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Hypoglycemia And Exercise Intensity

Exercise Strategies For Hypoglycemia Prevention In Individuals With Type 1 Diabetes

Exercise Strategies For Hypoglycemia Prevention In Individuals With Type 1 Diabetes

Go to: The Difference Between Aerobic and Anaerobic Exercise By definition, aerobic exercise (e.g., swimming, jogging, cycling, or walking) involves the continuous and repeated movements of large muscle groups for at least 10 minutes at a time (24). The initial stages of this type of exercise are fueled mostly by muscle glycogen, after which glucose and nonesterified fatty acids become the main source of fuel. In individuals without diabetes, insulin release from pancreatic β-cells decreases, and glucagon secretion increases during moderate-intensity aerobic exercise. These changes ensure that fatty acids (stored in adipocytes) and glucose (stored mainly in the liver as glycogen) are released from storage to fuel the exercising muscles. As a result, blood glucose levels can remain relatively stable during exercise for several hours without food intake. For individuals with type 1 diabetes, the lack of β-cell function leads to the requirement for exogenous insulin (introduced into the body by injection or infusion). Circulating levels of insulin consequently cannot be regulated endogenously and depend on the quantity and timing of insulin taken by the individual before exercise. Insulin levels are often higher than they would be in the absence of diabetes, which has the result of limiting glucose production by the liver while stimulating glucose uptake by muscle, adipose, and liver cells for storage. As a result, blood glucose levels often decrease dramatically during physical activity for individuals with type 1 diabetes unless carbohydrates are consumed before, during, and after exercise. As exercise intensity increases, the relative roles of insulin and glucagon decrease (25). Glucose breakdown becomes rapid and exceeds the capacity of the oxidative systems. This re Continue reading >>

Intermittent High-intensity Exercise: Higher Now, Lower Later?

Intermittent High-intensity Exercise: Higher Now, Lower Later?

In a previous column, we talked about how insulin action is affected by many different factors. The one with the biggest impact is the amount of glycogen stored in skeletal muscles and how that is impacted by regular physical activity. This week, though, we need to discuss the impact of high-intensity exercise and how the resultant glycogen content may impact blood sugars differently over a longer period of time. It is well established that high-intensity exercise can raise blood glucose levels in people with both types of diabetes, albeit temporarily. Recently published research studied the impact of doing short sprints interspersed during a longer bout of moderate exercise in subjects with Type 1 diabetes. In that case, a higher exercise intensity done intermittently (such as during sports requiring a stop-and-start action like tennis and soccer) allowed for blood glucose levels to be maintained more effectively — and even rise some due to the greater release of glucose-raising hormones — during and for at least two hours following that activity1. You may also remember that doing a 10-second sprint at the end of moderate exercise has a similar ability to maintain blood glucose levels for a couple of hours post-exercise2. What has not been fully researched, though, is what happens to the glycemic balance hours later after participating in such activities. How are blood sugar levels affected by the higher-intensity work (albeit short-lived and intermittent) over the longer term? In a very recent study, researchers assessed the glucose responses of patients with Type 1 diabetes during and for 20 hours after completing two different types of exercise using continuous glucose monitoring3. The subjects either underwent 30 min of intermittent high-intensity exercise (IHE Continue reading >>

Low Blood Sugar Levels During Exercise: Is Non-diabetic Hypoglycemia Threatening?

Low Blood Sugar Levels During Exercise: Is Non-diabetic Hypoglycemia Threatening?

Hypoglycemia is the term used for defining low blood sugar levels, and when we’re talking about non-diabetic hypoglycemia, we refer to below normal values of blood sugar that occur in people who aren’t affected by diabetes. The symptoms of hypoglycemia can vary from one person to another, and can be accentuated by certain factors such as the lack of sleep, fasting or dehydration. Triggers of hypoglycemia in non-diabetic people can be very different, but today we’ll only discuss about exercise-induced low blood sugar levels, and we’ll try to understand why this symptom occurs, how threatening it is and how it can be prevented and managed. Exercise can decrease one’s blood sugar levels, but in healthy people the hypoglycemic episode is only temporary. If you constantly experience low blood sugar levels after or during exercise, it may be wise to schedule an appointment with your doctor and get tested for diabetes. Problems with the adrenal and pituitary glands, as well as liver problems, may also trigger hypoglycemic episodes, so it’s important to exclude any potential health issue from the list. Back to exercise-induced hypoglycemia: you probably experienced it several times after strenuous exercise, so the symptoms may sound very familiar. Hypoglycemia manifests through dizziness, headaches, inability to focus, shaking, sweating, blurred vision, irregular heartbeats, and even loss of coordination, anxiety and seizures if you don’t restore the glycogen reservoirs fast after the first symptoms occur. Why do these manifestations appear when exercising? Your body relies on glucose as its main fuel, so this form of sugar is the first one used by the organism for producing energy during exercise. The muscles and brain require glucose to function properly, and gl Continue reading >>

Exercise As It Relates To Disease/preventing Hypoglycemia In Type 1 Diabetics During And After Exercise

Exercise As It Relates To Disease/preventing Hypoglycemia In Type 1 Diabetics During And After Exercise

Type 1 diabetes is a chronic disease in which the beta cells of the pancreas are destroyed and cannot produce insulin, the hormone that is responsible for the uptake of glucose from the blood.[1] Type 1 diabetes accounts for around 10 to 15% of all diabetics with over 16 million people worldwide diagnosed with the disease.[2] Regular insulin injections are required to increase the amount of glucose extracted from the blood and utilized within the body for energy. Hypoglycemia is a state of low blood glucose in which circulating blood glucose levels drop below 3.5 mmol/l.[3] Hypoglycemia may occur as a result of excessive insulin dosages, low glucose intake eg: missing a meal or not eating enough carbohydrates and/or participating in prolonged or unplanned exercise.[4] Severe hypoglycemia can lead to seizures,coma and death. Shaking, Trembling & Quivering Abnormal Heart Beat Anxiety & Arousal Paleness & Sweating Increased Appetite Tingling & Numbness Increased Body Temperature Weakness & Fatigue Confusion Behavioural changes Involuntary Crying Participation in exercise generally increases the risk for type 1 diabetics to develop hypoglycemia during exercise and up to 24 hours after completion.[6] The body becomes more sensitive towards insulin causing insulin to be utilized at a greater rate, this can lead to an abrupt drop in blood glucose levels. In healthy individuals the body has mechanisms that counteract this problem these are known as counterregulatory responses. Healthy counterregulatory responses to lowering blood glucose levels show a decrease in insulin production and an increase the production and release of glucose. In type 1 diabetics these counterregulatory responses are diminished as the body is not able to decrease the amount of synthetic insulin adminis Continue reading >>

Diabetes, Exercise And Competitive Sports

Diabetes, Exercise And Competitive Sports

Sports Science Exchange 90 VOLUME 16 (2003) NUMBER 3 Diabetes, Exercise and Competitive Sports Peter A. Farrell, Ph.D. Department of Exercise and Sport Science East Carolina University Greenville, NC 27858 KEY POINTS People with diabetes mellitus—rapidly approaching one-third of the US population—either cannot produce insulin (Type 1 DM) or the insulin they produce is ineffective in stimulating the uptake of blood sugar (glucose) into the body’s cells (Type 2 DM). Accordingly, if diabetes is untreated, blood sugar rises to dangerously high levels that can eventually cause blindness, nerve damage, and other complications. Blood sugar can be controlled by the appropriate administration of insulin and other drugs and/or by the manipulation of dietary carbohydrate and exercise. During exercise, the contracting muscles produce their own insulin-like effect, causing the rapid uptake of glucose from the blood. In people without diabetes, the body naturally reduces its production of insulin to compensate; otherwise, blood glucose would fall precipitously. (A low blood glucose concentration is known as hypoglycemia.) Those with Type 1 DM (and those with Type 2 DM who use insulin to control their blood sugar) must adjust their pre-exercise insulin dosage and their carbohydrate intake before, during, and after exercise to avoid becoming hypoglycemic. Regular exercise training is usually beneficial for those with diabetes because exercise can reverse many of the adverse metabolic effects of the disease, including the likelihood of becoming obese. Although precautions must be taken, athletes with uncomplicated diabetes (no other serious diseases) have become champions at elite levels in a wide variety of sports. INTRODUCTION Regular exercise is highly recommended for many peop Continue reading >>

First-ever Guidelines On Safe Exercising With Type 1 Diabetes!

First-ever Guidelines On Safe Exercising With Type 1 Diabetes!

