People, possibly diabetics, happily exercising, yesterday

Soaraway Shoot Up reader Anna reports back on her findings at Animas’ recent sport and exercise weekend.

Well, you have heard about the great success that was the Animas Sports and Exercise weekend but apart from the fun of synchronising hypos and attempting to adhere to the rules of football, without really knowing what they are, the point of the weekend was to learn from the country’s top specialist on exercise and diabetes, Dr Ian Gallen.  So in the hope that you too will be spared the embarrassing gym hypos and diet-ruining carb-loading, I’ve tried to highlight some of the key lessons we learned.

Keep on hand a little black book

During the exercises, there was always someone on hand with a little black book, keeping records of hour blood glucose (BGs) before, during and after exercise.  The point of this is to learn from the successes – and the failures – each time you exercise.  It was very useful to see what was happening in those first sessions, so I can just imagine the value of having a week’s worth of information to learn from.  While it was handy having a nurse on hand to do this on the weekend, I have yet to convince the husband that this will be a good investment of his spare time, so the onus is on me.

Don’t be scared of the temporary basal rate (TBR)

When we were advised to reduce our basal rates by around 80% for intense exercise, my eyebrows hit the roof.  But you see, during exercise muscles are able to take on glucose from the blood without the need for insulin, meaning all that extra insulin you are putting in can result in a nasty mid-exercise hypo and significant amounts of f-words and pledges never to put yourself through this again.  Character building as that is, it gets a bit tiring.  A good shove in the right direction is this, adapted from a chart in a book called ‘The Diabetic Athlete’s Handbook’:

Although it might look a little complex, the first column is effectively referring to the intensity of the exercise you are performing and the rate at which your body can transport and use oxygen during exercise (referred to as ‘VO2 max’).  Your personal V02 max takes into account your maximum heart rate, which can be calculated by taking your age away from 220.  So my maximum heart rate should be 191 (220 minus 29).   As a guide for intensity levels, the following is a good rule:

Low intensity <40% max heart rate
Medium 40-80%
High intensity >80%

So taking the above into account, if I have been exercising with a heart rate of 190 (probably not going to happen, unless it is a marathon run to the pasty shop sale) for 60 minutes that would be me performing at the very top of my capability, and as a result I would look to lowering my basal rate by anywhere up to 100%!

Give your body a head start

Another thing to consider is the timing of that temporary basal rate (TBR).  For pumpers, putting on a TBR at the beginning of exercise will mean there is still too much insulin on board.  The suggestion given was lowering to your TBR 30-60 minutes before your exercise.  I tried this on Friday and while preparing for a very intense body combat class I lowered to 20% basal rate 30 minutes before exercise.

Having had a little hypo at the beginning, next time my plan is to put on a TBR an hour before in the hope I might avoid that dip (so it says in my helpful little black book…).  The other key message was to cancel that TBR around 30 minutes before you stop the exercise to avoid blood sugars spiking once you stop.

Get a better source of energy

Isomaltulose (say that after 3 glasses of Pinot!) is a carbohydrate which has a GI rating of only 32, compared to glucose’s rating of approximately 95.  This means it is used by the body at a much steadier rate compared to other forms of carb.  Taking around 30g for every 60 minutes of exercise, diluted in either water or ‘Zero’ products (calorie free electrolyte drinks) for those who don’t like the taste, can provide a good source of energy for your body, particularly for those doing longer stints of cardio such as cycling which are likely to drop blood glucose at a much faster rate.  Just sip it at a steady rate to help keep hydrated and hot on the heels of anyone attempting to beat you to the finish line.

Give it one last burst

This was probably the biggest light-bulb moment for me.  When approaching the end of exercise – be it swimming, cycling, jogging or any other cardio (biggest BG-dropping exercises) – doing 30 seconds to 1 minute of flat out ‘sprinting’ will cause blood sugars to rise at the end of exercise.  Quite a neat little discovery, the ‘sprint’ is most-likely related to adrenaline which causes a rise in blood sugars.  This could provide a great way to stop that post-exercise low and was evidenced by one of the swimmers who put the method into practice. It is certainly a good option for those who don’t want to take on extra calories at the end of their exercise.

Prepare

After considering all of the above, the key message is to prepare.  Take a ‘what if’ bag if you can with glucose tabs, testing kit, phone and a way to identify yourself.  The above will make your attempts a success, but if you aren’t going to stop this nasty habit of killing your own beta cells, then safety is a must.

So there you have it.  The ‘nutshell’ version of what could have been a 20,000 word post.  Hopefully these tips will give you a starting point for your exercise endeavours and may help as a starting point for your future success.  It was certainly refreshing for me, having whined for years that [whiney voice] ‘I just don’t know where to start’, to have someone telling us exactly where the starting point is.  And now that you know where it is too, it is just about fine-tuning and getting to know your not-so unpredictable body.

So quit your own whining and go hit the treadmill, there’s a triathlon with your name all over it!

Good luck, future athletes!