Blogger Round Table Session 6: Staying Fit with Type 1 Diabetes

Moderated by Allison Blass

Exercise is a crucial element of a healthy life with diabetes. Among a myriad of other benefits like burning calories and keeping the heart healthy, exercise also helps the body use insulin more effectively and helps to naturally lower blood sugar levels. People find different ways to stay active–hiking, biking, running, and the old stand-by: the gym. But while exercise has many benefits, it also poses unique challenges to people with diabetes. Adrenaline can increase blood sugar and strenuous exercise can cause late-night low blood sugars. There’s also the question of where to put those glucose tablets when you go for a run (check out Amy’s unconventional answer!). In this blogger round table, our panel discusses how they manage their diabetes while staying active and healthy.

What’s your favorite way to stay fit?

Amy: I love aerobics classes where I get to jump around to loud music. I also jog quite a bit, and cycle and hike when time permits. I try to work out three to four times a week.

Kerri: Admittedly, I’m a bit of a gym rat. I hit the gym with my husband regularly–aiming to get there every night after work. Health and fitness are a big part of our household, and I work hard to stay fit. Usually, I get about 15 to 20 minutes in a resistance circuit (jumping rope, lifting weights, abdominal exercises, etc.) followed by 30 to 40 minutes of a cardiovascular workout (either walking or jogging on the treadmill or cycling between the treadmill and the elliptical). Working out in the gym is best for my lifestyle because being in one place allows me to have my water bottle, iPod, and my diabetes supplies close at hand. I am also a big fan of hiking, outdoor adventure sports like white-water rafting, and going to the beach, but my work schedule often keeps me from getting outside during the day. I’ll take my exercise any way I can get it!

Scott S: I’m not sure I really have a “favorite” way, but I find walking is immensely beneficial as both a stress reliever and having great health benefits, too.

Gina: I like to do elliptical and aerobics classes for exercise.

What does your pre-exercise routine look like?

Scott J: This changes as my motivation level changes and as my diabetes changes around other things in my life. But lately I’ve been doing a packet of oatmeal in the morning for breakfast, with Symlin and an extended insulin bolus through my pump. I’ll also correct any higher-than-target BGs here too. I have a special “basketball” basal pattern programmed into my pump that will reduce my basal insulin about an hour before ball starts, then ramps back up near the end. I will monitor closely during play, and adjust up with Gatorade or down with insulin as needed. I have to be careful with the insulin during this time because the exercise really increases my sensitivity. There is a lot of routine involved in my exercise, and it took a lot of trial and error to get it right. I still do struggle with spontaneous exercise.

Allie: Only caveat is I’ll check my sugar. I want to know where I am before I get in there. I don’t like to drop more than 100 mg/dL in an hour. Anything more than that triggers an optical migraine. Funny how hypoglycemia can bring out the worst in people (and secondary conditions of diabetes). I check my blood pressure before I go to the gym, too. Before I leave the gym I’ll spend a good 10 minutes stretching to bring down my blood pressure. We don’t want any problems on the journey home.

Bernard: I always check my blood sugar at least 30 minutes beforehand. If I’m planning on doing more intense exercise I’ll check an hour before. This gives me a chance to dial down my basal insulin rate and take any extra carbs I may need to cover the exercise. I typically reduce my basal rate to 55 percent of normal for most of the time that I’m exercising. So if I’m doing an hour bike ride, I’ll dial down my basal rate an hour before starting and for about 45 minutes. That way the lower basal rate will be almost in action when I’m actually on the bike. I like to start with my blood sugars levels on the higher side, say 150 mg/dL. For exercise like racquetball, I know that my levels can drop from 150 to 80 in the course of one game. So if I’m going to do really strenuous exercise I’ll also drink some fast-acting carbs before starting.

Gina: Usually, I eat dinner before the gym so I don’t snack before, but I experience low blood sugars during a workout so I have three temporary basals through my pump. One hour before exercising I have to turn the temp basal to 50 percent, then during, my temp basal is set to 0 percent, and then for an hour after, I turn it back to 50 percent again. This prevents me from experiencing hypoglycemia.

Sandra: Depends on the activity. In general, Joseph checks his blood sugar, then has a snack if he’s got insulin on board and/or he has a BG below 150. If activity will be intense or go on for a while, we sometimes lower his basal by 30 to 50 percent as well. Though, because he’s a growing adolescent (and MAN is he growing), we’d rather compensate with more food than less insulin.

Where do you keep your emergency supplies and glucose meter, especially if you’re outside? Do you just work out at a gym?

