Insulin Pump Use and Exercise Strategies

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Whether you have type 1 or type 2 diabetes, if you use insulin, you may choose to use a specialized insulin pump for both your basal and bolus insulin delivery (1). Pumps have a small catheter placed under your skin and are programmed to cover your basal insulin needs by delivering small doses of fast-acting insulin to mimic normal insulin release by the pancreas. Insulin pumps are programmed to deliver small, basal doses of fast-acting insulin to replicate quasi-normal insulin release by the pancreas throughout the day. These pumps are not ideal for everyone, and the choice to use one should be an individual one.

The goal of insulin pump therapy is to provide insulin just like your body would—that is, in small doses all day long, with bigger doses after meals. Although this physiological pattern can be closely mimicked using injection regimens (e.g., Levemir for basal and Apidra boluses), insulin pumps make delivery easier and offer more flexibility by allowing you to have different basal rates of insulin delivery during the day or use temporary basal settings (such as during and after exercise). Pump users have the luxury of suspending the pump or immediately reducing basal delivery of insulin for activities, which you cannot do as easily without planning ahead if you use injections.

Although the number of insulin pump companies has dwindled recently, a number of pumps with various features are still available. Although you still have to be smarter than your pump, these “smart pump” features have helped take a lot of the guesswork out of it. Most pumps have options for small basal increments (0.05 unit per hour or less), temporary basal rates, insulin-on-board calculators, menu-driven programming, and various bolus patterns. Normal boluses, for instance, give the insulin dose all at once, but extended ones allow a dose to be given over a longer period to avoid peaks and valleys in coverage for foods that are more slowly absorbed; combination boluses combine these two strategies for optimal coverage of foods like pizza. Some are waterproof at shallow depths. The race is on to create the best combination of insulin pump therapy and continuous glucose monitoring (CGM) with algorithm-driven control systems. These “closed-loop” systems integrate features and make decisions for you, although exercise remains a sizeable management hurdle to overcome.

Insulin Pump Exercise Strategies

Insulin pumps give users the opportunity to reduce basal insulin levels and/or bolus doses in desired amounts and for different durations. As a result, pump use may reduce your exercise-induced hypoglycemia risk compared to multiple daily injections. Some strategies using pump features may be helpful, based on the purpose and timing of insulin dosing (1).

Altered Bolus Doses Before Exercise: You can adjust your meal and correction doses of insulin with a high degree of accuracy to accommodate for exercise. Calculate boluses as usual (entering the actual carbohydrates and blood glucose) and then adjust them using a percentage. For postmeal activity (i.e., when bolus insulin is still peaking, such as within 2 hours after eating), reduce your meal bolus by 25, 33, or 50 percent, depending on your upcoming activity.

Lower Basal Rates During Exercise: Reducing your pump’s basal rate before, during, or after exercise by programming a temporary basal rate can allow you to eat less to compensate and prevent lows, particularly when exercising for 2 hours or more. If you can plan ahead, try reducing your basal rate somewhat starting 1 to 2 hours before exercise to make sure your insulin levels are lower when you begin. Try reducing it by 50 percent, although you may need to lower it by 80 percent for prolonged exercise.

Lower Basal Rates After Exercise: Lowering your basal insulin for a time after exercise can also keep you from getting low later when your muscle glycogen is being restored. How much you will need to reduce it will vary by person and by situation. A common starting point is to reduce your basal rate by 25 percent for 6 to 8 hours afterward if you anticipate possibly getting low later.

Alternate Basal Insulin Profiles: You can use altered delivery patterns if you are going to be doing a full-day activity, such as during summer camp, or while engaging in intense sports conditioning, or when completing major projects around your home. Pumps allow you to switch to a basal pattern that is entirely different from your usual one, allowing for significant delivery rates during peak activity and more modest reductions when you are resting afterward. If you have a pump that allows you to alter bolus calculation formulas along with basal settings (insulin delivery profiles), such as the Tandem pump, you can also use a lesser hyperglycemia correction factor, decrease your insulin-to-carbohydrate ratios, and raise your target glucose during times when you will be more insulin sensitive.

Challenges to and Solutions for Pump Use During Exercise

Insulin pump use does present its own set of challenges related to physical activity and sports. For instance, some athletes have issues with getting infusion sets to stay in place during certain activities or with excessive sweating. Others have complained that the pump or tubing simply gets in the way during exercise, and they may prefer to remove the pump entirely while active. Given that pumps deliver rapid-acting insulins only, removal of the pump for an excessive length of time (longer than 1 hour) can result in severe hyperglycemia and ketone formation, potentially leading to diabetic ketoacidosis (DKA). Exposing your pump to water and extreme weather conditions can also threaten its integrity and the insulin in it.

