The nurse has reinforced home care measures to a client diagnosed with diabetes mellitus regarding exercise and insulin administration. Which statement by the client indicates a need for further teaching?

• A. I should perform my exercise at peak insulin time.
• B. I should always carry a quick-acting carbohydrate when I exercise.
• C. I should always wear a Medic-Alert bracelet especially when I exercise.
• D. I should avoid exercising at times when a hypoglycemic reaction is likely to occur.

Answer: (A)

Exercising with diabetes can lower blood glucose because muscles use glucose more for energy and insulin sensitivity increases during activity. This makes timing of insulin important: doing exercise when the insulin is at its peak means there is the greatest insulin effect during activity, which can cause blood glucose to plummet and lead to hypoglycemia.

That is why performing exercise at peak insulin time is the statement that indicates a need for further teaching. It’s safer to schedule activity when insulin action is not at its peak, or to adjust meals, carbohydrate intake, or insulin dosing around exercise to prevent lows.

Carrying a quick-acting carbohydrate during exercise is helpful because it provides an immediate option to treat any hypoglycemia that might develop. Wearing a Medic-Alert bracelet is prudent so others know you have diabetes in an emergency. And avoiding exercise when a hypoglycemic reaction is likely is sensible—planning around glucose status helps keep activity safe. If exercising when insulin is active is unavoidable, monitoring glucose closely and having a plan to counteract potential lows is essential.