Allie: When I rode horses (outside) I would keep a glucose meter in the car. Emergency supplies for lows are protein bars–also in the purse, in my car. Since I check my sugar before going into the gym, I always know how much glucose/energy I have onboard for the next 60 minutes. If there’s a threat of a low (debilitating) I’ll wait ’til my sugar is at least high enough for safety’s sake. Disconnecting the insulin pump is always an option, too.

Amy: I take my purse with me right into aerobics classes and lean it in a corner somewhere. If I’m jogging or cycling, I just make sure to wear my medical ID bracelet and bring along some glucose tabs or gel–usually stuffed into the front of my sports bra. Looks cute…NOT.

Kerri: At the gym, I keep my gym bag close by, so I always have access to my meter, juice, water bottle, and other assorted goodies. For the times I exercise outside, I usually disburse my supplies within the group, as I never exercise outside alone. If I’m walking on the beach with my best friend, I carry the meter and wear the pump and she holds the bottle of juice. When we went white-water rafting, the supplies were split between myself, Chris, and the rafting guide.

Bernard: I carry my supplies with me or in my gym bag. On the bike they’re in a little pouch under the saddle. For running I have a small pocket in my running vest. I used to only work out at a gym, but these days I tend to exercise outdoors.

What effect does exercise have on your diabetes, like dropping or going up? How do you adjust for that?

Scott J: Most of the time it drops my blood sugar. But if I get involved in a really intense game of basketball, and my adrenaline starts rushing, it can make my blood sugar go up. That is almost impossible to plan for, mostly because each and every day the level of intensity is different at the YMCA. To adjust for that, the only thing I can do is monitor frequently and make adjustments on the fly. I also find that I am pretty resistant to my insulin for about three hours after basketball, but after that three hours I am overly sensitive. I can almost eat dinner without any insulin many times, when I would typically need about 10 units (depending on the meal, of course). It also makes me more sensitive the next morning (and probably through the night for that matter, but the dinner may be offsetting that).

Manny: Typically, my BGs go down after exercise. I test as soon as I arrive at my destination and, if I am walking for more than 30 minutes, I also test halfway. I carry glucose tablets with me to help in the case of a low.

Kerri: The first few months I was making a commitment to exercise, I saw some wild fluctuations in my numbers. My body didn’t know how to react to the workouts and I would hit extreme highs and lows. It took about six weeks for me to train and respond to the blood sugar trends, and about two months into it, I hit my stride. Now I know how to be more proactive about my exercise numbers–if I’m high before working out, I’m not shy about correcting the number. And I have trained myself to eat the right amount to treat a pre-workout low. I still make mistakes, but they are fewer these days.

Scott S: I find that post-exercise can be somewhat less predictable. Sometimes it’s a non-event, other times I may see blood glucose levels drop for hours afterward. That’s one reason I prefer activities (such as walking) that deliver (for me) more predictable results. As with anything, your own experience will yield patterns, but until you know what those patterns will be, testing is the safest way to address any concerns.

Sandra: Often, Joseph’s blood sugar will spike a bit (from the adrenaline) just after exercise, and then drop later. Of course, there have been many times when his BG has dropped in the middle of exercise. Thankfully, so far, he’s always felt himself going low when that’s happened. To compensate, we have him either eat a snack before particularly vigorous activity or cancel his active food bolus (if one is still delivering) and/or lower his basal insulin during and for a number of hours after exercise. Sometimes, we do all of the above, depending on type of activity, his blood sugar, insulin on board, etc. And then we have him test, a lot.

Have you ever trained for an athletic event? Did you have to change anything to prepare for that?

Amy: Last year I trained for the ADA Tour de Cure. It was fascinating to see what a strong effect all that cycling had on my BG levels. At first, a training ride would knock me way down, maybe 100 points or more, so I would have to eat and drink while training. Then I learned to eat a granola bar or banana before I set out, and then use an aggressive temp basal to avoid lows. I also sipped Cytomax (sugary sports drink) along the way. If I was on the bike for three hours or longer, I would often have delayed lows overnight, too, so I learned to set a temp basal for those nights after heavy training.

Kerri: I haven’t trained for any formal athletic events, but I did do some unique sports, like white-water rafting and (of course) “training” for my wedding. For the rafting trip, I had to readjust to working out using Lantus and Humalog instead of my insulin pump, and that took a good four or five days to find a workable medium for my weekend trip. The wedding was another mission entirely–I was looking to accomplish what so many brides-to-be aim for: being as fit as possible for my big day. This included ramping up my workouts the months prior to my wedding, and my blood sugars were back into their wild swings. But, in the end, it just took time and trial-and-error to adjust to a new regimen.

