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?