Friday, February 11, 2011

Exercise - Good or Bad?

I know what you're thinking, why the controversial titles? 

Ask my wife, and she will tell you I like to argue(and get the last word), but I say, know I don't, oh I am arguing with my self.

Anyhow back to the topic of exercise. 

We all know it is good for us. We know it prevents heart disease, helps with weight loss, blood pressure, stress, and all that positive stuff. But what does it do for our diabetes?

Well, I believe it certainly helps with lowering the A1C and I must say, personally it has probably enabled me to survive 28 years with out complications, especially the first half of my life with D, prior to my understanding about tight control, MDI's, and Pump therapy. 

I do think with Type 1 diabetes, when exercise is included, it makes management a little trickier, if not more difficult. Question is, what do you think?

I notice a tonne of research on exercise for the general non diabetics, and quite a bit for type 2 diabetes, and slightly less on type 1 Diabetes. The Canadian Diabetes Association Clinical Practice Guidelines published an article titled "Physical Activity and Diabetes".  They provide a brief explanation of the benefits of exercise stating:

"Moderate to high levels of fitness are associated with substantial reductions in morbidity and mortality in both men and woman and in both type 1 and type 2 diabetes"

In other words, you'll live longer with out major health issues.

 It describes the precautions, link and read up your self, if you like. The article then provides 3 strategies for managing exercise and type 1 diabetes:

1. "Consume extra carbohydrates for exercise"
2.  "Limiting pre-prandial bolus insulin doses"
3.  "altering basal insulin for pump users"

No real specifics are included, in how much carb, how much to reduce, but it is a general recommendation.

Then on page S38 of the Clinical Practice Guidelines they provide general recommendations for the amounts, and types of exercise folks with diabetes should partake in.

Now, I do find the CDA article discussed above to be informative, however, I want more "meat and potatoes", more detail, like do I reduce my bolus 30%, or 40%?  This is a rhetorical statement, as I know what to do,  but what about new PWD, or people caring for PWD; do they know?

I found another article written by Michael Riddell and colleagues titled, Type 1 Diabetes and Vigorous Exercise: Applications of Exercise Physiology to Patient Management.  That's a mouthful!

In the intro it is stated:

"Despite decades of improved insulin therapy and significant advancements in blood glucose (BG) monitoring, large excursions in BG concentration remain a major challenge for the active person with type one diabetes mellitus" 

"Me managing my stress"
I must say this echoes my personal experience with BG fluctuations and vigorous exercise.

The paper goes into extensive details related to exercise physiology and type 1 diabetes.  Too much for this blog writer.  The great thing about the paper is the table on page 67, titled, "Practical guidelines to limit BG excursions before, during and after exercise.  Follow the link: Type 1 Diabetes and Vigorous Exercise and go to table 2. 

As you can see detail is nice, and necessary for safe exercise in type 1 diabetes.

So to answer the question; is exercise good or bad?  I guess that depends on how prepared you are.


Sigal et al (2008) Physical Activity and Diabetes, Canadian Diabetes Association Clinical Practice Guidelines, S37-S39.

Riddell et al (2006) Type 1 Diabetes and Vigorous Exercise: Applications of Exercise Physiology to Patient Management, Canadian Journal of Diabetes.


Celine said...

When I tell my non-diabetic runner friends how much thought and prep go into an easy 5k run (never mind a 30k race), they are shocked. Yep, it's a ton of work to plan a workout when diabetic. Much, much easier to just sit on the couch.

But I am fit, healthy, full of energy and complication-free...and very willing to take the necessary steps to take care of myself. I'm firmly on the exercise is good bandwagon.

Valerie said...

I agree with the above comment! It is definitely a GOOD thing for your overall health. When I exercise, I tend to have more energy, feel more positive and just feel healthier and better than when I don't exercise. However, it does make management more tricky. I start lowering my basal little by little prior to working out and I put it at zero and take my pump off while working out because my level tends to drop easily. I always bring juice and glucose tablets with me, and I tend to need them (or eat a snack) before working out. I also find myself using less insulin overall.

Jonah said...

From what I've read, I think there's a huge benefit when people go from couch potato to active but no large benefit in going from active to athletic.

So I walk a few miles per day and don't worry that I don't do much more strenuous or organized exercise.

Donna ((Sweet Momma)) said...


I found you through the blogger basal! I am a D Mama blogger. My son was dx 11/2008 at 27 months old.

I love the subject of this post. I know, for my part, I always intend to encourage exercise in both my children. Sugar Boy will need a lot more monitoring, of course, but I think the long-term benefits are so important that its worth the extra diligence to keep his sugars stable. I didnt grow up with a heavy emphasis on exercise, and as a result I think that now as an adult it's the reason I shy away from it so much. I would be much healthier for more exercise. I want to be sure my kids have that emphasis early on... and I hope I can help them to enjoy the act of exercising as well. I guess time will tell. :)


Misty said...

Hi there! I found your blog through the Blogger Basal. I have a 7 year old T1.

This is a great topic. Overall, when she exercises regularly her numbers are better. But you are right that it takes a lot of preparation and care. I find it difficult with Ally because sometimes exercise makes her bg go up up up....and then she drops several (even 10) hours later. Other times she drops during the activity. Still learning here!