My Difficult Relationship with Physical Activity

Type 1 and LADA
1

Hey all- long-time lurker, first-time poster. Definitely appreciate the communal resources of this group, and a recent move across the country drew my attention to an issue on which I would love to get some different perspectives.

Type-1 diabetic for about 21 years. I’m 31 now. I have never been big into exercise. My interests have always just been in things that are diametrically opposed to the typical activities that are aligned with physical fitness. I’m pretty thin, and I’d say pretty out of shape.

Of course, I also realize that being physically fit is beneficially for everyone (particularly those living with diabetes), so I’ve definitely tried to remedy this issue. However, I have been frustrated by exercise’s wild effect on my numbers. I’m either dropping super low and feeling horrible during/after, or I’m spiking super high afterwards…and feeling horrible.

As I mentioned at the beginning of the post, I just moved across the country, and into an apartment on which I am on the second floor. Just the simple act of walking up steps carrying things into my new place has been shockingly difficult for me! I could only make a couple trips before feeling really weak, and checking my blood sugar revealed that I had dropped dangerously low just off relatively simple activity! I understand that it’s usually best to eat before doing anything strenuous, but I can’t exactly predict when the UPS guy is going to deliver my packages…and I can’t tell him to wait ten minutes so I can eat when he arrives, either. Is this a normal thing?

Am I especially sensitive to the effects of physical activity, and is that because I have been relatively sedentary for much of my life? Is there anything that I can do to change/improve this? And are there any good resources out there geared towards people like me (wanting to become more active, but without feeling horrible from numbers drastically sliding in both directions)?

Looking forward to hearing any insight you guys have to offer. Thank you in advance!

2

I think that adding more physical activity to your routine will make your body less likely to drop in bg or have other exercise induced fluctuations. I think of it this way-- those fluctuations are a reaction to a stress (exercise) on your body… If you intentionally put controlled amounts of stress on your body by exercising or being active, the things like carrying boxes upstairs or physical work, etc aren’t such a shock to your system and less likely to cause fluctuations

3

And as far as managing your bg for exercise it just takes a bit of trial and error. Some of the avid exercisers here seem to have it down to a science where they’ll eat precisely x amount at this time, etc. I’m more likely to just eat an apple or something a while before I go on a run or workout. Different techniques might work for you-- just gotta ease your way in and see what works

4

My perspective on physical activity may or may not be of any use to you, because I'm something of an outlier on the topic: I don't enjoy exercising for the sake of exercising, never have and at this point in my life probably never will. I even think it's a sign of our unnatural culture that people have to do silly contortions because their actual lives are sedentary. No intention to offend anyone, I do admire people who stay in shape.

That being said, I know that my weight is easier to manage and my blood sugar as well when I get more exercise, but the only way I can stay motivated to do that is when I integrate it into my life. Ironically I was much more active when I lived in a city than now that I live in a beautiful mountain area. I'm visiting the Bay Area this week and the very first day I spent literally hours walking around Berkeley going in and out of shops. I always walked when I lived here because it was my mode of transportation (Zipcars for when I needed a vehicle). At others points in my life I biked everywhere. Where I live now there are hiking trails everywhere but I'm not motivated, and my house is up a winding hill so I drive everywhere.My bike is a dust rack. So that is my suggestion as to how a non-exerciser exercises - find something that is easily integrated into daily life.

As for controlling blood sugar when exercising, I'm going to be completely unhelpful and you probably shouldn't even read this part: From everything I've read on here over the years it sounds like it is somewhat of a crap shoot whether it drives your blood sugar up or down and how you stay stable with intensive exercise. As a matter of fact that's my main argument for why I don't bother: It's just one more variable I don't need! Seriously, though, I do think it seems that most people - like in other aspects of D management - learn their own patterns to integrate the exercise into their blood sugar control: when to eat, what to eat, whether to have a separate basal pattern for exercise, whether to reduce basal PRN before exercise, etc. And in time you will hear from others and find how to tailor it to your own needs/body responses. The one I don't really get though is when people eat to prevent/correct lows when they exercise. For me the prime reason to exercise would be weight control and that would kind of defeat the purpose. See I told you, my two cents is worth literally two cents!

5

It's always interesting. While I can bang in 100 miles on a bike ride and come out of it with bloods around 83 if I lump a load of boxes around or clean out the shed my BG will crash through the floor as I'm not fit "that" way (very little upper body strength at all). So yeah, I'm just like you and probably many others with surprise exercise of a different variety our bodies aren't used to.

I've come a long way from when I started getting fit. Almost ten years back I looked at myself and thought eek, need to sort myself out. Was overweight and generally didn't have much drive for anything. I went the cycling route, and as a winter project built a mountain bike off parts off ebay as a pet project. At first I was quiet pleased to do 3-4miles on it. 6 months later I was reasonably happy doing 10 mile. Happily rode at that kind of level for a couple of years just doing a little, and lost a reasonable amount of weight. Had a few problems with blood levels but was trying to manage.

