Do you have Diabetes?

Do you take Insulin or other medication for your Diabetes? (excluding metformin)
Are you attending rehabilitation in a physiotherapy department ?
If you answered YES to all the above questions the following information is for you.

The increase in activity working with the physiotherapists can cause your blood sugar levels to drop quickly. If they go below 4mmol/l this is called a ‘hypo’. You are at more risk of a hypo when you are doing exercise.

The exercise level needed to participate in a rehab group may be a lot more than you are used to.

For some of you it may have been a long time since you were exercising, for others it may only have been a few weeks but the effect on your blood sugars can be great.

To get the most out of your visit to the Physiotherapy department your blood sugar level needs to be under control.

How to prevent blood sugar problems with rehabilitation 

  • Hypos can happen up to 36 hours after strenuous or prolonged physical activity, so you might need to adjust your medication or carbohydrate intake to compensate. (E.g. consider a bed time snack)
  • For planned exercise, reducing your insulin would be the preferred choice, while additional carbohydrate would be needed for unplanned exercise. Your diabetes healthcare professional will be able to help with what works best for you.
  • Do not inject insulin into your leg if you are going to be walking or exercising the leg muscles within the next 12 hours (muscle use increases the rate the insulin is absorbed)
  • Do not attend for your appointment if you are unwell. Please contact the centre if you are unable to attend
  • Be aware that anxiety or worrying about the rehabilitation process can make your blood sugar levels drop more than you would expect
  • Remember that the DVLA states that following a hypo you must wait for 45 mins after your blood sugars have returned to above 5mmol/l before driving again.
  • Your blood glucose levels should be reading between 8 and 15 before starting your rehab Session
  • Bring appropriate food with you in case your blood sugar   levels drop—see overleaf. Avoid chocolate and fatty foods as they can cause you to gain weight.

Blood sugar levels

If less than 5mmol/l take 20g of carbohydrates before getting active and wait until blood sugar is over 5mmol/l before starting your exercise.

5-8mmol/l take 10g of carbohydrates.

8-15mmol/l you can begin to exercise.

15mmol/l and above - check your blood ketone levels.

No ketones - then you may start to exercise but may need a small correction dose of insulin. If ketone level is below 1mmol/l you may need a small correction dose of insulin and continue to check blood sugar levels.

Ketones between1-1.4mmol/l, take correction dose insulin but you must wait 1 hour before you begin to exercise. Ketones above 1.5. You must contact your GP, diabetic specialist nurse or go to A&E.

How can you recognise when your blood sugar is getting too low?

You may feel some of these symptoms
  • Short tempered or cross
  • Shaky
  • Sweaty
  • A bit confused
  • Heart beat racing or slow
  • Difficult to concentrate
  • Feel hot
  • Feel sick
  • Feel hungry
  • Eyesight blurred

Confirm it by testing your blood sugar levels with a monitoring kit from the physio department or your own Freestyle Libre system. As the Libre measures the glucose in the fluid around your body cells there can be a short delay, especially if you are exercising or just eaten. Therefore the finger prick test can be more time accurate.

If it is below 4mmol/l you are having a ‘hypo’

What to do if you have a hypo

Immediately treat with a 15–20g of a short-acting carbohydrate such as:

  • 200ml full sugar fizzy drink such as cola or lemonade
  • 200ml of fruit juice
  • Lucozade (only 100ml )
  • five sweets, e.g. jelly babies
  • 4 teaspoons of sugar in warm water

Check your blood sugar again after 10-15 minutes and if still low repeat the treatment. Once returned to above 4mmol/l take 10-20g longer acting carbohydrate (see below)

Follow-on treatment

To prevent your blood sugar levels dropping again, you will need a follow-on snack of 10g–20g of a longer-acting carbohydrate such as:

  • half a sandwich or slice toast
  • Fruit (banana, apple etc.)
  • a large bowl of cereal or 1 weetabix
  • 2 digestive biscuits
  • 200ml of milk or 1 yoghurt (15g)
  • the next meal, if due

Please discuss any concerns regarding your diabetes and rehabilitation with your physiotherapist or specialist diabetic nurse.

You may find these websites and contacts useful:

www.diabetes.org.uk
Helpline phone: 0345 1232399. Open Monday to Friday from 9am to 6pm. Physical Activity Helpline Advisor—ask for Francesca

www.dafne.uk.com

https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/driving

Confidentiality

‘The Trust’s vision is to keep your information safe in our hands.’ We promise to use your information fairly and legally, and in-line with local and national policies. You have a right to understand how your information is used and you can request a copy of the information we hold about you at any time.

For further information on confidentiality contact the Information Governance Team:

Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

pals@ncic.nhs.uk | 01228 814008 or 01946 523818

If you would like to raise a complaint regarding your care, please contact the Complaints Department:

complaints@ncic.nhs.uk | 01228 936302