Diabetes Unscripted
Creating a community for folks living Type1 diabete to learn and grow from one and other. Because until there's a cure there's a community.
Diabetes Unscripted
S1E6: Fitness Journeys with Diabetes Management
Discover how athletes with type 1 diabetes are acing their fitness goals while managing their blood glucose levels effectively. Join us as we promise to unlock practical strategies and technology tips that can revolutionize your diabetes management during workouts. From the thrilling ice of hockey to the serene greens of golf, our guests share their firsthand experiences, emphasizing the importance of personalized fitness plans and the role of insulin pumps and continuous glucose monitors. You'll gain insights not just from everyday athletes, but also from Olympic swimmer Gary Hall Jr., who brings a unique perspective to managing diabetes on and off the competitive stage.
Get ready to explore the nuances of sports and diabetes management, where race mornings can be as unpredictable as the weather. Our discussion shines a light on the importance of timing, nutrition, and preparation, offering you actionable advice to conquer long-distance challenges. We'll delve into the experiences of athletes who have mastered the art of balancing insulin dosages and nutrition, adopting individualized approaches that suit their unique needs. The wisdom shared within the diabetic community, combined with expert guidance from healthcare professionals, serves as a beacon for those looking to enhance their performance while keeping glucose levels in check.
In our concluding segment, we shift the focus to practical exercises and daily activity choices that empower individuals with diabetes to maintain an active lifestyle. We highlight the importance of preparedness, from carrying fast-acting treatments like Smarties to setting higher low alerts during exercise. Drawing from experiences as a college athlete, we underscore the need for adaptability in high-pressure situations and the value of working closely with healthcare providers to develop tailored management plans. As we wrap up, you'll walk away with a toolkit of strategies to not only manage diabetes but also embrace an active and fulfilling lifestyle.
You're listening to Diabetes Unscripted, where we are focused on creating a platform for people living with diabetes to share, learn and support one another, because until there's a cure, there's a community. Getting into this week's episode of Diabetes Unscripted into this week's episode of Diabetes Unscripted the question that we're going to be covering this week is one of my favorites, so I'm super excited for the content ahead, and the question that the interviewees were asked was do you have a fitness plan, what is it and how do you manage your VGs during these activities? There is a multitude of valuable information in the many answers ahead. I will put in a quick summary at the end, but without further ado, here we go.
Speaker 2:I still referee USA Hockey in high school. During the summer I play a lot of golf, tennis, I am working on walking to lose some weight and I would say my fitness plan, when I start activities, whether I use a temp basal or depending on what pump I'm using at the time, I'd like my blood sugar to start at about 150. And then, depending on the activity, it may be a little bit higher. But with today's technology some pumps only allow you, whether it's an exercise mode, to be around 145 to 150. Omnipod allows you to finagle that a little bit more.
Speaker 2:The one thing that I would say is, with the plan that you have, you want to make sure that you talk to your doctor, your endo, to make sure that you're not just doing things that could potentially be harmful. But with the experience you kind of learn as you go. I know where I want my blood sugars when I referee because I know for about a five year period there was five straight years my wife had to call EMS for me because I was unresponsive, and that was after refereeing quite a few hockey games. You know, learning through that, you know, kind of helped me working with my endo, working with my community, as far as things that they do and things that I could do better. One thing that I would tell anybody when you're dealing with a plan or in diabetes in general listen to what others do. It may not be right for you, but it still educates you. And then there's always things that you know. Whether it's at diabetic camp, whether it's through the diabetic community, there are things that you hear that might interest you to try. That may be very successful. I've been very fortunate because one of my best friends does a lot of activities and with things that he has discussed, it helped me become better when I do activities.
Speaker 2:Now I would say when I was most active and that was when I was refereeing quite a bit of high school, college and USA. You know what I learned is when you are refereeing, often your stored glucose is used, and that's also when I had the same experiences with Lowe's that I was hyper unaware. So I learned how to better manage those activities. And for me personally at the time I was much more active and it was not uncommon for me to referee seven days a week. What I learned for me and for my health was that I needed to not referee as much and be more aware of blood sugars, going into games and then, as well as monitoring them afterwards. Well, I would say when I first learned that the technology is not what it is today, so it was often that I would either shut the pump off or disconnect for two to three hours afterwards. And then, you know, look at the Dexcom, which is what I was wearing at the time, to see where I was Now today and when I do things that are much more active.