Reference:

  1. Excerpted from Colberg, SR, Chapter 3, “Ups and Downs of Insulin and Other Medications,” in The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities. Champaign, IL: Human Kinetics, 2019.
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Brain Hormones and Relaxation Lower Mental and Physical Stress

Overweight woman stretchingAt each dawn of a new year, many people make resolutions to be more physically active—only to fail in changing their lifestyle habits in a sustained manner. Don’t be one of the many who start exercising only to stop again a few months later. Read more about why daily release of feel-good brain hormones is so important and why you should learn how to relax more as well.

Go for Daily Exercise Release of Endorphins and Other Brain Hormones

One of the most publicized mental benefits of exercise resulting from a bodily change is the release of brain hormones. The primary hormones released are called endorphins, of which there are 40 types. Basically, they are stress hormones with receptors throughout your brain and body that calm you and relieve muscle pain during intense exercise. In the brain, they contribute to your feeling of well-being or “runner’s high” that usually arises during exercise, giving you a second wind. Exercise positively influences the same brain hormones (that is, endorphins, serotonin, dopamine, and norepinephrine) as antidepressant medications, but exercise is likely even more effective than drugs for treating depression. Each workout actually boosts your mood, at least for a little while. Some people are positively addicted to this release of endorphins and need to get their daily dose. Endorphins also likely improve your body’s insulin action, thereby reversing or decreasing insulin resistance, which is why moderate aerobic training works so well for lowering it (1).

You also release dopamine in your brain during exercise, which is a key player in getting you to adopt an active lifestyle. When you release dopamine, it activates the pleasure centers in your brain, and you end up associating activity with an elevated sense of delight. That makes your brain recall pleasant feelings associated with training, and then you will be more likely to continue doing that activity to get your boost of feel-good hormones. Serotonin release, which physical activity causes, is associated with short-term improvements in your mood as well. As a bonus, you get the release of two brain endocannabinoids, which are brain neurotransmitters that dull pain. Exercise to get a maximal release of endorphins and other feel-good brain hormones on a daily basis. As a side benefit, you will feel less depressed and anxious and enjoy a greatly improved mood and better physical health.

Practice Relaxation as Well

Although each workout you do causes some physical damage to your muscles, you ultimately end up stronger, faster, and better, and your body responds by releasing fewer stress hormones (ones like cortisol, not brain endorphins) during subsequent workouts. Similarly, when you practice using relaxation techniques to control your mental stress levels, your mind learns to reduce your body’s sympathetic nervous stimulation as well. The more consistently you practice relaxation, the easier it is to avoid eliciting a strong stress response when “life happens” the next time (1).

During recovery, your parasympathetic nervous system keeps your heart rate low and digestion high, so it is no wonder that a warm shower, a big meal, and a long nap after a workout make you feel more relaxed. You are in an anabolic (building and repairing) state then, and your glycogen is being restored while your muscles are being repaired and strengthened. For best results, balance exercise with adequate rest and recovery from workouts as well.

Sport psychologists recommend relaxation to enhance performance in athletic events and even speed up healing from injuries. Relaxation techniques can help you control the stress of competition as well as the stress coming from other avenues of your life. One method to relax is to sit quietly and focus your mind. But you can even use relaxation techniques while exercising. For example, punch the air with your fists to release your anger or anxiety and consciously relax the tense muscles in your body. Use your imagination to visualize more blood flowing to all the parts of your body that need it (like your heart, muscles, hands, and feet). You may be able to enhance the blood flow to your feet simply by visualizing it, verifying that a strong mind-body connection really exists. Also, take deep and steady breaths and release them slowly, particularly during your warm-up and cool-down periods when you are not working out as hard. Whenever you start to feel winded during a workout, take deeper breaths to bring more oxygen into your lungs and body.

In summary, daily release of endorphins, dopamine, serotonin, and other mood-enhancing brain hormones and neurotransmitters through activity simultaneously better manages your blood glucose and improves your mental outlook. Learning how to use relaxation techniques can benefit you physically and mentally as well.

