Diabetes Education Certification Physical Activity & Exercise 3 — Questions and Answers
Question 1: A patient with type 1 diabetes uses an insulin pump. What is the most evidence-based pump adjustment strategy for a 60-minute moderate aerobic workout?
- Suspend the pump entirely 15 minutes before exercise and resume immediately after
- Reduce the basal rate by 50–80% starting 60–90 minutes before exercise (Correct answer)
- Increase the bolus by 20% at the meal before exercise
- Keep pump settings unchanged and consume extra carbohydrates during exercise
Correct answer: Reduce the basal rate by 50–80% starting 60–90 minutes before exercise
Reducing the basal rate by 50–80% approximately 60–90 minutes before aerobic exercise is a well-supported strategy to attenuate exercise-induced hypoglycemia.
Question 2: What is 'nocturnal hypoglycemia' in the context of exercise, and when is it most likely to occur?
- Low blood glucose during nighttime exercise sessions
- Delayed-onset hypoglycemia occurring 6–15 hours after an afternoon or evening exercise session (Correct answer)
- Hypoglycemia caused by sleeping instead of exercising
- Morning hypoglycemia triggered by skipping the pre-exercise snack
Correct answer: Delayed-onset hypoglycemia occurring 6–15 hours after an afternoon or evening exercise session
Delayed nocturnal hypoglycemia can occur 6–15 hours post-exercise as muscles replenish glycogen stores, increasing glucose uptake while the patient sleeps.
Question 3: A 68-year-old patient with type 2 diabetes and osteoarthritis in both knees wants to start exercising. Which activity is MOST appropriate?
- High-impact aerobics class
- Running on a treadmill at 6 mph
- Water aerobics or swimming (Correct answer)
- Basketball
Correct answer: Water aerobics or swimming
Water-based exercise is ideal for patients with osteoarthritis because buoyancy reduces joint stress while still providing cardiovascular and glucose-lowering benefits.
Question 4: Which RPE (Rating of Perceived Exertion) range on the Borg 6–20 scale corresponds to moderate-intensity exercise?
- 6–9
- 10–11
- 12–14 (Correct answer)
- 16–19
Correct answer: 12–14
An RPE of 12–14 ('somewhat hard') on the Borg scale corresponds to moderate-intensity exercise, roughly 40–60% of VO2max.
Question 5: A diabetes educator is counseling a patient about the 'talk test' as a method to monitor exercise intensity. What does passing the talk test indicate?
- The patient is exercising at vigorous intensity
- The patient is exercising at moderate or below intensity (Correct answer)
- The patient should increase exercise intensity immediately
- The patient's blood glucose is within a safe range
Correct answer: The patient is exercising at moderate or below intensity
Being able to carry on a conversation without gasping indicates moderate or light intensity, a practical proxy for staying below the ventilatory threshold.
Question 6: Which of the following best describes the recommended approach to resistance training for adults with type 2 diabetes?
- 1 set of 20 repetitions at maximum weight, once per week
- 2–3 sessions per week targeting all major muscle groups with 8–12 repetitions per set (Correct answer)
- Daily resistance training of the lower body only
- Resistance training only if aerobic goals have been fully met first
Correct answer: 2–3 sessions per week targeting all major muscle groups with 8–12 repetitions per set
The ADA recommends resistance training 2–3 days per week targeting all major muscle groups, with 8–12 repetitions per set at moderate-to-hard intensity.
Question 7: A patient with type 2 diabetes has a resting blood pressure of 168/98 mmHg before a scheduled exercise session. What is the most appropriate action?
- Allow vigorous exercise since walking will lower blood pressure
- Proceed with low-intensity stretching only
- Postpone exercise and refer for blood pressure management before resuming (Correct answer)
- Have the patient drink water and recheck after 10 minutes
Correct answer: Postpone exercise and refer for blood pressure management before resuming
Exercise should be postponed when resting BP exceeds 160/100 mmHg; the patient should be referred for evaluation and BP optimization before resuming structured exercise.
Diabetes Education Certification Physical Activity & Exercise 3
A patient with type 1 diabetes uses an insulin pump.
What is the most evidence-based pump adjustment strategy for a 60-minute moderate aerobic workout?