor
his blood glucose to obtain a baseline before exercise begins and then
frequently during and after.
The educator should also provide him with general recommendations for safe exercise such as keeping hydrated, wearing good fitting shoes, etc. The bottom line is to individualize recommendations based on a comprehensive assessment!