Type 1 diabetes and Exercise

EXTRACT FROM: https://www.jdrf.org/t1d-resources/living-with-t1d/exercise/?utm_source=newsletter&utm_medium=email&utm_campaign=20190416_springtraining_email&utm_content=standard_exercise_bottomtextlink&s_src=bsd_newsletter_email&s_subsrc=20190416_springtraining_email_standard_exercise_bottomtextlink&mkt_tok=eyJpIjoiTldNNU5HSTFabUUxTXpndyIsInQiOiJ3aG5QbE4rZ2N2Rm9qQUZZWDVHUklUeTN0NEU5RExRczhnZlZRbXhyMW1RV2Q1bzhncndmcFRIdkRHVWZBRGJXT25zZHRXMmhGR2NhM1FWRVFhNkZmSWpQNmNMQSszZGpIMjBIQ0FmUm5cL1RLaHF1aFA3dnVObVwvTU81Ym10QnRyIn0%3D


Let’s get physical with T1D. 
From getting started to crushing your fitness goals, this guide provides some tips and tricks into getting the most out of your workouts. 

People living with type 1 diabetes (T1D) can and should experience the benefits of exercise. Physical activity is great for your body and has positive effects on your mind—and T1D should not prevent anyone from reaping the benefits. Exercising with T1D does require extra preparation, but by following some guidelines, everyone can incorporate exercise into their life.  
Check out this video from Eric Tozer, T1D athlete and keep scrolling to learn more about exercise and T1D. 

Be Safe. Be Smart.

Everyone should exercise. Here are some things to consider while exercising with T1D.
Preparation is important. Knowing how your body will react to exercise and being prepared to respond are key to all athletic activity.
Different intensity and types of exercise affect blood-sugar and insulin levels differently. Sometimes, there is an increased risk of hypoglycemia (low blood sugar); other times, the risk is of hyperglycemia (high blood sugar). And just as different types of exercise correspond with different physiological responses, the body also has varying responses to training versus competition. Something else to keep in mind: athletes with T1D have increased potential for injuries too.
That may seem like a lot, and it is, T1D should not be a barrier to achieving fitness goals. There are professional, elite athletes with T1D who perform at the top of their game, through preparation, experience, monitoring and effort.
Everyone experiences the benefits of exercise:
  • enhanced muscle mass
  • improved heart health
  • decreased stress and tension
  • weight control
  • positive mood, overall mental health
People with T1D may enjoy additional advantages, such as:
  • consistent insulin sensitivity
  • better balance, stability and joint function
  • potential lowering of blood-lipid levels and insulin dose reduction.
With great exercise, comes great responsibility
It goes both ways: exercise affects glucose control; glucose control affects exercise. Consistent physical activity produces consistent insulin sensitivity, which helps the body process glucose more evenly (avoid spikes), maybe even improving HbA1c.  
Some considerations:
  • Risk for hypoglycemia can be reduced by avoiding too much insulin on board (IOB) during and after exercise.
  • Continuous glucose monitors (CGMs) or regular blood-sugar testing provides critical information to preemptively minimize blood-sugar highs and lows.
  • Plan ahead! Reduce insulin and add carbs for aerobic (longer duration, lower intensity) exercise, which causes blood sugar to drop, or increase for anaerobic (short duration, high intensity), which may cause spikes.
  • After most exercise, insulin sensitivity is higher for 24 hours. Carbohydrates needed to replace liver glycogen levels must be balanced with decreased insulin levels.

Intensity. Speed. Environment. Duration… all affect the body’s reaction

There are three types of exercise:
  • Aerobic
    • Aerobic exercise is usually continuous, light-to moderate intensity exercise and includes activities like running, walking, long-distance swimming, biking or tennis. Aerobic exercise typically tends to lower BGLs.
  • Anaerobic
    • Anaerobic exercise is generally shorter in duration, of maximal to super max intensity and includes activities like sprinting, gymnastic, ice hockey, or weight training. Anaerobic exercise typically tends to raise BGLs.
  • Mixed
    • Mixed exercise is combination of the aerobic and anaerobic activity such as basketball or soccer. Managing BGLs with mixed exercise is difficult, but using a tool like a continuous glucose monitor can help greatly.
Glucose levels during sports affect performance in many ways: strength, stamina, speed, agility, flexibility, safety and mental sharpness.
  • Insulin resistance, which is when the body requires more insulin to process glucose, is a problem. Exercise combats this by increasing insulin sensitivity and glucose uptake by muscles. Muscles are better able to absorb glucose when contracted.
  • Exercise thwarts postprandial (after-meal) hyperglycemia by slowing carbohydrate absorption, increasing glucose utilization and accelerating insulin action.
Practice vs game day – each can have dramatically different effects on your T1D.  Adrenaline and stress both raise blood glucose levels and are typically present on the day of your game or event. 
Check out this video of T1D athlete Sophie Schunk and continue reading about T1D and exercise. 

Balancing Act: Finding your blood-glucose zone and PEAK fitness zone

Caution: Delayed Onset Hypoglycemia can occur typically 6 to 12 hours (sometimes 24 hours) after exhaustive exercise, due to replenishment of muscle glycogen stores and enhances insulin sensitivity. It is possible to prevent this by:
  • keeping records of your fitness regimen and the effects it has on your body
  • using a CGM or frequent blood testing to monitor your body’s response to activity
  • Decreasing basal insulin or meal boluses after activity
  • consuming slow-acting carbohydrates after activity
Similar recording and monitoring tactics can be used to prevent hyperglycemia (blood-sugar highs). Some other options include:
  • bolusing (at a half dose) 30 to 60 minutes prior to activity to offset rise of blood glucose, delayed bolusing or adding post-workout cool-down (depending on conditions of rise)  
  • incorporating relaxation, breathing, visualization tools to address pre-workout emotional stress
  • limiting pump disconnection time
  • hydrating
  • administering rapid-acting insulin (only under certain conditions)
T1D athlete Maddie Maloney uses a combination of yoga and meditation to get in the right headspace for exercise. Watch her explain how she does it. 

Caution: Ketones

A lack of insulin, due possibly to poor absorption, illness or missed doses—can cause ketone production. This can lead to ketoacidosis, dangerously high levels of ketones and blood sugar.
Some ways to prevent ketoacidosis:
  • check for ketones prior to exercise when blood-glucose levels are high for no apparent reason
  • do not exercise when ketones are positive
  • if you have missed a dose of insulin, put off exercising until you have adjusted for it
  • do not disconnect pump for more than 90 minutes without replacing insulin
Athletes with T1D should plan ahead and take precautions to keep exercise and blood sugar in balance.
People with T1D must consider many factors that affect blood glucose during exercise: active insulin, infusion site (remove pump or not), food consumed, time of day, weather, emotional state, duration and intensity of the activity… and yet physical activity is so important. Exercise is for everyone. People with T1D plan for everything they do—the same patience, flexibility, cautions and spirit should be applied to exercise. Have fun and get out there. 

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