Troubleshooting


Hypoglycaemia (Low blood sugar with exercise)

Too much insulin in the resting state Test of basal insulin, carbohydrate ratio and correction factorSee your Diabetes nurse specialist
Absorption from injection sites increases during exercise Consider switching injection site away from active muscles
Increased body temperature increases insulin absorption Consider reduction in insulin dose
Basal insulin levels unable to drop during exercise as they would in people without diabetes Consider reduction in basal insulin (see adjusting insulin for exercise)
Hypoglycaemia overnight following exercise. (Muscle and liver stores are being replaced for many hours after exercise so blood glucose levels may drop overnight) Take complex carbohydrate meal after exerciseMeasure blood glucose frequently overnight (set alarm for 2am)Consider reduction in basal insulin
Failure of stress hormones to push glucose back up (can occur following previous bad or frequent hypoglycaemia or after particularly strenuous exercise) Consider avoiding exercise on the day after a very low blood sugar
Prolonged aerobic exercise without adequate glucose replacement or insulin reduction Review plan from this exercise and adjust for next exercise (see adjusting insulin for exercise)Consider 10second sprint at maximal intensity after exercise
New exercise regime with differing levels of aerobic activity Review plan from this exercise and adjust for next exercise (see adjusting insulin for exercise)

 


Hyperglycaemia (High blood sugar with exercise)

Inadequate insulin in the resting state Test of basal insulin, carbohydrate ratio and correction factor
Very vigorous aerobic activity (at very strenuous activity the stress response is activated which increases blood sugar) May require extra insulin doses after exercise (can last 1-2 hours after exercise has stopped)
Match days or tournaments May require different regime to training days. May need extra doses of insulin
Prolonged pump disconnect Limit pump disconnect or give additional small boluses during exercise.
Missed injections, illness, pump blockage (If the blood sugar is already high and rising before exercise or if ketones are already present then any exercise will make this situation worse and could be dangerous) Avoid starting exercise if blood sugar >14Correct blood glucose with insulinTake extra fluid to avoid dehydrationConsider changing pump infusion set
Ketones in blood or urine(If the blood sugar is already high and rising before exercise or if ketones are already present then any exercise will make this situation worse and could be dangerous) Avoid starting exercise if blood sugar >14Correct blood glucose with insulinTake extra fluid to avoid dehydrationChange pump infusion set if no cause found
Too much carbohydrate consumed during exercise or too much reduction in insulin Review plan from this exercise and adjust for the next exercise (see adjusting insulin for exercise)
Increased component of anaerobic exercise May need to correct at the end of exercise
Review plan and adjust for the next exercise