*Disclaimer: All content and information in this blog is for informational and educational purposes only. Always consult your health care provider before making any adjustments to your exercise routine or diabetes management.
Let’s face it, at some point or another your endocrinologist or healthcare provider encouraged you to start exercising more. You heard all of the great benefits physical activity has for your insulin sensitivity and overall health that you decided to give it a shot. But you soon figured out that there was a huge learning curve when it came to managing blood sugars and exercising. You might be frustrated and fed up with your blood sugars because some days your blood sugar goes high and other days it goes low. Trust me, I get it- I’ve been in your position which is why I decided to share with you the top 4 things I learned in my personal training certification to help you break down the barriers to exercise and have more blood sugar predictability during your workouts.
When you log onto social media, you are destined to see someone saying that their workout was ruined by a low blood sugar or that they were annoyed that they couldn’t get through a workout without having carbs. Having a low blood sugar during a workout isn’t ideal- it’s annoying, frustrating, and maddening to stop a workout and eat something. This mindset can make you dread working out rather than being motivated at the opportunity to move your body. The success of your workout shouldn’t be defined based on your blood sugar levels, instead it should be based on being able to move your body consistently in a way you enjoy and being able to take in all the health benefits.
The movement that you choose to engage in should be something that you truly enjoy and look forward to. There are different types of workouts and each one brings their own health benefits, but the best exercise for you is the one that you can stay consistent with. For example, I love that weight lifting makes me feel strong while hot yoga makes me feel grounded. But, you will never catch me in a Zumba class (the lack of coordination and rhythm is REAL). When thinking about movement you enjoy, ask yourself a few questions like:
So, whether you prefer hitting the weight room or dancing the night away at Zumba, the best workout for you is the one that you enjoy the most. When you enjoy the workout, it won’t feel like work or a punishment. You’ll find that time goes by quickly and it is easier for you to stay consistent.
Physical activity and movement of any kind has a number of health promoting benefits. While these benefits include increasing insulin sensitivity, which can aid in blood sugar management, there are a number of benefits that promote your overall health and wellbeing. Being able to look at exercise as an opportunity to take care of your body as a whole rather than just for blood sugar management can change the way you think about exercising.
The 4 key players for exercise and blood sugar management are often overlooked, but can have a significant impact on how your blood sugars will behave during a workout. Being able to acknowledge these four components can be really empowering because you will be able to manipulate them on your own terms- leaving you with more control over the variables and more control over the outcomes of your workouts.
The first factor you want to look at is the intensity of your workout. For example, running often makes my blood sugars go low, while CrossFit would make my blood sugars go high. Well, that’s kind of proof in the pudding, right? Two very different intensities in movement can lead to very different outcomes in blood sugars. When you focus on the intensity of your workout, you are able to identify where your body is getting its energy from. When we're looking at energy, our body can either pull from oxygen, or your breath. This form of movement is also known as aerobic movement which means your body is using oxygen for energy. Meaning you can get through your workout without any added energy needed. On the other end, anaerobic exercise is often associated with higher intensity movements. Your body can’t keep up that intensity for too long which requires energy to be pulled from additional resources like calling on your liver to start dumping additional glucose for energy. Being able to determine the intensity of your workout can help you predict what direction your blood sugars may travel during a workout. Below are a few tools to help you determine the intensity of your workout and what the impact different workouts will have on your blood sugar:
If you have an Apple Watch or a Fitbit, or you just know how to measure your heart rate on your wrist, then this is a great tool that you can utilize. When you are focusing on your heart rate, you want to determine what your maximum heart rate is. The way that you can easily estimate this is just by taking the number 220 and subtracting your age. For example, I would take 220, and I would subtract my age, which is 27. I would get an estimated maximum heart rate of 193. So anything that I'm looking at, in relation to my heart rate, I'm gonna compare it to the number 193. 193 is basically the max that I can go, I'm not going to stay there for very long, because your body can just not withstand that intensity for very long.
When measuring intensity, you also want to look at the percentage of your maximum heart rate. So again, when you're working out, you can use this as a measurement. So let's just say I'm working out, my heart rate is 160. And I want to take that and put it over 193 to get an estimate of what percentage of my max heart rate I'm currently working at. So just to do the math here, you would divide 160 by 193 which would mean that I’d be working out around 83% of my maximum heart which is relatively high. From here, you would want to see what is happening to your blood sugars or what you can expect to happen to your blood sugars. Knowing that I am working at a higher intensity, I can expect to see a spike here or that there’s a little bit more work to be done before that spike is apparent.
