Hi Everyone, I am new here, but I am curious if I am totally alone or if anyone else shares my opinions on the topic of exercise and diabetes. Here are a few things that I believe. I may be completely on my own here, but does anyone else agree with me on any of these?
I think some of the guidelines on pre-exercise precautions are crazy. Like some of the recommendations in Sheri Colberg’s Diabetic Athlete’s Handbook. Look at table 2.3 - carb increases before exercise. I’m nowhere close to that. For example, for a moderate 2 hours workout, if over 200, she says take in an additional 15-30 grams of rapidly absorbed carbs. No way I would do that! I would take extra insulin before a workout in those conditions (depending on amount of insulin I already have, which way my BG is going, and all the other factors, of course!).
So many of the phone apps or websites give similar recommendations, like they totally freak out at the idea of exercising with decent BG. They want to play it so “safe” and would rather you be high. Ugh, I hate that.
Neither of these is ideal or preferred, but if I had to choose, I’d actually rather start at 50 (mg/dL) than 200. I can bring BG up in a few minutes, but bringing it down can take an hour. I think 50 is easier to fix than 200 when exercising. Am I alone here?!
Dexcom - great when sleeping, but not so much when running!
I love doing IM shots for more rapid BG lowering. Much faster than subcu.
For long slow endurance runs, my preferred BG is between 65-75. It feels so much easier in that zone. It’s different for faster paces, but I am talking about easy runs longer than 10 miles. Does anyone else feel that way?
I’m not scared by low BG when running. What do you do if your BG is 50 when running? I take some sugar and keep going. It only sucks for a little while, it comes up quickly as long as I don’t have a stupid amount of insulin floating through my body. If I have too much insulin on board, then I might bail.
I am not advocating anyone else do this stuff. I am asking if anyone shares these opinions because I feel like I am completely on my own with my perspective. I am tired of the overly cautious doctors, endos, and experts in the diabetes world who want you to exercise at 150. Are there any others with me on any of this stuff?
Please forgive me for having ideas so far outside the mainstream. Wanted to know if there are any other “rebels” here to connect with.
I raised my hand because I am a rebel, too! Agree with all except number 4 (for N/A), and number 5 (never have done IM, on purpose). It is hard for me to do a nice workout with food in my belly.
As they do more studies using both CGM and more sophisticated fitness trackers, they will probably develop more precise recommendations for how many grams of carbs you need to prevent lows while exercising…and I suspect that for many people, unless they’re sprinting like crazy or are in the Olympics or something, the amount is a lot less than they’ve typically been told. In fact I think some of the presentations at the ADA this year seemed to have conclusions exactly to that effect.
I’d also say that everybody’s different. Someone who runs all the time won’t require as much of a metabolic uptick to go on a jog as someone who is totally out-of-shape. My guess is that guidelines are tailored towards people who are either newer to diabetes or newer to exercising with diabetes. If you’ve been running forever while t1d, my guess is you’ve got a better handle on your body than experts.
Agree with most everything. Since switching to tresiba I’ve ran upwards of 10 miles without having to add carbs… amazing stuff… and I don’t use a cgm. I’ve never had a severe exercise induced low with tresiba and I run a lot… yes sometimes my bg drifts down into sub optimal ranges but never any crashes
I think it really depends on the person, how well controlled their diabetes is and how good shape they are in. If I were to coach somebody completely new to exercise I would rather they were at 150 mg/dl than 50 mg/dl for the first few workouts. Obviously I would rather have them around 100 mg/dl but I think that’s a given.
When it comes to myself, I’m like you, I not scared of running low. My exercise of choice is resistance training so I eat before and after to fuel the workout, not to drive my sugars up. I adjust my insulin rather than my food to manage my BGs during exercise.
Part of the problem with the recommendations is that they seem to think that all exercise will lower your BG. But for me, there are certain faster running paces that spike me more rapidly than any food ever could. I have become confident enough with this now, that I can be at 75, and if I am going on a short but intense run (like a 5 k race), I will actually take a few units of insulin right before starting, and when I am finished I will still be way up there, like 180. It took me a long time to have enough confidence to do something like that - taking insulin at 75 BEFORE a run! It goes against everything you hear and every bit of safe medical advice you get, but it is totally predictable for me!
I’m with you on that one @Eric2 I found that it was my CGM and a ton of experience gave me the courage to bolus with no food prior to a workout, not anything I’ve ever been taught by my medical team
I really don’t even pay that much attention to it… I start out at normal levels and I end at normal or a shade lower than ideal but I don’t really plan my exercise around it… if my bg is elevated when I start running will always lower it significantly . if it’s normal it just kind of hovers there or maybe drifts down a bit but nothing alarming
Not sure any of it is a matter of belief. You’re talking about your experience, which is different For what it’s worth, my old GP would disagree strongly with you about exercise and blood sugar. I fired him and got another doctor after he repeatedly told me to “quit exercising entirely” since my long-term average BG is now around 90 mg/dL. He was convinced I’d die either on the bike path or in my sleep from hypoglycemia.
For what it’s worth, I bike rather run, and I do so at fairly high intensity. I also do multiple strength workouts a week. Overall, exercise is very important to maintaining my BG. While trying to “pre-load” to be at 200 mg/dL before exercise seems like complete madness to me, I can understand not wanting to be low. I commonly start a ride between 80-90 mg/dL in a fasted state. I will usually be down around 60 mg/dL at 60 minutes, and I will eat something at that point to bring me back up to the 90s. I really don’t like messing around any lower than that.
