Reference no: EM133266500

Case: You are the clinical exercise physiologist for a 55-year-old man (DD) recently diagnosed with Type II diabetes. He is 5' 10" (178 cm) and weighs 220 lb (100 kg); BMI = 31.6 kg/m2 with an HbA1C of 6.6%. He has no diabetes-related complications (e.g., peripheral or autonomic neuropathy), no other co-morbidities, and is taking no medications. A cardiopulmonary stress test (CPT) on a cycle ergometer reveals a normotensive exercise response and unremarkable EKG with no arrhythmias or ST segment changes. His peak HR is 160 bpm and his VO2max is 28.0 mL/kg/min with a 200 W peak.

DD is trying to improve his glycemic control and lose weight via diet and exercise. For the last four months, he has been walking at a moderate pace for 30 min x 3 d/wk on his own.

You have been working with DD for two weeks and have put him on a low carbohydrate, high fat, ketogenic diet (LCHF) in which he consumes < 20 g carbohydrate (CHO) per day. He has tolerated the diet well and has noticed that his fasting blood glucose in the morning before breakfast is now around 110 mg/dL instead of the 145 mg/dL that was typical before beginning the LCHF diet.

He comes to your facility to exercise four days per week at 1300 (1 pm), several hours after his mid-morning LCHF meal. For the first two weeks of his LCHF diet, his blood glucose has been in the 105-110 mg/dL range at the beginning of his exercise sessions; the sessions have gone well with no symptoms or hypoglycemic responses. Today on arrival, his blood glucose is 90 mg/dL (5 mM/L) and his blood ketones are 1.5 mM/L.

Question: Given all of the above information (diet, exercise history, blood glucose), does DD need to ingest supplemental CHO before today's moderate-intensity continuous cardiopulmonary workout, and if so, how much?