If you don’t have access to your heart rate, that’s completely fine too because there are other tools that you can use, like the talk test. This is so easy, you don't need any extra tools, you can use it during whatever workout you're doing. With the talk test, you are going to be saying your ABCs while working out. Initially, you want to be able to get a baseline or reference point so you can compare any changes in intensity of your work. An example would be being able to hold a decent conversation with your friend while on a walk. During low intensity exercise, you may take a few extra breaths here and there, but you have no problem getting through your ABCs. On the other hand if you were to start doing sprints, you likely wouldn’t be able to hold a conversation very long, if at all without huffing and puffing.
The third indicator that you can use for intensity is rate of perceived exertion (RPE). There are two different metrics you can use to measure RPE, but for simplification, I prefer using a scale of 1 to 10. On a scale of 1 to 10, 1 would be no movement at all where you aren’t exerting your body in any way. Whereas at a 10, you are solely focused on your workout and will likely have difficulty maintaining that exercise for very long.
At one point or another, you might have heard someone from your care team say, “always get a 15g carb snack prior to working out.” This statement really oversimplifies things and you want to be able to take things one step further by looking at the last meal you had prior to working out. When you are considering your last meal, you want to look at the macronutrient distribution plus the timing of your last meal are going to tell you a lot of different things about potential ways to prepare your blood sugars prior to working out.
The macronutrient distribution includes looking at the carb, protein, and fat composition of your last meal. The macronutrient composition of your last meal will allow you to determine how your body will be fueled for your body. If you’re having a higher protein meal, you might have easier blood sugars to keep stable than say a higher carb meal.
Once you are able to determine the macronutrient distribution of your meal, you also want to take a look at the timing of your last meal. Identifying how long before your workout you ate can let you determine how much time you had to digest your meal and how much insulin on board you may have left. You want to be careful when it comes to working out with insulin on board, or active insulin, because if you may find yourself with a really low blood sugar. You want to be mindful of how much insulin you have active in your body to either minimize the amount of board or use it strategically to know what your reference point is so you don’t go too low. This is where you can work with your care team on using temp basals or cutting back on your boluses depending on your trends.
There isn’t a best practice about what time is best to get in a workout. It is mostly dependent on your preferences, routine, and availability. But, there are a few key differences to be mindful of depending on which time of day you prefer to get your movement in. It is all about flexibility so if you have different options, you have a lot more flexibility in what approach you take.
In the morning, you likely don’t have much insulin active. Considering you just slept for about 8 to 10 hours and now you are going into a workout, you won’t have much insulin floating around in your bloodstream. Next up- you may also be faced with high levels of stress hormones, particularly cortisol, in the morning. These stress hormones can trigger your liver into dumping glucose into your bloodstream so it is common for people to see higher blood sugars during exercising in the morning.
In the evening hours, you likely need to prepare a bit differently as you likely just spent 8 or more hours walking around at work, eaten multiple meals, and already have insulin hard at work. In this scenario, you may need to utilize temp basal or eat a snack depending on which variables you choose to manipulate.
The final variable you want to be mindful of is the length of your workout. There is going to be a big difference in your blood sugars if you were to walk around the block versus a 5-mile walk. Being able to predict the length of your workout can help you with determining how long of a temp basal you need, how much you may need to snack on, and how it may impact your blood sugars.
You are usually taught to eat something before a workout or bring a juice or, again, just do anything to raise our blood sugar so we can prepare for your blood sugar to go low. When in reality, you should also be set up to learn how to manipulate the movement to work for your blood sugars. Because again, when you have both sides, you can really take action in whatever way that you need. So instead of manipulating your blood sugars, you can manipulate the movement, you can manipulate the meal timing, you can manipulate the insulin on board, whatever way that can help you get through a workout.
One of the best ways to identify how different variables influence your blood sugar is by tracking the variables and manipulating them one at a time. When we take our clients through this process, everything is just troubleshooting. You want to track the variables like: intensity, your last meal, the timing, the length, and what happened to your blood sugar so you can decide which variable to manipulate in order to keep your blood sugar within range. You can create a number of different protocols so you can walk into a workout with more confidence and empowerment.
While exercising with type 1 diabetes can be quite a guessing game, there are plenty of ways you can learn to manage all of the variables. Check out Episode 16 “Your Diabetes & Exercise Questions Answered” on Keeping it 100 Radio: Uncensored Diabetes Conversations available now on Spotify or Apple Podcasts. We will continue to dive deep into the topic of exercise and blood sugar management so you can finally have interruption-free workouts.
The long-awaited announcement of FDA approval of Omnipod 5 finally came in January 2022. This system is the first automated insulin delivery system that is completely tubeless. Omnipod 5 is a hybrid closed-loop AID (automated insulin delivery device) that is comparable to the current Medtronic and Tandem systems. Here’s what you should know: