DIABETES MELLITUS

Brief History. W.S. is an 18-year-old woman who began experiencing problems with glucose metabolism following a viral infection when she was 12. She was subsequently diagnosed as having type 1 DM. Since then, her condition has been successfully managed by insulin administration combined with dietary control. Once-daily administration of intermediate-acting insulin combined with periodic administration of short-acting insulin usually provides optimal therapeutic effects. She is also very active athletically and was a member of her high school soccer team. She is entering her fi rst year of college and is beginning preseason practice with the college’s soccer team. The physical therapist who serves as the team’s athletic trainer was apprised of her condition.

Problem/Influence of Medication. Exercise produces an insulinlike effect; it lowers blood glucose by facilitating the movement of glucose out of the bloodstream and into peripheral tissues. Because insulin also lowers blood glucose, the additive effects of insulin and exercise may produce profound hypoglycemia. As a result, a lower dosage of insulin is usually required on days that involve strenuous activity. The physical therapist was aware of this and other potential problems that could arise.

1. What instructions should the therapist give W.S. about monitoring and adjusting her blood glucose levels?

2. What precautions should the therapist have in place during practices?

3. How can the therapist help guard against any problems that might arise after practice?