Getting Started?

Healthy Living Physical Activity
1

Hello!

I'm going to try and keep this quick and to the point, but (as I have come to realize with all things related to D) my question is a little more complicated than it might seem at first.

I was just diagnosed about a week ago - huge shock, and I found out by checking myself into the ER with what I thought was a bad parasite after a trip to Mexico (turns out I was going through DKA for a few days).

I lost a fair amount of weight from the DKA, so my CDE has told me to keep my activity level very low and let my body gain back its strength. I'm doing my best to follow her advice, but since running and mountain biking have been such a big part of what I've done for the last few years my days have felt pretty empty.

At my girlfriend's sister's place today they were taking down some trees after the Easter celebration and I couldn't help but get involved and get my hands dirty - hardly a long training run but the physical activity felt awesome. I checked my BG a couple of times and had a 10 point drop per hour (did about two hours of work) and then we had a late lunch. I definitely feel as though my strength isn't what it was even a few weeks ago but, again, it just felt good to be active.

My girlfriend and I have a trip planned to visit my family in India on April 16th and I anticipate a fair amount of walking/hiking while we're there (they live in mountains) - I'm not planning on starting to run, but I don't want to be afraid to go for long walks or hikes. So, I have a few questions:

What is the best way to get started measuring the effects of exercise on my BG?

Is it safer to exercise earlier in the day for starters so I can be more aware of potential lows, etc. instead of having them creep up while I'm asleep?

I know D is so different from person to person, but are there any ballpark figures (hrs. of exercise vs. BG points dropped, etc) to help get folks started?

I've heard a lot about aerobic vs. anaerobic and high vs. low intensity exercises and their relative effects on BG, is there any consistency there or is that a personal matter, as well?

Thanks so much in advance for any help - I am thrilled to be able to ask questions on this site! I'm happy to share any info that might be helpful - just let me know.

Thank you again!

2

I like to exercise in the evening. It just works out better. My BG would probably like it more if I worked out in the AM as there seems to be dawn phenomenon going but the rest of me isn't going. The book "Think Like a Pancreas" has pretty good, detailed instructions for what they call "excarbs", or carb substitution for exercise, either replacing what exercise burns with food or taking less insulin. There's what seems to be a decent article on the subject here: http://www.diabetesnet.com/diabetes-control/exercise-and-diabetes/excarbs-exercise that might be useful? I would look to start before you go 1/2 way around the world to try to get a good start on figuring things out in a more controlled environment too? There's a brand of shorts for running, Race Ready shorts, that have a mesh pocket that'll hold a BG meter for running, although I put mine in a bag to keep it from getting sweaty.

3

Thanks Acidrock,

I've read a few of your posts about running as I've been looking at the boards and that's one of the things that got me thinking about this.

I'm definitely going to try some exercise - probably hiking for the most part - before I leave. I don't think I will try any running while I'm out there - I've been grateful for my CDE's conservative approach to my I:C ratios (steady progress as opposed to a rollercoaster) and I'd like to take that same philosophy with exercise.

I'll check the link you sent as well - I'm planning on buying "Think Like A Pancreas" and "Using Insulin" tomorrow. I've seen a few posts about "The Diabetic Athlete" (I think that's the title) but will probably hold off on picking that up until I get more comfortable with the basics of BG management.

I've always found evenings to work best for my schedule, so that might be another piece of the puzzle after I get the exchanges worked out a bit better.

Thanks for the info- I'm sure I'll have more questions!

4

The Big Blue Test is good for starters. You check your blood sugars. Exercise for 15 minutes. Then check your blood sugars again. Since everyone is different, you will see the immediate impact of exercise on your sugars.

I've found that exercise affects me 3 or 4 hours later, sort of a delayed response to my physical activity. Again, everyone is different.

5

Hi and welcome to our "club". I'm sorry you had to join but I'm glad you're actively seeking help.

I'm a T2 so some of my issues will be different.

