Exercising with Type 1 Diabetes: The Insulin-Food Balance Challenge

Addressing how to balance blood glucose levels during (and after) exercise with type 1 diabetes is not new. In fact, it is likely the KEY topic to address to be successful at being physically active if you take exogenous insulin and want to prevent hypoglycemia or hyperglycemia during exercise. Strategies include changing in insulin doses and/or supplementing with food, either of which can be done in myriad ways depending on the activity, timing, and more.

A recent 2020 study revisited whether it works better to supplement with carbohydrates or lower bolus (meal-time) insulin doses before exercise to prevent lows (1). Its conclusion—for this particular group of subjects doing continuous, moderate-intensity cycle ergometer exercise for ∼45 minutes—was that taking in 15 to 30 grams of carbohydrate when blood glucose levels decreased to 7.0 mmol/L (126 mg/dL) prevented hypoglycemia better. Okay, but….

My issue 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 with the same physical fitness level, age, sex, and diet undertaking a specific type, intensity, duration, and timing of activity. Exercising with type 1 diabetes is so much broader than that. Moreover, it’s not just short-term insulin dosing or immediate carbohydrate intake that have an impact on balancing blood glucose and affecting how successful you are at being active.

Whether participating in sports or physical activity on a recreational basis or striving to be a professional or Olympic athlete, anyone who takes insulin must pay attention to his or her unique nutritional and dietary patterns, including intake of macronutrients (carbohydrate, protein, and fat), micronutrients (vitamins and minerals), fluids, and supplements like caffeine to maintain metabolic and glycemic balance (2). Athletic performance aside, nutritional recommendations may also differ on an individual basis relative to exercise, glycemic management, and body weight goals. Balancing all these dietary factors can be challenging for individuals with type 1 diabetes, and many related aspects have yet to be fully researched in this population.

Carbohydrates undeniably have the most immediate impact on blood glucose and must be matched with adequate insulin doses to manage blood glucose peaks after eating (3), but protein and fat intake can impact insulin needs as well (4). When you’re an active individual with type 1 diabetes, you must balance all your dietary choices before, during, and after exercise to manage blood glucose levels not to just prevent lows or highs, but also for optimal performance and recovery from working out or competing. It’s possible to eat many different ways including low-carbohydrate (5), and the best nutritional practices to optimize performance may or may not be best for blood glucose management, optimal health, and body weight simultaneously, potentially making achievement of athletic and health goals difficult at times.

As for insulin dosing, people vary so much with regard to their usual doses, insulin sensitivity, types of insulin used (basal and bolus choices), delivery (that is, insulin pump use vs. injections or inhalation), and more. It makes the whole balancing act that much more difficult, especially when blood glucose responses vary with the type of activity being done, including how long, how hard, how often, and under which environmental conditions. Even hydration status matters! Given how limited studies by nature must be to limit all these conditions, it takes individual trial-and-error to figure out what works best to maintain blood glucose levels in a fairly tight (and hopefully normal) range for each and every unique activity bout.

Many insulin users have still managed to figure out how to compete athletically at the highest levels, although it is far from simple when balancing blood glucose levels with these many confounding variables (6). It’s certainly still 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 compared with bolus insulin dose reduction around exercise in adults with type 1 diabetes: A retrospective, controlled analysis. Can J Diabetes, 2020 (in press), https://doi.org/10.1016/j.jcjd.2020.03.003.
  2. Colberg SR, Nutrition and exercise performance in individuals 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 the mealtime insulin dose in type 1 diabetes. J Diabetes Complications. 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 glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era. Diabetes Care. 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 for improved glycaemic 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]. Diabetologia. 2020;10.1007/s00125-020-05183-8, https://doi.org/10.1007/s00125-020-05183-8.

5 Key Strengthening Exercises for People with Diabetes

Although stay-at-home restrictions are loosening around the USA and summer is coming, you may still need to get some of your activities indoors at home for a variety of reasons. If you aren’t doing resistance workouts already, you should really consider adding some resistance exercises to your normal regimens.

In fact, if you do nothing else, doing these 5 key exercises is critical for people with diabetes who may have weak core muscles, altered gait and balance, and central and peripheral nerve damage.  If you lose your core strength, it will affect your ability to do all activities of daily living, including walking and living independently.

Do at least one set of 8-15 reps of each one, but work up to doing 2-3 sets of each one per workout.  For best results, do these exercises at least 2 or 3 nonconsecutive days per week — muscles need a day or two off to fully recover and get stronger — but just don’t do them right before you go do another physical activity (as a fatigued core increases your risk of injury). 

These and many more exercises are available on Diabetes Motion Academy for free download. You will find all the illustrations for the following exercises here as well.

Exercise 1: Crunches with waist worker

Exercise 2: Chair sit-ups OR Low back strengthener

Exercise 3: Modified push-ups

Exercise 4: Squats OR Suitcase lifts

Exercise 5: Sit-to-Stand exercise

#1: Crunches with waist worker

Crunches:

Directions:

•     Lie down on your back with your knees bent.

•     Place your hands on your head right behind your ears.

