The physician has ordered that a daily exercise program be instituted by a client with type I diabetes following his discharge from the hospital. Discharge instructions about exercise should include which of the following?

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-2)

Explanation

Exercise increases glucose uptake by the muscles, which can lead to hypoglycemia (low blood sugar) in individuals with type 1 diabetes.
Consuming a carbohydrate snack before or during exercise provides an external source of glucose to fuel the activity.
This practice helps prevent a significant drop in blood glucose levels, ensuring the client can exercise safely.
The amount and timing of the snack depend on the intensity and duration of the exercise, as well as the pre-exercise blood glucose level.

Option A: Exercising just before a meal, when blood glucose may be at its lowest point between meals, significantly increases the risk of hypoglycemia.
Option C: The primary concern after exercise in type 1 diabetes is delayed-onset hypoglycemia, which can occur up to 24 hours later as muscles replenish their glycogen stores. Delayed hyperglycemia is not the typical response.
Option D: This is dangerous advice. Starting exercise with a blood glucose level of 100 mg/dL or less poses a very high risk of developing severe hypoglycemia during the activity.

Clinical Relevance

Nursing practice connection: Use the key finding related to Exercise Management in Type 1 Diabetes to guide bedside assessment, documentation, and the next nursing action.
Patient education on exercise is a critical nursing responsibility to prevent life-threatening hypoglycemia and promote safe self-management of diabetes.
Nurses must teach patients to recognize the signs of hypoglycemia (e.g., shakiness, sweating, confusion) and to always carry a source of fast-acting carbohydrates during exercise.
What if the client engages in high-intensity anaerobic exercise (like sprinting or heavy weightlifting) instead of moderate aerobic exercise? The nurse should explain that this type of activity can sometimes cause an initial increase in blood glucose due to hormonal responses, but the risk of subsequent hypoglycemia still exists.

How to Approach the Question

First, identify the core concept: managing blood glucose during exercise in type 1 diabetes.
Recall the physiological effect of exercise: it increases muscle uptake of glucose, which lowers blood sugar.
Recognize that in type 1 diabetes, injected insulin continues to work, compounding the glucose-lowering effect of exercise. This makes hypoglycemia the primary risk.
Evaluate each option based on patient safety. The correct answer will be the one that mitigates the risk of hypoglycemia.
Option A (exercise before meals) and Option D (start with BG ≤100) both increase the risk of hypoglycemia, so they are incorrect.
Option C misidentifies the primary delayed risk (it's hypo-, not hyperglycemia).

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 2 p. 1110-1112

Practise the full NORCET 5 Prelims - Sept 2023 (Shift-2)

Attempt every question from this paper in a timed mock, then review the full solution for each one.