Diabetes Exercise and Activity 5 — Questions and Answers
Question 1: A person with Type 2 diabetes and obesity wants to start exercising but has joint pain. Which is the BEST starting recommendation?
- Run 5 miles daily to maximize calorie burn
- Start with low-impact activities like water aerobics or cycling (Correct answer)
- Avoid all exercise until reaching a healthy weight
- Focus exclusively on upper body resistance training
Correct answer: Start with low-impact activities like water aerobics or cycling
Low-impact activities like water aerobics or cycling provide cardiovascular and metabolic benefits while minimizing stress on joints, making them ideal starting points for people with obesity and joint pain.
Question 2: What is the purpose of wearing medical identification during exercise for a person with diabetes?
- It is required by gym regulations for diabetic members
- To alert bystanders and emergency responders to the person's diabetes if they become incapacitated (Correct answer)
- To track workout duration and intensity automatically
- Medical ID improves insulin absorption during exercise
Correct answer: To alert bystanders and emergency responders to the person's diabetes if they become incapacitated
Medical identification ensures that emergency responders know the person has diabetes and may need glucose treatment if they become unconscious or confused during or after exercise.
Question 3: Which lab value should be checked before a person with diabetes starts a vigorous exercise program, to screen for underlying cardiovascular disease?
- Serum potassium
- Resting ECG or stress test depending on risk factors (Correct answer)
- Fasting triglycerides only
- Urine microalbumin
Correct answer: Resting ECG or stress test depending on risk factors
People with diabetes have elevated cardiovascular risk, so a resting ECG or exercise stress test (based on age and risk factors) is recommended before initiating vigorous exercise programs.
Question 4: A person with well-controlled Type 2 diabetes on a sulfonylurea (like glipizide) starts a new walking routine. Why is hypoglycemia a particular concern?
- Sulfonylureas block glucose absorption during exercise
- Sulfonylureas stimulate constant insulin secretion regardless of activity level (Correct answer)
- Walking reduces the effectiveness of sulfonylureas
- Sulfonylureas cause rebound hyperglycemia after exercise
Correct answer: Sulfonylureas stimulate constant insulin secretion regardless of activity level
Sulfonylureas stimulate insulin secretion independent of blood glucose levels, so when exercise additionally lowers blood glucose, the constant insulin stimulus can cause hypoglycemia.
Question 5: What is the role of glucagon in exercise for people with Type 1 diabetes who have exercised to the point of severe hypoglycemia and are unconscious?
- Glucagon should be taken orally to raise blood glucose
- Glucagon can be injected to trigger the liver to release stored glucose (Correct answer)
- Glucagon is only effective when the person is awake and cooperative
- Glucagon blocks insulin from lowering blood glucose further
Correct answer: Glucagon can be injected to trigger the liver to release stored glucose
Emergency glucagon injection (or nasal glucagon) signals the liver to release stored glycogen as glucose, raising blood sugar in a person too impaired to swallow oral carbohydrates.
Question 6: How does regular physical activity affect insulin requirements in Type 1 diabetes over the long term?
- Insulin requirements increase significantly with regular training
- Insulin requirements often decrease due to improved insulin sensitivity (Correct answer)
- Insulin requirements remain completely unchanged by exercise habits
- Regular exercise eliminates the need for insulin entirely in Type 1
Correct answer: Insulin requirements often decrease due to improved insulin sensitivity
Chronic exercise training improves insulin sensitivity in muscle and adipose tissue, often allowing people with Type 1 diabetes to reduce their total daily insulin dose over time.
Question 7: Which strategy helps prevent hypoglycemia the night after a long afternoon endurance exercise session in a Type 1 diabetic?
- Skip the bedtime snack to avoid weight gain
- Reduce the evening long-acting insulin dose and have a bedtime snack with protein and carbs (Correct answer)
- Double the evening insulin to control the post-exercise glucose rise
- Avoid drinking water after 6 PM to prevent nocturnal hypoglycemia
Correct answer: Reduce the evening long-acting insulin dose and have a bedtime snack with protein and carbs
Reducing evening basal insulin and eating a protein-carbohydrate bedtime snack addresses both the depleted glycogen stores and the ongoing muscle glucose uptake that drives nocturnal hypoglycemia after endurance exercise.
Diabetes Exercise and Activity 5
A person with Type 2 diabetes and obesity wants to start exercising but has joint pain.
Which is the BEST starting recommendation?