Exercising with Type 1 Diabetes: The Insulin-Food Balance Challenge
Tackling how to balance blood sugar during (and after) exercise with type 1 diabetes is nothing new. In fact, it is likely that the KEY topic to address to be successful in being physically active if you are taking exogenous insulin and want to prevent hypoglycemia or hyperglycemia during exercise. Strategies include changing insulin doses […]

Tackling how to balance blood sugar during (and after) exercise with type 1 diabetes is nothing new. In fact, it is likely that the KEY topic to address to be successful in being physically active if you are taking exogenous insulin and want to prevent hypoglycemia or hyperglycemia during exercise. Strategies include changing insulin doses and / or supplementing with food, which can be done in multiple ways depending on activity, timing, etc.

A recent study from 2020 re-examined whether it is best to supplement with carbohydrates or reduce bolus insulin doses (at mealtime) before exercise to avoid the drops (1). His conclusion - for this particular group of subjects doing continuous, moderate-intensity ergometer exercise for ∼45 minutes - was that taking 15 to 30 grams of carbohydrate when blood sugar fell to 7.0 mmol / L (126 mg / dL) prevented hypoglycemia better. OK but….

My problem with these types of studies is not that they don't prove a point - they do - but it's that they prove a very, very narrow point. The results can only be generalized to people of the same level of fitness, age, gender, and diet who undertake a specific type, intensity, duration, and time of activity. Exercising with type 1 diabetes is so much more than that. Plus, it's not just short-term insulin dosing or immediate carbohydrate intake that impacts your blood sugar control and your success at being active.

Whether participating in sports or physical activity for recreation or striving to be a professional or Olympic athlete, anyone who takes insulin should pay attention to their unique nutritional and dietary habits, including including its intake of macronutrients (carbohydrates, proteins and fats), micronutrients (vitamins and minerals), fluids and supplements like caffeine to maintain metabolic and glycemic balance (2). Along with athletic performance, nutritional recommendations may also differ on an individual basis with respect to exercise, blood sugar management, and body weight goals. Balancing all of these dietary factors can be difficult for people with type 1 diabetes, and there are many related aspects that still need to be fully researched in this population.

Carbohydrates undoubtedly have the most immediate impact on blood sugar and must be combined with adequate doses of insulin to manage blood sugar spikes after eating (3), but protein and fat intake can also have a negative impact. impact on insulin requirements (4). When you're an active person with type 1 diabetes, you need to balance all of your food choices before, during, and after exercise to manage blood sugar levels not only to avoid drops or highs, but also for optimal performance and recovery after training or in competition. There are many different ways to eat, including low carb (5), and the best nutritional practices for optimizing performance may or may not be the best for blood sugar management, optimal health, and body weight. simultaneously, potentially achieving difficult sporting and health goals at times.

When it comes to insulin dosage, people vary so much when it comes to their usual doses, insulin sensitivity, types of insulin used (basal and bolus choice), administration (that is, (i.e. use of the insulin pump versus injections or inhalation), etc. This makes the whole balance much more difficult, especially when blood sugar responses vary depending on the type of activity being performed, including duration, hardness, frequency, and environmental conditions. Even the state of hydration counts! Given how limited studies by nature must be to limit all of these conditions, it takes individual trial and error to determine what works best to keep blood sugar levels within a fairly narrow range (and hopefully. , normal) for each unique activity. .

Many insulin users have yet to figure out how to compete in sports at the highest levels, although balancing blood sugar levels with these many confounding variables is far from straightforward (6). It is definitely worth it to be physically active with type 1 diabetes, just a challenge!

References:

  1. Eckstein ML, McCarthy O, Tripolt NJ et al. Efficacy of carbohydrate supplementation versus reduction of bolus insulin dose around exercise in adults with type 1 diabetes: a controlled retrospective analysis. Can J Diabetes, 2020 (in press), https://doi.org/10.1016/j.jcjd.2020.03.003.
  2. Colberg SR, Nutrition and Physical Performance in People with Type 1 Diabetes. Can J Diabetes, 2020 (in press), https://doi.org/10.1016/j.jcjd.2020.05.014.
  3. Bell KJ, King BR, Shafat A, Smart CE. The relationship between carbohydrate and insulin dose at mealtime in type 1 diabetes. J Complications of diabetes. 2015; 29 (8): 1323-9, https://doi.org/10.1016/j.jdiacomp.2015.08.014.
  4. Bell KJ, Smart CE, Steil GM, Brand-Miller JC, King B, Wolpert HA. Impact of fat, protein, and glycemic index on postprandial glycemic control in type 1 diabetes: implications for intensive diabetes management in the era of continuous blood glucose monitoring. Diabetic treatments. 2015; 38 (6): 1008-15, https://doi.org/10.2337/dc15-0100.
  5. Scott SN, Anderson L, Morton JP, Wagenmakers AJM, Riddell MC. Carbohydrate restriction in type 1 diabetes: a realistic therapy to improve glycemic control and athletic performance? Nutrients. 2019; 11 (5): 1022, https://doi.org/10.3390/nu11051022.
  6. Riddell MC, Scott SN, Fournier PA, et al. The competitive athlete with type 1 diabetes [published online ahead of print, 2020 Jun 12]. Diabetology. 2020; 10.1007 / s00125-020-05183-8, https://doi.org/10.1007/s00125-020-05183-8.

If you’re having trouble beginning an exercise plan or following through, you’re not alone. Many of us struggle getting out of the sedentary rut, despite our best intentions.

You already know there are many great reasons to exercise—from improving energy, mood, sleep, and health to reducing anxiety, stress, and depression. And detailed exercise indications and workout plans are just a click away. But if knowing how and why to exercise was enough, we’d all be in shape. Making exercise a habit takes more—you need the right mindset and a smart approach.

