From New York, USA:
My 13-year-old son, diagnosed at age three, has a health care plan for school that is approved yearly by his diabetes team. It has, for the past six years, indicated that he should not exercise if his blood glucose level is 300 mg/dl [16.7 mmol/L] or above, without ketones and this approach has been approved by his endocrinologist and/or CDE. At the most recent review of this plan, his CDE has indicated that he SHOULD exercise (participate in physical education class) even with a blood glucose that is 300 mg/dl [16.7 mmol/L] or above as long as there are no ketones present. We always check for ketones with a blood glucose level of 240 mg/dl [13.3 mmol/L] or above. I have read in several places that exercising with substantially elevated blood glucose (300 mg/dl [16.7 mmol/L] or above) is not recommended due to the possibility of developing ketones. What is the recommended practice for exercise with elevated blood glucose without ketones?
There is some disagreement on this point, but most would say if the blood sugar is elevated, above the 240 mg/dl [13.3 mmol/L] to 250 mg/dl [13.9 mmol/L] range, check ketones. If ketones are positive, take extra insulin and do not exercise since the muscle, by definition, is receiving inadequate insulin and, therefore, inadequate energy/glucose utilization. This would send a message metabolically to try to increase glucose levels because of the initial inadequate insulin effect. In sum, I vote for the initial guidelines and not the new nurses' views.
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