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. 

"Confusing"

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.

Trev

Sources:
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.

Timing is Everything

In life, timing is often the factor that determines ones path.

Think about this for a moment.  Those serendipidous moments in life where a neigbour or friend pops over and talks you into an opportunity.  What if the timing was off and you weren't home. Running into the right person at the right time happens to us all.

Even in negative situations you've heard the saying; when one door closes another opens.  That is timing!  I personally have left a job, thinking crap, what will I do now, only to stumble upon a better job, timing was right and the opportunity crossed my Path. 

I don't believe in luck, but I do believe in timing, and that; opportunity favours the prepared.

Once again what in the hell does this have to do with Mr Diabetes?  Well not to repeat myself but timing is everything in diabetes management and of course the more prepared you are(knowledge, tools, strategy, support) the better your opportunity will be in managing your diabetes.

Above I mention some keys to diabetes preparedness.  If you have diabetes or care for someone with the big D, then here is your diabetic emergency preparedness plan in a nut sell. The list below is not prioritized as they are all important. So here goes:

1.  Learn as much as you can about diabetes. How you do that is up to you, but read multiple sources. If it's research; look at the number of people who participated in the study, if it was your friend's aunt and your brother and they claim that nutmeg causes poor glucose control that's an opinion and not research.  The more people(sample size) the more accurate(valid)the research result will be.  I could get into more detail about critiquing research but this is a blog and not a book.

2.  Keep learning, yes I am repeating myself, but never stop, I have met folks who have had diabetes for many years, and tell me, "I did the training" and I ask "when?" and they say"1985"  I kindly suggest they go for more training and read more current information. Never ever stop learning, go ahead and get sick of it, but don't stop.

3.  Tools. Not the garden variety, but tools like; meters, CGMs, Pumps, uploads, downloads, new insulin, pens, finer needles, glucagon, medication, and I am sure I am missing an item or two. Point is, use whatever device needed to improve your control and quality of life.

4.  Support.  Includes:  Family, Friends, Co-Workers, Class-Mates, Physicians, Nurses, Social Workers, Dietitians, Endos, and most importantly others with Diabetes, as they are the only folks that unequivocally understand your predicament. Don't dismiss your feelings, they need to be dealt with and this is where support is crucial.

5.  Strategy.  You have to have a game plan.  If you don't make one now, then sit down with some of the folks listed in paragraph 4 and get it done.  If you have a plan you not only know what direction your going but you increase your odds of getting there. With Diabetes you increase your odds of getting there in one piece, or complication free.    It is now Proven (DCCT Study) that good control reduces complications, that's motivation in itself! Know your body. Trial and error. Testing, recording, analyzing, tweaking, and choosing a treatment regime that works for you and controls your glucose. This also includes diet, carb counting, understanding what certain foods do to your glucose. Plans involve setting goals, specific goals like; I am going to test 4 times a day or I will test 2 hrs after I eat to ensure I am taking enough insulin to cover my meal.  Write stuff down, food, readings, mood, exercise, illness. Trust me, it makes it easier to adjust if it's staring you in the face. 

6.  Remember the 80/20 rule. We are human, and it is impossible, actually, totally unachievable to always have your glucose in range, it is impossible to eat perfect every day, it is impossible to keep positive everyday, but it's totally possible to say to yourself, "I did well 80 % of the time this week" That is what counts! Celebrate the good readings, and choices, don't hold onto the highs and lows, let em go and try again the next day.

When the "time comes" you will succeed in managing Mr Diabetes; if you are prepared and have the knowledge, use the right tools, have a good game plan and lots of support!

Trev