By: Cheyenne Thornton
Photo from: Nascimento, B. (2016, October 14). Photo by Bruno Nascimento on Unsplash. Retrieved July 19, 2020, from https://unsplash.com/photos/PHIgYUGQPvU
Exercise and Type One Diabetes Mellitus
The American Diabetes Association advises that those with diabetes exercise regularly. Exercise can help manage diabetes and blood sugar. It can improve physical and mental health. Physically, is helps lower blood pressure and the body’s response to insulin.3 It can also reduce the risk of depression and improve self-esteem.3
However, there is a lack of advice given to patients on how to manage blood sugar during activity.3 The lack of advice creates gaps in the patient’s knowledge when managing blood sugar and exercise.4 In the end, patients are left feeling discouraged about exercising. I hope this post is a resource and a starting point for those with T1DM. Please talk with your doctor before you begin making any changes to your insulin or your daily activity.
How to go Longer, Farther & Faster
Whether it’s running, swimming, or skiing, you should be able to be active without fearing a drop in your blood sugar. Your doctor has most likely told you the benefits of exercise, but are you still left with the question, “How can I help my blood glucose from dropping during exercise?” If you have asked yourself this question, keep reading!
How to Prepare for the Lows & Highs
The best way to be ready for a change in your blood sugar, is to stay aware of your blood sugar levels! If you’ve just been diagnosed with diabetes type one by your physician, it could be helpful to keep track of how your activity changes your blood sugar. One way to do this is by creating a record on your phone or in a notebook.2 Your record can include information like the day, weather, and time of your workout. Also, it can keep track of your food intake, insulin, activity and your blood sugar.
The following points include ways to lows and highs in your blood sugar and to balance blood sugar levels while exercising.
1. Check Your Blood Sugar Before, During & After Exercise1
Before starting any exercise or activity, check your blood sugar. If your blood sugar is below 100 mg/dL, eat a carbohydrate serving (5g). After waiting 15-30 minutes, re-check your blood sugar. If your blood sugar is at 100 mg/dL or over, you are okay to begin. Repeat steps if blood sugar is still under 100 mg/dL after 15g of carbohydrate.
*Do not work out if your blood sugar is over 300mg/dL1
It is best if you begin your workout 30 to 60 minutes after eating a light snack or 1-3 hours after eating a meal.1 The snack or meal should include both carbohydrate and protein. It’s important that you do not depend on sports drinks that are high in sugar and carbohydrates before a workout. Drinking these beverages will cause a spike in your blood sugar that will only last 30-60 minutes.7 However, eating a meal/snack that is adequate in protein and carbohydrates will help maintain your blood sugar for longer. 2. Preventing Low Blood Sugar During & What to Bring with You
It’s Sunday and you’ve planned for a 12-mile hike, so what should you take with you? On days when you know you will be active for a longer period of time, you want to go prepared! You should bring water to keep yourself hydrated along the way (~8 fl.oz. for every 30 minutes of exercise)1 and a quickly accessible snack. A handy snack that is a source of glucose is essential for stopping a drop in your blood sugar.
You should stay aware of your blood glucose while exercising. Plan to check your blood glucose every 15-30 minutes.1 If your blood sugar drops below 100mg/dL consume a serving of carbohydrates (15g). Your source of glucose can be 3-4 glucose tabs, 1 Tbsp. of honey or maple syrup, a sugar packet, dates, or ¼ cup of raisins.1 Bring a source of protein as well. Pairing a source of glucose with a source of protein will help stabilize your blood sugar for a longer period of time.5 Refueling smarter means refueling less!
Pairing your choice of glucose with an ounce of almonds, pistachios, or a packet of peanut-butter makes for a tasty snack! All three options contain a good amount of protein.
½ cup of almonds provide 14g of protein and 76.5 mg of magnesium. Magnesium can help prevent your legs from becoming tired during a workout.5,10
½ cup of pistachios offers 13g of protein and 1.9 mg of iron. Iron is essential for getting enough oxygen to your muscles and reducing lactic acid build-up!5
*Certain diabetes medications may impact your body’s ability to use up certain sugars. Please discuss with your doctor the form of glucose recommended for you during drops in blood sugar.