•     While breathing out, contract your abdominal muscles to lift your head, neck, and shoulders off the floor and curl forward no more than 45 degrees.

•     Hold for a moment before returning to the starting position, then repeat.

Waist worker:

Directions:

•     Lie on your back on the mat with your legs bent, your feet flat on the floor, and your left hand behind your head.

•     Stretch your right hand across your body toward your opposite (left) knee and circle your hand three times around your knee in a counterclockwise direction; your right shoulder blade will lift off the mat.

•     Repeat the circular movement around the right knee using your left arm, but in a clockwise motion.

•     Keep your head in a neutral position and relax your neck to ensure that the contraction is in your abdomen area only.

#2: Chair sit-ups OR Low back strengthener

Chair sit-ups:

Directions:

•     Sit up straight in a chair with your feet on the floor, hands to your sides for support.

•     Bend forward, keeping your lower back as straight as possible, moving your chest down toward your thighs.

•     Slowly straighten back up, using your lower back muscles to raise your torso.

•     For added resistance, put a resistance band under both feet before you start and hold one end in each hand during the movement.

            OR

Low back strengthener (Superman exercise):

Directions:

•     Lie on your stomach with your arms straight over your head, your chin resting on the floor between your arms.

•     Keeping your arms and legs straight, simultaneously lift your feet and your hands as high off the floor as you can (aim for at least three inches off the floor).

•     Hold that position (sort of a Superman flying position) for 10 seconds if possible, and then relax your arms and legs back onto the floor.

•     If this exercise is too difficult to start, try lifting just your legs or arms off the floor separately–or even just one limb at a time.

#3: Modified push-ups

Directions:

•     Get on your hands and knees on the floor or mat.

•     If using a band for extra resistance, position it across your back and hold one end of it in each hand so that it is somewhat tight when your elbows are straight.

•     Place your hands shoulder-width apart on the mat.

•     Tighten your abdominal muscles to straighten your lower back and lower yourself (from your knees, not your feet) down toward the mat as far as you can without touching it.

•     Push yourself back up until your arms are extended, but without locking your elbows.

•     If this exercise is too hard, stand facing a wall and place your arms on it at shoulder height and your feet about a foot away; then, do your push-ups off the wall (with or without a resistance band).

#4: Squats OR Suitcase Lifts

Squats:

Directions:

•     Stand with a dumbbell (or household item, like water bottles) in each hand and your feet shoulder-width apart, with your toes pointing slightly out to the side.

•     If you’re using a resistance band, tie both ends of your band onto a straight bar or broom handle, which is placed squarely across your shoulders with the loop of the tied band placed under your feet.

•     Keep your body weight over the back portion of your foot rather than your toes; if needed, lift your arms out in front of you to shoulder height to balance yourself.

•     Begin squatting down but stop before your thighs are parallel to the floor (at about a 70-degree bend), keeping your back flat and your abdominal muscles firm at all times.

•     Hold that position for a few seconds before pushing up from your legs until your body is upright in the starting position.

•     Do squats with your back against a smooth wall if needed to maintain your balance.

OR

Suitcase lift:

Directions:

•     After placing dumbbells (or household items) slightly forward and between your feet on the floor, stand in an upright position with your back straight.

•     Keep your arms straight, with your hands in front of your abdomen.

•     With your back straight, bend only your knees and reach down to pick up the dumbbells.

•     Pick up the dumbbells or items in both hands, then push up with your legs and stand upright, keeping your back straight.

#5: Sit-to-Stand exercise

Directions:

•     Sit toward the front of a sturdy chair and fold your arms across your chest.

•     Keep your back and shoulders straight while you lean forward slightly and practice using only your legs to stand up slowly and to sit back down.

•     To assist you initially, place pillows on the chair behind your low back.

From Diabetes Motion Academy Resources, Sheri R. Colberg © 2020.

Manage Your Stress with Some At-Home Flexibility Exercises

Hamstring stretch illustratedFeeling stressed out by the pandemic or by being trapped at home with no end in sight? If you’re a regular exerciser like me, the closure of gyms and fitness centers in most parts of the country may be limiting your options to de-stress by being active. Take a few minutes each day and work on your flexibility with these simple exercises you can do at home. These and many more illustrated exercises are available on Diabetes Motion Academy for free download.

Flexibility exercises in their simplest form stretch and elongate muscles. Good flexibility is as important a part of fitness as stamina. Muscles must be strong, but they also have to be long (as opposed to contracted) to work optimally. In fact, stretching can do a lot more for your figure than aerobic exercise because flexibility work results in a supple, toned, and streamlined body. Moreover, the benefits of greater flexibility may go beyond the physical to include stress reduction and promotion of a greater sense of well-being. Exercise disciplines which incorporate stretching with breath control and meditation include yoga, tai chi, and Pilates.

In creating your flexibility workouts and completing them a minimum of 2-3 times a week, it’s again important to include stretches for all of the major muscle groups in your body. You will regain some of your flexibility by stretching regularly, although your gains may be ultimately limited by your genetic makeup, arthritis, metabolic control, and other variables. Nonetheless, even people with type 2 diabetes experience flexibility gains by doing just eight weeks of stretching of their major upper- and lower-body muscles thrice weekly in conjunction with a moderate resistance training program, so likely everyone will benefit to some degree from regular flexibility training and from moving their joints through their full range of motion.

