@BeastOfGevaudan, I’m certain that the ranges my doctor has given me are exactly as you said…a safety net while I figure things out. I haven’t gone low at night yet…ever…so that might not be an issue for me. I’m not a drinker (maybe 1-2 a month) so that’s a big help. Until your doctor believes that you are in charge and really managing your diabetes, I think they have to be cautious! I have a husband and 4 kids and I have every intention of tightly managing my condition! Thanks!!
@KellyW Here’s another bit of info.
There is a difference between a nutritionist with a certification and clinical dietitian with a degree who is works with people living with chronic illness.
I am not at all encouraging that you seek direction from any “professional” with only a certificate who is not a clinician. What I am suggesting is seeking direction from an academically prepared clinical exercise physiologist/clinical dietitian who is experienced in working with athletes diagnosed with T1DM.
You are living with a clinical condition that necessitates the perspective of someone who has the academic preparation in anatomy and physiology,nutrition and exercise physiology and knows, how a body living with disease responds to exercise as well as how the individual’s body responds to food.
Example. A person with celiac disease should not seek direction from a nutritionist with a certificate. NO BUENO.
If ever you meet someone with a certificate wants to give you advice, I would ask him/her whether they have insurance, whether they are a true clinician, and whether advising people living with chronic illness is within their professional scope of practice. If the person cannot answer the questions for you then at least you’ve done your due diligence before you decided whether or not you want to receive that advice.
As a person who is not diagnosed with diabetes, my purpose is simply to share what I know in the hopes that might be helpful to others. It is not my place to advise. We don’t know each other.
I do wish you success in figuring out what works best for you!
Be well.
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also keep in mind that anyone can call themselves a “nutritionist”. It takes training and certification to be a Registered Dietician or RD.
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It has been my experience that a Registered Dietician (RD) who is also a Certified Diabetes Educator (CDE) is trained and certified to work with someone with diabetes particularly on the topics of behavior, diet and nutrition. That doesn’t mean they will be competent to give you advice on exercise or nutrition needed to support exercise. This is just a weakness in what it means to be a CDE, you don’t have to be deep in everything and behavior and nutrition trump other things. If you ask your RD/CDE for advice on nutrition for exercise and you get a blank stare, don’t be surprised, just suggest that they get Dr. Colberg’s book and read it.
"This is just a weakness in what it means to be a CDE, you don’t have to be deep in everything and behavior and nutrition trump other things. If you ask your RD/CDE for advice on nutrition for exercise and you get a blank stare, "
As a CDE and on behalf of all CDEs, I apologize, Brian, for the experiences that you’ve encountered with CDEs. As unprepared as they might be in exercise and nutrition, one thing I can say is they want to help people and that is a good thing.
I would actually prefer to get a “blank stare” or have the CDE acknowledge “that s/he doesn’t know” and subsequently refer the person with diabetes to someone else, than to receive advice from a pseudo professional who believe s/he knows. A “blank stare” is far less dangerous than advise coming from someone who does not have the academic preparation to prescribe exercise or medical nutrition therapy to someone living with a chronic disease. When you don’t know, you don’t know. Nobody knows everything.
In an ideal world diabetes management would involve inclusion of academically-prepared clinicians in possession of the CDE credential representative of various professions, MDs, dietitians, clinical exercise physiologists…Specialists, according to their academic preparation so that all on the diabetes self-management team might refer the person living with diabetes to the appropriate academically trained CDE.
Unfortunately, at present that is not the case.
Regarding Dr. Sheri Coldberg. She is well regarded and well published in the realm of exercise and T1DM. She holds the title FACSM, which is Faculty of the American College of Sports Medicine, yet, believe it or not, she can’t prescribe exercise to those living with diabetes as she is not in possession of the ACSM Registered Clinical Exercise Physiologist credential nor is she in possession of the a CDE credential. You must have clinical hours in order to earn those credentials, which I have earned… She’s a researcher. I am so very grateful for the research she and others like Dr. Lenny Kravitz conduct as their research informs the clinical exercise physiology profession. Dr. Colberg, Dr. Kravitz and myself are indeed, knowledgeable and at the very top of our game And I am 100% confident that the research Dr. Colberg includes in her publications would be very helpful to you.
However, as a consequence of Dr. Colberg’s professionalism, I am 100% confident she would suggest that you also speak with a registered dietitian who is a clinician whether or not that person has a CDE credential or not. What is important that the clinician has the academic preparation and experience in working with athletes who are living with T1DM.