References:

  1. Excerpted from Colberg, SR, Chapter 6, “Thinking and Acting Like an Athlete,” in The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities. Champaign, IL: Human Kinetics, 2019.

Updated Federal Physical Activity Guidelines: Do They Apply to People with Diabetes?

shutterstock overweight exercise pixIn mid-November 2018, the U.S. Department of Health and Human Services finally released new physical activity guidelines (as a 2nd edition) to update their previous set from a decade before (1,2). Various activity guidelines for adults with diabetes have been updated several times in the interim, including a 2010 position statement on exercising with type 2 diabetes (3) published jointly by the American College of Sports Medicine and the American Diabetes Association; a 2016 ADA position statement on exercise and physical activity for all types of diabetes (4); and a consensus statement on being active with type 1 diabetes published in The Lancet in 2017 (5).

In those three sets of recommendations specific to diabetes, it was clear that everyone with diabetes can benefit from being more regularly active. Adults with diabetes should undertake a variety of activities, including aerobic, resistance, flexibility, and balance training (the last one particularly for adults over 40 or anyone with neuropathy), as well as stay more active on a daily basis just doing lifestyle activities or sitting less for better blood glucose management and weight control. The activity recommendations for adults and youth with diabetes have essentially been the same for everyone else of a similar age without diabetes.

So, what do the new federal guidelines add to the mix, if anything? Based on a review of the current research, the biggest change from the previous set of guidelines is likely that you don’t need to be active for a minimum of 10 minutes at a time for it to be beneficial to fitness and well-being. Given that many studies in the past decade have shown that breaking up sedentary behavior with short (3-minute) breaks can alter metabolism for the better, these recommendations are not surprising. They also recommend that people should sit less overall, again not a shocking guideline at this point. Studies done with people with diabetes have reached the same conclusions, so these updates certainly apply to everyone.

Another change in the federal guidelines applies to the weekend warriors: they now state that adults can derive similar health benefits if they perform all their weekly recommended physical activity in a single day or two rather than over the course of multiple days. However, whether this guideline applies as directly to people with diabetes is questionable. Past guidelines (3,4,5) have recommended that adults with diabetes not go more than two days without doing some physical activity, and many have recommended doing daily or near daily exercise for better blood glucose management. Given that the enhancing effects of your last bout of physical activity on insulin sensitivity may only last 2 to 72 hours, it seems unlikely that people with diabetes will gain all the same benefits by being a weekend warrior only—at least not when it comes to blood glucose management through reduced insulin resistance. For now, the recommendations for people with diabetes to do some type of exercise at least every other day will likely remain in place for that reason.

Finally, the new guidelines expanded out recommendations for all adults to get 150 minutes of moderate aerobic activity or 75 minutes of intense activity (or a combination thereof) each week to include up to double that amount—300 minutes moderate or 150 minutes intense aerobic training—and beyond for additional benefits. As if the bar weren’t set high enough already, you now have to find even more time to be active to gain optimal health benefits. While we already knew this was true, apparently the federal government also now recognizes how important it is for all of us to be the anti-couch potato and get as much as activity as possible to optimize our collective health! Luckily, the guidelines for doing resistance training at least two days a week are still unchanged, although we all know that doing three nonconsecutive resistance workouts a week is a preferable goal to maximize muscle gains and prevent losses of muscle (where we store carbohydrates) from aging and disuse.

In summary, these new federal physical activity guidelines really did not change what we should be doing already: getting at least 75 to 150 minutes of aerobic exercise weekly depending on its intensity (but closer to double that amount for optimal health), doing resistance training at least twice a week (but preferably three), stretching regularly, working on our balance ability if we’re older, moving more, sitting less, getting up more often, and taking the stairs instead of the elevator. So, go get active!

References:

  1. Physical Activity Guidelines for Americans, 2nd Edition, 2018. Accessed at https://health.gov/paguidelines/second-edition/.
  2. Executive Summary: Physical Activity Guidelines for Americans, 2nd Edition, 2018. Accessed at https://health.gov/paguidelines/second-edition/pdf/PAG_ExecutiveSummary.pdf.
  3. Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer B, Rubin RR, Chasan-Taber L, Albright AL, and Braun B. Exercise and type 2 diabetes: The American College of Sports Medicine and the American Diabetes Association: Joint position statement. Diabetes Care, 33(12): e147–e167, 2010.
  4. Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, Horton ES, Castorino K, and Tate DF. Physical activity/exercise and diabetes: A position statement of the American Diabetes Association. Diabetes Care, 39(11); 2065–2079, 2016.
  5. Riddell MC, Gallen IW, Smart CE, Taplin CE, Adolfsson P, Lumb AN, Kowalski A, Rabasa-Lhoret R, McCrimmon RJ, Hume C, Annan F, Fournier PA, Graham C, Bode B, Galassetti P, Jones TW, Millán IS, Heise T, Peters AL, Petz A, and Laffel LM. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinology, 5:377–390, 2017.