Flexibility Training “Do’s” and “Don’ts”

Do:

  • Use a full range of motion around joints when stretching
  • Complete at least one stretch per major muscle group, optimally holding each stretch for 15 to 30 seconds
  • Stretch all parts of your body two to three days per week
  • Complete equal stretching exercises on both sides of your body or a joint
  • Breathe deeply during all stretches to relax your muscles more

Don’t:

  • Bounce during stretches, as doing so can cause muscle tears and joint injuries
  • Forget to stretch opposing muscle groups equally (e.g., quads and hamstrings)
  • Stretch to the point of causing sharp pain or intense discomfort
  • Continue with a stretch if you feel a sharp or immediate pain in any joint or muscle
  • Hold your breath or strain while stretching

To get the maximum benefit from static stretching, perform each stretch slowly. Doing the exercises correctly, with good form, is much more important than doing them quickly. To have any lasting effect on the muscle being stretched, you need to hold the stretch for at least 10 seconds to start. The more regularly you stretch, the better you become at judging how far to take your body. Aim to increase the duration of your stretches, so that you are eventually able to hold them for up to 30 seconds, the point at which muscles optimally start to lengthen. Also, be sure to stretch both sides of your body equally, as well as opposing muscles on both sides of a joint (such as biceps and triceps on the upper arm).

Download the free, printable PDF for illustrations and instructions of these flexibility exercises:

 

Upper-Body Stretches

#1: Neck stretch

#2: Shoulder/upper back stretch

#3: Chest/shoulder stretch

#4: Shoulder/biceps stretch

#5: Upper back/triceps stretch

#6: Wrist stretch

 

Lower-Body Stretches

#1: Quad (front of thigh) stretch

#2: Hamstring (back of thigh) stretch

#3: Alternate hamstring (back of thigh) stretch

#4: Gluteal (bottom) stretch

#5: Calf stretch

#6: Ankle stretch

 

Other Stretches

#1: Abdominal stretch

#2: Back/gluteal stretch

#3: Complete back (cat) stretch

#4: Total body stretch

                                                                                                                                               

From Diabetes Motion Academy Resources, “Flexibility Exercises,” Sheri R. Colberg © 2017.

Exercising in a Pandemic: 10 Easy Exercises to Build a Strong Core Without Leaving the House

Pelvic tilt

Just in time for the novel coronavirus (COVID-19) social distancing and closures of gyms and fitness centers in many areas, here’s a revisit of many important core exercises you can do at home to keep yourself strong and healthy. Download the free illustrated PDF (Chapter 21) for illustrations. You can also find a variety of other at-home exercises on Diabetes Motion Academy Resources for free download.

Many people are stuck at home for one reason or another think they can’t work on staying fit, but the truth is that you can get a stronger core and stay fitter without leaving home. You’d be amazed at how easy it is to get your fit on.

Remember: Your body core — the muscles around your trunk and pelvis — is particularly important to keep strong so that you can go about your normal daily activities and prevent falls and injuries, particularly as you age. Having a strong body core makes you better able to handle your daily life, even if that’s just doing grocery shopping or playing a round of golf.

Core exercises are an important part of a well-rounded fitness program, and they’re easy to do at home on your own. To get started on your body core workout, you don’t need to purchase anything. (Some of the advanced variations do call for equipment like a gym ball or dumbbells.)

Tip: Include all 10 of these easy core exercises in your workouts, doing at least one set of 15 repetitions of each one to start (where appropriate). Work up to doing two to three sets of each per workout, or even more repetitions if you can. For best results, do these exercises at least two or three nonconsecutive days per week; muscles need a day or two off to fully recover and get stronger. Just don’t do them right before you do another physical activity (because a fatigued core increases your risk of injury).

#1: Abdominal Squeezes

This exercise (Figure 21-1) is great for working your abdominals and getting your body core as strong as possible. If you’re female and have had gone through a pregnancy at some point, getting these muscles in shape doing these squeezes is a must.

  1. Put one of your hands against your upper stomach and the other facing the other direction below your belly button.
  2. Inhale to expand your stomach.
  3. Exhale and try to pull your abdominal muscles halfway toward your spine.

This is your starting position.

  1. Contract your abdominal muscles more deeply in toward your spine while counting to two.
  2. Return to the starting position from Step 3 for another count of two.

Work up to doing 100 repetitions per workout session.

#2: Planks or Modified Planks

Nobody likes doing planks, but they get the job done when it comes to boosting the strength of your core. Both planks and modified planks (Figure 21-2) work multiple areas, including your abdominals, lower back, and shoulders.

  1. Start on the floor on your stomach and bend your elbows 90 degrees, resting your weight on your forearms.
  2. Place your elbows directly beneath your shoulders and form a straight line from your head to your feet.
  3. Hold this position as long as you can.

Repeat this exercise as many times as possible during each workout.

