When you’ve got Type 1 diabetes, figuring out when and how to exercise takes a lot more effort than simply carving out time from a busy day. You need to ask yourself how long it’ll have been since you’ve eaten, or how long it will be before your next meal. You need to keep track of what your basal insulin is, whether and when you want to drop it, and what and when your last bolus was. You need to be sure to test your blood sugar before, during and after exercise. You need to carry some fast-acting carbs. And you need to know what effect different types of exercise will have on your blood sugar — for me, a half-hour walk will drop it, whereas a workout with weights will either keep it steady or make it go up.
Like many other people with Type 1, I’ve dealt with these questions and decisions nearly every day for the past 11 years — I’m not going to let diabetes stop me from staying in good shape. But here is my question to my diabetes on this otherwise lovely Wednesday afternoon: exercise is definitively good for my body. So couldn’t you cut me some slack?
I’m particularly frustrated at the moment by the difference time of day makes in how my blood sugar responds. I’ve been exercising mostly at 6:30 in the evening for the past couple months, in the form of an intense spin class. Crazy cardio + early evening timing = drop in my blood sugar. This is annoying in itself, because I often find that the insulin I take for lunch just hangs out in my body doing basically nothing until I hop on the bike. Then my glucose plummets and I have to stuff my face with glucose tablets just to stay in a safe range. The result? Early afternoon highs, and post-exercise lows — and the annoying feeling that comes when your disease forces you to re-consume the calories you’ve just worked so hard to burn. Also, while I’ve brainstormed with my endocrinologist about the insulin-hangs-out-till-I-exercise problem and have tried dropping my basals by 50% two hours before I work out (and for an hour afterwards), the problem still occurs.
But I find that when I exercise in the morning, my bg is even more confusing. Usually I avoid this by simply not exercising before noon — I don’t like to do so, and I know that anything before 7:30 or 8 is a guaranteed disaster. But just this week, my favorite spin teacher started teaching a class at 8:30 in the morning, a time that works better for my schedule. I thought I’d give it a try, in hopes that whatever hormones are wreaking havoc on my body before 8am might calm down by 8:30.
Unfortunately, they have not — which I discovered on Monday, when I headed to class having only eaten a spoonful of peanut butter, left my basal as-is, and watched as my blood sugar started creeping up around 20 minutes into the 40-minute class. It ended up stuck in the 160s for much of the morning, which is a pretty frustrating way to spend the day after you’ve managed to get yourself sweaty ten hours before you’re used to.
Fast forward to today: I ate yogurt with a bit of granola, a breakfast that usually would require more than 5 units to cover. I took 3.2 and headed nervously out the door. Went to class. Blood sugar was remarkably stable till three quarters of the way through, when it dropped to 80 and I took 3 glucose tabs just to prevent any possibility of a low.
I ended up fine. So I suppose I should be happy. But I’m not — because come Friday, if I go to the class again, I’m going to have no guarantee that my body’s going to react the same way. That scares me. And I hate that. I hate that trying to “do the right thing” for my health leaves me feeling terrified that I may actually do more harm than good. I hate feeling like I’m taking a gamble every time I try to avoid a morning exercise high. I hate having to take insulin when I exercise to begin with — it is extremely counterintuitive to me, and makes me scared. And since I am a guesstimator to begin with — I have never found an insulin-to-carb ratio that works consistently for me — I feel that there’s no way I can guarantee that what worked today will work on Friday.
So that’s my vent for the day. Long story short, I hate the fact that with diabetes, even positive behaviors, like exercise, are fraught with danger. I hate the unpredictability and the feeling that all the effort I put in to maintaining my health could, if I get it wrong, send me to the emergency room. So here’s my message to diabetes: if I work up the willpower to exercise in the morning, I wish that you’d leave me alone.