I was scared to exercise at first after I started on the short-acting insulin (Novolog.) I'd already experienced one scary hypo while on just the long-acting insulin (Lantus.)

What I have learned is that each body is different and the only way to know exactly what you need to do with your unique physiology and metabolism is to test, test, test and then...test. Some folks fly without logging, but I log everything in a notebook and watch for patterns.

I usually test right before exercise, and then every thirty minutes or so while exercising. I also make sure to ALWAYS have fast-acting glucose on my person (pocket or waist belt) or very nearby (e.g. in a backpack.)

Another thing I have learned is that if I suddenly feel really strange/shakey, I should treat first and then test. We can always bolus for a glucose tab if we need to in the event of a mistake. But if we're dropping fast, waiting to treat until after we test can mean missing that window of opportunity where we're still coherent enough to know something's wrong and can chew and swallow a glucose tab (or a Smarty or a Skittle.)

There are calculators on-line to help you estimate how many calories you'll be burning as you exercise. You can plan breakfast or snacks accordingly. I was surprised to learn that you burn the same number of calories per distance regardless of the amount of time you take to cover that distance. That is, if you walk a mile or run a mile you're still burning approximately the same calories per mile, you just burn them quicker if you run vs. if you walk. For this reason, it's a good idea to keep track of the distance you travel when running or walking, your time spend exercising, your BG's during the exercise, your recovery nutrition (the runners I know swear by chocolate milk, for some reason...smile), BG's, etc.

That way, you can plan the next run or hike or day on your feet at a parade or whatever with a sense of how much fuel you burn during a given distance covered or a given time spent exerting yourself (running five miles, running five miles with hills, hiking 2 hours on hills, "hiking" two hours at IKEA, etc.)

Knowing both time and distance can help you plan.

Also keep an eye out for delayed post-exercise hypoglycemia, especially after an unusually vigorous exertion -- you might get a drop in blood glucose 8 to 24 hours after (for example) a long run or race.

6

There are plenty of us on here who are really active and into (what most would consider) extreme sports/activities (marathons, backpacking, etc). I do all of these things and I can assure you that they are POSSIBLE with D -- however, there's a lot of trial and error that goes into it.

  1. Start by reading as much as you can. Think Like a Pancreas and Pumping Insulin are probably two of the best books out there. Even if you don't have a pump, Pumping Insulin has some good guidelines of how insulin works and how you need to adjust things for exercise. Think Like a Pancreas is probably the best all-around book, though.
  2. If a pump is a possibility, get that process started. For those of us who are very active, pumping can make a WORLD of difference. Smaller doses of insulin and variable basal rates are lifesavers for me.
  3. Check your BG and monitor the effect of exercise, carbs, and insulin as much as you can. Check your BG at the beginning, middle, and end of some activity and record the results. Experiment with having a small snack, decreasing your basal insulin beforehand, etc. Some folks just use a simple Excel spreadsheet, others use iPhone apps, and others (like me) rely on their pump's software. This is a personal choice and just go with whatever works best for you.
  4. Learn to be prepared. I do a lot of backpacking and being prepared on the D front is critical. Always make sure you have extra insulin, test strips, carbs, protein, etc.
  5. For me, short bursts of exercise generally cause my BG to go up, especially if that exercise is something that causes an adreneline rush. Long, slow runs tend to make me go low, so I decrease my basal rate to about 70%. However, if I'm running a road race, my BG will always skyrocket from all the excitement. I generally have to turn my basal rate up to about 170% to stay anywhere within range. I think my experience is pretty common, but remember - your diabetes may vary (YDMV).
  6. I tend to exercise in the afternoon and evening. I find that evening workouts put me within range for bedtime and generally result in good morning BGs. Not always, but generally.

At this point, you need to really focus on getting your BGs into (somewhat) normal range. You will slowly begin to feel better and get your strength back, but it will take time. I would probably avoid anything super intense right now and stick to hikes/walks in moderate conditions. Just PLEASE make sure that you pack what you need each time you head out --- having the right D supplies handy will ensure you're ready for whatever happens.