#3: Side Planks

A modification of regular planks, this side plank exercise (Figure 21-3) works some of the same and some slightly different muscles that include your abdominals, oblique abdominal muscles, sides of hips, gluteals, and shoulders. Try doing some of both types for the best results.

  1. Start out on the floor on your side with your feet together and one forearm directly below your shoulder.
  2. Contract your core muscles and raise your hips until your body is in a straight line from head to feet.
  3. Hold this position without letting your hips drop for as long as you can.
  4. Repeat Steps 1 through 3 on the other side.

Switch back and forth between sides as many times as you can.

Tip: Try these plank variations to mix things up a bit:

* Raised side plank: Lifting both your top arm and your leg upward brings other muscles into play and makes your core work harder to maintain balance, but don’t let your hips sag.

* Gym ball side plank: Resting your supporting arm on a gym ball, use your core muscles to control the wobble to further strengthen your side muscles.

* Side plank with lateral raise: While holding the side plank position, slowly raise and lower a light dumbbell or other weight with your top arm to improve your coordination and strength.

* Side plank pulse: From the side plank position, add a vertical hip drive by lowering your hips until they’re just off the floor and then driving them up as far as you can with each repetition of this move.

#4: Bridging

If you work on your abdominal strength, you also need to build the strength in your lower back to keep things balanced. Bridging (Figure 21-4) is a good exercise to do that as it works your buttocks (including gluteals), low back, and hip extensors. Remember to breathe in and out throughout this exercise.

  1. Slowly raise your buttocks from the floor, keeping your stomach tight.
  2. Gently lower your back to the ground.
  3. Repeat Steps 1 and 2.

Tip: Try the bridging with straight leg raise variation: With your legs bent, lift your buttocks up off the floor. Slowly extend your left knee, keeping your stomach tight. Repeat with the other leg. Do as many repetitions as possible.

#5: Pelvic Tilt

An easy exercise to do, the pelvic tilt (Figure 21-5) works your lower back and
lower part of your abdominals.

  1. Lie on your back on the floor with your knees bent and feet flat on the floor.
  2. Place your hands either by your sides or supporting your head.
  3. Tighten your bottom, forcing your lower back flat against the floor, and then relax.
  4. Repeat Steps 2 and 3 as many times as you can.

#6: Superhero Pose

Whether you want to leap a tall building with a single bound or not, try doing this superhero pose exercise (Figure 21-6) to get a stronger core. It works many areas, including your lower back, upper back, back of shoulders, and gluteals.

  1. Lie on your stomach with your arms straight over your head.
  2. Rest your chin on the floor between your arms.
  3. Keeping your arms and legs straight, simultaneously lift your feet and your hands as high off the floor as you can.

Aim for at least three inches.

  1. Hold that position (sort of a superhero flying position) for 10 seconds if possible, and then relax your arms and legs back onto the floor.

Tip: If this exercise is too difficult, try lifting just your legs or arms off the floor separately — or even just one limb at a time.

#7: Knee Push-Ups

Push-ups are hard to do if you haven’t built up the strength in your shoulders yet, so this knee version (Figure (21-7) is an easier way to start for most people. This exercise works your chest, front of shoulders, and back of upper arms.

  1. Get on your hands and knees on the floor or a mat.
  2. Place your hands shoulder-width apart on the floor.
  3. Tighten your abdominal muscles to straighten your lower back and lower yourself down toward the floor as far as you can without touching.
  4. Push yourself back up until your arms are extended, but don’t lock your elbows.

Tip: If knee push-ups are too hard for you, try doing wall push-ups to start instead. Stand facing a wall at an arm’s length and place your palms against it at shoulder height and with your feet about a foot apart. Do your push-ups off the wall.

#8: Suitcase Lift

This exercise (Figure 21-8) is the proper way to lift items from the floor. Before you begin, place dumbbells or household items slightly forward and between your feet on the floor. You work the same muscles used in doing squats (lower back and lower body) with this activity.

  1. Stand in an upright position with your back and arms straight, with your hands in front of your abdomen.
  2. Bending only your knees, reach down to pick up the dumbbells.
  3. Grab the dumbbells or items in both hands and then push up with your legs and stand upright, keeping your back straight.

#9: Squats with Knee Squeezes

These squats (Figure 21-9) are not your normal squats. They’re more like a combination of squatting and wall sitting with a twist. You work the front and back of thighs, inner thighs (adductors), hip flexors and extensors all with this one exercise.

  1. Stand with your back against the wall, with your feet aligned with your knees and straight out in front of you.
  2. Place a ball or pillow between your knees and hold it there with your legs.
  3. Inhale to expand your stomach and then exhale and contract your abdominal muscles.
  4. Bend your knees and lower yourself into a squat.

Warning: To avoid injuring your knees, don’t bend them more than 90 degrees.

  1. Squeeze the ball with your thighs, drawing your stomach muscles more deeply toward your spine.
  2. Do as many squeezes as you can up to 20 and then return to the starting position.

#10: Lunges

Lunges (Figure 21-10) are a common activity to work on the front and back of thighs, hip flexors and extensors, abdominals, and lower back all with one exercise. Do them with proper form to avoid aggravating your knees, though.

