What do you do when someone asks you to participate in physical activity on the spur of the moment, but you just took some insulin? You may be stuck trying to compensate for this activity entirely with food, but you may have some newer options that come from technology. For starters, if you wear a pump you can choose to lower your basal insulin delivery, and you can use its insulin-on-board calculator to see how much insulin you need to offset with either insulin reductions or food intake. However, just using your blood glucose meter can help you stay on top of your glucose levels, so check often during the activity. If you use a CGM (continuous glucose monitor), you can continue to monitor throughout to detect downward trends and treat yourself early enough to prevent lows (but just remember that there is a lag time). If you use the other wearable devices we will be discussing next, feedback on your heart rate, steps, or other variables can help you figure out how many extra calories you may need to take in to match your activity and prevent a drop in your blood glucose. With these newer technologies, at least you have options that you may not have had otherwise (1).
Exercise Technologies and Wearable Devices
You may benefit from exercise-related technologies that allow you to monitor your heart rate, blood pressure, steps, sedentary time, exercise intensity, calorie use, and other variables in real time. For instance, heart rate monitors are good for achieving and maintaining appropriate exercise intensity, particularly if you are a data-driven person and are motivated by such feedback. However, keep in mind that you need to use individualized target heart rates based on your health status. Any medications that you are taking that may limit your heart rate also need to be considered. Many apps can track your heart rate in real time and allow you to train more effectively.
Tracking steps and other physical activity can also be useful. Step counters can motivate you to be more active throughout the day, not just during your planned workout times. Keeping a daily log of step counts can allow you to determine correlations between your activity and blood glucose responses. Apps for tracking workout progress and analyzing glucose patterns related to different forms of exercise can supply the feedback, allowing you to make regimen adjustments
in real time to avoid glucose lows and highs. Many smartphones now also have integrated accelerometers that can give you data on all daily movement including your steps, along with your sleep patterns and other useful information. It is likely in the future that some of the issues surrounding exercise with fully closed-loop systems may be addressed with wearable devices that provide input about changes in activity and heart rate that can impact your blood glucose.
Whether you choose to partake of the latest technologies or not, it helps to keep some general principles in mind whether you are already regularly active or getting ready to be. These vary somewhat by your diabetes type, but are largely based on whether you have to manage your insulin levels during exercise because you use insulin. Read through these general recommendations as well as the precautions for any complicating health issues and keep these points in mind to get the most out of your workouts.
1. Excerpted from Colberg, SR, Chapter 5, “Using Technology and Monitoring to Enhance Performance” in The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities. Champaign, IL: Human Kinetics, 2019