Speaker 2:I treat before I'm low. I'm doing a lot more with food management than I am with just finagling the pump. Now it could also be setting, you know, 50% well before. So that would allow me to to help combat those six-hour lows, just prevent lows. I do not recall if I was getting. I don't believe so because, again, when I started doing that, there was a lot of unknowns. I do recall after I won't say a couple years, but probably after a year of doing that or after a couple months. You know, like most things, we learn. And then what was nice is, you know, I would shut it off for three hours and the lowest my blood sugar would go throughout the night would probably be, I would say, down into the eighties, which was very manageable.
Speaker 4:So, yeah, we talked about them a little bit. But the high intensity interval training, those would be the HIIT classes. Um, I'm a huge proponent of those um, mainly because they are they're for a very specific amount of time, right, so I could work that into my schedule easy peasy versus the idea of like a three hour, something. You know, sometimes that can feel overwhelming or it can just feel like there's no, I can't make time for that. I don't want to make time for that. But for me, the hour to hour and a half of a very specific workout class that's been so helpful to working out and living with type one. But then it's bringing, bringing along your sugar right, making sure that you've got something to treat if things go haywire and making sure you've got an extra sight change. Another cool thing about those classes, too, too, is that they're in like a space where you have like your own area to just put your stuff too, and that might sound weird, but you can bring along all those extra things and they're in a nice little bag for you and then put the bag right next to you while you're doing your workout, right? Versus something that maybe is like traveling or on the move or whatever that that could bring like a whole nother barrier and more obstacles along the way too, but I think it's not like I really am a huge proponent for those workout classes. And then another thing that I do as well is and this is going to sound crazy too Another thing that I do as well is and this is going to sound crazy too but it's getting 10,000 steps every day. So that might not seem like it's super good workout, but if you are actively committed to achieving 10,000 steps every single day, that's a real thing that you've got to manage and figure out your time around as well. That also can amount into a maybe figure out your time around as well. That also can amount into a maybe less extreme version of exercise as well. So we have the super cool Lakeland Trail right around where I live, and the trail is. It's an awesome place where you can pack along all your things that you need and never get quite too far away from home. And then that's been something that I've enjoyed doing and I'm on day like 150 now of getting 10,000 steps or more. So it's like I like seeing my street keep building every day, so that's pretty cool. So, yeah, yeah, it's just packing along your whatever you're going to use to treat, making sure you've got a site with you, um, but for the most part I think you can. You can do whatever workout class or whatever workout or exercise that you want to do, um, and then it's. It's finding where diabetes is going to fit into that.
Speaker 4:Yeah, yeah, yeah, yeah. So maybe that first step is getting those steps too. You know, getting out and just walking around and see how your blood sugars respond to that. So I agree, I don't know if it has to be as extreme as like what the perception of fitness is too. Fitness can be getting 10,000 steps a day. So so it's swimming for me. Swimming is so hard on my blood sugar and I don't I swimming, even if it's just like playing around, swimming like not intense, like butterfly swimming, it's. It can be like just goofing around and I like, even on trips and stuff, when, when we go in the pool and it's just really hard and I don't know why my blood sugar is so so, so it's getting out and it's having some crackers and cheese and whatever we packed for our picnic next to the pool okay.
Speaker 5:So my typical advice for fitness is and for myself is to attempt to do exercise every day period. I'll take anything you got. If you can give me a marathon, do it. If you can give me five minutes, do it, but just don't be sedentary that entire day, because just a little bit of exercise goes a long way to lowering insulin resistance and making your body feel better. If you were to drill it down to more specifics, I generally say 30 minutes of cardiovascular every day.
Speaker 5:A lot of people say well, you know, muscle building exercise is more important because it sucks up sugar the whole day, instead of cardiovascular, which is a spurt. My answer to that is I'm still trying to be weight neutral my entire life, so I need to burn the most amount of calories as fast as possible. So I need to burn the most amount of calories as fast as possible and, generally speaking, the most advantageous, fastest burning of as many calories as possible is a cardiovascular workout. So I personally do cardiovascular workouts the majority of the time because I'm trying to get the most caloric burn. That being said, in an ideal I would do both cardiovascular and lifting exercises daily to try to stay in shape.