  1. Keep your upper body straight, with your shoulders back and relaxed and chin up.
  2. Pick a point to stare at in front of you so you don’t keep looking down, and engage your core.
  3. Step forward with one leg, lowering your hips until both knees are bent at about a 90-degree angle.

Make sure your front knee is directly above your ankle, not pushed out too far, and don’t let your back knee touch the floor.

  1. Focus on keeping your weight on your heels as you push back up to the starting position.

Tip: To prevent injuries, if you feel any pain in your knees or hips when you do a lunge, do the following instead:

  • Take smaller steps out with your front leg.
  • Slowly increase your lunge distance as your pain gets better.
  • Try doing a reverse lunge (stepping backward rather than forward) to help reduce knee strain.

                                                                                                                                               

Excerpted from Colberg, Sheri R., Chapter 21, “Ten Easy Exercises to Build a Strong Core Without Leaving the House” in Diabetes & Keeping Fit for Dummies. Wiley, 2018.

10 Ways to Get Motivated to Exercise (When You’re Not)—Part 2 of 2

Unmotivated gal lying down

Last time we covered the first five ways to get motivated to exercise, and we’re back this month to give you the next five to keep your motivation going strong. Check out the following sections for more ideas for those days where you just can’t seem to get moving.

#6: Get an Exercise Buddy (or Several)

You don’t need to go it alone when being active. Having a regular (and reliable) exercise buddy increases your likelihood of participating, and it also makes your activities more social and fun. Get your spouse, family members, friends, and co-workers to join in your physical activities, especially during your leisure time. Having a good social network to support your new or renewed exercise habit helps you adhere to it over the long run.

Remember: Oftentimes your community is a good place to look for other exercise options. To become more involved in structured exercise programs, find out what exercise programs are in your workplace or community. You can often find groups of health-conscious people walking together during lunch breaks, or you may be able to join a low-impact aerobics or other exercise class offered at your workplace or a nearby recreation center.

Take the time to find out what’s available in your area. The more you can get involved in making your lifestyle changes as part of a larger community, the more likely you are to be successful in making them a lifelong habit.

Tip: If you can’t find a human exercise buddy, borrow or adopt a dog that needs to be walked regularly.

#7: Schedule It

Put your planned exercise down on your calendar or to-do list like you would other appointments. You show up for your doctor appointments, so why should scheduling your physical activity be any different? Never make the mistake of assuming it’ll happen just because you claim that you want to do it a certain number of days per week or month. It takes some planning ahead and the commitment to make it a priority.

#8: Set Goals and Reward Yourself

Setting goals helps keep your interest up. For instance, if you walk for exercise, you may want to get a pedometer and set a goal of adding in 2,000 more steps each day. Break your larger goals into smaller, realistic stepping-stones (such as daily and weekly physical activity goals) for all your active lifestyle changes, and use SMART goals. Trackers, activity logs, and other motivational tools are also widely available online.

Tip: Reward yourself when you reach your exercise goals (but preferably not with food). Who says that sticker charts and non-caloric treats are just for kids? Maybe you can promise yourself an outing to somewhere special, the purchase of a coveted item, or anything else that is reasonable and effectively motivates you to exercise.

If you miss one of your goals, try to make the rest of them happen anyway. Then reward yourself when you meet any of your goals, even if you don’t make them all happen.

#9: Take Advantage of Opportunities for Spontaneous Physical Activity

You don’t have to do activities at a high intensity for them to be effective for diabetes and weight management. You can also add physical movement all day long doing anything you want to, including gardening, housework, and many other spontaneous physical activities.

For instance, if you have a sedentary desk job take the stairs rather than the elevator whenever you can. Walk to someone else’s office or the neighbor’s house to deliver a message instead of relying on the phone or email. Or park your car at the far end of the parking lot and walk the extra distance. Guess what? You’ve just gotten yourself more active without giving it much thought.

#10: Take Small Steps

If you get out of your normal activity routine and are having trouble getting restarted, simply take small steps in that direction. You may need to start back at a lower intensity by using lighter weights, less resistance, or a slower walking speed. Starting out slowly with small steps helps you avoid burnout, muscle soreness, and injury.

For example, if you don’t want to exercise on a given day, make a deal with yourself that you’ll do it for a short time to get started (which is often the hardest part). Even doing only 5 to 10 minutes at a time (rather than 30 or more) is fine. After you’re up and moving, you may feel good enough to exceed the time you planned on doing in the first place. The key is to begin through any means possible.

Remember: You’re in this for the long term, so even taking just small steps in the right direction will eventually allow you to reach your fitness goals and reclaim your good health.

By way of reminder, the first five tips from last month follow:

#1: Check Your Blood Glucose

#2: Start with Easier Activities

#3: Pick Activities You Enjoy

#4: Spice It Up

#5: Have a Plan B

                                                                                                                                               

From Colberg, Sheri R., Chapter 22, “Ten Ways to Get Motivated to Exercise (When You’re Not)” in Diabetes & Keeping Fit for Dummies. Wiley, 2018.