Bernard: Currently I’m training for a sprint triathlon. I try to exercise two to three times a week, sometimes just swimming or biking. Sometimes I do a “brick,” where I bike and then run. Apart from keeping an eye on my blood sugar levels more closely, I needed to increase my sleep. When I started to have muscle cramping issues I bought an electrolyte replacer that has dextrose. Someone also suggested Nunn, which is a sugar-free electrolyte replacer. Now when I’m cycling I carry two drinking bottles, one with and one without carbs but both containing electrolytes.

What has been your biggest struggle with exercise and how are you working to overcome it?

Scott J: Spontaneous exercise is really hard for me to deal with. I usually end up having to eat something just to avoid lows, which makes me feel upset, like I’m defeating the purpose of the exercise or something. Lows during basketball really mess me up, too. They sap my energy and I usually don’t feel that I recover all the way, meaning I will be fine “blood sugar wise,” but still feel messed up (not necessarily low, but just lacking energy). When I’m high during basketball I am all out of sync. My brain is telling my body to do something, but my body responds a split second too slow. Everything is out of whack!

Manny: You have to schedule time for it. You can also do things like park far from where you are going, so you have to walk more, and use the stairs instead of the elevator if possible. Gardening and housework goes a long way, too.

Kerri: My biggest struggle is self-confidence. Sometimes I don’t feel strong enough or “fit enough” to attempt different exercises in front of other people. It could be something as small as an abdominal exercise or something as challenging as the rafting trip. But I’m often very shy about putting myself out there, physically, and it has made trying new things a little tricky. Having the help of my friends and my loved ones, and being able to giggle at myself, has helped me overcome this hurdle. And when it comes right down to it, I have nothing to hide. Trying to be healthy is nothing to be ashamed of!

Scott S: My biggest struggle is unpredictable work/travel schedules, which tends to throw a damper on predictability in terms of scheduling meals, insulin dosages and blood glucose levels. Less predictable schedules are really not conducive to ideal diabetes care that most books and so-called “experts” prescribe, but that’s life! Some people find new tools like pumps and/or CGMS immensely helpful once they learn how to use them. I think CGMS might be a great tool for me to address my own issues, but until I have one, frequent testing is the next best thing.

Bernard: Doing it regularly, so that I’m building on strength and learning more about how best to control blood sugars. I’ve also really learned the importance of stretching. With diabetes I think warming up and cooling down is even more important because (I think) damaged muscles and joints may take a little longer to repair.

Gina: The lows have been by far the biggest issue. It’s also been very hard to lose weight even though I work out three to four times a week. I am now working with a nutritionist who put me on a low fat/calorie diet.

Sandra: The biggest struggle for us has been trying to keep in check the fear that Joseph might experience a severe hypo as a result of intense physical activity. It’s been hard at times to let go–knowing what could happen. Thankfully, we’ve found that teaching and encouraging safe habits in our son (i.e., testing regularly, being in tune to his body’s signals) and focusing on the rewards of all that exercise (a stronger, healthier, happier kid–one who is far more likely to lead an active lifestyle as an adult) goes a long way toward calming that fear.

What’s the best advice about exercise that you have heard or have learned on your own?

Scott J: I know it sounds cliché, but find something fun. Then do it a million times until you figure out the blood sugar/food/insulin balance to make it work. It will be frustrating for a while, but you will develop a confidence in your routine that brings the fun to a whole new level. That and expect the days where nothing goes as planned, even though you planned everything.

Allie: Eating healthy is 90 percent of keeping fit. Many people with diabetes are already eating healthy. Exercise is the small contribution that makes the biggest difference!

Manny: When you are high, go out for a walk. Forty to 50 minutes will bring down your values in a way that you wouldn’t believe.

Amy: Diabetes should never stand in the way of a good workout. I love to exercise, and even though diabetes complicates things, I try to think of it as a power source as well. That is, I no longer spend a minute worrying about whether I’m fit enough to accomplish a certain workout goal. Instead, I focus on keeping my BG levels in range. If I can do that, I can do anything.

Scott S: Find a good exercise coach/diabetes specialist/sports nutritionist if you’re planning any major events (like a marathon). The money will be very well spent, as many people I’ve met had said that most CDEs aren’t really skilled at working with athletes. Those who have done so have said these specialized skills can be tremendously helpful.

Gina: Always bring extra juice and fast-acting carbs on top of what you already carry; sometimes you need more than 15 carbs to bring you up. I learned that the hard way.