Speaker 5:Now with regard to blood glucoses. That is such a loaded question for the variety of ways in which you treat your blood glucoses those who have continuous glucose monitors and pumps and exercise modes. I usually drop in the exercise mode like a half hour. If I'm taking insulin shots, I'm taking less of my rapid acting. If I'm doing 30-minute bursts, if I'm doing a marathon that day, I might take half my basal, aka long-acting insulin, but that's not going to help you if you're on certain long actings Like, for example, degladec has a very long half-life, which is a very good insulin, which is why it doesn't cause hypoglycemia. But pulling a shot back the day of the big race isn't going to really influence your background bas, uh, basal insulin, that much. So this is very Taylor specific. You need to talk to your physician if you're really, or you need to come up with your own via internet, via these discussions, uh, via living life with other people with type one diabetes, to get some ideas on what's best for you some ideas on what's best for you.
Speaker 3:I am a long distance runner. I feel like my biggest piece of advice with this it was really getting into the marathon platform and seeing that, diabetes or not, people had to be really thoughtful about what nutrition they were getting. So I always thought I had to have snacks with me in these long runs because I had diabetes, because what if I had a low blood sugar? But it's not. You're depleting all of your energy, diabetes or not. You need food during some of these runs. So figuring out exactly what works for you is across the board. So I thought that was really interesting when I started looking at this. More Absolutely, you need to pay attention to what your blood sugars are doing and, again, live in the gray area. I am so fortunate that I tolerate gels very well, but I do have a friend that packs potatoes and peanut butter and jelly sandwiches and I just thought that was something that people talked about. They didn't actually do. But, sure enough, and she does not have diabetes, so she is packing those full snacks, full meals. I do gels, I do actually raisins. I really like anything that's easy to chew. Well, I think you have to really watch your active insulin. So I think checking that all of the time to make your dosing decisions is really important. There's a really fine balance between your high and you need to give some insulin and what that insulin is going to do In terms of hydration. I would say that's no different than anybody without diabetes for me, unless I do have a high blood sugar and then I am extra thirsty and now I'm cranky because I'm high and I'm thirsty and I don't have water because I don't carry it because it's heavy and I know that that's wrong. However, I'm stuck in my ways and I won't change that. And I won't change that Absolutely because I am a nervous rock on race mornings and I know that and it's really a factor of timing. So when I'm doing these training runs, you know I can start whenever I choose. If my blood sugar is lower than I'm comfortable with with starting, I'll wait an extra 15 minutes On a race morning. You really don't have control over that.
Speaker 3:I remember I did run the Disney half marathon, which I have to say was my least favorite run of them all, because I had to wait multiple hours to start and part of that was that I had my pre-race snack and ate and then my blood sugar was so high and I was waiting and I just didn't know when my group was going to start. So that was probably one of my worst marathons, just because I kind of messed up the pre-race plan. So it's very different than your training because you just don't have the flexibility. So one of my favorite races, and really the one that I do most consistently, is the Detroit Free Press, and that one I like because they start so on time. So I know exactly if they're starting at seven, I can probably eat something at 650, 655 and I'll be pretty solid because I can expect when I'm going to start with that race.
Speaker 3:I think in general, my race mornings are so different. Just because I'm waking up earlier than I normally would. Everything is a little bit different and that's very stressful. That's what I did at first and that was part of this trial and error which is running in general. No people without diabetes have to fuel every six to eight miles, so I started doing that too. Now I wouldn't do a full gel, I started doing a half, and if I need to do a half I'll do it more often if I like physically need that. But that's really a lot of practice.
Speaker 3:Yes, I have something this is kind of one of my favorite things that I find really interesting. So this says that athletes with type 1 diabetes report that competitive exercise events cause their glucose levels to rise dramatically. And this is from Gary Hall Jr, who was an Olympic swimmer. So he said I was finger sticking frequently all day. Leading up to the 50 meter race in the evening In the ready room prior to being paraded out to the starting blocks, my blood sugar level was 138. To being paraded out to the starting blocks, my blood sugar level was 138. After the race, I tested within 10 minutes and I was 388. The race lasted 21.98 seconds. So I think just looking at all of the different factors is interesting, sure does? I just think it's important to realize all these different factors and why there's a difference between a practice and a game mark, I remember you gave me a great piece of advice with a insulin pump.
