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May 19, 2004

Exercise and Sports, Hypoglycemia

Question from Camden, Tennessee, USA:

I have a 14 year old son who has recently been diagnosed with type 2 diabetes and complex partial seizures. He is taking Glucophage and his A1c has come down from 8.0 to 5.4. He is very athletic and plays football and baseball. Recently, he has had a few hypoglycemic attacks while playing sports. His lowest blood sugar was 55 mg/dl [3.1 mmol/L], but he was severely confused and will sometimes have seizures. What are the best snacks to give him while he is playing ball to keep him from having these attacks? We give him sports drinks and they keep him elevated most of the time.

Answer:

You should feel comfortable raising your questions to your own diabetes team. Glucophage typically does NOT lead to hypoglycemia when used alone! In fact, Glucophage is NOT a hypoglycemic agent; it is an anti-hyperglycemic agent. It does not tend to cause the blood sugars to go down, but rather prevents them from going up by limiting the amount of glucose manufactured by the liver.

So, a combination of decreased food intake or increased exercise and another oral agent or insulin in conjunction with Glucophage is a more likely scenario to cause a low glucose. Perhaps he is SO athletic that the use of Glucophage is a bit much for him now.

While I would suggest adding some extra protein to his meal plan, I think you should talk to his regular diabetes team in case they need to reassess the dosing of Glucophage. (You sure it’s Glucophage alone and not a combination tablet or a similar sounding material called Glucotrol?)

DS
Additional comments from James Michael Schurig, RD, LD, CDE:

Usually most younger athletes don’t feel like bulking up on extra carbohydrate foods, via an extra snack or meal, before prolonged activity. Sports drinks can provide carbohydrates to prevent exercise induced hypoglycemia, but sometimes a combination of carbohydrate and protein together, such as you would find in a granola bar, would prevent hypoglycemia for a more sustained period. Frequent monitoring of blood sugars pre and post exercise will allow you to modify carbohydrates and/or protein as needed to achieve the desired blood sugar goal.

JMS