Copied from something old published by Gary Scheiner:
“For those of you unfamiliar with the concept of IOB (let’s just call it IOB since it saves me a few keystrokes), it refers to the amount of bolus insulin that was previously delivered but is still active (working) in the body. This is important to know because it prevents “stacking” of insulin when bolusing for high blood sugars within a few hours of a previous bolus. For instance, I (like many of you, I’m sure) don’t like the feeling of being in the 200s. I used to check my blood sugar a few hours after eating, and if it was elevated, I would apply my usual “correction” bolus formula. And sure as sugar, I’d wind up low a few hours later. Now that the pumps deduct IOB, that rarely happens.”
“Bolus wizard” was/is Medtronic’s name for the programming in their pumps that calculates doses. Bolus Calculator is a more generic term that includes anything that does the math for you.
I think all pumps calculate IOB in some fashion, but there are apps that do it too for those of us on MDI. I know there was a good discussion somewhere on the internet about IOB though, I’ll keep digging for it and post a link if I find it!
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Well that didn’t take long…
Official explanation of, and calculation techniques for, finding “Insulin on board”… [here]
(http://www.diabetesnet.com/diabetes-control/rules-control/bolus-board). This link sends you to a slightly overwhelming but extremely thorough explanation of what IOB is and generally how to calculate it.
I think all pumps calculate IOB in some form or fashion now, and there are apps (RapidCalc and ManageBGL, and there might be others) that suggest insulin doses and take into account IOB as well for those of us using MDI.
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While pumps generally track IOB and subtract IOB from corrections, there is a more complicated dynamic going on here. Pumps don’t track what I term “Carbs on Board (COB)” and as far as I can tell they don’t subtract IOB from mealtime boluses. Gary Scheiner’s bolus calculator does subtract IOB from mealtime boluses, but again if you still have COB you will underbolus for the meal.
Getting back to the question by the OP.
I’ve discovered that the only way to really hone in on what works for you is by trial and error.
Personally, I’ve found that a good 40 minute cardio workout on the treadmill will bring my bg down 30-50 points. But, when I hop on the weight machines, I rise at least 40 points due to the rush of adrenaline. So, I attempted to reverse my workout…weights first and then cardio. That works for me. My bg’s are much more stable and I avoid the risk of a low bg.
I also have discovered that since I’ve been working out more, I do not need as much glucose to correct a low. Usually 1-2 glucose tabs will bring me back into range with a nice soft landing.
I hope this helps.
Sarah
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@curlysarah FYI, your response is consistent with the science.
Best.
Since for most of my diabetes career I have suffered from chronic high fasting blood sugars I always did cardio first followed by weights. My blood sugar would tend to soar over 100 mg/dl with weights so I actually have to bolus for weights.
I also for the last few years have tended towards interval training rather than cardio. With interval training you sprint all out for 1 minute and then light cardio for a few minutes until my heart rate returns and then rinse and repeat. The mixture of aerobic and anaerobic activity actually does well to keep my blood sugar relatively stable. Interval training also has the added benefit of being time efficient, you can do it for 20 minutes three times a week and it is probably the same as an hour of cardio three times a week.
For sure! Its not full-proof by any means, and like you said IOB only goes so far when calculating doses because you should also take into consideration “carbs on board”, and also that each pump manages IOB their own way for bolus or corrections is funky too, BUT, I’ve found that tracking IOB (using the app RapidCalc) to be the missing piece in predicting --and therefor being able to prevent-- lows while exercising, and it only took 23 years to figure that out. : /
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@Brian_ Per ACSM Guidelines…
“The use of vigorous-intensity and near-maximal intensity interval training is the elevated risk of cardiac events in those with underlying disease. Although interval training has been used safely with cardiac patients, the patients must be medically stable. Vigorous and higher intensities should not be used in the fitness setting with moderate-risk or high-risk clients, even though they may have no known disease, unless clearance is obtained by a physician.”
ACSM (20100 American College of Sports Medicine’s Resource Manual for Guidelines for Exercise Test and Prescription (6th Ed.) p. 454
GThanks for the basic info about interval training as it relates to T2’
Excercise and muscle development can improve insulin resistance,
But but you should investigate the effects on a person with T2’
On that I have a bit more experience than you, if you would like to to discuss it.
Out of respect to your offer to discuss interval training and T2DM, I respond to your invitation @Fraser70. However, my purpose for being a member on TuDiabetes is not to debate or compare who knows more than the next. I am genuinely happy that you have found what works for you and your thirst for growth. Never stop learning.
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