Speaker 5:You said flip it in or give yourself a micro bolus right before you exercise, which is counterintuitive to like what I would think to do. But I gave myself a micro bolus before the exercise, which then shut down the insulin pump from bolusing during the exercise for like the last half hour hour, which was really cool, because what was happening is you would have this is a little scientific, I know, but a sympathetic nervous system discharge, meaning you would have like a fight or flight response during exercise that would raise my blood sugar and then the insulin pump would try to tackle that blood sugar in the middle of my exercise. But by giving myself the micro bolus during before the exercise, it locked out the micro bolus during before the exercise, it locked out the pumps ability to do that. So I mean this is stuff that yeah, I mean this is stuff that you can never find in a textbook. This is not stuff that, like this is where you get your street credit. This is where you get like talking to your t1d buddies, because that's where you're going to find that stuff. So, like I said, mark is a amazing person that's helped a lot of people, including myself, with type one diabetes, management for even exercise and a whole bunch of things. So exercises to each their own and and similarly, I wouldn't allow urban legend to spook your exercise or, like one bad hypoglycemic event during exercise, to ruin all exercise for the future.
Speaker 5:There's a lot of stories I hear of people you know they were going for a run. They forgot to bring some glucose. They thought they were going to die. They had to like hail somebody over from the side of the road to like pick them up and call EMS. Lots of stories like not lots, but occasional stories like that. And similarly, you got some aunt or uncle or friend of the family or your own family telling you I'm really nervous about you exercising.
Speaker 5:Swimming it's very scary. You have diabetes, don't do it, please. What if you go low while you're swimming? No, you can't do that, right, you have to like march on, you have to just go. So you shouldn't go swimming without having some glucose around, right or having people who know that you have diabetes, right, and not maybe swimming for an hour or playing in the pool for an hour. Check your blood sugar. Those are all like you know, it's like wearing a belt and suspenders to keep your pants on right. It's a little overdoing it, but like you should do it sometimes, and Mark's wearing a belt and suspenders right now.
Speaker 6:All right, yeah, so I have had a chance to do some some interesting things over the years in terms of diabetes and fitness. In 2011, I was part of Team Type One with their Run Across America, so there were 10 of us and we ran from Oceanside, california, to New York City over a 15-day period, so each of us averaging between 25 and 35 miles per day at a little over an eight-minute per mile pace, and it was really something that I loved being a part of. But, as you I'm sure would know now, even without explanation like that poses a lot of issues, because even a more conventional exercise duration and severity can be a challenge, right? What I have found is that, when it comes to exercise, a plan that works 80% of the time, it's a smashing success, like pat yourself on the back dude, yeah, so there's a number of. There's so many things at play, whether it be, you know, high heart rate exercises, stop, quick, stop and starts, stop and starts, aerobic versus anaerobic. All these things can affect blood sugar in different ways, and even if you do this similar thing one day and then again, the next response can be different.
Speaker 6:A couple things that I'm doing now that I didn't always do is leaving my pump on. Now that I didn't always do is leaving my pump on the times that and I know, like in the past, I want to disconnect, more for a psychological reason than anything, I in the past have felt like, hey, this is my exercise time. You know, this is like no diabetes. For the next hour and a half I don't have it. But then what I've noticed is, you know, two and a half hours after I'm exercising I'm still trying to correct that stuff down. So what I've been doing over the last year is leaving the pump on and going to the activity, exercise activity mode, and glycemically I'm so much better off for doing so. So that's, that's a change that I've made.
Speaker 6:Also, being prepared for lows, always having something to treat. I've been in situations where that hasn't happened and I've had no money and I've been in stores and asking for free food and it's just a sad, sad, funny, fun situation. But I don't recommend it because it can be a dangerous situation. So just be prepared to deal with issues as they occur, because they occasionally will, and when they do it, just accept them. This is life, everybody has challenges and this is. It ain't that bad. So, yeah, I try, I'm prepared with ways to treat blood sugar. I've used, I'm using now more consistently, smarties. So go to your favorite bulk food type of store, whether Costco, sam's, whatever. And I have bags of these Smarties like I don't even know, a thousand maybe now. But the way, the reason I buy them is I first of all, they're very fast acting. Secondly, I don't really like them very much, so they don't pose a temptation. I'm not going to go out of my way to be eating Smarties, but they're very effective in treating it.
