I'm Christel from Diabetes Strong I love to exercise but it can be really
really complicated when living with insulin dependent diabetes
and no one told me up front you know how to not go low during exercise
that ultimately led me to start Diabetes Strong but it's also really frustrating
because we know how to significantly reduce the risk of low blood sugars
during exercise there are guidelines available
and if you struggle with low blood sugars during exercise it's most likely
because no one has ever sat down and just explained it to you
low blood sugars are the worst and there's probably nothing more irritating
or frustrating when you have to stop mid workout maybe even before even
getting started to drink juice or eat but it doesn't have to be that way low
blood sugars and exercise does not have to go hand in hand
and you don't have to carb up to go for a walk around the block
there are two levers we can pull when it comes to reducing the risk of low blood
sugars during and after exercise and I say reduce
because this is diabetes we'll never be able to completely eliminate
the risk of low blood sugars the two levers are
you can either eat more or you can manipulate your insulin levels
or your IOB so your active insulin on board
because in reality the only reason why you go low during exercise
is if you have too much IOB
so before we start talking about
strategies for reducing lows during exercise by manipulating insulin or
food let's just talk about why you generally go low during exercise
the type of exercise that most often make blood sugars drop is called aerobic
exercise so you can see the heart rate here this
is the heart rate profile of aerobic exercise
it's that type of exercise where heart rate comes up and it stays up
while you're doing the activity and once you're done the heart rate comes down
again so examples of that would be brisk
walking jogging biking swimming or everyday
activities such as going to Target going to the mall vacuuming cleaning
gardening walking your dog around the block
generally as your heart rate comes up your blood sugars will start to drop
some people for most people it they'll start to drop in about
10-15 minutes but it's very individual but for most people once the activity is
done and the heart rate is back into normal
level blood sugars will stop dropping or maybe even start to climb up a little
bit January 2017 we finally got
good guidelines for how to adjust food and insulin
for exercise so it was published in The Lancet
and I can leave a link to it down below if you're interested
it was about type 1 diabetes and exercise
I think it's applicable to anyone who injects insulin
multiple times a day so let's not get too caught up in labels here
let's look at it
every time I show these guidelines this is the first one I show this is directly
from the from the the publication this is don't
read this this is gonna be too much let me show you instead this
this is a summary of those guidelines that we just looked at
this is for exercise longer than 30 minutes again it was published in The
Lancet in 2017. what you need to focus on are two
different things first are you fasting are you not fasting
fasting means that you haven't injected any insulin or eaten within the
last four hours most for most people that would be when
we get up in the morning there are two levers again as I mentioned
there's a basal reduction or the carbs there are different strategies depending
on whether or not you are in a pump or you are on MDI multiple daily
injections basically if you use pen or syringes
for pump if you use a pump it is recommended that you reduce your basal
so your background insulin with 50 to 80 percent up to 90 minutes before you start your
exercise the 90 minutes is because insulin
doesn't start to work right away it takes a little while so insulin most
things like your Humalog and your Novolog starts it doesn't
enter the blood stream until 10 to 15 minutes after it's injected it doesn't
peak until 90 minutes or for an hour hour to 90
minutes in okay an alternative is to completely
suspend all insulin delivery for up to 60
minutes up to 60 minutes is because we don't
want you to be completely without any insulin that can lead to DKA even with
good blood sugars so that's the reason for the 60 minutes
alternatively is if you already if you haven't suspended
you want to go for your workout and your you suspect that you might go low is to
eat more carbohydrates if on MDI multiple daily injections
there is the possibility of reducing your basal
insulin with up to 20 percent but that's
predominant for prolonged exercise meaning that if you go for like a half
marathon or iron man or something a little more more
aggressive if you do find that you go low fasting in the morning
they recommend eating up to 20 to 30 grams of carbs an
hour most people do not go low in the morning on MDI simply because
long-acting insulin does not get impacted as aggressively by exercise
as rapid acting insulin does now we're done with our workout we're
still on the left hand side or under fasting
well if you're going to eat within an hour and a half after exercise in 90
minutes it's recommended that you reduce your
bolus meaning your mealtime insulin by up to 50 percent
because your insulin sensitivity how effective your body is at
utilizing the insulin you inject is going to be heightened post
activity there's also a recommendation of an
overnight basal reduction of up to 20 percent so if you tend to see low blood sugars
after a day of exercising you can consider reducing your insulin
that was the fasting side of things let's look at the
non-fasting or you know those situations where you're
maybe you're exercising after breakfast you're exercising afternoon or evening
so you've eaten within the last four hours here we go
here is the suggestion if you're not fasting reduce your bolus or
your meal time insulin by 25 to 75 percent
that's a huge range it's huge because how much
you need to reduce it is going to be very
dependent on you and your physiology so we'll talk a little bit more about how
you find out how much you reduce it in a second
alternatively if you're in a situation where the insulin is injected once it is
it's in the body it's in the body you can't really do anything about that
would be to eat 0.5 to 1 grams of carbs per
kilogram that you weigh okay so that's a a little bit more
I think most people just grab 15 to 20 grams of carbs but
if you want to be really technical about it this is the formula for that
then there's how to adjust your basal insulin so the recommendation is to do
exactly the same as if you were fasting so there you just follow the same
guidelines which is a pump basal reduction of 50 to 80 percent
or suspension and if MDI potentially do a basal
reduction so to summarize in order to reduce the
risk of low blood sugars during exercise you need to adjust your
insulin or you need to eat more so adjusting
your insulin is focusing on your active insulin onboard or your IOB
both from your basal so your background insulin as well as
all the boluses you take being for your meals and for corrections
finding the right amount of IOB should be done for given activity as well as
for time of day so for example most of us are more
insulin sensitive in the afternoon so you'll need a different
formula or a different adjustment for afternoons
it can be really hard to learn your IOB
needs or finding your formula if you don't
have a structured approach I recommend writing things down and then
start to look for trends I will link to my free exercise sheet
below it's a tracking sheet that I recommend
that you use it's the one I use with all my clients
if you use that consistently I promise you you will start to see trends
you'll start to see your formula you'll be able to adjust your insulin
and significantly reduce the amount of lows that you have when you exercise
I really believe that there's nothing we can't do with diabetes
it does require that we have the right mindset that's why you're here
we have the right tools and the right knowledge and the knowledge is exactly
what we've been working on today thank you so much for watching this
video if you enjoyed it please give it a like
give me a follow thank you so much