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.

Diabetes Supplies vs. Rent & Groceries?

The personal economic impact of diabetes often presents itself as the title suggests.

In Canada the economic impact is best illustrated in a report put forth by the Canadian Diabetes Association called the  The Cost of Diabetes in Canada: The Economic Tsunami 


This report outlines the economic impact from a national perspective; how much it is costing tax payers, and the burden diabetes places on our health care system.  It does not however discuss the personal struggles individuals experience financially when managing their diabetes.


It's a no brainer that, with out appropriate coverage for diabetes supplies diabetes control is worsened. 


There's been a number of instances in 28 years where I've had no coverage. Times when I'd have to limit the number of test strips I use, or the type of insulin I choose.  Recently I changed jobs, and went with-out coverage (for myself and 2 type 1 kids) for four months. 

I went off my pump for 3 months to offset the cost, and spent $1400 per month to cover test strips, insulin, supplies, infusion sets, and the usual regime of Rx medication associated with diabetes completely out of pocket. 


We are still catching up.  I am speaking from a Canadian perspective, and couldn't imagine having to pay out of pocket for basic medical care. 


It frustrates us as a family. It has been a "thorn" for many years, simply because Type 1 diabetes is a disease that you can not delay or avoid, you simply wake up one day and are told you have it.  


It's unfortunate that anyone has to pay for essential medical supplies. It's not like we can choose not to test, or take insulin.  Some PWD(people with diabetes)choose the best therapy and often have to choose between rent or groceries, and whether or not to continue insulin pump therapy.  


Fortunately some Canadian provinces are catching on and have implemented programs that provide pumps and supplies to individuals free of charge.  Notice how I say most...


Most people fear job losses, and general economic set backs, but when you have diabetes one must also fear worsening control and choosing between rent or buying essential medical supplies. 


That's just not right! 




Trev