10 Ways to Get Motivated to Exercise (When You’re Not)—Part 1 of 2

Unmotived guy lying downDiabetes is a complex metabolic condition, and your blood glucose levels can impact you not only physically but also emotionally and mentally. Often, feeling depressed or anxious about diabetes management can be demotivating for taking better care of yourself. Whether that care involves getting more physically active or making more healthful food choices, getting and staying more motivated can only benefit you and your blood glucose.

Remember: Exercise can lessen your feelings of stress, anxiety, and depression, among other mental benefits. In many cases, treating anxiety or mild to moderate depression with regular exercise is at least as effective as, if not more effective than, using medications to treat these symptoms; even just five minutes of aerobic exercise can stimulate anti-anxiety effects. And the side effects from being regularly active are much more positive. Being active can also positively affect your self-confidence, body image, and self-esteem.

But some days knowing all those benefits may not be enough to get you going. We’ve got you covered. Check out the following sections for ideas for those days where you just can’t seem to get moving.

#1: Check Your Blood Glucose

When you start a new exercise, checking your blood glucose before, during (if you’re active more than an hour), and after your workout pays off. A reading that changes — especially in the direction that you want it to — can be very rewarding and motivating. If you don’t check, you may never realize what a positive impact you can have on your diabetes simply by being active.

For example, say your blood glucose is a little high after you eat a meal, and you want it to go lower without taking (or releasing) any more insulin. You can exercise after your meal and bring your blood glucose down within two hours after eating and taking insulin, or you can avoid or lower post-meal spikes in your blood glucose. You wouldn’t know the extent of the effect you can have without using your blood glucose meter to check.

#2: Start with Easier Activities

Start slowly with easier activities and progress cautiously to working out harder. Exercising too hard right out of the gate is likely to make you end up discouraged or injured, especially if you haven’t exercised in a while.

Remember: If you often complain about being too tired to exercise, your lack of physical activity is likely what’s making you feel sluggish. After you begin doing even light or moderate activities, your energy levels rise along with your fitness, and your physical (and mental) health improves.

#3: Pick Activities You Enjoy

Most adults need exercise to be fun, or they lose their motivation to do it over time. It’s human nature to avoid doing the things you really don’t like to do, so try to pick activities you truly enjoy, such as salsa dancing or golfing (as long as you walk and carry your own clubs). Having fun with your activities lets you more easily make them a permanent and integral part of your diabetes management. If you haven’t found any that you enjoy much yet, choose some new ones to take out for a test run (so to speak).

Tip: Choose an exercise that suits your physical condition and overcomes or works around your limitations.

#4: Spice It Up

An essential motivator involves mixing your workouts up with different activities. People commonly complain about exercise being boring. Feelings of boredom with your program can be the result of repeating the same exercises each day. To make it more exciting, try frequently doing different physical activities for different durations and at different intensities. Knowing that you don’t have to do the same workout day after day is motivating by itself.

#5: Have a Plan B

Always have a backup plan that includes other activities you can do in case of inclement weather or other barriers to your planned exercise. For example, if a sudden snowstorm traps you at home on a day you planned to swim laps at the pool, be ready to walk on the treadmill or substitute some resistance activities. You can always distract yourself during your second-choice exercise to make the time pass more pleasantly. Read a book or magazine, watch your favorite TV program, listen to music or a book on tape, or talk with a friend on the phone while you’re working out.

Check back soon for the final five ways to get motivated to exercise—when you’re not!

                                                                                                                                               

Excerpted from Colberg, Sheri R., Chapter 22, “Ten Ways to Get Motivated to Exercise (When You’re Not)” in Diabetes & Keeping Fit for Dummies. Wiley, 2018.

Getting and Staying Motivated to Be Physically Active

Walking a dog in snowThis time of year, all of the fitness clubs and gyms run specials to bring in new members, and they know—and even count on the fact that—most of those people will no longer be regularly attending classes or doing workouts by the time spring hits. How do you avoid becoming one of those exercise dropouts?

Even elite athletes have some days when they are not as motivated to exercise. You know those days—the ones when you have trouble putting on your exercise gear, let alone finishing your planned workout. For the sake of your blood glucose and your health, do not use one or two bad days as an excuse to discontinue an otherwise important and relevant exercise or training routine.

Here is a list of motivating behaviors and ideas for regular exercisers and anyone else who may not always feel motivated to work out:

  • Identify any barriers or obstacles keeping you from being active, such as the fear of getting low during exercise, and come up with ways to overcome them.
  • Get yourself an exercise buddy (or a dog that needs to be walked).
  • Use sticker charts or other motivational tools to track your progress.
  • Schedule structured exercise into your day on your calendar or to-do list.
  • Break your larger goals into smaller, realistic stepping stones (e.g., daily and weekly physical activity goals).
  • Reward yourself for meeting your goals with noncaloric treats or outings.
  • Plan to do physical activities that you really enjoy as often as possible.
  • Wear a pedometer (at least occasionally) as a reminder to take more daily steps.
  • Have a backup plan that includes alternative activities in case of inclement weather or other barriers to your planned exercise.
  • Distract yourself while you exercise by reading a book or magazine, watching TV, listening to music or a book on tape, or talking with a friend.
  • Simply move more all day long to maximize your unstructured activity time, and break up sitting with frequent activity breaks.
  • Do not start out exercising too intensely or you may become discouraged or injured.
  • If you get out of your normal routine and are having trouble getting restarted, simply take small steps in that direction.

