HND702 Diabetes Management: Michael's Exercise and Diabetes Control

This report focuses on the management of type 1 diabetes, specifically addressing the impact of exercise on blood glucose control. It analyzes the case of Michael, a 26-year-old with type 1 diabetes, and discusses the physiological impact and clinical implications of exercise, including the importance of balancing food intake and insulin dosing. The report highlights the benefits of aerobic exercise like jogging, while also emphasizing the risks of hypoglycemia and the need for careful monitoring. It explores factors influencing blood glucose homeostasis during exercise, such as exercise intensity, duration, and frequency. The report also covers technological advancements and the importance of carbohydrate intake, micronutrients, and the role of technology in diabetes management. The report emphasizes the need for careful planning, monitoring, and adjustments to insulin and food intake to ensure safe and effective exercise participation for individuals with type 1 diabetes, providing recommendations for managing potential complications and promoting a healthy lifestyle.

Running Head: MANAGEMENT OF DIABETES
Management of Diabetes
Student Name
Student Number
Institutional Affiliation

MANAGEMENT OF DIABETES 2
Management of Diabetes
Introduction
While being physically fit and active perhaps because of engaging in some sort of
healthy exercise or any physical escapades that do not harm the body bestows and revitalise
several health benefits on persons with type 1 diabetes. It is also imperative to realize and
learn that entirely, blood glucose control cannot be effective in the absence of balance and
checked insulin dosing and food consumption to regulate euglycemia at the times the
exercise of any kind. Currently, various technological innovations and applications have
emerged to help insulin users like Sylvie so that they could maintain their physical fitness
while applying optimal blood glucose control; however, there are some limitations associated
to the use of such devices. In addition to the advent of these new technologies and their
progressive improvements, researchers and specialists in this field are actively searching
others mean to put together the entire data to maximize on blood glucose control and
performance. Also, they are actively involved in ensuring integration of physical therapies
that would involve establishing, ‘smart' machines to promote closed-loop systems that can
utilize other inputs and learn, with social conditions that enable the machines to satisfy the
user’s needs (Miller et al., 2015). The paper seeks to demonstrate the understanding of the
physiological impact and clinical implications of exercise, blood glucose control through
insulin intake in type 1 diabetes as given in the case of Michael and Sylvie. It also seeks to
critically clarify strategies to prevent and manage diabetic emergencies in the very same
context.
Part 1
Not only for Michael, a 26-year-old man, physical activity or rather, exercise, has
brought genuinely established health goodies/benefits for people living with type 1 diabetes.
These health goodies include but not limited to the following; better-borne health enhanced

MANAGEMENT OF DIABETES 3
cardiovascular fitness and improved physiological conditions and wellbeing. However,
despite these health benefits, there is a lot of procrastination among adults with type1
diabetes in taking part to participate in the physical activity than their counterparts without
diabetes. In fact, research studies show that at times they can even go-ahead to adopt
unhealthy lifestyles that can lead to more risks such as cardio-metabolic risks (Metcalf et al.,
2014). In spite of the fact that this aspect of exercise revolves around and/or controlled by
multiple factors; for instance, perspectives regarding the loss of control and low fitness
levels, the overriding challenge to physical activity (exercise) is apparently the dread of
extreme hypoglycaemia, together with the lack of insights or knowledge regarding the vital
clinical strategic measures for hypoglycaemia avoidance.
Besides, studies show that entire control of this condition with exercise has registered
mixed outcomes in type 1 diabetes studies, with a faction of it showing benefits and others do
not due to resistance or aerobic training (Carolan-Olah, 2016). Therefore, it must be
recommended at this point and noted that for overall glycaemic control to be enhanced
considering Michael's situation, he must be able to balance food intake skilfully and insulin
dosing to regulate or rather, maintain blood glucose levels within the required range before,
during and after the physical activity/exercise (Perry & Gallen, 2009). Numerous barriers to
safe and efficient exercise participation persist. In this situation, the present and future
technologies and innovations in this area should be recommended, applied and improved to
facilitate Michael to be physically fit or active. The health and initiate reduction of negative
ramifications with this type of diabetes occurs due to reduced sporting activities and physical
exercises.
To perfect control of blood glucose levels during exercise, Michael should know
about the factors associated with glycaemic management. These include but not limited to;
participation in changing types of physical activity, the deviation in insulin regimens and

