CDE Exercise Prescription 5 — Questions and Answers
Question 1: A patient uses a continuous glucose monitor (CGM) during exercise. At what CGM glucose trend and level should they consume 15-20g of carbohydrate prophylactically?
- Glucose 250 mg/dL with upward arrow
- Glucose 90 mg/dL with a rapid downward trend arrow during aerobic exercise (Correct answer)
- Glucose 180 mg/dL with flat trend during rest
- Glucose 140 mg/dL with upward arrow after a meal
Correct answer: Glucose 90 mg/dL with a rapid downward trend arrow during aerobic exercise
A glucose of 90 mg/dL with a rapid downward CGM trend during aerobic exercise indicates imminent hypoglycemia risk warranting prophylactic carbohydrate intake.
Question 2: Which adaptation to resistance training is most responsible for long-term improvements in resting metabolism in patients with type 2 diabetes?
- Decreased bone density
- Increased skeletal muscle mass (Correct answer)
- Reduced lung capacity
- Decreased heart rate variability
Correct answer: Increased skeletal muscle mass
Resistance training increases skeletal muscle mass, which is the primary metabolically active tissue that elevates resting metabolic rate and improves glucose disposal.
Question 3: A patient with type 1 diabetes reports hypoglycemia consistently 8-12 hours after afternoon swimming sessions. What is the most likely cause?
- Immediate exercise hypoglycemia during swimming
- Delayed (late-onset) post-exercise hypoglycemia due to glycogen repletion and enhanced insulin sensitivity (Correct answer)
- Swimming causes the pancreas to overproduce insulin
- The chlorine in pools lowers blood glucose
Correct answer: Delayed (late-onset) post-exercise hypoglycemia due to glycogen repletion and enhanced insulin sensitivity
Delayed hypoglycemia 6-15 hours post-exercise occurs because muscles replenish glycogen stores and insulin sensitivity remains elevated, increasing glucose uptake during this window.
Question 4: What is the Talk Test as applied to exercise intensity prescription?
- A patient must be able to sing full songs during exercise
- Moderate intensity allows comfortable conversation but not singing; vigorous intensity limits speech to a few words (Correct answer)
- If a patient cannot talk at all, exercise intensity is appropriate
- The Talk Test only applies to patients over age 70
Correct answer: Moderate intensity allows comfortable conversation but not singing; vigorous intensity limits speech to a few words
The Talk Test is a practical intensity guide: moderate exercise allows conversation but not singing, while vigorous exercise allows only brief phrases.
Question 5: For a patient with diabetic peripheral neuropathy exercising regularly, what foot care practice is most critical?
- Go barefoot indoors only
- Inspect feet daily for blisters, cuts, or pressure points and wear well-fitting, moisture-wicking socks and proper footwear (Correct answer)
- Soak feet in hot water after every workout
- Apply petroleum jelly between toes before exercise
Correct answer: Inspect feet daily for blisters, cuts, or pressure points and wear well-fitting, moisture-wicking socks and proper footwear
Daily foot inspection and appropriate footwear prevent undetected wounds that can progress to serious infections in patients with reduced foot sensation.
Question 6: Which patient scenario represents the highest absolute risk for exercise-induced cardiovascular event and warrants a stress test before starting vigorous activity?
- 40-year-old with type 2 diabetes, HbA1c 7%, and no symptoms
- 60-year-old with type 2 diabetes, 15-year history, known CAD, and exertional chest tightness (Correct answer)
- 25-year-old with type 1 diabetes for 3 years
- 50-year-old with impaired fasting glucose only
Correct answer: 60-year-old with type 2 diabetes, 15-year history, known CAD, and exertional chest tightness
A patient with known coronary artery disease and symptomatic exertional chest tightness has clear high cardiac risk and requires evaluation before vigorous exercise.
Question 7: What is the rationale for recommending that patients with type 2 diabetes exercise within 1-3 hours after a meal?
- Post-meal exercise always causes hyperglycemia that must be corrected
- Post-meal exercise helps blunt postprandial glucose spikes and reduces overall daily glucose variability (Correct answer)
- Exercising on an empty stomach is always preferred for fat burning
- Meal timing has no effect on the glycemic response to exercise
Correct answer: Post-meal exercise helps blunt postprandial glucose spikes and reduces overall daily glucose variability
Exercising in the postprandial window utilizes meal-derived glucose, effectively blunting the postprandial glucose peak and improving overall glucose control.
CDE Exercise Prescription 5
A patient uses a continuous glucose monitor (CGM) during exercise.
At what CGM glucose trend and level should they consume 15-20g of carbohydrate prophylactically?