Exercise, Weight & T1D

[mrmikelawson]

I came across a set of guidelines published in THE LANCET yesterday by a team of researchers that have guidelines to help people with type 1 diabetes exercise and avoid unsafe fluctuations in blood sugar. The full set of guidelines require a (free) membership to read, but one piece that I think is interesting and worth pulling out is this:

The authors note that a majority of people with type 1 diabetes are now overweight or obese, and tend to be at least as inactive as the rest of the population. A large percentage of patients do not maintain a healthy body weight nor do they achieve the minimum required moderate-to-vigorous aerobic activity (150 minutes per week). This is in contrast to a few decades ago when most patients with the disease were relatively slim and active.

Knowing what most of us know about obesity, I can’t say that this is surprising, but it was interesting to see it spelled out. Is this a fact that most people are aware of?

[Mariana11]

Interesting. Some of us fear hypoglycemia events. (and we should be reading those guidelines) I know, this shouldn´t prevent us exercising, specially if we take precautions before and after the activity. But …could this be a reason?

[mrmikelawson]

I have certainly found hypos to be a barrier to making exercise a habit.

Hypos ruin exercise in a few ways for me. For starters, if I’m on a treadmill running off some calories, but need to stop and eat something to battle a low, I instantly think of how useless the calorie burning on the treadmill was. Sort of like…

Another way that hypos “ruin” exercise is that I have this added stress or fear in the back of my head that I need to worry about. What’s my current BG? What will a couple of mile run do to my BG? Do I have low supplies? These are totally just excuses, but are also real thoughts that run through my head and are counterproductive when I’m trying to motivate myself to get up and get active.

[Mariana11]

JDRF PEAK Experts Develop First-Ever Consensus Guidelines on Safe Exercise for People with Type 1 Diabetes - JDRF Interesting opinion quoted here “The lack of reliable information on how to exercise safely has created obstacles for people with T1D who want to maintain a healthy lifestyle”.

[Sally7]

Mike, your post here is right on time for me, as I was going to post something along this line but of course not with all the back up to statements, just experiences and feelings.
Background. Diagnosed at 8 in 1970. Was a skinny little kid who never stopped moving. Than the diabetes. And over the years started putting on weight. Never looked overweight as I have always hid it well but it was always there. Still pretty active through high school, on sports teams through school but than I started working. So activity was reduced greatly.
I also hated high blood sugars. I still hate them and did in the past(yes, sometimes still do), I’d stack to get rid of that horrible high feeling. And you all know what happens, lows and more food.
Reality is, if you are fighting lows, you’re taking to much insulin. Took me years to realize how much I was taking and how little I really needed.
So the past three years, I have been given the opportunity to walk to and from work, I work in a different department at work so average about 10 miles a day and my insulin levels are in half. I was just feeding the insulin, which I feel put on a lot of extra weight.
So with the extra walking and the less insulin things were looking good. But just couldn’t get under that major number. So my endo and I talked about some type 2 meds and decided on Victoza. And the combination of less, insulin, more walking and a drug that curbs my appetite I have lost 38 pounds. The first time in many years that I have not been in the overweight range (and yes was in the obese range for a time). Very cool and not very easy but as you have pointed out, there are many of us in this situation. All I can say is, it’s a battle but if you can find a doctor willing to try different approaches, it can happen. Good luck to us all as you continue the battle of the scale.

[mrmikelawson]

38 pounds?!?!? That’s amazing. I’m really happy your hard work came with such a great payoff. Did you have any trouble getting your doctor to consider prescribing a type 2 drug to help you manage your type 1 diabetes? Or was it the doctor’s suggestion?

My current HCP is adamantly against introducing any type 2 drugs into my treatment plan. I appreciate my doctor’s knowledge and respect the education she has (that I do not have)…but I’m sort of curious if I should keep trying to convince her, or if I should just start over with a doctor that is more open to some nontraditional techniques like yours.

[Eric2]

A lot of great points on this thread already. I’d love to discuss some of these things sometime. I know there is a lot of extra baggage for diabetics when it comes to exercise, but I’ve learned a great deal that has helped me tremendously.

The point that was made mrmikelawson, about running off some calories and then putting them back. I totally get what you are saying! But trust me, exercise helps you in so many ways. It isn’t just the calories you are burning on the treadmill. Your whole metabolism gets better. Over time, your insulin:carb ratio gets changed, your correction factor changes, insulin sensitivity, total insulin usage. Over time, your body become a much more efficient machine. If you exercise regularly, you will lose weight. Unless you are just standing on the treadmill eating pies, I promise you, you will not add more than you burn. But I understand your point, and I loved that gif!