7

Thanks for the great advice!

Keeping everything I might need (and then some) on hand is something I'm trying to practice on a day to day basis - even if I'm just heading into work for a few hours (my employer's letting me work from home as needed until things stabilize a bit more) or going to grab some groceries.

It sounds like a lot of active PWD's swear by their pumps, so I'm very interested starting that conversation with my CDE.

I'm also curious about CGM's - I seem to see/hear less about CGM's on the athletic boards/forums as compared to pumps - any primary reasons for that? Is it just easier to wear a pump and carry your meter and glucose supply as opposed to wearing a CGM and having to carry insulin, extra glucose, and potentially a meter since the CGM readings need to be calibrated?

Thanks again everyone!

8

CGMs can be great tools and there are people who absolutely swear by them. I have tried using a CGM, both the one that is integrated with my pump (the Minimed Revel) and the Dexcom. For me, both were too inaccurate and they also led to some bad habits...like testing less and bolusing based on what the CGM said (read: laziness). For me, finger sticks (upwards of 15/day) just work better for me. They keep me honest and focused on top of things.

The other issue I ran into was, well, lack of real estate. Between pumping and using a CGM, my skin was beginning to look pretty bad. Given my insulin sensitivity, pumping is pretty much a necessity for me and I need to preserve my skin. If I have to choose between a CGM and my pump, I'm choosing the pump each time. Granted, I am a pretty small person, so I'm sure others have more room to work with.

But everyone is different as to what works for them. I know very active people who don't use pumps, but swear by their CGMs. I know active people who use both.

A pump is, IMO, definitely something every T1 should at least try. You may not like it and that's fine. There's nothing wrong with shots and plenty of people still use them. But if you're really active, the ability to turn your basal rate down "on the fly" and adjust basal rates is so incredibly wonderful. For me, it translates into fewer serious highs and lows, which means I feel better and have more energy.

I would try talking with your CDE/endo immediately about a pump. Read Pumping Insulin and as many posts in the pump forum as you can. Watch videos on YouTube to get acquainted with how the pumps operate. There are three main pumps to choose from in the U.S. - Minimed Revel, Animas Ping, and Omnipod. Do your research and decide which one would best meet your needs. If you don't feel that your endo/CDE is supportive of your decision to pump (should that be what you decide), remember that you are free to try another practice. However, I think, for the most part, CDEs and endos are generally supportive of T1s trying pumps. So long as you're testing and on top of things, a pump can be a really great tool.

10

Thanks Shawnmarie and MegaMinx - great advice on both.

MegaMinx - I was thinking about the honeymoon factor, as well. A friend of mine was diagnosed in December as T1 (like me, completely out of the blue and he had a very similar experience: DKA, ER/hospital visit, etc.) - and he got back into running very quickly after his Dx.

He had been looking into some supplements and visited a naturopath (sp?) and said he's had a few days when running and exercise have allowed him to keep off insulin. Even if the supplements/vitamins he's taking are having a positive effect on his beta cells, I'm guessing it's doing more along the lines of extending his honeymoon than anything else.

I'm not saying that's a bad thing by ANY means - I hope to keep my beta cells (and the rest of me) as healthy as possible for as long as possible - but I don't want any honeymoon period to lull me into a false sense of stability and let up on my management. Like you said - things can change fast and I want to be as prepared as I can be.

I'll check out the honeymoon posts/discussions and learn what I can!

Thanks again for all the great advice!

11

Hi. Welcome! What insulin are you taking and how much? I take Lantus and Humalog with meals. When I was first diagnosed I was told not to exercise until my BG got into more normal range. It took about two to three weeks to get them down, but my sugars had been so high that I felt low at 140 at first. What are your numbers like? Have you had lows? That’s the danger really of exercising with a long acting insulin on board. I used to avoid lows by eating about 10grams of carbs before, sometimes during, and after exercise. I also noted that my insulin carb ratio after exercise was much better (I have a pretty significant dawn phenomenon which I didn’t realize until I did a CGM trial, which I recommend highly. I had lows in late afternoon and sometimes around 3am when I would ramp up the intensity of my work outs. Now that my honeymoon phase has tapered I find that my BG goes up during the first 30 min of exercise and then slowly goes down. I can pretty much hike or do a moderate intensity work out without any extra carbs.