3. Checking Your Blood Sugar After Exercising
Exercising can have a lasting impact on your blood sugar for hours after a workout.2 Make sure to check your blood sugar right after finishing your workout. Try to eat a snack soon after your activity. Your snack should consist of at least 15g of carbohydrate and protein, causing a longer effect on blood sugar.5
Exercising and Spikes in Blood Sugar
Sometimes during or after exercising you may have a spike in your blood sugar. While exercising, your body may release stress hormones that help provide energy to your muscles.8 However, these same hormones could cause your blood glucose to go up. This is more likely to occur if you are exercising before eating breakfast, on an empty stomach or excessively.8 If this occurs during your workout, stop and wait until your blood sugar goes down before resuming exercise. Do not give yourself insulin during this waiting period. Using active insulin during this time could increase the risk of low blood sugar once you return to your activity.
Photo from: Johnson, M. (2020, June 30). Photo by Mykenzie Johnson on Unsplash. Retrieved July 19, 2020, from https://unsplash.com/photos/5Hib8uDTm6g
Insulin Use & Exercise
It is recommended that you do not inject insulin into a muscle that will be used during a workout. For example, if you were about to play a game of tennis, you should not inject insulin into your arm.6 Placing insulin into a muscle that will be used could increase risk of low blood sugar. This is due to the way your body absorbs insulin when the muscles are warm from movement. A safe location to inject insulin before a workout is usually the abdomen.7,8
Your body’s use of insulin is impacted by the weather outside. It’s crazy that even the climate you are working out in impacts your blood sugar! Cooler climate may slow the body’s use of insulin and cause a spike in your blood sugar.7 In contrast, warmer conditions may increase the body’s uptake of insulin, raising the risk of low blood sugar.7
There are two primary hurdles to exercising for those with type one diabetes. The first barrier is the fear of low blood sugar.5 The second barrier is the changes in insulin that should be made while exercising.6 The following sections provide tips for insulin use based of research. Before applying any advice, please talk with your doctor.
Changes made to insulin
I recently discussed the barriers to exercise for those with T1DM with a close friend. They shared with me the confusion around the use of insulin before and during exercise. With all the research that has been done on diabetes, I assumed this information would be shared with patients. Well, I assumed wrong. The following section is from research conducted by Dessie P. Zaharieva and Michael C. Riddell and published with the ADA.
Table One: Bolus Changes9 Research has shown that it could be helpful to make changes to your bolus dose if exercise were to occur 2-3 hours post meal.9 Below are the potential changes that have shown to be helpful in diabetics who engage in exercise.9
Chart from: Zaharieva, D. P., & Riddell, M. C. (2015). Prevention of Exercise-Associated Dysglycemia: A Case Study–Based Approach. Diabetes Spectrum, 28(1), 55-62. doi:10.2337/diaspect.28.1.55
*Before changes are made to insulin, please talk with your doctor. The study done to produce these estimates was done on individuals manually injecting with insulin. Using an insulin pump may impact these estimates.
Basal Changes In order to reduce the risk of low blood sugar, individuals should lower or pause their basal insulin for a period of time before and during exercise. Changes should be made to basal insulin 60-90 minutes before beginning an exercise until the workout is finished.9 Blood sugar should be checked every 15-30 minutes while exercising.1 If blood sugar goes up, the workout should be stopped. Give time for your blood sugar to return to normal. If it does not, end workout and use insulin to help bring blood sugar down.3
Zaharieva, D. P., & Riddell, M. C. (2015). Prevention of Exercise-Associated Dysglycemia: A Case Study–Based Approach. Diabetes Spectrum,28(1), 55-62. doi:10.2337/diaspect.28.1.55
*Before changes are made to insulin, please talk with your doctor. The study done to produce these estimates was done on individuals using an insulin pump.
After your workout you should continue to check your blood sugar levels. Exercise can cause low blood sugar throughout the day and into the night. It is advised that you reduce your post exercise basal and bolus insulin. This will lower the risk of low blood sugar occurring in the night.7
Conclusion
I hope the above tips are a good starting place for your exercise journey! Again, please check with your doctor before making any changes to your activity or insulin. Please continue to follow the blog! I will continue to share with you any new research about nutrition, diabetes, and health. Here are two snack recipes that are great to have before your workout and to take with you. Hope you enjoy!
Nutrition Facts: Created by Cheyenne Thornton using NutritionCalc Plus
Hummus photo from: Barbaros, N. (2020, June 04). Photo by Nicholas Barbaros on Unsplash. Retrieved July 19, 2020, from https://unsplash.com/photos/FBbGyco88GU
A Snack for Home…
This snack is perfect for 30-60 minutes before you head out the door for your workout.