As a person with type 1 diabetes who exercises regularly, I can tell you it's pretty much of a guessing game. I have some strategies that I use to keep my glucose in range for my spin class, aerobics, kick box, hiking and other workouts, but they are far from fool-proof -- and I've yet to find any really solid advice on BG management during these sweat-fests. So I for one am really intrigued to see the first-ever official guidelines on managing exercise with T1D published in The Lancet journal last week as a 14-page report titled “Exercise management in type 1 diabetes: a consensus statement.” This comes on the heels of the ADA's sweeping 2017 Standards of Diabetes Care, which we just reviewed yesterday. The new info-packed paper honing in on exercise was compiled by an international team of 21 researchers and clinicians, including some familiar names like JDRF's Artificial Pancreas lead Aaron Kowalski, and Drs. Bruce Bode of Atlanta Diabetes Associates, Anne Peters of USC Keck School of Medicine, and Lori Laffel of Joslin Diabetes Center. It offers "guidelines on glucose targets for safe and effective exercising with T1D, as well as nutritional and insulin dose adjustments to prevent exercise-related fluctuations in blood sugar." So what did these experts come up with? Well, let me just say that it's a comprehensive and informative paper -- explaining everything from the physiology of diabetes and exercise and the body's differing metabolic responses to aerobic vs. anaerobic activity, to sports energy drinks and the relative benefits of a low-carb, high-fat (LCHF) diet. Disclaimers, and a Green Light The authors are careful to make a few important disclaimers, first and foremost that one-size recommendations do not fit all, so strategies should be built around exer Continue reading >>

Don’t Sweat It! Exercise And Type 1 Diabetes

Don’t Sweat It! Exercise And Type 1 Diabetes

The benefits of exercise are wide ranging. Regular physical activity can help people manage their weight, sleep better, reduce the risk of some diseases, including type 2 diabetes (T2D) and heart disease, and improve overall quality of life—among other proven benefits. People with type 1 diabetes (T1D) can gain the same benefits from exercise as anyone else. Yet studies show that many people with T1D do not engage in regular physical activity owing to a fear of hypoglycemia, or dangerously low blood-glucose levels. Exercise scientists and athletes with T1D alike say that people with T1D can exercise safely and effectively. It’s a matter of observing how your body responds to exercise, learning to balance insulin, food, and physical activity, and using research-supported strategies to minimize the risk of hypoglycemia during and after exercise. Managing hypoglycemia associated with exercise Sheri Colberg-Ochs, Ph.D., professor of exercise science at Old Dominion University in Norfolk, VA, has both professional and personal interests in understanding the risks and benefits of exercise for people with T1D. As an exercise physiologist, Dr. Colberg-Ochs studies the relationship of exercise to diabetes and lifestyle management. She has also lived with T1D for 44 years, while staying fit and active. Dr. Colberg-Ochs notes that the risk of hypoglycemia during and after exercise can be managed. “There’s not a tried and true method that works for everyone. It’s very individual, based on the type of activity and your normal diabetes regimen,” she says, “but you can certainly reduce the frequency of hypoglycemia that’s associated with being physically active.” The risk of hypoglycemia is affected by the type, duration, and intensity of physical activity. Aerobic a Continue reading >>

How To Treat Exercise-related Hypoglycemia

How To Treat Exercise-related Hypoglycemia

Did you know, according to diabetes experts, muscles are responsible for about 90 percent of the body’s use of glucose as fuel? Exercise also affects various hormones which have a direct impact on blood sugar levels. It’s not surprising then, that non-diabetic hypoglycemia (or low blood sugar) is common in frequent exercisers and athletes. If you’ve ever worked out on an empty stomach, you’ve probably experienced the dizziness, muscle weakness and exhaustion of a blood-sugar crash. Understanding how your blood-sugar levels are controlled, and what you can do to prevent these crashes, can help you avoid these symptoms. 1. Understand What Hypoglycemia Is And How Blood Sugar Works The sugar called glucose, which is stored in the muscles and liver, is the primary fuel your muscles use during strenuous activities. As part of a careful balancing act, two hormones are released to try to maintain healthy levels of glucose in the blood, where it can be used readily. Insulin is released into the blood by the pancreas when blood sugar levels are too high, where it bonds with specialized receptors on the cells. Insulin stimulates the cells at these receptors and tells them to absorb glucose. Once these cells respond to insulin, blood sugar levels drop. When blood sugar is too low, however, the pancreas releases glucagon instead. This hormone tells the liver to releases some of its stored glucose into the blood so that can be used as fuel. Exercise puts much higher demands on your muscles, forcing them to utilize more fuel — in much the same way as making your car go faster, or pull a heavy load, will increase how much gas it burns. Overtraining can even cause a permanent shift in this balance by increasing insulin sensitivity, which will make it much more difficult for yo Continue reading >>

Type 1 Diabetes: Exercise Often Raises Blood Glucose In Type 1 Diabetes

Type 1 Diabetes: Exercise Often Raises Blood Glucose In Type 1 Diabetes

Regular physical activity and exercise are recommended for the general population for overall improved health. However, exercise of moderate intensity increases the risk of hypoglycemia during and following exertion in those with type 1 diabetes mellitus (T1DM). Accordingly, exercise guidelines for T1DM focus on prevention of exercise-induced hypoglycemia. The risk of hypoglycemia may discourage some with T1DM from exercising. Children and youth may be embarrassed by the temporary reduction in coordination and physical performance associated with hypoglycemia and by the fear of letting teammates down while playing. Some parents may discourage their children from normal participation in physical activity and from playing competitive sports because of concern about severe hypoglycemia. However, this fear may reduce a child’s physical activity, which may lead to reduced overall health, reduced enjoyment from exercise, and restricted confidence in meeting the demands imposed by living with a chronic health condition like diabetes. As a result, long-term exercise habits as well as personal growth and psycho-social development may be blunted. Concern with hypoglycemia from exercise is probably even more heightened in those with hypoglycemia unawareness, or the absence of symptoms during hypoglycemia. However, some of these concerns might be allayed by the realization that vigorous exercise tends to raise blood sugars rather than lower it. The fact that vigorous exercise tends to raise blood sugar appears to be relatively unknown to many with T1DM. However, the effect has been confirmed in a number of studies. These studies have identified an exercise threshold that elicits this response. The threshold exercise intensity occurs at or above 80% of a person’s maximum exercis Continue reading >>

The Impact Of Brief High-intensity Exercise On Blood Glucose Levels

The Impact Of Brief High-intensity Exercise On Blood Glucose Levels

Go to: Abstract Moderate-intensity exercise improves blood glucose (BG), but most people fail to achieve the required exercise volume. High-intensity exercise (HIE) protocols vary. Maximal cycle ergometer sprint interval training typically requires only 2.5 minutes of HIE and a total training time commitment (including rest and warm up) of 25 minutes per session. The effect of brief high-intensity exercise on blood glucose levels of people with and without diabetes is reviewed. Results Six studies of nondiabetics (51 males, 14 females) requiring 7.5 to 20 minutes/week of HIE are reviewed. Two weeks of sprint interval training increased insulin sensitivity up to 3 days postintervention. Twelve weeks near maximal interval running (total exercise time 40 minutes/week) improved BG to a similar extent as running at 65% VO2max for 150 minutes/week. Eight studies of diabetics (41 type 1 and 22 type 2 subjects) were reviewed. Six were of a single exercise session with 44 seconds to 13 minutes of HIE, and the others were 2 and 7 weeks duration with 20 and 2 minutes/week HIE, respectively. With type 1 and 2 diabetes, BG was generally higher during and up to 2 hours after HIE compared to controls. With type 1 diabetics, BG decreased from midnight to 6 AM following HIE the previous morning. With type 2 diabetes, a single session improved postprandial BG for 24 hours, while a 2-week program reduced the average BG by 13% at 48 to 72 hours after exercise and also increased GLUT4 by 369%. Conclusion Very brief HIE improves BG 1 to 3 days postexercise in both diabetics and non-diabetics. HIE is unlikely to cause hypoglycemia during and immediately after exercise. Larger and longer randomized studies are needed to determine the safety, acceptability, long-term efficacy, and optimal exerc Continue reading >>

The University Of Western Australia

The University Of Western Australia

Mary B. Abraham, MD,1,2 Raymond Davey, PhD,2,3 Michael J. O'Grady, MBBCh,1,3 Trang T. Ly, PhD,1,2,3 Nirubasini Paramalingam, BSc,1,3Paul A. Fournier, PhD,4 Anirban Roy, PhD,5 Benyamin Grosman, PhD,5 Natalie Kurtz, DrMedVet,5 Janice M. Fairchild, FRACP,6 Bruce R. King, PhD,7 Geoffrey R. Ambler, MD,8 Fergus Cameron, MD,9 Timothy W. Jones, MD,1,2,3 and Elizabeth A. Davis, PhD1,2,3 Background: Sensor-augmented pump therapy (SAPT) with a predictive algorithm to suspend insulin delivery has the potential to reduce hypoglycemia, a known obstacle in improving physical activity in patients with type 1 diabetes. The predictive low glucose management (PLGM) system employs a predictive algorithm that suspends basal insulin when hypoglycemia is predicted. The aim of this study was to determine the efficacy of this algorithm in the prevention of exercise-induced hypoglycemia under in-clinic conditions. Methods: This was a randomized, controlled cross-over study in which 25 participants performed 2 consecutive sessions of 30 min of moderate-intensity exercise while on basal continuous subcutaneous insulin infusion on 2 study days: a control day with SAPT alone and an intervention day with SAPT and PLGM. The predictive algorithm suspended basal insulin when sensor glucose was predicted to be below the preset hypoglycemic threshold in 30 min. We tested preset hypoglycemic thresholds of 70 and 80 mg/dL. The primary outcome was the requirement for hypoglycemia treatment (symptomatic hypoglycemia with plasma glucose <63 mg/dL or plasma glucose <50 mg/dL) and was compared in both control and intervention arms. Results: Results were analyzed in 19 participants. In the intervention arm with both thresholds, only 6 participants (32%) required treatment for hypoglycemia compared with 17 partici Continue reading >>

Blood Glucose Responses To Type, Intensity, Duration, And Timing Of Exercise

Blood Glucose Responses To Type, Intensity, Duration, And Timing Of Exercise

The Big Blue Test (BBT) is an annual initiative by the Diabetes Hands Foundation to raise awareness of the importance of physical activity in managing diabetes. Individuals with diabetes voluntarily exercise and record self-monitored blood glucose levels. During the 2012 BBT, 5,157 diabetic participants (∼90% insulin users) anonymously entered exercise type, intensity, duration, time elapsed since last meal, and blood glucose readings before and after one or more bouts of exercise separately through www.BigBlueTest.org or an iPhone app. Based on a prior BBT (1), exercise choices were walking, running/jogging, cycling, conditioning machines, dancing, and other exercise (nonspecified). Intensity was moderate or vigorous. Duration was ≤10, 11–19, 20–29, or ≥30 min. The timing of exercise after the last meal was 30 min and 1, 2, or ≥3 h ago. Data were reported as mean ± SD. Walking was reported most frequently (48.5%), followed by other exercise (18.7%), running/jogging (11.9%), cycling (8.8%), conditioning machines (6.4%), and dancing (5.7%). Overall, mean blood glucose levels were lower (−31.3 ± 47.1 mg/dL, 16.8%) after exercise, although only 75.8% decreased, 8.8% were unchanged, and 15.4% increased. Walking resulted in the smallest decrease (−25.0 ± 42.4 mg/dL) compared with nonspecified exercise (−33.5 ± 50.0 mg/dL), running/jogging (−40.1 ± 55.1 mg/dL), cycling (−42.4 ± 48.8 mg/dL), conditioning machines (−35.9 ± 48.8 mg/dL), and dancing (−37.4 ± 45.3 mg/dL, P < 0.05). Moderate exercise resulted in a mean decrease of −32.7 ± 44.1 mg/dL, whereas blood glucose only decreased −28.0 ± 53.6 mg/dL after vigorous activity of all durations (P < 0.05). Longer exercise duration generally resulted in increasingly greater decreases in blood Continue reading >>