While practical concerns like a busy schedule or poor health can make exercise more challenging, for most of us, the biggest barriers are mental. Maybe it’s a lack of self-confidence that keeps you from taking positive steps, or your détermination quickly flames out, or you get easily discouraged and give up. We’ve all been there at some point.

Whatever your age or sport level—even if you’ve never exercised a day in your life —there are steps you can take to make exercise less intimidating and painful and more fun and instinctive.

Ditch the all-or-nothing attitude. You don’t have to spend hours in a gym or force yourself into monotonous or painful activities you hate to experience the physical and emotional benefits of exercise. A little exercise is better than nothing. In fact, adding just modest amounts of physical activity to your weekly routine can have a profound effect on your mental and emotional health.

Be kind to yourself. Research shows that self-compassion increases the likelihood that you’ll succeed in any given endeavor. So, don’t beat yourself up about your body, your current sport level, or your supposed lack of willpower. All that will do is demotivate you. Instead, look at your past mistakes and unhealthy choices as opportunities to learn and grow.

Check your expectations. You didn’t get out of shape overnight, and you’re not going to instantly transform your body either. Expecting too much, too soon only leads to frustration. Try not to be discouraged by what you can’t accomplish or how far you have to go to reach your fitness goals. Instead of obsessing over results, focus on consistency. While the improvements in mood and energy levels may happen quickly, the physical payoff will come in time.

Many of us feel the same. If sweating in a gym or pounding a treadmill isn’t your idea of a great time, try to find an activity that you do enjoy—such as dancing—or pair physical activity with something more enjoyable. Take a walk at lunchtime through a scenic park, for example, walk laps of an air-conditioned mall while window de course, walk, run, or bike with a friend, or listen to your favorite music while you move.

Even the busiest of us can find free time in our day for activities that are important. It’s your decision to make exercise a priority. And don’t think you need a full hour for a good workout. Short 5-, 10-, or 15-minute bursts of activity can prove very effective—so, too, can squeezing all your exercise into a couple of séances over the weekend. If you’re too busy during the week, get up and get moving during the weekend when you have more time.

The key thing to remember about starting an exercise program is that something is always better than nothing. Going for a quick walk is better than sitting on the couch; one minute of activity will help you lose more weight than no activity at all. That said, the current recommendations for most adults is to reach at least 150 minutes of moderate activity per week. You’ll get there by exercising for 30 minutes, 5 times a week. Can’t find 30 minutes in your busy schedule ? It’s okay to break things up. Two 15-minute workouts or three 10-minute workouts can be just as effective.

For most people, aiming for moderate intensity exercise is sufficient to improve your overall health. You should breathe a little heavier than normal, but not be out of breath. Your body should feel warmer as you move, but not overheated or sweating profusely. While everyone is different, don’t assume that training for a marathon is better than training for a 5K or 10K. There’s no need to overdo it.

Health issues ? Get medical clearance first. If you have health concerns such as limited mobility, heart disease, asthma, diabetes, or high blood pressure, talk with your doctor before you start to exercise.

Warm up. Warm up with dynamic stretches—active movements that warm and flex the groupes de muscles you’ll be using, such as leg kicks, walking lunges, or arm swings—and by doing a slower, easier version of the upcoming exercise. For example, if you’re going to run, warm up by walking. Or if you’re lifting weights, begin with a few light reps.

Drink plenty of water. Your body performs best when it’s properly hydrated. Failing to drink enough water when you are exerting yourself over a prolonged period of time, especially in hot conditions, can be dangerous.

There’s a reason so many New Year’s resolutions to get in shape crash and burn before February rolls around. And it’s not that you simply don’t have what it takes. Science shows us that there’s a right way to build habits that last. Follow these steps to make exercise one of them.

A goal of exercising for 30 minutes a day, 5 times a week may sound good. But how likely are you to follow through ? The more ambitious your goal, the more likely you are to fail, feel bad about it, and give up. It’s better to start with easy exercise goals you know you can achieve. As you meet them, you’ll build self-confidence and momentum. Then you can move on to more challenging goals.

Triggers are one of the confidentiels to success when it comes to forming an exercise habit. In fact, research shows that the most consistent exercisers rely on them. Triggers are simply reminders—a time of day, place, or cue—that kick off an automatic reaction. They put your routine on autopilot, so there’s nothing to think about or decide on. The alarm clock goes off and you’re out the door for your walk. You leave work for the day and head straight to the gym. You spot your sneakers right by the bed and you’re up and running. Find ways to build them into your day to make exercise a no-brainer.

People who exercise regularly tend to do so because of the rewards it brings to their lives, such as more energy, better sleep, and a greater sense of well-being. However, these tend to be long-term rewards. When you’re starting an exercise program, it’s important to give yourself immediate rewards when you successfully complete a workout or reach a new sport goal. Choose something you look forward to, but don’t allow yourself to do until after exercise. It can be something as simple as having a hot bath or a favorite cup of coffee.

If your workout is unpleasant or makes you feel clumsy or inept, you’re unlikely to stick with it. Don’t choose activities like course or lifting weights at the gym just because you think that’s what you should do. Instead, pick activities that fit your lifestyle, abilities, and taste.

Activity-based video games such as those from Wii and Kinect can be a fun way to start moving. So-called “exergames” that are played standing up and moving around—simulating dancing, skateboarding, soccer, bowling, or la petite balle jaune, for example—can burn at least as many calories as walking on a treadmill; some substantially more. Once you build up your confidence, try getting away from the TV screen and playing the real thing outside. Or use a smartphone app to keep your workouts fun and interesting—some immerse you in interactive stories to keep you motivated, such as running from hordes of zombies !

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