How Diets Impact Performance (in Active People with Diabetes)

French friesMany insulin users have chosen to go “low-carb” to better manage diabetes, which may or may not impact how well they perform in athletic events. How do many athletes with diabetes who swear by extreme low-carb diets that are either high in fat (like a keto diet) or higher protein (e.g., Dr. Bernstein) perform? How do their dietary choices impact both their blood glucose management and their ability to be active?

Although I personally choose to follow a more balanced diet with a moderate intake of lower-GI carbohydrates (making up less than 40 percent of my total calories), it’s mostly because I prefer plant-based foods. As a semi-vegetarian (choosing to not eat mammals), I don’t particularly like poultry, fish, and seafood that much either but eat some because it makes managing my blood glucose easier. I avoid most bread and white flour products and strictly limit how much rice, white potatoes, highly processed carb foods, and other rapidly-absorbed, high-GI carbohydrates I eat. Natural, plant-based fiber is a staple in my diet. I also exercise daily doing a variety of activities and experience very few lows when active. I don’t actively eat low carb, but I am carb-conscious and careful with my intake.

Here’s what some other active individuals with diabetes say about their diets and performance (excerpted from The Athlete’s Guide to Diabetes, Feb. 2019):

”I eat mostly low carb, but find that I often need to eat more carbs after sports in order to prevent overnight lows. I try to eat 30 percent of my daily calories from carbs, 30 percent protein and 40 percent fat each day.” — Molly M. (Canada)

“I stick to a low-carb diet. I eat a lot of meats, salads, eggs, and nuts. I avoid bread, pasta, processed food, and any type of sugar unless my blood glucose is low. I found that a low-carb diet makes it way easier to control my blood glucose throughout the day, especially during exercise. The more Humalog I use, generally the more tired I feel, and I also gain weight much easier and faster.” — Aaron G. (Minnesota)

“I normally eat a plant-based (vegetarian) nutritional lifestyle. I almost always work out fasted in the morning as I’ve discovered this is how I feel best and how I can maintain the best control over my blood glucose. I also practice intermittent fasting, with my first meal each day generally at about 11:00 a.m. and my last food intake around 8:00 p.m. My carb intake varies daily, and I don’t particularly aim to eat low carb as I eat a lot of fruit, sweet and regular potatoes, and beans. I eat eggs almost every day and rarely eat any kind of dairy product.” — Daniele H. (Pennsylvania)

“I eat reasonably low carb most of the time, though I do “carb up” for race days and tests sometimes (for performance reasons).” — Jennie B. (United Kingdom)

“I have been following a low-carb, high-fat diet for a couple of years. It makes it easier to keep blood glucose levels stable and keeps me full so less tempted to snack between meals. Though I don’t eat low enough carb to stay in ketosis. I eat 40 to 60 grams of carbohydrate per day.” — Andrea L. (France)

“I follow the metabolic efficiency diet. I eat about 125 to 150 grams of carbs per day with a diet focused on low glycemic carbs, fiber, healthy fats, and proteins. I avoid white flour and high glycemic foods.” — Conor S. (Pennsylvania)

“I stick to low carb unless in an environment of heavy training (marathon training). Consuming periodic glucose during endurance exercise and events can optimize my performance. I eat no fast food and a healthful diet full of greens and fish.” — Bill K. (Pennsylvania)

“Per Dr. Bernstein’s protocols, I eat low carb, moderate protein. I typically exercise in the morning and do not have active bolus insulin on board. I will eat small portions of dried fruit to bring my blood glucose up to 120 if it’s below that when I start. If I am going to do a race that will last more than 90 minutes, I will use UCAN 60 minutes before the race for slow acting carbohydrate during the event.” — Jason S. (New York) 

“I eat low-carbohydrate, high-protein, high-healthful fat meals. I recently cycled from Perth to Sydney, solo and unsupported in a time frame of 20 days, following low carb. As a fat-adapted athlete, this also disproved any theories that such exercise must be performed consuming a high-carbohydrate diet.” — Neil M. (Australia)

