Friday, March 2, 2012

Can Exercise Kill You?

Okay I must admit the title sounds a little ominous. But in my reality participating in physical activity can  in effect make diabetes harder to control and can cause serious fluctuations in blood glucose. As anyone who has been jolted out of bed at night (sweating, shaking and fumbling for a quick source of carbohydrate only to rebound the next morning into the high teens) with an extreme low due to exercise performed earlier in the day. Sorry for the run on but need to get my point across.

The Canadian Diabetes Association recently sent out a News Letter that had some stats about what type of support Canadians get from Province to Province. There was one number or stat that stood out regarding exercise and diabetes. "Ninety per cent do not have a fitness expert to consult with when they require specific advice about how exercise impacts their diabetes." Interesting.....but not surprising.

In the past 20 of my 30 years living with a dead pancreas, I know I sound melodramatic, I have found it extremely difficult to find a health or fitness professional locally to assist me in this area of my diabetes management. Sure you get basic guidelines, like feed your activity or reduce your insulin by a certain percentage prior to exercise, but I must admit that as usual, my approach and control is the result of self awareness and self experimentation using my trusty glucometer. 

As I age, and routines change; I am still learning new things about exercise and diabetes. For example; that if I perform a high intensity workout I often require extra insulin prior to the work out. Once again due to the stress response mentioned in the last post. Crazy, as I have always been instructed to feed or reduce for activity. I also understand that everybody reacts slightly differently to exercise, stress, food, etc.  So it is likely hard to narrow down specific exercise recommendations.

Back to the stat; 90 % of people - That's a high percentage who would benefit from a specialist in exercise and diabetes. I also notice that there's a  lack of detail out there on exercise and diabetes, and that any info out there is difficult to weed through and unfortunately these details and lack of accessibility can in some cases be crucial to all diabetics (Type 1 in particular) So hopefully in the future our health care team will also include an exercise expert focused on diabetes or the option to see one. I doubt it though, as my docs over the past few years tell me that active people are a rarity these days so if a person is doing anything remotely resembling exercise, that is good enough. But what about the select few of the Type 1's out there that require expert support in the area of exercise?  Trial an error is good but there are certainly tips I would have loved to know years ago that I know now regarding nutrition, glucose response to the different types of activity, etc.

What I have learned using myself and observing my kids in terms of exercise and diabetes:
-over training is not good, my limit is 2 intense work outs per week.
-If i train near my max heart rate I typically don't need to feed the activity and generally require a bit of rapid insulin
-If I train at a low intensity I either have to lower my insulin by 30 % (Thanks to my Nurse educator) and this seems to work, or feed the activity 10-15 gms of CHO for every 1/2 hour - keeping in mind we are all different and I am sharing what works for me.
-If I don't drink enough fluid or water during the time during and prior to the work-out then my sugar level tends to really spike with high intensity training.
-I get sick really frequently if I workout more the 3 times a week with high intensity training (circuit weigh training, Muay Thai Boxing, and never work out more then an hour (includes warm up)

Even with frequent testing and self observation, fine tuning etc, I still have the occasional low, and would still love a good guideline and expert advice and feedback on the specifics, like carb loading and intake on training days, specific tips to stay healthy looking through the goggles of a diabetic paradigm. Questions like; will a certain activity worsen or accelerate any diabetic complications?

Feel free to point me in the right direction. And overall I do believe that just the right amount and type of activity will keep up healthy but too much of any activity is damaging.




Jonah said...

My take after reading studies on activity level and diabetes is that being a couch potato causes insulin resistance and harder to control bg, but that serious athletes do not do any better overall with diabetes control that those of us who are moderately active.

The most interesting exercise tip I've seen is that combining exercise that raises blood sugar with exercise that lowers blood sugar may prevent major blood sugar problems. For example, if you sprint (which for most people raises blood sugar) and jog (which for most people lowers blood sugar).
As a general rule, aerobic exercise lowers blood sugar and anaerobic exercise raises blood sugar, but this doesn't always predict what will actually happen because many exercises are a combination of aerobic and anerobic and if you are competetive and playing some sport the adrenaline rush can be a major complicating factor. For me, dehydration and time of day, active insulin, and the past few days' activity level make a big difference in how exercise effects me- generally if I do two workouts in a day, the second one has little to no effect on my blood sugar.

Here is a list of risks I know exercise can pose for diabetics (you might already know them):
1. This is kinda obvious, but, hypoglycemia.
2. If you are already at risk of ketoacidosis, exercise may increase the rate of ketone production.
3. If you already have some retinopathy, exercise that causes sudden changes in blood pressure- particularly weight lifting, chin ups, that kind of thing- can cause retinal detachment.
4. Shoveling snow and other major forms of exercise in people with heart disease who are not really in shape can cause heart attacks. So can dehydration, so hydrate!
5. Injuries are common in some sports and the healing process can be slower/ more complicated with diabetes.
6. If you wear a pump and have to disconnect to swim (I don't know if any pumps are totally waterproof but some aren't) then staying disconnected too long will lead to nasty highs and ketosis.

Anonymous said...

Gary Scheiner of is a PWD (Type 1 since age 17) and an exercise physiologist who set up the exercise program at Joslyn (for Type 1s). He consults remotely, from a one-time only to three-month, six-month or yearly retainer fee. He also has specific programs geared toward cgms training, pump start and exercise and Type 1. So everyone can have their own exercise physiologist, CDE combination. Some insurance companies may pay but his fees are reasonable. And you can consult for just a short period of time. Well worth a phone call.