A local sportive started for charity, just 40mile and went into it. Needed to set my goals bigger and really loved it. Was awfully slow, and utterly wrecked at the end. But did it. Was really pleased at how things went.

Got asked to raise funds for the local primary school, and asked to ride the coast to coast route, 150 miles over three days. Went for it and had no end of problems with lows, highs, utter crazy levels. The others doing it thought I was going to drop out mid way through the first day. But one thing being T1 teaches us, it's that we never give up...even when we probably should hehe. Stuck at it, and over the following days improved massively learning more and more about how my injections (wasn't on a pump at this time) needed tweaking to ride with. But I made it, and on the following day was under control and was flying. The others couldn't believe the change.

I got a pump the following year, and control improved massively due to a lot of problems I was having with Lantus and exercise. It was much easier to manage and predict and correct my levels. My range improved drastically, and my weight fell off ever further. Lost over a stone with the change to a pump.

The following months I redid the coast to coast route, but this time with a group of scouts, carrying quiet a crazy amount of bags for them. Tools, medical supplies, coats and things. A much easier ride this time, and much easier to keep bloods in control also. I followed that by doing the sportive again, but this time the longer (and much more crazier) route. It was hard, but great to discover that changing to a pump really enabled me the ability to avoid all the problems I had due to Lantus when doing exercise.

Following year, I rode the length of the county. 1000 miles, in ten days, on my own. No support, no backup, just me, a bike, and a tent strapped to my back. It was great fun! And learned more about my levels doing that and how my body works that I ever have from any book or doc.

I've come a long way from being pleased at doing 3 miles. My bloods have improved and can just hop on a bike and ride. Bloods I can keep usually pretty stable also. But little things always jump out to surprise and keep you on your toes. The weather, the wind, heat, humidity, stress, not allowing that guy you see down the road in front of you stay there and you have to pass him! It all alters our levels. But the more you exercise the more you know what your body will do, and what you need to do to keep it stable while doing that. Ignore the books, just go out and learn. But as said above, while I can ride like a crazy thing, if you give me a shed to clean out or lift a load of boxes up and down stairs I'll be having a hypo in no time. Different forms of exercise though. Sorry for wittering on there, it kind of just snowballed :P

6

If you’re taking basal via mdi there aren’t many other options other than to eat if you want to counteract a forseeable drop in bg. Those on a pump may just be able to turn their pump down or off in advance but even then the timing becomes complicated… That’s why a lot of people think it makes sense to eat a little before exercising. Exercise doesn’t have to go hand in hand with not-eating in order to be effective for weight management. A physically fit body burns more calories even at rest than one less so.

7

Just start with something simple like walking around in a big store, then maybe progress to leisurely riding a bicycle or something else that's low impact. It's important to stay in shape but we all don't have to be super hero's....who would they save?.....

I must plan ahead if I'm going to do any extended activity or my BG will get to low. I can do things it just takes planning since my insulin regiment is very aggressive.

8

I'm with JohnG and Zoe. If I'm doing something fun like dancing for exercise (stretching) where I can maintain a level BG; however, if I'm doing aerobic exercise, my BGs are all over the place and more often than not they are plummeting.

I feel your pain SeanSean. A simple task such as grocery shopping I now have to have a pre-shopping snack or else I'll have a hypo in the middle of the cereal aisle. My mom's hypos give her plenty of time to get hard candy from her purse, unfortunately mine don't. One minute I'm sweating like ice cream cone in the middle of August, the next second I start losing my vision and become quite ornery (per my mom).

Then I have to take another break and a sugary drink before I can unload said groceries from the car to the downstairs apartment and then putting them into the pantry. I'm not even on insulin yet. I've fought hypos 'on and off' since I was diagnosed with Graves Disease at age 13.

It's weird how your body can adjust and compensate for certain activities while others it can't.

I agree with the previous posters that stress can cause hypos too. I check my BGs before leaving work because I always get stuck in rush hour evening traffic and end up dropping. I don't have that problem in the mornings--yes to rush hour traffic, no to hypos.

9

My BG is way more stable when I exercise routinely, even if its just 3x per week. Basically, I carb load about an hour before I exercise, and that seems to prevent a crash. I also do a lot of intervals, which allows me to check whenever I need to. I've found that my BG drops about 100 points per mile that I run, so I almost always suspend/reduce my basal rate (on the omnipod) before I do more than 40 minutes of cardio.

I work in retail, which requires me to be on my feet for 8 hours at a time, and I find that I often go low if I don't have a 20 carb snack before my shift.

10

Check, check, and re-check.

It's basically trial and error, hopefully with the learning more on "trial" and less on "error."

11

Ave you seen this yet?

http://www.tudiabetes.org/video/live-interview-the-athletic-diabetic-with-gary-scheiner-cde

I struggled with how to modify dosing for planned exercise until I changed to cuting bolus down by a third to half for the meal immediately prior to exercise. Made a huge difference, trying to reduce basal did not cut it for me.