12

Sorry my iPad cut me off. For at least hour. Anyway I use my CGM now to see trends and watch for lows. I always test to make sure my CGM is accurate. Also when I was in my honeymoon I could not inject Humalog within a hour of my workout as the exercise made me super sensitive and I would go low within 20-30 min. Everyone is different. Get extra test strips and test ALOT. It’s really the only way you know how your body is reacting to exercise. Sometimes it’s difficult to sense a low when your exercising as you are already sweating, etc. Also don’t exercise if your BG is over 250. It can make you go higher. Exercise helps me so much. It’s definitely more work, but worth it.
Good luck and keep asking questions. The info on this site is so helpful and we’ve all been there.
Molly

13

Thanks for the reply Molly!

As far as my insulin goes, I am currently on Levemir for my long lasting (18 units, once daily - I take it at 10:30 at night) and Novolog for my fast acting/mealtime (I just picked up my new prescription of Humalog which I will switch to once my Novolog pen runs out - have you been on Humalog all along or did you get switched to it from a different fast acting insulin - if so, any challenges there?).

My I:C ratio is 1:13 and my correction factor is 50 and my BG target number right now is 120. My CDE was very up front with me that she was starting me conservatively, so when I meet with her this Thursday I wouldn't be surprised to see those numbers change.

Regarding my overall BG, it was still spiking over 300 one or two days out of the hospital, but it has stabilized a lot since then. I've had one morning where I woke at 140 and yesterday I woke at 129 - generally I'm in the range of 129-189 right out of bed, with my last meal generally being dinner around 7:30-8:00. There are some general patterns, but I've only been diagnosed for a week and a half so the picture is pretty incomplete. I do occasionally see a measurement in the mid 200's, but those usually drop pretty quickly. I've been instructed not to correct without food at this time - again, my CDE is being conservative in getting me acquainted with carb counting and insulin.

One of the biggest things I'm noticing is that because I'm on pens I can't adjust for small increments - for example, if the fast acting dose I calculate should be 3.5 units, I have to pick 3 or 4 units and considering how sensitive we all are to different carbs and insulin, that can make a big difference. I have rounded up when the increase in insulin isn't huge (usually .3 units or less) and those have probably resulted in some of my lower readings.

I'm testing a lot - and I'm sure I could test even more - but my hope is that having numerous (especially pre and post meal) measurements will give my CDE some good data to dig into.

I haven't experienced any lows yet, at least since my DX. However, in the past I've felt the symptoms of low blood sugar when I missed meals and would feel better as soon as I had some carbs. Despite those experiences, the last physical I had never gave any indications of T1 - I guess that's part of the mystery. (One of my co-workers, who has a lot of D in her family and is tested for it every 6 months, said she had episodes in college where she would pass out from low blood sugar but every test for D came up negative!)

The prospect of lows scares me - less so now than even a few days ago as I've been reading and on these boards - but I'm diligent about keeping tabs with me at all times as well as my meter - and it's one of the main reasons I'm testing almost on the hour every hour during the day.

Wow, I just realized how much I've been typing - sorry about that!

I'll close by saying that thinking about exercise within the context of my D is really one of the strangest things I've experienced. There are obviously some tough emotions at this time when I have to be so aware of what my body's doing now when a few months ago I could walk out my door and hit the trail without too much thought. That being said, I also have this weird feeling of excitement when I think about the prospect of figuring this out - I don't know if it's just the part of me that likes a challenge or if I'm starting to get beyond the initial shock of my Dx and realizing that I can still do all the things I love with some extra effort - I'm sure it's a combination of both!

Thanks again!