BGs on the BBB: Best Body Bootcamp Week 6
Wednesday, February 20th, 2013 | Posted under Diabetes, Health + Fitness
There are a number of things I loathe about living with diabetes, but I think managing diabetes while exercising probably takes the cake (no pun intended). There is just so much that can go wrong that it’s hard to know where to begin.
First of all, the simple act of exercise is designed to spur the body to burn up glucose. I mean, glucose is the body’s first choice when it comes to energy, so that’s what’s going to go first. In normal people, the body can handle that because it can produce its own glucose fast enough, plus it knows exactly how much to dial down on the production of its own insulin. Guess what a type 1 PWD can’t do?!
The second issue is that exercise affects your body’s metabolism for longer than just your workout. Which means you can see low blood sugar drops all the way until the next day! What the crap? Sometimes it feels like a game of Russian roulette: when’s the low blood sugar going to hit?
The third issue is that exercise is usually performed because the person exercising (I won’t go so far as to athlete…) wants to lose weight or at least not gain weight. Guess what you have to do when you have a low blood sugar? You have to consume glucose, which comes nicely packaged with calories. Sometimes it can feel like you’re “eating the gym.”
These are just a few of the things we have to deal with.
Of course, once you realize the physiologically your body actually needs fuel after a workout, you can start to feel a little bit better about the whole eating thing. But still, I would much rather much on a tasty apple with almond butter than sitting in a puddle of misery at the gym sucking on a Minute Maid juice box. Not where I want my calories to come from.
That being said, exercising with diabetes is totally possible. And I totally advise you not to look at me when figuring out how to do that.
Sorry, but it’s true.
I have been semi-active for most of my life and I have yet to really figure out what the hell my body likes to do with exercise. Sometimes I drop like crazy during exercise. Sometimes I spike like mad right afterward. Sometimes I stay so stable I wonder if I actually did anything (until I look at my tomato face in the mirror and remember otherwise).
These days, I’m on MDIs (multiple daily injections), which is a technical sounding term for poking myself a bunch. The upside is that I don’t have to worry about an insulin pump bouncing around while I run. The downside is that once I take my long-acting insulin, I’m stuck with that dose for 24 hours. I can’t lower it one iota (see aforementioned dialing down of insulin prior to working out).
That said, I do seem to have a relative groove going on with my running scheme and the Best Body Bootcamp, so I thought I’d go ahead and share.
Before a Workout
My preferred time of day for working out is typically right before or right after dinner. It’s just what works for my and my husband’s schedule (since we go together typically). I prefer to have my blood sugars in a mid-normal range. Not too high, not too low. Typically around 150 mg/dl. If I start too low, then I’m probably going to go low, and if I start to high then I don’t perform as well.
If we eat dinner before working out, I’ll adjust my insulin depending on my blood sugars. I might shave a few units off my dose if I feel like I’m going to be working out intensely or if I’m eat a particularly low-carb meal. I rarely have to worry about doing anything if I exercise with no active insulin. I usually just go to the gym as usual. I might drop twenty or thirty points, which is why I make sure that I never exercise too low, but since I’m eating right when I get home, it’s rarely an issue.
During a Workout
I don’t typically test while working out, but I do have hypoglycemia unawareness when exercising. Going low while exercising is rare, but it does happen, so I’m in the process of getting a continuous glucose monitor. This will hopefully keep tabs on me.
At the gym, I bring my purse with me, which has my diabetes bag and a juice box. When I go running, I wear a SPIbelt with a GU inside. I don’t run with a meter (I’ve tried, hence the CGM that should be arriving soon) because it’s too heavy. On occasion, if I start to feel abnormally sluggish, I’ll treat myself, wait 15 minutes, and then walk back. I also always go out with my phone so that I can call someone, and I also wear a medical ID bracelet. My adventures in running definitely motivated me to get that after years of being without one. (I know, I suck.)
Right now, my workouts are not long enough that I need to fuel in the middle. I think once I start upping my mileage, I will start consuming carbohydrates mid-run. I received a Nathan’s running pack for Christmas and I’m actually eager to break that out when I start reaching 60 minutes of running!
After a Workout
My after workout procedure is much like my before workout procedure: it all depends on where I’m at. If I end at a decent blood sugar, it’s nice because then I can eat dinner and not worry about anything. Strength training seems to give me the most sporadic end results. Most of the time, I end at my target, which is 20-30 points lower than where I started. But occasionally I’ll end higher or lower than I expected, but I’ve never taken a close look as to why. I think it’s part of the diabetes variability, but I also think it’s part of the exercise variability. How many of us exercise the exact same way each time?
I have noticed over many years that everyone has certain things that will make them drop or spike more than others, or certain routines or certain blood sugars they must be at to handle their diabetes and exercise. It reminds me that diabetes is very much a science experiment, which is why I’m glad my friend Ginger wrote a whole book about it! Working out on an insulin pump used to frustrate me a lot, because I always wanted to take my pump off, but then I would go high with the missing basal. I actually find that my own body really likes to keep things as normal as possible, with very little futzing around when it comes to compensating with lower doses. My adjustments tend to be fairly minimal, and I think that has helped me avoid a lot of roller coasters. Of course, YDMV (your diabetes may vary)!
How do you manage your diabetes and exercise?
Comments on this post
Thanks for writing up your exercise experiences! (Or, one of many). I love this ‘Guess what a type 1 PWD can’t do?!’
