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Exercise-Related Hypoglycemia in Type 2 Diabetes Treated With Oral Glucose-Lowering Medications

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	Presentation

 
D.L. is a 58-year-old African-American man and business executive who was diagnosed with type 2 diabetes at the age of 52 years. In addition to diabetes, he has a history of hypertension and coronary artery disease (CAD). The diagnosis of CAD was made in late 2005, after D.L. experienced an episode of chest pressure and shortness of breath while at work.

He consulted his primary care physician, who referred him for a cardiovascular evaluation to assess probable myocardial ischemia. The evaluation included a graded exercise test with thallium nuclear imaging, which revealed ischemic changes with exercise and reduced exercise tolerance. Coronary arteriography showed occlusion of the left anterior descending branch of the coronary artery (LAD), and angioplasty of the LAD with stent placement was performed. D.L. was referred to cardiac rehabilitation for an exercise and lifestyle change program.

D.L. had completed 2 months of supervised exercise when he returned to his primary care physician after experiencing hypoglycemia both during and after exercise. Before this time, progression of his physical activity program had been excellent. He was exercising three mornings per week from 7:30 to 8:30 A.M. in the rehabilitation program and was walking 30-45 minutes on weekend days. Hypoglycemia was now a safety concern for both D.L. and the cardiac rehabilitation staff and was a barrier to further progression of his exercise program.

On examination, D.L.'s height was 6 feet, 2 inches, and his weight was 215 lb (BMI 27.6 kg/m²). He had lost 15 lb in 2.5 months by consistently . . . [Full Text of this Article]

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