MANAGEMENT OF DIABETES 4
food consumption for exercise; and the need to maintain normal or close to normal blood
glucose levels in the entire time (Gregg, Sattar & Ali, 2016). Regulating and balancing all
these assertions can be overwhelmingly difficult for Michael and perhaps many others, who
might decide rather be less active to shun in particular, hypoglycaemia (Broderick, 2014).
Also, there is what we call the exercise variables that impacts on glucose homeostasis and
these can be the type of intensity and the time or duration of participation. For example, if
Michael participates in aerobics in particular and sprint and resistance training in general; the
outcome can be a wide range of blood glucose responses. The gap between exercise intensity
also affects results, because, with high-intensity activities, there is increased secretion/release
of counter-regulatory hormones, including glucagon and epinephrine which subsequently
causes immediate and a long-term effect on glycaemic balance.
Michael covers 4,500 meters twice a week while jogging, from this, there is no
doubt that putting up with this type exercise is very challenging especially when he has
included insulin intake with his meals. Blood sugar control is not always an easy task
with physical activity like jogging or any kind of aerobics especially for those requiring
significant laps as in the case of Michael. However, it can be done and it is very possible
for Michael to enjoy jogging, when he puts a little more effort and redoubles his self-
study. When Michael maintain being active and committed to jogging regularly,
although it will take a little more strength to balance his blood sugar, he will be able to
learn whatever is going on in his body during the exercise. Jogging and strength-
training (anaerobic exercise) for him might show varied results on the blood sugar, but
the heart rate will rise during both exercises. Aerobic exercise like jogging is powered
by glucose as its primary fuel. Meaning that jogging, running, gardening, cycling, power
yoga or any type of aerobics that raises the heart for a certain lapse of time, will
eventually lower the blood sugar. This is very true in the case of Michael. On the other

MANAGEMENT OF DIABETES 5
hand in any anaerobic activity like sprinting or strength-training that can trigger the
heart rate to go up and down sequentially, will make the muscles to be broken down
thus, more fats burnt and this might increase a person’s sensitivity to insulin while the
body works to repair the muscles (Baker Heart & Diabetes Institute, 2017). So for such
exercises, it is very common to note the rise in a person’s blood sugar because the
insulin in body will majorly in muscles repair. With that said, jogging as a form of
aerobic exercise is absolutely critical for Michael, because primarily it will help him
control diabetes and prevent long-term complications that may occur. Alongside insulin
intake after the jogging, it will make it easy for him to control the blood glucose and
also increase his insulin sensitivity. This means, after this jogging, Michael’s body will
not require as much insulin to process carbohydrate. This is healthy and economical in
the long run. Also maintaining this pace of exercise will not only help him to manage his
diabetes but also inspire healthy habits in him.
Duration of exercise also affects the results; therefore, it is worthwhile for Michael to
know that with prolonged periods of exercise can obviously result into greater blood glucose
utilization and hypoglycaemia risks, and these prolonged sessions of exercise of, ranging
from aerobics to sprints have been demonstrated to exhibit hormonal responses in athletes
with type 1 diabetes (Riddell et al., 2017). The frequency of exercise can also affect results,
meaning doing exercise more than once daily or on more than one day in a row has an impact
on the blood glucose results during the periods of exercise and even afterwards (Evert, et al.,
2014). Suppose Michael is highly trained in aerobics, he can obtain very similar
cardiopulmonary exercise responses as his trained counterparts without diabetes. Similarly,
the effects of physical activity are quite dependent by the nature of the sporting activity,
where times of intensified exercise are interchanged with times of much less exercise; for
example, in Australian football, basketball or volleyball.