Marianna11, yes absolutely. I agree with the opinion quoted. And it isn’t just a lack of reliable information, there is so much bad information out there too.

There is a lot to learn about exercising with diabetes. I mentioned this on another thread, when exercising, you can “feed the basal”, or you can “fuel the exercise” and “bolus the fuel”. And what you do and how you do it depends on so many things. Your correction factor for high BG is different while exercising, so how you correct is different.

The type of exercise affects which way your BG will go. Before certain workouts, if I am at 90, I will take insulin immediately before running, because I know the workout will make me spike. It sounds crazy to most people, and certainly a CDE would freak if I told them I do that.

There are easy ways to test when running. Fumbling for strips is horrible. I made this to help with that problem, and I can test without stopping. And I also put a BG meter on a watchband.

There are so many things diabetics have to consider differently. Like for fat burning exercise, if your blood sugar is too high, you won’t be able to metabolize fat. Nobody tells you that, because they always worry about hypos. But if you look at what is required for fat metabolism - the krebs cycle, and what it requires - a small background of carbohydrate metabolism, you can connect the dots and see that if your BG is too high, you are not able to metabolize carbs, and ultimately you won’t burn fat. You will just use muscle glycogen. Not that using muscle glycogen is bad, but if you want to be metabolizing fat, and you are instead using muscle glycogen, you aren’t accomplishing what you want. If you want to burn fat, you should try to stay in range to allow the background of carb metabolism to occur. (“The Krebs cycle is is the only metabolic pathway to burn fat in addition to carbohydrates and protein for energy production.” - Human Metabolism & the Krebs Cycle | Healthfully).

Apologies for my scattered bunch of thoughts here. I agree with the quote referenced in the link:

@Mariana11

“The lack of reliable information on how to exercise safely has created obstacles for people with T1D who want to maintain a healthy lifestyle”.

When trying to find good reliable information, it took me forever. I’d love to hear thoughts on exercise, weight management, and handling the little extra baggage we have to attend to with diabetes.

[Sally7]

Yes, the weight loss is great but it has been over three years, so that’s about 12 pounds a year. Not a lot in the big picture but for me any loss is great.
And while some of it is the Victoza, as I said it has been a project in the works. Not taking as much insulin as I use to. I know I was feeding the insulin. Defeats the goal of exercise, if you are feeding the lows due to insulin. And just walking a lot more than I ever have has helped. We also got a cute little lab puppy, so walking the dog a lot as she has so much energy, so upped my steps every day.
I brought up the off label drugs with my endo and I have a great one, who listens and offers suggestions. The other one I asked about was Invokona. And he said we could try either, but I did!'t want to risk the yeast infections due to all that sugar being peed out. So I decided on Vivtoza and had great support for the whole medical team. So he didn’t bring it up, I did due to discussion online and at workshops/support groups. But it was great that he didn’t tell me which one I had to use, we talked about it. Very cool to have a team approach.

[Sally7]

It’s so true that most people would flip out if they knew someone with normal blood sugars was taking insulin before exercise. But many of us know very well that the spike a few hours afterwards will happen. I go the temp basal rate for the post exercise spike. It’s a work in progress, but yes your plan is not crazy and a give you a high five for finding what works and going with it. One day the medical professionals (who I give great respect to) will learn that what works for one person with diabetes, won’t work for the next. Heck for me, what works today will probably not work for me next month. Hardest part about exercising is getting out there and doing it. Such a struggle for most of us, myself included. But with a new puppy in the house, that makes me get out there a couple times a day!

[David49]

All makes sense, like most Westerners Type 1 diabetics are eating more and eating more carbs (as an average). One of the things that I don’t see here (yet) is the importance of resistance training. People focus on cardio for weight loss, but that actually makes very little sense. Science shows that when people do a bunch of cardio to burn calories, they often immediately turn around and eat more calories to cover the deficit. Cardio makes you hungry. It’s great for the heart, but it isn’t going to help most people lose weight.

Resistance training, on the other hand, builds muscle tissue, which is more metabolically active, more efficient at using insulin, and has many other benefits. For many people, lifting serious weight even reduces appetite overall (when compared to a similar effort expended on cardio). Many people (not just diabetics) are afraid of going to a gym and hitting the weights, but it can have an absolutely enormous difference on health and BG control.

[Eric2]

@Sally7

But many of us know very well that the spike a few hours afterwards will happen. I go the temp basal rate for the post exercise spike.