“I am, for the most part, on a Paleo diet. My carb intake is ~20 to 40 grams a day. By not needing to cover a large card intake, my boluses are less, thus I am not partaking in an odyssey of hours of either being hugely high or low due to a miscalculation. The law of small numbers is the key here.” — Jay H. (Wisconsin)

“Changing my diet to no starchy carbs has been magic. I dropped Lantus from more than 30 units down to 18 per day since dropping ALL starchy carbs. I eat no breads, pasta, cereal…The carbs I consume include veggies only. Most of my workouts now require no insulin management, and I seldom get low.” — Tom S. (Texas)

“I am carb-conscious. I do not eat low carb but make smart carb decisions. I aim to eat unprocessed, homemade food as much as possible. I love cooking in the backcountry and enjoy finding recipes that are dehydrated, lightweight, nutritious, and carb-rich for trekking days, and fueling.” — Jen H. (Canada)

“I was most helped by switching my diet and way of handling my diabetes to the Dr. Richard K. Bernstein method. I spent 47 and a half years stuffing glucose in my face all day long when I was skiing, hiking, or swimming just to keep my blood sugar above 100 (5.6) and then having it fly up to the 200 to 300s later. Now that I’m eating very low carb, this problem is greatly minimized. Eating this way has significantly flattened my blood glucose graph and prevented the precipitous, scary lows of the past. I’m so thankful to have found this way of handling type 1 diabetes.” — Mary Alice (California)

“I tend to eat low on the glycemic index and very little gluten. I substitute bean noodles for wheat, and quinoa is a staple. I eat a lot of slow-cooked meals with beans and vegetables. Breakfast is usually full-fat Greek yogurt. During trail races, I eat hard-boiled eggs and potatoes, items that provide nutrition, but don’t require a bolus. I don’t drink sports drinks or anything with sugars that need insulin. For low correction, I eat dried fruit which I find is kinder on the stomach than simple sugars in sports drinks. I don’t eat Gu or other sports gels. The less insulin in my system around exercise the better. This is not to be mistaken for low-carb or low-calorie diet; it’s just low-GI.” — Blair R. (California)

Can Exercise Overcome Impact of Air Pollution on Diabetes Risk?

China air pollutionIt’s known that lack of exercise, poor eating habits, genetics, and lifestyle factors can all contribute to the onset of prediabetes and type 2 diabetes. I have spent many years touting the benefits of lifestyle change to prevent and manage these health conditions—and in some cases reverse them. Exercise is a particularly important lifestyle management tool because of its ability to lower inflammation (the underlying cause of insulin resistance) naturally.

But what being active by itself is not enough to overcome the negative environmental effects? Studies have been coming out for over a decade already examining the association between the onset of type 2 diabetes and persistent organic pollutants (POPs) like those found in pesticides, as well as air pollution emitted by cars and trucks. While we usually think of air pollution as mainly contributing to respiratory problems and lung diseases, there’s mounting evidence that it is also implicated in health conditions like type 2 diabetes.

A recent systematic review and meta-analysis (1) on studies conducted in Europe and North America reported a positive association between air pollution and risk of developing type 2 diabetes. In a recent study (2), air pollution was found to have contributed to 3.2 million new diabetes cases in 2016, or about 14 percent of the total, globally. In the United States, air pollution has been linked to 150,000 new cases of type 2 diabetes each year. Although less evidence has been collected in developing countries where air pollution concentrations are much higher in many of them, long-term exposure to air pollution (including both ambient particulate matter and gaseous pollutants) has been reported to be associated with an increased risk of type 2 diabetes and higher fasting blood glucose levels, especially in individuals who were younger or overweight or obese, in 33 different regions of China (3).

Fresh off another trip to China (and exposure to an excess of smoggy air) where I lectured about the importance of lifestyle management to prevent and manage diabetes, I still find it hard to assess exactly how much of the environmental impact of poor air quality that exercise can overcome. Even though exercise is anti-inflammatory in nature, particulate matter and other toxins in the air are breathed in and lead to inflammation in the body, a state underlies most metabolic diseases, including insulin resistance, obesity, type 2 diabetes, heart disease, and more. Insulin resistance is present long before the onset of type 2 diabetes and results not only from inherited and lifestyle factors but also likely from environmental conditions. Unfortunately, developing countries that are more dependent on the use of coal are at greater risk. One in two people in China already has prediabetes or type 2 diabetes (compared to one in three in the U.S.). Rates of cigarette smoking are higher in China as well, and few, if any, regulations are in place to reduce exposure to second-hand smoke in the cities and even in office settings in many Chinese cities. (The cigarette smoke was heavy in one fitness/recreational area full of treadmills that I recently walked through in a building in Nanjing, China.)