MANAGEMENT OF DIABETES 6
Michael might be, in several circumstances, unable to sufficiently change endogenous
insulin levels and have usual hormonal glucose counter-regulation at the periods of his
aerobics. Also, he might be at risks for both hypo and hyperglycaemia both at early and late
stages. For hypoglycaemia, the risks can be very problematic suppose moderate to lively
heart stimulating exercise is done toward the evening or at dusk (Powers et al., 2017). Late
states of hypoglycaemia are activated by the term of activity and the wellness of the person.
Physical exercise enduring over 80 minutes, can twofold the danger of hypoglycaemia,
particularly in teenagers and youthful grown-ups like Michael. Type 1 diabetes control with
physical action may likewise be confounded on account of Michael if distinctive insulin
regimens and conveyance frameworks are made accessible. This is a result of the way that
most insulin regimens rely upon a basal-bolus approach. This is the place insulin siphons
through a quick acting insulin simple customized to create limited quantities of insulin in a
regular premise to meet the basal needs. In some specific clinical research, it was understood
that people with sort 1 diabetes using insulin siphon treatment and undertaking as often as
possible moderate to-high force oxygen consuming activity had less susceptibility to post-
exercise hyperglycaemia in comparison to the several daily injections without triggering the
risks of post-exercise late condition of hypoglycaemia (Mascarenhas et al., 2016). However,
it is also imperative to note that despite the use of the mentioned pump therapies in the place
of multiple daily injections, people like Michael can still undergo a prolonged variability with
regards to glucose profiles at the periods of exercise.
In situations or circumstances where insulin adjustments fail to meet the physical
activity, or when the nature of the activity is prolonged, balancing the intake of carbohydrates
basing on intensity and duration of the physical activity and making sure that insulin levels
circulate effectively can help synchronize blood glucose control thus, preventing
hypoglycaemia (Bergenstal, et al., 2016). Food intake especially carbohydrate among the

MANAGEMENT OF DIABETES 7
persons with type 1 diabetes when they undertake vigorous exercise maybe during
euglycaemia is compared to that in sound partners, with a lot greater reliance on sugar as an
essential sustenance hotspot for moderate to high increased action. This also helps in shifting
lipid oxidation in the times of long exercise (Mascarenhas et al., 2016). But, in the events of
hyperglycaemic exercise, blood glucose and carbohydrate intake are enhanced no apparent
muscle glycogen. Exercise done at times one is injected by insulin peaks increases
dependency on carbohydrate use to curtail hypoglycaemia; however, it does not reduce the
use of muscle glycogen.
A mix of micronutrients is recommended for Michael to use after exercise because it
can effectively thwart later-onset of hypoglycaemia. Also, it is worthwhile to indicate that the
intake of adequate carbohydrate at the times of the exercise, has proven to be very effective
and critical in enhancing physical activity participation and preventing hypoglycaemia. As
already pre-empted in the discussions above, technology is very vital in the endeavours to
control and prevent diabetes. Recently, several technologies have emerged to aid physical
activity in people like Michael living with type 1 diabetes (Mascarenhas et al., 2016). These
include; machines and devices that are responsible for tracking heart rate, expended calories,
the intensity of movement, distance covered together with specific machines including insulin
pumps, progressive glucose monitors and blood glucose monitoring systems. A lot of
interests have also emerged in the application of wearable sensors; with the ability to
measures and scale physiological scenarios like the heart rate, distance covered, calorie used
et cetera et cetera.
Also, many a time, the people with type1 diabetes use cell phone developments like
the applications that can record and apportion data with an assortment of wellness and
wellbeing following destinations. There is a dynamic information originating from triaxial
lower leg accelerometers that can make transmission from home and network using Wi-Fi or

