Hypoglycemia: strategies to limit it in susceptible subjects
From several studies it appears that the risk of developing hypoglycemia (blood glucose < 3.5 mmol /l or < 63 mg/l) is highly individual: some athletes are very prone to develop it and others are much more resistant.
A strategy to minimize glycemic and insulinemic responses during exercise is to delay carbohydrate ingestion just prior to exercise: in the last 5-15 min before exercise or during warm-up (even though followed by a short break).
- Warm-up and then exercise increase catecholamine concentrations blunting insulin response.
- Moreover, it has been shown that ingestion of carbohydrate-containing beverages during a warm-up (even if followed by a short break) does not lead to rebound hypoglycemia, independent of the amount of carbohydrates, but instead increases glycemia. When carbohydrates are ingested within 10 min before the onset of the exercise, exercise will start before the increase of insulin concentration.
Therefore, this timing strategy would provide carbohydrates minimizing the risk of a possible reactive hypoglycaemia.
In addition, it is possible to choose low glycemic index carbohydrates that lead to more stable glycemic and insulinemic responses during subsequent exercise.
An intriguing observation is the lack of a clear relation between hypoglycaemia and its symptoms (likely related to a reduced delivery of glucose to the brain). In fact, symptoms are often reported in the absence of true hypoglycemia and hypoglycemia is not always associated with symptoms. Though the cause of the symptoms is still unknown, it is clearly not related to a glycemic threshold.
Some athletes develop symptoms similar to those of hypoglycemia, even though they aren’t always linked to actual low glycemia. To minimize these symptoms, for these subjects an individual approach is advisable. It may include:
- carbohydrate ingestion just before the onset of exercise or during warm-up;
- choose low-to-moderate GI carbohydrates that result in more stable glycemic and insulinemic responses;
- or avoid carbohydrates 90 min before the onset of exercise.
Jeukendrup A.E. Carbohydrate feeding during exercise. Eur J Sport Sci 2008:2;77-86. doi:10.1080/17461390801918971
Jeukendrup A.E., C. Killer S.C. The myths surrounding pre-exercise carbohydrate feeding. Ann Nutr Metab 2010;57(suppl 2):18-25. doi:10.1159/000322698
Mahan L.K., Escott-Stump S.: “Krause’s foods, nutrition, and diet therapy” 10th ed. 2000
Moseley L., Lancaster G.I, Jeukendrup A.E. Effects of timing of pre-exercise ingestion of carbohydrate on subsequent metabolism and cycling performance. Eur J Appl Physiol 2003;88:453-8. doi:10.1007/s00421-002-0728-8
Shils M.E., Olson J.A., Shike M., Ross A.C.: “Modern nutrition in health and disease” 9th ed. 1999