However, I can think of two reasons why the experts seem to be on the other side of the fence: a) many diabetics don’t obsess over their numbers and management to the degree many of us on this website do, and so many experts are worried that starting at a “normal” BG could be dangerous to unaware folks; b) the technology (CGMs, even meters, fast acting insulin) has changed dramatically in the last ten years, and I suspect the “guidelines” were formulated in the relative dark ages. In short, many experts don’t trust diabetics to manage their own BG (my doctor certainly didn’t), and they haven’t really adjusted to diabetics have very good tools to manage our own blood sugar. Also, you and I, even if we work out or run a lot, probably aren’t doing the kind of exercise that these guides are written for. Professional athletes and competitors are subject to stress on the body that most of us amateurs probably don’t replicate often.
I can burn 1,000 calories and drop my BG by 100 mg/dL in about 70 minutes of hard riding on a road-bike. I manage this by ingesting carbs in the middle of my ride. I don’t test when I feel low, I test at about 45 minutes because I know I’m going to be low(ish). I can’t even imagine what my situation would be like if I were burning two or three thousand calories on a four-hour endurance ride at a pro pace. Some riders who I know routinely burn through 3,000, 4,000 calories and eat upwards of 6,000 kcal before and after race days in order not to start losing muscle mass. I know there are professional, diabetic (Type 1) riders out there, but how they manage those kinds of diets and their BGs on those kinds of rides I have no idea. I suspect I would find it challenging, and would want a CGM attached and a constant supply of carbs.
I totally agree with you! My new endo recommends that BGs be at least 200 before running! I did that for a few months and felt ill the entire time for my runs with absolutely no energy. I got the courage from this forum actually to listen to my own body, and NOT eat so that my BG is 200+ before a run! I think now how ludicrous that is and so dangerous. I agree, I am most comfortable in the 70s range for a run. Yes, indeed, I do go low during the run on occasion, just as you do on your rides, but I always carry glucose tabs. I also usually eat 1/2 banana before a run, but that can have a boomerang effect after the run, or at least I’m assuming it is the banana because sometimes my BG will climb into the upper 100s or higher immediately after the run even if I end the run low. Btw, @Eric2, the xDrip+ has a smartwatch wear version that can be used in standalone mode, so you don’t have to have your phone with you to continue to monitor your BG just wear the watch, and all data syncs back up with your phone upon reconnecting. I am using it and have found it to be extremely useful for exercising.
I agree. If I exercise first thing in the morning, there’s no need for me to increase BG before hitting the cardio. I can start at 80 and be fine. In the afternoon, it’s a different story, probably due to the fact that I’m very insulin sensitive and I’ve been bolusing throughout the day. If I don’t start near 200, I’ll completely tank before 30 minutes of cardio is complete, so I increase my BG before beginning. It’s what works for me.
I do occasionally get a pretty severe exercise-induced low now and then, but I hate having to eat carbs to burn carbs, and the thought of taking more if I were already at (god forbid!) 200 is flat out absurd. I haven’t read the book so I don’t know if she mentions this, but one thing I’ve found is that exercise-induced lows generally bounce back considerably so I’m very leery of treating them right away. I usually try to give it 1/2 an hour unless I’m getting that photo-flash effect in my eyes, but that’s pretty rare.
This I don’t agree with though:
I have my iPhone on my bike holder with the app open the whole time I’m riding and I find it very helpful. I’ve occasionally bailed on a bike ride when my G5 indicated I was dropping sooner and faster than I expected, and saved myself a lot of trouble as a result.
But @Shadow2’s experience totally mirrors mine as to exercise and time of day:
Don’t get me wrong, I really do like the Dexcom, and I still take it on my runs. But there are times when I am running when the Dexcom reading is far behind my BG reading. I think the issue is that during exercise, my BG rises and falls faster than when I’m inactive, and the fast rise and fall takes the Dexcom longer to “catch-up” with the BG reading.
I am in the minority, but I actually test BG while running. It took me a while to be able to do that, but I have built some gadgets that make it possible.
One advantage the runners have is that we can always use both hands, while the cyclists can’t always do that. But on the other hand, you have places to mount hardware - like you could have a lancing device built into a handlebar, and places to hold the test strips. Fun for me to think of the possibilities there!
Forgot to say–welcome to TUD, @Eric2! And yeah, the actual numbers lag quite a bit for me too. It’s more about being out on a ride and I start seeing double down arrows, so I know I’d better pop a glucose tab or two and take the shorter route back to homebase.
Were you taking any blood sugar meds at the time or was he convinced you were just going to spontaneously suffer from profound hypoglycemia with no cause whatsoever? Without meds (particularly insulin ) you are at zero risk for profound hypoglycemia… enjoy it
I was only taking Metformin ER at that time, and although I do have issues with hypoglycemia (and have since I was a child), the chances of having, in your words, a “profound” hypoglycemic episode are pretty slim. With or without Metformin, which isn’t an insulin promoter. This is precisely the reason why I got a new doctor and kept exercising: the man, for all his qualities, didn’t understand enough about diabetes to make rational decisions or help me manage my care.
For what it’s worth, my old GP would disagree strongly with you about exercise and blood sugar. I fired him and got another doctor after he repeatedly told me to “quit exercising entirely” since my long-term average BG is now around 90 mg/dL. He was convinced I’d die either on the bike path or in my sleep from hypoglycemia.