Diabetes And Exercise

Diabetes And Exercise

Tweet People with diabetes are encouraged to exercise regularly for better blood sugar control and to reduce the risk of cardiovascular diseases. The reason for this is that muscles which are working use more glucose than those that are resting. Muscle movement leads to greater sugar uptake by muscle cells and lower blood sugar levels. Additional benefits of exercise include a healthier heart, better weight control and stress management. Exercise is the common term used to describe any bodily activity that enhances or maintains physical fitness and overall health and wellness. Why is exercise important? As well as strengthening the cardiovascular system and the body’s muscles, many people exercise to keep fit, lose or maintain a healthy weight, sharpen their athletic skills, or purely for enjoyment. Frequent and regular physical exercise is recommended for people of all ages as it boosts the immune system and helps protect against conditions such as: Heart disease Stroke Cancer and other major illnesses In fact, it is known to cut your risk of major chronic illnesses/diseases by up to 50% and reduce your risk of early death by up to 30%. Other health benefits of exercising on a regular basis include: Improves mental health Boosts self esteem/confidence Enhances sleep quality and energy levels Cuts risk of stress and depression Protects against dementia and Alzheimer’s disease Furthermore, exercise is free, can be carried out anywhere at anytime and has an immediate effect on your health. What counts as exercise? In the UK, regular exercise is defined by the NHS as completing 150 minutes of moderate intensity aerobic activity a week. Aerobic activity at moderate intensity basically means exercising at a level that raises your heart rate and makes you sweat. This incl Continue reading >>

Sports And Exercise: The Ultimate Challenge In Blood Sugar Control

Sports And Exercise: The Ultimate Challenge In Blood Sugar Control

by gary scheiner, MS, CDE Sometimes, it amazes me how smart the pancreas really is. It always seems to know what to do to keep blood sugars in range, even under the most challenging circumstances. Having an argument with your partner? It churns out some extra insulin to offset the “fight or flight” response (make that flight only, if you’re smart). Upset stomach keeping you from eating the way you normally eat? Insulin secretion drops off a bit. Can’t resist the aroma of a fresh bagel (something that, in my opinion, was forged by the Diabetes Devil himself)? Pancreas cranks out just enough to cover it. Participation in sports and exercise presents a special challenge. That’s because physical activity can affect blood sugar in multiple ways. With increased activity, muscle cells become much more sensitive to insulin. This enhanced insulin sensitivity may continue for many hours after the exercise is over, depending on the extent of the activity. The more intense and prolonged the activity, the longer and greater the enhancement in insulin sensitivity. With enhanced insulin sensitivity, insulin exerts a greater force than usual. A unit that usually covers 10 grams of carbohydrate might cover 15 or 20. A unit that normally lowers the blood sugar by 50 mg/dl might lower it by 75. Some forms of physical activity, most notably high-intensity/short duration exercises and competitive sports, can produce a sharp rise in blood sugar levels followed by a delayed drop. This is due primarily to the stress hormone production or “adrenaline rush” that accompanies these kinds of activities. Let’s take a look at these two different situations in greater detail. aerobic activities Most daily activities and aerobic exercises (activities performed at a challenging but sub-m Continue reading >>

Exercise-induced Non-diabetic Hypoglycemia

Exercise-induced Non-diabetic Hypoglycemia

If you experience headaches or dizziness when exercising, you may be experiencing hypoglycemia, or low blood sugar levels. Your body converts food into glucose, a type of sugar, and uses it for immediate energy needs or stores it in your muscle and liver cells as glycogen to use between meals or during exercise. Exercise, especially strenuous exercise, can deplete glycogen stores and cause you to experience symptoms of hypoglycemia. Video of the Day When you begin your workout, your body takes glucose in your bloodstream or glycogen in your liver and uses it to propel your muscles. After 15 minutes, you rely on liver glycogen stores. When those are depleted, you turn to fat as an energy source. An unfit person consuming 45 percent of her calories from carbohydrates, stores 100 grams of glycogen in her liver. At a moderate exercise pace, you burn 1 gram of glucose per minute and would theoretically completely diminish your glycogen stores after 1 hour and 45 minutes of exercise. Hypoglycemia's Effect When glycogen stores are depleted, you also experience hypoglycemia. According to the University of Maryland Medical Center, your brain relies on glucose for fuel, so without sufficient amounts, you can experience dizziness, sweating, blurred vision, headache, loss of coordination, anxiety, irritability and heart palpitations. If you don’t get more sugar into your system, it can lead to seizures, coma, permanent brain damage and even death. Eat complex carbohydrates before working out if you are prone to symptoms of low blood sugar. Complex carbohydrates include whole-grain breads, cereals and pastas and vegetables. While exercising for long periods, eat or drink simple carbohydrates, such as sports drinks and pretzels. The University of Maryland Medical Center states that Continue reading >>

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