So, then, how much of the inflammatory effect of polluted air can the anti-inflammatory properties of exercise can cancel out? Although we can’t control all the air that we breathe and even if healthy lifestyle habits including a better diet, more physical activity, improved gut health, and a weight loss regimen are not enough to overcome the effects of environmental pollution, it’s still likely that lifestyle improvement can drive down the risk of getting type 2 diabetes or improve your ability to manage it. Just do your best to limit your exposure to particulate matter in the air by exercising indoors on days with worse air quality (regardless of where you live), wearing a mask to limit your exposure to air pollution when outdoors, and avoiding cigarette smoke (both indoors and outdoors) as much as possible.

                                                                                                                                                           

References cited:

  1. Eze IC1, Hemkens LG, Bucher HC, Hoffmann B, Schindler C, Künzli N, Schikowski T, Probst-Hensch NM. Association between ambient air pollution and diabetes mellitus in Europe and North America: systematic review and meta-analysis. Environ Health Perspect. 2015 May;123(5):381-9. doi: 10.1289/ehp.1307823.
  2. Bowe B, Xie Y, Li T, Yan Y, Xian H, Al-Aly Z. The 2016 global and national burden of diabetes mellitus attributable to PM2·5 air pollution. Lancet Planet Health. 2018 Jul;2(7):e301-e312. doi: 10.1016/S2542-5196(18)30140-2.
  3. Yang BY, Qian ZM, Li S, Chen G, et al. Ambient air pollution in relation to diabetes and glucose-homoeostasis markers in China: a cross-sectional study with findings from the 33 Communities Chinese Health Study. Lancet Planet Health. 2018 Feb;2(2):e64-e73. doi: 10.1016/S2542-5196(18)30001-9.

Engage in Cross-Training to Get More Fit

SB pool side view.jpgIf you’re like a lot of other people, you may get bored doing the same physical activities day after day. More than half people who start exercise training programs drop out in the first six months. So, what you do to keep your workouts fresh sometimes matters more for getting the most out of training and staying with it. For these reasons (and more), you may want to consider doing cross-training.

Cross-training covers a lot of ground, including combining different types of activities (like cardio and resistance training) in one workout, doing both during the week, or including other types of training in your routine. For example, you may want to do a variety of activities on a weekly basis. For example, you can walk on Monday, Wednesday, and Friday but swim on Tuesday and take dance classes on Saturday.

Cross-training is recommended because it:

  • Uses several different activities to help you reach your exercise goals
  • Adds variety to your workouts
  • Helps fight insulin resistance
  • Leads to lower doses of diabetes medications for many people
  • Gives you flexibility in your program (for example, substituting indoor machines for outdoor walking if it’s raining outside)
  • Reduces injuries because you don’t repeat the same movement all the time
  • Minimizes boredom because you’re always changing up your exercises
  • Uses different muscles so more of them get the benefit of exercise training
  • Makes your daily activities easier on your joints and body
  • Keeps your body challenged to adapt and improve in different ways
  • Allows you to rest some muscles so they can recover from workouts without stopping you from exercising altogether on other days
  • Helps you develop new exercise skills and proficiencies

What cross-training ensures above all else is the ability to continue being active for the rest of your life and more motivated to move your body. Nothing is worse than getting sidelined from your regular training due to overuse or acute injuries caused by being active. Constantly stressing your body in the same way can lead to tendinitis in joints, bursitis, tendon ruptures, muscle tears and pulls, and possibly acute injuries. Each activity you do stresses your muscles and joints differently, so doing a variety lowers your chances of getting an injury.

In addition, cross-training helps you deal with any activity-related injuries without losing all your conditioning while waiting for the injury to heal. If you have lower leg pain, you can still work out your upper body doing other activities and vice versa. Try to alternate weight-bearing activities like walking with non-weight-bearing ones (for example, swimming and stationary cycling) to avoid injuring another part of your body while waiting for an existing injury to heal.