MANAGEMENT OF DIABETES 8
a cell phone to a remotely controlled server for information investigation, assemblage and
writing about the factors like; separation secured, term of the activity or potentially even the
kind of vitality used in case of a movement (Bergenstal et al., 2016). A few machines can
likewise spend significant time in the estimations of nourishment admission, calories in and
out, sugar consumption, measure the heaviness of the body, muscle versus fat, BMI, calculate
power and make the transmission of the results through wireless technology to the online
accounts, have graphs, trends, periodic goals displayed digitally. Therefore, for persons like
Michael with type 1 diabetes accurate calculations or rather, estimations of carbohydrate,
calorie intake, and the energy expenditure during any activity, is very vital for monitoring and
maintaining euglycaemia (Riddell et al., 2017). In these parameters, the glycaemic impacts of
fats and protein are deemed relevant for physical activity. With these modern technical know-
how, despite the fact that is possible to do the estimation of the carbohydrate and other food
intakes with regards to heart rate, the exercise variable like intensity, duration, calorie used
and blood glucose responses, there is still great variability existing because of the potential
effect of other factors including variations in subcutaneous insulin absorption and the
diminishing attributes in the sensitivity of the insulin.
Finally, ketone testing allows adequate warm-up and cool down, wearing appropriate
socks and shoes and drinking plenty of fluids are some other critical parts of type 1 diabetes
management. Ketone testing, in particular, will help Michael to avoid some dangerous
complications, usually short term; for example, it prevents ketoacidosis from happening
(Riddell et al., 2017). Before delving into most of the physiological therapies, it is
recommended that Michael should ensure the continuous supplies of ketone testing in his
prescription.
Part 2

MANAGEMENT OF DIABETES 9
According to (Wright et al., 2009), diabetic ketoacidosis (DKA) is an intense
metabolic state of type 1 diabetes mellitus. Individuals like Sylvie experiencing type 1
diabetes are at more serious dangers for diabetic ketoacidosis than their partners with type 2.
DKA is additionally inclined to assaulting certain ethnic gatherings like those of the West
African plummet. Also, low-income earners are susceptible to this condition than their
counterparts with high income, perhaps because of the economics surrounding insulin intake
(Wrighte et al., 2009). Drug abuse is also another contributing factor when you frequently
smoke green substances or sniff white substances or drink colourless liquids (alcohol in
particular), your insulin become less. The substances can also trigger the production of anti-
insulin hormones thus, propelling the body in the direction of DKA. So, these are important
areas to note even before any advice are unleashed.
With that said and done, the good news is that DKA is preventable by simply
adhering to a certain set of specific and simple guidelines or rules for that matter. So, the
entire advice to Sylvie is pegged upon the very parameters of following these simple rules.
First off, the reason why people can easily get DKA is that most a time, they tend to forget
that diabetes can make someone sick. So, to help Sylvie remember, as an expert and educator,
I must recommend sick-day rules, some of which are highlighted in the sick-day management
plan developed in the paper below. It has a list of guidelines intended to thwart any
occurrence of DKA (Diabetes Australia, 2016). Essentially, for her to stay out of the hospital,
she must continuously eat, drink clean water, check her blood glucose, and take the
prescribed medications. It is also imperative to know when to seek further medical help or
attention. Because Sylvie is sometimes feeling nauseated and vomit, she cannot hydrate
herself. Therefore, it is important that she goes to the clinic for intravenous liquids; including
insulin itself. In the event that she is got dried out insulin can't ingest through the skin;
therefore, appropriate therapies must be considered.

MANAGEMENT OF DIABETES 10
Currently, the hospitals in Australia have made great strides in adopting the advanced
methods of treating DKA; in fact, only one per cent of the adults with DKA who are
subjected to proper care end up dead from it. Also, there is a lack of long-term complications
from this condition, so getting insulin appropriately makes one better. But, because Sylvie's
condition has not advanced to this stage of DKA, just adhering to the above pieces of advice
makes her worry not. Lack of insulin makes cells to undergo starvation because they are
simply deprived of any glucose from the blood. However, naturally, the body has got some
counter-regulatory mechanisms to ensure that, even in the absence of glucose, the cells can
extract fuel or energy from somewhere; known as fat and protein as discussed in the case of
Michael (Riddell et ., 2017). However, for the body to tap into these alternative fuel sources,
there must be some ramifications. Breaking down of fat for energy manufactures a by-
product known as ketone bodies which are left behind, as a tiny acidic molecule.
These acidic molecules are responsible for the naming of DKA. Perhaps it can take
only some few hours for these ketone bodies to build up and acidify the entire body in the
absence of an adequate supply of insulin. The body is supposed to exhibit a very narrow pH
range, and if the pH gets too acidic, then the cells get dysfunctional, and they don't perfume
their tasks as they are supposed to. Like glucose molecules, these ketone bodies can also pull
over into the urine, which is the reason why ketone strips can be used to detect DKA (Baker
Heart & Diabetes Institute, 2017). Also, blood ketone strips can be used as an early warning
that DKA is on the way. This is why it is important that Sylvie gets to the hospital as early as
now to verify these conditions and to get help on how to thwart or prevent her condition from
proceeding to DKA.
Ketoacidosis, in combination with dehydration, can be deadly. In spite of the fact that
demise from DKA is extremely uncommon, it very well may be progressively regular in kids
with type 1 diabetes, frequently happening from cerebral oedema (Inzucchi et al.,2015). This

