Diabetes and Exercise, the Saga Continues

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I find that my life with diabetes revolves around several recurring themes, with issues around how to exercise with diabetes ranking high among them (see, for example, this blog post from last year, aptly titled “Morning Exercise and Diabetes”). It makes me feel annoyed to repeat myself, but then I realize I’m probably going to be dealing with a repeating version of that issue for the rest of my life. I’ve been doing it for nearly 13 years, and I don’t see any reason to think it’s ever going to get easier.

That’s kind of strange, now that I think about it. I’m spending my free time these days trying to teach myself how to sight read the piano (more on that later — but man, it’s hard!) and the reason I keep going is that I know that eventually, if I keep at it, I will get better. My goal posts will move — I started with really bad versions of Christmas carols, and I’ve moved on to really bad versions of the Star Spangled Banner. While it feels a bit imperceptible, I know there’s been progress. Likewise, if I work out consistently I will eventually get faster, be able to lift heavier objects, etc. I will improve. 

But diabetes doesn’t seem to be like that. Diabetes presents the exact same challenges (in a maddeningly revolving and unpredictable format) every single day. And no matter how many times I try to face those challenges, I’m never going to “conquer” them. I feel like I’m stuck on a permanent plateau.

I’m not saying that there is never room for improvement with diabetes; if my blood sugars were out of control or if I felt like I were eating poorly or not exercising enough, then I definitely would be able to make some lifestyle changes that would make a difference. But I eat well and I exercise regularly and I wear a pump and a CGM. My A1cs are good (even if the perfectionist in me would like them to be at non-diabetic levels) — but I have wide fluctuations nearly every day. I’m extremely frustrated that even with my best efforts, my blood sugars seem to have a mind of their own. 

Take yesterday: I dragged myself out of the house to go to a 10:30 am spin class. I ate a small serving of berries and lowfat cottage cheese an hour before class, and took about 2.6 units (a little lower than normal just to make sure I wouldn’t go low). Get to class, feel kind of bad, check my blood sugar, and it’s 235. I take a correction bolus. Nothing. Take another. Nothing. (And then worry about stacking.) In the meantime I’m feeling like total crap, unable to keep up with the tabada interval series that the teacher was leading us through (I actually had to get off my bike and hang out in the bathroom for a minute, which made me feel lame). It then occurred to me that there was a reason I felt horrible: my muscles had no glucose! It all was just hanging out in my bloodstream. I struggled through class, made it home, and then — as always — the insulin finally did kick in and I narrowly avoided a low. 

Fast forward to this morning: I go to a 7:30 class at the gym. I eat a small cottage cheese (7 grams carb) and take 2 units, which previously has worked for this particular class. I do my intervals, lift my weights, test my blood sugar. 195. Seriously? I’d started at 95 just 45 minutes beforehand. As yesterday, I didn’t feel too great — and again, like yesterday, that no doubt was partially due to the fact that I did not have enough glucose actually getting absorbed into my muscles. 

It makes me wonder what would it be like to go through an entire workout with perfect blood sugar. I once spent a summer biking across the United States, a trip that crossed the Rockies on Trail Ridge Road (a road that peaks at 12,183 feet above sea level). When we got back down to more normal levels, I felt like a super hero — I was so strong. Is that what it’d feel like to work out at a steady 90? (I don’t really think that training at high blood sugar is the equivalent of high altitude training, but you know what I mean.)

Anyway, all this is to say that I am newly frustrated by this perpetual paradox of diabetes: the more I do to take care of myself, the more my blood sugar seems to rebel. The best time in recent memory was after I had shoulder surgery and wasn’t exercising at all (which, therefore, also made me less hungry) — but that is not a strategy I think would be healthy to pursue long-term. It’s driving me crazy, and I still — after 13 years of this BS — don’t really know what to do.

With that said, I have picked up on some general trends that might be useful to share: 

1. Morning exercise (up till about 10 or so) is likely to raise my blood sugar rather than lower it. 

2. After around 10am (and especially in the afternoon/evening) the opposite is true: the same exercise that raised it in the morning will drop it, sometimes extremely dramatically.

3. The harder I work, the more likely my blood sugar will rise. This is partly because my muscles/liver are releasing more glucose to fuel the intense exercise, and partly because really intense exercise tends to also cause the release of stress hormones, like adrenaline, that can make you insulin resistant. 

4. As a result, lower intensity sustained “exercise” like walking (I put that in quotes because that doesn’t really count as exercise for me) will make it drop. 

Got it? Now just factor in your meals, stress, fatigue, sickness, hormones and whatever else is going on in your life and you have the recipe for perfectly controlled blood glucose at all times. 

Ah, if only it were that easy. . . .

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Scott K. Johnson

Oh man, I SO feel your pain on this one.

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