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’:
|
% Intensity of exercise (VO2 max) |
% basal rate reduction for 30 mins exercise |
% basal rate reduction for 60 mins exercise |
|||
|
25 |
25 |
50 |
|||
|
50 |
50 |
75 |
|||
|
75 |
75 |
<100 |
|||
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!
Very interesting. I drop my basal by a much smaller amount (for a medium intensity of an hour I find a drop of 30% suits me fine, and for a higher intensity, a drop of 50% works) – but I’ve been told that this is perhaps because I’m used to it – apparently your muscles get used to exercise and use glucose more efficiently once you’ve been doing it for a while (or something) – anyway, works for me.
I’ve also started doing a ‘Fast Class’ at the end of my gym workout – its a 10 minutes quick class that anyone can join in – high intensity etc – and it does indeed seem to work out better when I do it than when I dont. So now I just need to persuade myself that I do really want to do it rather than giving up and hitting the showers…
I’m interested in this Isomaltulose thing – did they say what forms it came in? Where I buy it? I’d like to try it on cycling trips, as it sounds better (healthier) than the jelly babies etc I currently use…
That’s really useful. I’ve been using something similar from calcs in my head but the piece about fast exercise at the end is something to try.
Excellent write up Anna. Thank you.
Hi Annette – really interesting to here you talk about the ‘fast class’ as that would definitely back up the maximum sprint theory. Although I think that only needs 30 seconds to a minute but if it works for you that is obviously the right mix. I noted that in spinning we always do what is called a ‘sprint’ at the end of the class which would explain why I have more luck after spinning than normal cycling.
They did also explain that doing exercise regularly would mean your blood sugars become more stable. I always need a different basal rate after exercise, so I suppose if I was doing it every day I would always need that basal rate, as opposed to needing it for a special occasion.
Isomaltulose is also called ‘Palatinose’ (probably its more commonly-used name)and I think you can just buy it on the net. It seems to be more commonly used these days and certainly the athlete’s at the weekend (the real ones, that is, not ones like me) all seemed to use it. That included a female ‘iron man’ competitor and a decathlete! Perhaps try in places like sports shops where they sell protein shakes and performance enhancers (I don’t mean steoirds, although that would most deinitely help!) Ha!.
I’m more of a monoathlete type who likes to keep it to an hour, but it may well help if you do prolonged exercise and get tired.
Thanks very much for all this information! Very helpful indeed.
Currently I reduce my basal to around 30% for 1-2 hours pre-exercise, then go down to 0% (well, take the pump off) during exercise for 1 -2 hours.
Really liking the tip about cancelling the TBR half an hour before finishing.
Also, going to look out for this Isomaltulose/palatinose stuff you speak of and give it a go.
Hi Melissa, glad you found it useful. If I find a place where Palatinose is sold I will definitely post and let you know.
Happy exercising!
Hi Anna, great write up I just wish I was more energetic (time/money and general loathing of getting hot and sweaty) is my excuse!
I wonder if you (or any one else) have any comments on my problem though I have had a few low issues whilst walking the dog (we walk briskly most of the time covering 2-3miles at a time) My Diab team have suggested a few things the latest turning my pump off for 1/2 of walk and back on at 10% for the last part. Whilst my basal rates are steady and no need for any change without any exercise as soon as the dog and I venture out for an hour I plummet. I tend to hypo just before the end of my walk despite running at 10% for the whole time. I’m not keen on eating extra food before I go out or for that matter altering my TBR by50% 1/2 hour before walking as I usually find that life has a habit of going pear shaped and I’ve decreased and then no time for walk so then high!
Any comments or suggestions would be greatly appreciated.
HI Katherine,
I find the same; that brisk walking lowers it faster than anything. I would be nervous of you thinking I am an expert at this – I am still quite the beginner. But I would suggest lowering your basal before the walk by 30-60 mins like they suggested. Only taking it off at the beginning means you have had no time to lessen the insulin you have in your system and as mentioned above, muscles can take on glucose without insulin during exercise. So 5.5 might be good normally, but it you are about to exercise and aren’t eating anything, you’ll need that higher.
I would lower your basals earlier and if you can’t go out, just raise the basal again and consider bolusing for whatever insulin you would have missed. 50% basal shouldn’t allow you to go too far off track if your plans go amiss
Hope that helps.
Yeah, I have a similar problem I call “gentle-walk-itis”. Hard exercise – sprinting on the bike – drop the basal rates and away we go. BG remains fine. But a gentle walk round the block with doggy, I will drop the basal not quite so much but my BG will do a nose-dive.
Fascinating. I lower my basal by 90% to go dog walking – I’m not that regular about dog walks – well I go every day but at different times, and not that good about remembering to do it earlier, but this looks like the way forward for me. Also I always go hypo at the end, despite eating a lot of glucose all the way through! Maybe lowering basal half an hour before, turning insulin off altogether, having 10% back on half an hour before we get back AND running up the last hill might work… LOL!
Great write-up Anna, thank you.
I have a ‘sort of’ system that (mostly) works for my gym visits, but this has given me lots to think about. Love the idea of the ‘sprint at the end’ saving immediate post-treadmill dips 🙂