I am a huge fan of hummus, veggies and crackers. It provides carbohydrates, protein, and some healthy fats. Here is a recipe to my family’s homemade hummus. It’s delicious when paired with snow peas, carrots and pita bread!
Ingredients Needed
30 oz. of cooked garbanzo beans
2 minced garlic cloves
½ tsp. of cumin – ground
1 ½ teaspoon of salt
1/3 of a cup of tahini
3 tbsp. of lemon
2 tbsp. of lime
About ¼ cup of olive oil
Directions
Once the garbanzo beans have been cooked, place them in a blender. With it, add the cumin, garlic, salt, and tahini. Process until a desired consistently (~40 seconds).
Then add the lemon, lime juice and a fourth of a cup of water. While it's blending, slowly add the ¼ cup of olive oil.
Place in a bowl and enjoy! Place extras in an air sealed container. Will keep for 7-10 days.
A Snack for the Road…
When your blood sugar drops, you want to have a quick and accessible snack. It is also great when this snack is delicious! This is one of my favorite snacks to take with me on long hikes with friends. It’s easy to carry with me and satisfies my hunger. This snack is also perfect to manage blood sugar while exercising.
Photo of trail mix: Vitchakorn, M. (2017, December 29). Photo by Mgg Vitchakorn on Unsplash. Retrieved July 19, 2020, from https://unsplash.com/photos/AYTMVeGXG8w
Nutrition Facts: Created by Cheyenne Thornton using NutritionCalc Plus
Ingredients and Directions
2 cups of raw cashews and almonds (or your favorite raw nut)
1 cup of pumpkin seeds
½ cup of hemp hearts
1 cup of unsweetened raisins
½ cup of unsweetened coconut shavings
Pinch of salt
1 tsp of cinnamon
Place all ingredients in a large mixing bowl and stir. Once mixed, place in an air sealed container and enjoy for weeks!
References
1. Exercise and Type 1. (n.d.). Retrieved July 19, 2020, from https://www.diabetes.org/fitness/get-and-stay-fit/exercise-and-type-1
2. Cockcroft EJ, Moudiotis C, Kitchen J, Bond B, Williams CA, Barker AR. High-intensity interval exercise and glycemic control in adolescents with type one diabetes mellitus: a case study. Physiol Rep. 2017;5(13):e13339. doi:10.14814/phy2.13339
3. Jenkins DW, Jenks A. Exercise and Diabetes: A Narrative Review. J Foot Ankle Surg. 2017;56(5):968-974. doi:10.1053/j.jfas.2017.06.019
4. Litchfield I, Andrews RC, Narendran P, Greenfield S. Patient and Healthcare Professionals Perspectives on the Delivery of Exercise Education for Patients With Type 1 Diabetes. Front Endocrinol (Lausanne). 2019;10:76. Published 2019 Feb 19. doi:10.3389/fendo.2019.00076
5. Pinsker JE, Kraus A, Gianferante D, et al. Techniques for Exercise Preparation and Management in Adults with Type 1 Diabetes. Can J Diabetes. 2016;40(6):503-508. doi:10.1016/j.jcjd.2016.04.010
6. Thabit H, Leelarathna L. Basal insulin delivery reduction for exercise in type 1 diabetes: finding the sweet spot. Diabetologia. 2016;59(8):1628-1631. doi:10.1007/s00125-016-4010-8
7. Yardley JE. The Athlete with Type 1 Diabetes: Transition from Case Reports to General Therapy Recommendations. Open Access J Sports Med. 2019;10:199-207. Published 2019 Dec 6. doi:10.2147/OAJSM.S149257
8. Zaharieva DP, Riddell MC. Insulin Management Strategies for Exercise in Diabetes. Can J Diabetes. 2017;41(5):507-516. doi:10.1016/j.jcjd.2017.07.004
9. Zaharieva, D. P., & Riddell, M. C. (2015). Prevention of Exercise-Associated Dysglycemia: A Case Study–Based Approach. Diabetes Spectrum, 28(1), 55-62. doi:10.2337/diaspect.28.1.55
10. Zhang Y, Xun P, Wang R, Mao L, He K. Can Magnesium Enhance Exercise Performance?. Nutrients. 2017;9(9):946. Published 2017 Aug 28. doi:10.3390/nu9090946
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