Speaker 7:They're eight grams per or six grams per roll and it's six grams per roll and um, it's, it's, yeah, so I actually have a pretty good story for this question. Um, so, as a student athlete, I'm currently playing college golf and we recently took our first ever trip to the NCAA national tournament, um, which was down in Florida this past year, which was a huge accomplishment for our team. It was the first in like 35 years. So we were super excited, as was I Went down there. It was great. The tournament works. So it's like three days of golf and then two bonus days if you can, if your team qualifies, I believe which down in Florida, the temperatures were very hot.
Speaker 7:I ended up losing a sight change part early, a sight partway through the tournament, which required me to do it in front of all these teammates and in front of girls that I was playing with from different schools. And I quickly had to do it too, because we're under like a 15 minute, 10 minute per whole time protocol, so if you fell behind you'd get told you have to work faster and start playing quicker. So it was very quick. I had to move fast, yeah, so I quickly ran over to the bathroom, had to put a site in Immediately. What started to sweat that right off because it was just on my arm. So I wrapped it as much as I could. It was barely hanging on, but I made it through the tournament with it barely on and then we fixed it once I was out of the sun and heat. But that was one of the hardest experiences and it's not the first time that that had happened. Um, I have a friend coming up in a little fusion. Can you please?
Speaker 1:the two to valuable information. And those answers um, I want to just highlight a few. One is this is life right. So whether you consider yourself an athlete or just the average Joe at some point in time, on most days you're going to be active so much, like we've talked about in other episodes, I think it's important to look at your desired level of activity, work with your providers and figure out how to manage your blood sugars and don't let that be a limiting factor to your ability to do the activities that you love. A couple other things that I thought were really good. You know, tom Grossman said it best. He said if a plan works 80 percent of the time, it's a good plan. So you've got to be prepared for that 20 percent. I think that's super important. Something from previous episodes but I think is super relevant to exercise and activity is making sure that you're setting your alerts, um, setting your low alert higher during the activity so that you're getting you know. For example, for me, I want to know if I'm below 100 when I'm on a bicycle or I'm running. I don't want to wait until I'm getting my regular 70 low, because then I'm going to have to stop in order to treat or if I'm catching in the hundreds, I'm able to stay in the game.
Speaker 1:Another piece that was brought in was keeping the pumps on but potentially manipulating them, sometimes an hour or even two hours before the activity, where you know you're decreasing basal to compensate for the upcoming activity. I do think keeping pumps on is a really good idea. We see this a ton with kids. They take it off for a soccer game or a football game or hockey or whatever some kind of contact sport, and a lot of times they come out of that activity in range and everything's fine, but then an hour later they're fighting. You know 200 plus blood sugar from that gap and they're in their delivery. So not looking to give you medical advice here, but I am saying you know, work with your provider and it's not just about how does the blood sugar do during the activity, it's how is the blood sugar doing prior to the activity and how is the blood sugar doing post activity.
Speaker 1:Another thing that wasn't brought up that I think is super important to consider when you're doing activity is, particularly for the pumpers or for the shooters is active insulin right? If you're an injector, you know when was the last time you took rapid-acting insulin and do you still have some of that in your body that hasn't metabolized yet? If you're on a pump, you can look at active insulin or insulin on board, depending on which pump you have. And if you're doing any kind of carb load for that activity, you're going to have to cover active insulin plus the carbs that you would traditionally use to cover that activity. I think that's one thing that a lot of people get wrong, especially as we get further down the road with automated insulin delivery is the pumps maybe ramped up because you have an elevated blood sugar.
Speaker 1:so now you have active insulin, you eat the carbs that you always eat going into that activity, but you don't cover the insulin on board and end up hypoglycemic. So those are just a few tips and tricks, but thank you for tuning in to this episode. Thank you for listening to this episode of Diabetes Unscripted. The information presented in this podcast is for general knowledge. The mention of specific products, medication, treatments or services does not constitute an endorsement or recommendation. Always seek the advice of your physician or qualified health care provider with any questions you may have regarding your care.