2012-07-06

Diabetes and Exercise Part I: Preparation

Introduction
Today I thought I would kick off a new series of blog posts in which I intend to share information about Diabetes and Exercise that I have collected over the past few years.

When initially diagnosed with diabetes, patients hear a chorus of voices instructing them to exercise regularly, stay healthy, and of course watch what they eat. This advice sounds identical to Type 1 patients and Type 2 patients, despite the two types of diabetes mellitus being radically different conditions. As a result, much of the diabetes advice out there tends to paper-over the important details that differentiate the two. It results in some good soundbites, but also a great deal of confusion on the patients' part.

At least, that was my experience. As a result, much of what I know about diabetes and exercise so far is the result of my own reading and self-experimentation. That may not sound like a ringing endorsement of what I am about to write, but unlike the authors of the soundbites in your diabetes pamphlets, I embrace the fact that all bodies are different. Therefore, the most important thing to take away from this series is that each patient needs to exercise, observe, and carefully evaluate ever new exercise activity's impact on his/her body and adjust accordingly.

In short, no one set of "rules" will fit your own specific case. You need to become a "tinkerer" when it comes to figuring out what your body can do. The aim of this series is to share my own experiences with "tinkering," in hopes of helping you figure out how to do it yourself.

What You Need To Get Started
Any discussion of diabetes and exercise logically begins with a brief lesson on exercise physiology. However, I thought it best to delay that lesson for the time being to focus on more practical matters. If you're going to take on a new exercise regimen as a diabetic, you will have certain unique requirements that other people who exercise do not have to worry about.

Know Your Numbers
First of all, throughout this series - and elsewhere throughout my blog - I will be referring to various values for blood sugar readings. We in the United States measure those values in milligrams per deciliter, while those of you in other countries measure it in millimoles per liter.

A simple Google Calculator search will provide you the conversion directly, but if you'd like a bookmark to go back-and-forth between conversions, here is a handy online calculator for you.


Emergency Sugar
The first thing you need is an emergency source of sugar to protect you in the event that you experience hypoglycemia.

Let's start at the elementary level and answer the question that the absolute-beginners might have at this point: I thought lowering my blood sugar was the point - what's the problem with hypoglycemia? It's true that we aim to decrease our blood sugar with exercise, but keep in mind that lowering it below 72 mg/dL (4.0 mmol/L) sends the body into shock and creates a risk of potentially fatal seizure.

More to the point, as your blood sugar falls below the normal range, you will experience impaired mobility and cognition, and will begin to be less-able to help yourself. If this happens, you need sugar fast, and that's where your emergency stash comes in.

The recommended approach for treating hypoglycemia is to ingest 15mg of fast-acting sugar, wait 15 minutes, then test to ensure your blood sugar is back in the normal range. Repeat as many times as it takes to get you back to normal.

What works? Lots of people use candy (such as LifeSavers), and some people chew dextrose (pure sugar) tablets. I was a competitive athlete years before ever having to think about diabetes, so I prefer using sport gels, such as my personal favorite, Hammer Gel:

It should go without saying that if you experience exercise-induced hypoglycemia, you should stop exercising for the rest of the day.

Insulin
I haven't needed this one myself, yet. We'll get to the issue of exercise-induced hyperglycemia in a subsequent post, but for now, you should simply be aware that some people need to carry insulin with them in the event that their blood sugar increases dramatically to dangerously high levels. If this happens, a corrective bolus of rapid-acting insulin will be required to return your body into a safe state of being.

You can help avoid this by never exercising when your blood sugar is above 288 mg/dL (16.0 mmol/L), or when there are ketones present in the urine stream. If you are new to all of this, then you will get a feel for this stuff as you go.

Blood Glucose Meter
If you are worried about hypo- or hyperglycemia, you should take a blood glucose monitor with you when you exercise and test if you feel unwell. Fair disclosure: I skip this step myself, because I have done enough historical testing before and after workouts at various times of day and at various points before and after meals to understand what I am capable of.

But that is a level of experimentation I necessarily had to engage in. If you are less experienced, it is worth getting some blood glucose data behind you so that you can exercise in an educated manner.

A Spreadsheet
I have a spreadsheet that tracks my blood glucose readings. Various vendors make software that facilitates this, but I find a simple Excel spreadsheet or Google spreadsheet document does the trick just fine.

When you test your blood sugar, no matter how regularly, you often see a different picture when you're "in the moment," taking each reading one-by-one than you do when you collect all your readings by date, time of day, and relevant activity (before meal, after meal, before exercise, etc.) and go searching for trends.

When it comes to exercise, you will have to start assessing the impact of different kinds of exercise, and different levels of exertion, on your body and blood sugar. As we will see in subsequent posts in this series, the impact of exercise may be immediate, or it may be delayed up to twenty-four hours in the future! As you start out, these impacts seem erratic and unpredictable. So the better-informed you are and the better-aware you are of short- and long-run trends, the better you will be able to control your blood sugar with exercise.

Additional Tips For Starting Out
A few more things to keep in mind as you start out exercising with diabetes:
  1. For now, don't make radical changes to your diet. We diabetics have to tightly control what we eat to ensure that we stay healthy and keep control of our blood sugar. That means you will have to resist a lot of fitness-industry pressure to radically alter your diet in accordance with current fads. You may eventually choose to alter your diet according to what works best for you. But starting a new exercise regimen is a big change for your body. If you make two big changes at the same time, you are changing two variables, and it will be difficult to determine which of the two had a more relevant impact on your blood sugar. Change one, then change the other; don't change both at the same time.
  2. It is always a good idea to let someone else know where you're going. If you go for a walk, a run, a swim, a bike ride, whatever, take the time to let someone know what route you're taking and how long you think you'll be. You will probably not get into trouble out there, but if you do, you'll be glad that you let someone else know where to go looking for you.
  3. If you work out with a friend, let them know how to help you in an emergency. I wear a Medic-Alert dogtag and I always take time to let people know that if they see me pass out, they need to put sugar under my tongue and call an ambulance. Nine words that require less than two seconds to state could save your life some day: "Put sugar under my tongue and call an ambulance." Simple as that.
  4. If you have an insulin pump, turn it off.
In my next article in this series, I'll cover the physiological effects of exercise and what that implies about your blood sugar. Until then, give exercise a try and see what you can learn on your own!