You also add variety to your exercise program when you include activities like walking, cycling, rowing, swimming, arm cycling, weight training, yoga, and more. You have more flexibility to choose different options based on your time constraints, the weather, and other factors. Mixing up your activities allows you to work a variety of muscles. Each activity recruits either different muscles altogether or the same ones in different patterns, allowing you experience a wider use of the muscles in your whole body.

Many people do find that when they engage in a variety of activities — some of them more enjoyable to them than others — they’re more willing to put up with the ones they don’t like just to be able to do the others on alternate days. So, in addition to making your workout routines more enjoyable, cross-training can help you fend off the boredom that’s more likely to pop up when you don’t like doing activities you feel forced to do.

Avoid Weight Gain From Treating Lows and From Insulin Use

Weight gain

It’s possible to gain weight from treating too many bouts of hypoglycemia. I addressed this topic over a decade ago, but it remains relevant and worth revisiting, along with addressing some new insights on weight gain in general with insulin use.

Weight Gain from Treating Lows

Although you can’t avoid treating a low, everything you use contains calories (at least until mini and nasal doses of glucagon are available) and those extra (albeit medically necessary) calories can still end up as excess body fat. Some heavily training athletes have reported gaining fat rather than getting leaner from all their workouts due to chasing a lot of exercise lows. Avoid gaining extra body fat by treating each low precisely to limit calories. Don’t just grab the nearest candy bar when it may take just one glucose tablet to bring your blood glucose back to normal if you have a minimal amount of insulin on board.

The best advice is to start with 4 to 15 grams of a rapid-acting sugar (preferably glucose), and only take in more glucose or follow it with a balanced food or drink if your low doesn’t resolve itself within 10 to 15 minutes or if you anticipate needing protein or fat in your system to prevent later lows, such as after a long workout or if you took too much insulin. Overtreating your lows just leads to rebound hyperglycemia, more insulin to bring it back down, and potentially another low later — followed by more calories and potential weight gain.

Weight Gain from Insulin Use

In addition to lowering blood glucose, the hormone insulin promotes fat storage, and if you often end up taking too much, it can make you gain extra fat weight. You can adopt some strategies to keep weight gain from happening from insulin or other diabetes medications, regardless of what type of diabetes you have.

Why is using insulin often associated with weight gain? When you use it, your blood glucose is (usually) in a tighter range, and you stop losing some calories as glucose in your urine like you do when your blood glucose is running on the high side. Also, as mentioned, you can gain weight from having to eat extra to treat any lows caused by insulin or other medications. (Remember, even if you have no other choice than to treat hypoglycemia, calories are still calories.) You may find that cutting back on refined carbohydrates that require more insulin to cover them, exercising regularly, and checking your blood glucose to avoid taking too much of any weight-inducing medications will help you avoid gaining fat weight.

Most people diagnosed with type 1 diabetes gain some weight as soon as they start using insulin. Many of them lost weight before diagnosis — some of it muscle — so not all the weight regain is necessarily bad (some is from muscle mass). However, you can gain excess weight from taking too much daily insulin and treating lows or even from taking the right amount of insulin but eating too many calories.

It’s advisable to not give up exercise, but you should still avoid gaining extra fat if you can because it is often associated with being more insulin resistant and may require you to take even larger doses of insulin. You can lower your insulin needs by staying regularly active. Readjusting your ratio of basal to bolus insulin — specifically, lowering your basal doses and raising your pre-meal insulin — without increasing your total daily insulin dose may also prevent weight gain with type 1 diabetes.

Also, try to keep your insulin needs as low as possible because the more you take, the greater your potential for causing lows that lead to weight gain is. During any physical activity, your muscles can take up blood glucose and use it as a fuel without insulin. Following exercise, your insulin action is heightened for a few hours up to 72 hours. During that time, you need smaller doses of insulin to have the same effect. With that in mind, adjust your insulin doses downward to prevent lows after exercise that cause you to take in extra calories to treat them.

Finally, you may be able to avoid weight gain by looking at the type of insulins you’re using. For example, once-daily Levemir used by people with type 2 diabetes causes less weight gain and less frequent hypoglycemia than NPH insulin, even combined with use of rapid-acting injections of meal insulin. The same is likely true when using Lantus, Basaglar, Toujeo, and Tresiba. In type 1 diabetes, individuals end up eating less when using Levemir compared to Lantus, leading them to gain less weight. It also helps to dose with fast-acting insulins for the amount of food you actually eat rather than eating to match your pre-meal insulin doses.