MANAGEMENT OF DIABETES 11
is a swelling of the cerebrums that is probably going to occur during the treatment when
liquids get into the mind. Such circumstances and conditions can decimate synapses and
prevent the individual from relaxing. Grown-ups with type 1 diabetes may create DKA since
ailment is straightforwardly corresponding to the degree of stress; in this way; stress
hormones in the body; these hormones check insulin and raise the degree of glucose levels. In
the case of Sylvie, nausea and vomiting are likely to cause dehydration that can increase the
risks of DKA. Plus, if she doesn't feel like eating, she might obviously forget to take some of
her mealtime insulin, which is terrible and must be avoided at all costs (Baker Heart &
Diabetes Institute, 2017). The good news is that if she adhered fully above discussed rules
and advice, then there is no point of worrying about DKA, she can get right into her new job
without worries. Now, below is Sylvie’s comprehensive sick-day management plan.
Sylvie’s Sick-Day Management Plan
SICK-DAY MANAGEMENT PLAN
When sick, adhere to these guidelines
1. 1. Make sure you check your blood glucose and urine ketones every two or four hours. Test
for ketone if unwell, and the results must be interpreted in these regards;
 Under 0.6mmol / means normal level
 0.6 to 1.5mmol/L means higher than normal, need to test again
 1.6 to 3.0mmol/ means the risk of ketoacidosis
 Above 3.0mmol/L means need to hospital admission
2. 2. Take insulin continuously, even if you feel too sick to eat. This is because of the simple
and accurate fact that a sick body requires adequate insulin
3. 3. Keep your body hydrated through intake of caffeine-free fluids every hour, normally

MANAGEMENT OF DIABETES 12
8ounces per hour. Avoid alcoholic beverages or abuse of any substance, green or white.
4. Also, take fluids with carbs in the ratio of insulin intake. However, before insulin intake,
use fluids free of carbs, since this will act as regulatory mechanism for keeping your
body hydrated while managing the blood sugar.
5. 4. Continue with the intake of calories even if you are nauseated, vomiting or your blood
glucose levels are high. This can be done effectively by alternating 8 ounces of sugar-free
fluids per hour. Suppose, you are vomiting with moderate to high ketones then, it is
appropriate and advisable to visit the emergency room.
6. 5. Seek for your provider if blood glucose shoots above 250mg/dl for six or more hours or if
your urine ketones are above 3.0mmol/L. Record the readings for glucose and ketone
symptoms for your provider.
Figure1.0 Shows Sylvie’s Sick-Day Management Plan
Conclusion
While various strides have been made to allow individuals with type1 diabetes to
progress in the direction of dealing with their blood glucose levels during different physical
exercises, it is likewise still a long way from completely abridging the dread of such like
maladies and conditions. Innovation is assuming a focal job in these undertakings however
significantly more should be finished concerning the two cases examined in this paper. It is
profoundly plausible and prescribed that the use of present and future advancements will
really help more people managing type 1 diabetes. Therefore, moving into the future, there
should be full integration of the appropriate technologies into the management and
controlling of blood glucose levels. Also, the technology should be designed in such a way
that it can help in the creation of awareness both for the people with diabetes and those
without to help in dispensing the appropriate information regarding the disease.