As for other tricks that you can use, start with reminding yourself that regular exercise can lessen the potential effect of most of your cardiovascular risk factors, including elevated cholesterol levels, insulin resistance, obesity, and hypertension. Even just walking regularly can lengthen your life, and if you keep your blood glucose better managed with the help of physical activity, you may be able to prevent or delay almost all the potential long-term health complications associated with diabetes.

                                                                                                                                               

From Colberg, Sheri R., 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.

Carbohydrate Loading: Effective If Done Right for Even a Day

Pasta

What better topic is there to discuss after the gluttony most of us experience over the Thanksgiving and other fall/winter holidays than carbohydrate loading? (Actually, it probably should be excess calorie consumption in general, but you get the idea.) The following is excerpted from The Athlete’s Guide to Diabetes (2019) and gives you a better understanding of the topic from an exercise physiology (and diabetes) point of view.

Most athletes can benefit from taking in enough carbohydrate before long-distance events to start exercising with fully restored or even supercompensated glycogen stores. Traditionally, this loading technique consisted of 3 to 7 days of a high-carbohydrate diet combined with 1 or 2 days of rest or a reduction in exercise volume, a method known as tapering. For endurance athletes, loading is recommended to consist of taking in 8 to 10 grams of carbohydrate per kilogram of body weight (e.g., 560 to 700 grams for someone who weighs 70 kg, or 154 pounds)—but that is admittedly a lot of carbohydrate to handle if you have to match it with insulin or are very resistant, and it is not necessary.

Even a single day with enough carbohydrate and food intake and rest or tapering can effectively maximize your carbohydrate stores, so you do not need to spend a week, or even 3 days, overconsuming it. Maximal glycogen storage is dictated by how much muscle mass you have, but it is typically around 300 to 400 grams total in all your skeletal muscle, along with 75 to 100 grams of liver glycogen, for the average person. As long as you consume enough calories and taper or rest for a day, taking in up to 40 percent of your calories as carbohydrates is more than adequate to fully reload your glycogen. For someone consuming 2,000 calories and resting on a pre-event day, that amounts to around 200 grams of carbohydrate—more than enough if you are not starting out fully depleted. It’s also likely that you can fully restore your glycogen on far less carbohydrate, especially if you have been following a low-carbohydrate diet and are fully fat-adapted.

Training Tip: To maximize your glycogen stores, all you really need is 1 day and a combination of rest, enough calories in your diet, and good blood glucose levels for that day. You do not need to do traditional carbohydrate loading to make this happen.

The key for carbohydrate loading to be effective for exercisers with diabetes is to ensure that your muscles can take up any available glucose, which only happens if you have sufficient levels of insulin and enough sensitivity to it to prevent hyperglycemia and promote glucose uptake. Consuming higher-fiber carbohydrate sources and those with a lower glycemic effect will help prevent an excessive rise in your blood glucose and be effective for loading. In fact, a study showed that participants actually end up with higher glycogen stores when they maintain more normal blood glucose levels while loading with less carbohydrate (50 percent of calories from carbohydrate instead of 59 percent in that study). To optimize your liver glycogen replacement, keeping your blood glucose as close to normal as possible is also most effective.

From Colberg, Sheri R., Chapter 4, “Eating Right and Supplementing for Activity” in The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities. Champaign, IL: Human Kinetics, 2019.

What Is the Best Time of Day to Exercise? The Answer Is…

woman girl silhouette jogger

Photo by Pixabay on Pexels.com

I often get asked, “What is the best time of day to exercise?” Like most things related to physical activity—especially with diabetes as an added variable—the answer often is, “It depends.” What is your goal for being active? Are you trying to better balance your blood glucose, or is weight loss your goal? Do you take insulin? What is your normal diet? How much time do you have? Which activities? There are so many questions that likely need answering before you may be able to ascertain the best time for you personally to be active.

A recent article on CNN (1) proclaimed, ”Exercising before breakfast burns more fat, study says.” That article starts out by asking, “Should you eat before or after exercise in the morning?” It then states, “In 30 obese or overweight men, those who exercised before breakfast burned twice the fat as men who ate breakfast before they worked out.”

Before even reading the CNN article or looking up the actual research it quoted, I already had issues with their approach. You have to understand that the fuel your body uses during exercise matters less when it comes to weight loss than the total number of calories you use. Most calories burned during moderate or harder exercise come from carbohydrate sources simply due to the body’s more efficient use of that fuel compared to fat (or protein) (2). Your muscles use fat when forced to or when activity is light—but using more fat during exercise doesn’t mean you lose more body fat, which is how the press always interprets it. What’s more, fat is the primary fuel your body uses during recovery from exercise, which lasts far longer each day than your workouts, no matter what time of day you exercise.