It’s awesome that you have things like that which you are comfortable with for post-exercise control. Just getting the confidence to reduce or increase insulin for exercise is half the battle.

I advise everyone to make the adjustments over and over until they develop the confidence to do what works for them. That gives such a psychological edge, because you start to feel like you are beating the disease. Anything feels possible.

“Whether you think you can, or whether you think you can’t…you’re right.”

[Tony_T]

Eddie, I’m not exactly flipping out, but I’m astounded that you can be in range, go for a run putting insulin-on-board, and live. It would put a timer on my workout, because somewhere between 15 and 30 minutes, I’d be 1-2 minutes/mile slower than I think, and it’ll be time to stop (or worse).

I read in the Diabetic Athlete’s Handbook that interval workouts cause glucose spikes; it even recommends speeding up if you are feeling low in the middle of a workout. Is it possible you are pushing too hard during regular runs?

Tony

[Tony_T]

One more thing. Cool engineering. I use a Bayer Breeze 2 because I hate carrying around and handling strips. (It gives me the illusion of not having strips!) Unfortunately, it is way too big to be a wearable. I cannot imagine myself being dextrous enough to pull off a BG check while in motion, even with your kit.

I have been using a CGM for about 8 or 9 months. This will send a notification via Bluetooth to my phone for a high, low, or urgent low alert. This then gets bluetoothed (is that a word?) to my Garmin Fenix 3. Sadly, nobody has figured out how to just have the data go directly to the watch (without using a third party internet service). Still, some information is better than no information.

[Tony_T]

Thanks. I found the article in Lancet Diabetes and Endocrinology. Looking forward to reading it.

[Eric2]

@Tony_T

Is it possible you are pushing too hard during regular runs?

Not all workouts spike me, only certain ones. The ones that spike me are the very hard and short runs, and they are not the endurance runs. They are the ones that are above lactate threshold pace. A pace that I can’t keep up very long. I can’t do that everyday, but I need to do it every once in a while.

@Tony_T

I read in the Diabetic Athlete’s Handbook that interval workouts cause glucose spikes; it even recommends speeding up if you are feeling low in the middle of a workout.

If you are low during a workout, it would be possible to raise your blood sugar by speeding up. However, it’s not really practical because it would mess up your workout. If you are at a slower endurance pace, and you speed up for the sake of raising your BG, you have completely changed your workout. Imagine going for a 2 mile sprint in the middle of a 10 mile run. You have completely gassed yourself, and you then have to try and go back to finish your long run.

@Tony_T

Unfortunately, it is way too big to be a wearable. I cannot imagine myself being dextrous enough to pull off a BG check while in motion, even with your kit.

It’s really gotten easy with practice. I can’t do it at a fast pace, but at slower and longer paces, it’s not too hard. If you want to try it, I can hook you up with the process of how to make a holder. Or I can just make one for you. I have the mold built, all I need is to put in some of the silicone compound and press one out for you.

I’m gonna post my BGs from my last run in the flatliner’s thread. Check it out!

[Siri]

@mrmikelawson: Is it possible to post the whole article in this thread somehow? Or will it ruin your topic?

[mrmikelawson]

@Siri

Is it possible to post the whole article in this thread somehow?

I don’t own the content, so I don’t feel comfortable copying it here outside of their paywall/system thingy.

[Siri]

@mrmikelawson

I don’t own the content, so I don’t feel comfortable copying it here outside of their paywall/system thingy.

Off course, I wasn´t sure about the internet etiquette.

[jack16]

all if the studies I have seen say that exercise reduces BMI by 1 point,/percent body fat… when someones 5-30+ points over. it’s going to take more.

one way is cutting the sugar/starch carbs, which reduces the insulin, a fat storing hormone. …instead of the ‘burn glucose/store fat’ mode. like an insulin resistant T2.

I see no reason for T1’s to be different than the rest of the population, 30% can handle high carb, 70% are overweight or obese.

[David49]

@jack16

all if the studies I have seen say that exercise reduces BMI by 1 point,/percent body fat…

Can you expand on this? I don’t understand the phrasing. Exercise (energy expenditure) seems to me to only be able to “reduce BMI” if it results in an overall calorie deficit. One of the pitfalls that many people fall into is overestimating the amount of energy that (especially aerobic) exercise takes, and underestimating the calorie intake increase that often comes following exercise.

Strength training can (slowly, subtly) increase “effective” BMI by changing the fat to muscle mass ratio. While this isn’t reflected in the actual BMI ratio, it does change base metabolic rate (as I know you are aware of). But this often happens with an increase in computed BMI, if eating at maintenance.