20. February - 10:56 amI’m about three pages into Ginger’s book, and looking forward to getting time to finish it. I’ve exercised ever since I can remember, and have some general guidelines for during and shortly after exercise, but haven’t figured out the full length of time that the exercise might still affect my BGs. Or how to fuel properly.
Swimming in the morning- I disconnect from my pump, so bolus immediately after for what I missed, plus some extra. I don’t know if I rise because it’s the morning or because of the swimming.
Spinning and boxing make me rise. Ellipticalling can do anything! Biking and skiing are gradual decreases. Horse riding is a small rise. So many different responses to exercise…
THIS is the reason I haven’t exercised. I HATE trying to figure this out and in almost 5 years of having diabetes, I just haven’t taken the time to really understand my body and how it reacts to exercise.
I too have hypoglycemia unawareness when exercising. And I haven’t been able to rely on the CGM to keep up with me dropping. Even going for a walk, I’ll get home and be at 46 mg/dL and not realize it immediately because the CGM says above 70 mg/dL and won’t show a dropping arrow until I stop walking. I suppose it depends on how long I’ve been walking, but it’s something that scares me and has steered me away from exercising; which is sad.
Your story is inspiring. Maybe I can find the motivation and just go for it.
20. February - 12:14 pmMelissa, I really hope you find the mojo to exercise! It is SO worth it, even though I know how frustrating it is (erm, see below). The problem is that it is always the hardest in the beginning, when you begin an exercise program. Your body is adjusting to the change, and those first few weeks are often pure misery. But if you keep going….bam! You’ll have more energy, better insulin sensitivity, improved muscle tone, greater stamina, better mood, and better cardiovascular health. WORTH IT! Here is one idea: aim for two walks per week to start, and jot down a few notes on your phone about your diabetes management: the meal you ate before, your BG before, if you went low during the walk, your basals, if there were any lows/highs afterwards, blah blah blah. That’ll help you to target lows in the future. Good luck!
As for me, well, cue the word vomit…..
Oh the Russian roulette. Exactly. This continues to be a problem for me. Do a hard workout on a Tuesday night, BG is fine in the morning…but then low on Wednesday afternoon, WTF?! I mean, physiologically I understand that my body is sucking away glycogen to repair my damaged muscles, but the unpredictability is indeed maddening. I also agree about the background insulin and how hard it is to be “stuck” with that sometimes. One problem I frequently encounter on long runs is a sharp and sudden drop within the first 3 miles. ONLY on Saturday morning long runs, never on weekday morning runs. I wish I could change my basal rate on a pump, but I can’t. Blergh!
Complaining aside, I find that over the past year or so I have gotten much better about noticing patterns, adjusting things to fit these patterns, and generally bending diabetes to fit my exercise and not the other way around. Previously in running I was just sailing through in often-blissful ignorance, or too quick to cancel a workout when I assumed my BG was going haywire. Here are some variables that affect my exercise:
–type of exercise. Sprints cause a spike, easy runs and strength training do nothing, hard efforts (whether speed workouts or long runs) lead to lower doses and lower BGs the rest of the day.
–type of exercise THE DAY BEFORE. This is new for me, but I’ve noticed my BGs running higher if I didn’t work out yesterday. Conversely, if I did a hard workout yesterday, then I have an increased low risk and need to knock down my boluses by a unit or so.
–time of day. I usually bolus/eat nothing for morning runs, due to dawn phenomenon.
–fuel. I don’t take anything in unless a run is over 90 minutes. For long runs, I like something that I can have in tiny, frequent increments, like Gatorade or Shot Bloks.
–insulin timing. If I prebolus my normal 15 minutes, it can muck up my BG. So I do 5-10 minutes, or bolus afterwards if it’s only a small snack.
If I have any concrete advice to offer to you (and readers), it would be this:
20. February - 1:51 pm–Your meter and CGM are your best friend. My Dexcom has been invaluable in clueing me in to patterns and alerting me to lows during exercise that I would never have seen coming. I hope you get yours soon! That said, the meter is even better because it’s generally more accurate. (I just take care to keep a finger or two clean from sweat and Shot Bloks so I can test accurately). There are a lot of times when I feel kinda lightheaded from the effort, I test, and I’m okay. So having the meter on hand helps me to complete a workout successfully! I carry it all in a Spibelt, or in a running skirt pocket (which I wear over running tights in the winter). The Nathan’s/fuel belt pocket is good for holding diabetes gear too!
–Hydrate a lot, be cautious about carbs. Honestly, you might not need carbs if you’re running, say, 80 minutes. Especially if you’re generally eating low-carb and your body is switching to using fat as fuel. I’ve been experimenting lately with running on lower fuel, such as a 10-mile run with just water or 14 miles with just 3-4 Shot Bloks. And I felt good! Definitely experiment, but don’t feel like you have to take in a ton…especially if it’s going to mess up your stomach or BG levels. That said, drinking water is VERY important, even in winter, so keep bringing the water with you!
–Data data data….I’m trying to be better about logging the details of my diabetes management on long runs. When it goes well, I usually can’t say why….which is lame! So this can hopefully help me fine-tune my race strategy and pull off a perfect half marathon next month. (My goal is 1:45, cross your fingers!!)
Allison, this is great. Super information. I tend to think of it as managing my exercise, rather than managing my diabetes. At least it sounds better for me.
Sounds like you’re doing great. Keep up the great effort!
20. February - 8:03 pm