Delving into the research itself (3), they actually found that active muscles did use more intramuscular fat in these subjects during prebreakfast training—but after breakfast blood glucose spikes were unchanged after six weeks of moderate cycle training regardless of which time they trained. They released less insulin for breakfast eaten after training, but that is hardly a surprising finding given than eating a meal makes most people (who can) release insulin. Burning more fat during prebreakfast exercise also did not cause those men to lose more weight than those exercising afterward (again, this is unsurprising).

For anyone with diabetes, fasted exercise tends to prevent the typical drop in blood glucose during moderate aerobic exercise—due to higher levels of cortisol and other glucose-raising hormones released when fasting—but many people with diabetes find that exercising in the morning causes their blood glucose to rise, which can also be an issue. I know many people with type 1 diabetes who love to exercise before breakfast, but I personally hate exercising then because I am more insulin resistant for hours afterward and battle to lower my blood glucose. Research agrees with me and has shown this to be especially true for resistance or high-intensity exercise done in the morning in adults with type 1 or type 2 diabetes (4,5).

In all honesty, the best answer when asked what is the best time of day to exercise is: “When you have the time!” In other words, exercise whenever it fits best into your daily life—because no matter when you are active, it’s always better to do something than nothing at all when it comes to your overall health and long-term blood glucose management. Just make sure to adjust your diabetes regimen as needed to keep your blood glucose in check.

                                                                                                                                               

References:

  • LaMotte, S. Exercising before breakfast burns more fat, study says, October 18, 2019, https://www.cnn.com/2019/10/18/health/exercise-breakfast-fat-burn-wellness/index.html
  • Kerksick CM, Arent S, Schoenfeld BJ, Stout JR, et al. International society of sports nutrition position stand: nutrient timing. J Int Soc Sports Nutr. 2017;14:33. doi: 10.1186/s12970-017-0189-4
  • Edinburgh RM, Bradley HE, Abdullah N-F, Robinson SL, et al. Lipid metabolism links nutrient-exercise timing to insulin sensitivity in men classified as overweight or obese. J Clin Endocrinol Metab, 2019 Oct 19. doi: 10.1210/clinem/dgz104 [Epub ahead of print]
  • Toghi-Eshghi SR, Yardley JE. Morning (Fasting) vs Afternoon Resistance Exercise in Individuals With Type 1 Diabetes: A Randomized Crossover Study. J Clin Endocrinol Metab. 2019;104(11):5217-5224. doi: 10.1210/jc.2018-02384.
  • Savikj M, Gabriel BM, Alm PS, Smith J, et al. Afternoon exercise is more efficacious than morning exercise at improving blood glucose levels in individuals with type 2 diabetes: a randomised crossover trial. Diabetologia. 2019;62(2):233-237. doi: 10.1007/s00125-018-4767-z.

What Causes Blood Glucose to Go Down or Up During Exercise

Figure 1 Diabetes Motion Color (rev)

For all the time that I spend praising the “miracle” of being physically active to help better manage diabetes and health, there are times when exercising does lead to better manage blood glucose and times when it does not. It is not always possible to predict the glycemic outcomes in all cases either, although individual patterns and responses can be determined over time. It is helpful to know the main factors that are predictive of outcomes, however, as detailed below:

Exercise Generally Lowers Blood Glucose When:

  • Circulating levels of insulin are higher (such as after eating in those who make their own insulin and within 2-3 hours of the last bolus of mealtime or correction insulin in those who take insulin)
  • Prolonged and aerobic in nature (30 minutes or more when moderate in intensity, an hour or longer when easier)
  • Blood glucose levels are normal (or near normal) at start of activity
  • Muscle glycogen stores are insufficient (either to start or later during activity)
  • On a low-carbohydrate diet and not fully adapted to eating that way
  • Still recovering from recent prior physical activity
  • Done after a recent hypoglycemic episode (particularly if a more severe low)
  • Doing a new or unaccustomed physical activity (greater reliance on blood glucose)

Exercise Tends to Raise Blood Glucose When:

  • Active first thing in the morning when circulating insulin levels are low and cortisol levels are higher (before taking or releasing any insulin)
  • Short and intense (such as heavy weightlifting, sprinting, or high-intensity interval training)
  • Hyperglycemic, especially when ketones levels are also elevated (i.e., relative insulin deficiency)
  • Eating too much during physical activity (or a large amount right before starting)
  • Dehydrated to start or if get dehydrated while active
  • Exercising in environmental extremes (too hot or cold, high humidity, high altitude)
  • A cold, virus, or other type of infection lowers insulin action and raises physical stress
  • An exaggerated release of glucoregulatory hormones (epinephrine, norepinephrine, glucagon, cortisol, and/or growth hormone) occurs for any reason

Despite all the potential influences, the biggest overall impacts on glycemic responses arise from the timing of being active and the activity itself. Those two factors likely explain most of the variance, while the rest comes from people not being able to anticipate what insulin levels are likely to be during an activity and other unexpected environmental or bodily concerns.

Despite any aggravations associated with balancing blood glucose during physical activity, it is still worthwhile to be regularly active to gain all the physical and mental health benefits associated with it. To help establish patterns and trends, check blood glucose levels before, during, and after various activities and circumstances until it is as predictable as possible.