A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and family how diet and exercise affect insulin requirements, Nurse Joy should include which guideline?
A. “You’ll need more insulin when you exercise or increase your food intake.”
B. “You’ll need less insulin when you exercise or reduce your food intake.”
C. “You’ll need less insulin when you increase your food intake.”
D. “You’ll need more insulin when you exercise or decrease your food intake.”
Correct Answer: B. “You’ll need less insulin when you exercise or reduce your food intake.”
Exercise, reduced food intake, hypothyroidism, and certain medications decrease the insulin requirements. Growth, pregnancy, greater food intake, stress, surgery, infection, illness, increased insulin antibodies, and certain medications increase the insulin requirements. Exercise in patients with diabetes mellitus promotes cardiovascular benefits by reducing cardiovascular risk and mortality, assists with weight management, and it improves glycemic control. The increased tissue sensitivity to insulin produces a beneficial effect on glycemic control.
Option A: Patients with well-controlled diabetes on insulin regimen; higher serum insulin concentration is noted during exercise due to increased temperature and blood flow leading to increased absorption from subcutaneous depots. Exogenous insulin can’t be shut off. Hence, these patients have a drop in blood glucose levels much larger than in normal individuals.
Option C: An exercise program leads to increased activity of mitochondrial enzymes, increased insulin sensitivity, and muscle capillary recruitment. Adding resistance training to aerobic exercise provides an additional benefit of increased insulin sensitivity.
Option D: Use insulin about 60 to 90 minutes before exercise to prevent increased insulin absorption along with injecting in a site other than muscle to be exercised. For example, inject into arms when cycling exercise and into the abdomen when the exercise involves both the arms and legs.
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