#755 Bold Beginnings: Exercise

September 16, 2022Scott Benner

Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.

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Scott Benner 0:00
Hello friends, and welcome to episode 755 of the Juicebox Podcast.

Jenny Smith and I are back today with another episode of the bull beginning series and today Jenny and I are gonna talk about exercise. While you're listening today, don't forget two things. One, Jenny works at integrated diabetes.com. You can check her out and hire if you like, and to nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, in fewer than 10 minutes, you could go to T one D exchange.org. Forward slash juice box and fill out their survey. When you complete the survey. You've helped the podcast, you've helped people living with type one diabetes, and you may just have helped yourself T one D exchange.org. Forward slash juicebox. Hope you're enjoying the bowl beginning series. It's not done yet, there's more coming. If you've missed the earlier episodes, you don't even have to listen to them in order if you don't want to just go find them.

This episode of The Juicebox Podcast is sponsored by touched by type one, please go learn about my favorite diabetes organization at touched by type one.org and find them on Facebook and Instagram while you're at it. Today's episode of The Juicebox Podcast is sponsored by in pen from Medtronic diabetes in pen is an insulin pen that offers some of the functionality that you've come to expect from an insulin pump. I know you're thinking, Oh, Scott, please tell me more. Well, I will. Yes, the pen is a pen. But it also has an application that lives on your smart device. This app shows you your current glucose levels, meal history, dose history and activity log glucose history, active insulin remaining a dosing calculator and reports that you and your physician can use while you're trying to decide what your next step is. Well, well well, it's not just an insulin pen, now is in Penn today.com. That's where you're going to find out more information and get started. If you're ready to try the M pen, just fill out the form at M pen today.com or do some more reading. There's actually some videos you could check out too about the dosing calculator, the dose reminders, carb counting support, and the digital logbook. So if you want to lighten your diabetes management load, but you're not ready for an insulin pump in Penn is probably right for you in Penn today.com. In Penn also offers 24 hour Technical Support hands on product training and online educational resources. And here's something else that you'll find it in Penn today.com It is actually very exciting. Now this offer is for people with commercial insurance in terms and conditions do apply. But you may pay as little as $35 for the pen. And that's because Medtronic diabetes does not want cost to be a roadblock to you getting the therapy you need within pen $35 How crazy is that? In pen today.com in pen requires a prescription and settings from your healthcare provider. You must use proper settings and follow the instructions as directed. Or you can experience high or low glucose levels. For more safety information where to get started today, you can go to in Penn today.com What's next, Jenny? Hey, we're back with the ball beginnings series. And we're going to talk about something today. That's going to happen to everybody I hope exercise, but we're not gonna dig super deep into it. We just want to make sure that newly diagnosed people understand the impacts.

Jennifer Smith, CDE 4:20
Right? Absolutely. They think it's a neglected topic. At that initial like diagnosis and the overwhelmingness of everything that you're trying to learn about. Exercise is like way, way at the bottom and what to expect to try to learn right and also,

Scott Benner 4:40
I also think that when people think of exercise, they think of at 11 o'clock I'm gonna go to the gym and I'm gonna run on the treadmill and I'm gonna lift these things then I'm going to do this I'm gonna go back but exercise could be cleaning the house or cutting your lawn or your kid going to a store. Yeah, walking around it whatever. Do we say Walmart in the variable series? Yeah. So yeah, shopping, anything that takes your, your level of activity from where it kind of normally is to an elevated place because your settings for your insulin are usually set up for when you're sitting in school or at work or sleeping or whatever. And then, let's just explain. I'm going to ask you to do it. What happens when there's two kinds of exercise? Look at me, anaerobic, and your aerobic. What is

Jennifer Smith, CDE 5:39
it and the other one? You're so funny. Oh, my goodness.

Scott Benner 5:42
I made weightlifting like sign like movement.

Jennifer Smith, CDE 5:45
Yeah. Anaerobic. Yes, like resistance and weight training. In which you're not increasing or not for long periods, increasing your heart rate, right. And then there's cardio kind of exercise or aerobic where you're using oxygen at an increased rate, right. And they both do something different to your blood sugar

Scott Benner 6:07
or could Alright, so anaerobic like from my childhood, Lou Ferrigno, lifting weight. There you go, and aerobic. What's her name? married to the guy from CNN. Oh, yeah. Oh, my God, famous actress. Did that thing in Vietnam? People didn't want that. There you go. There you go. I knew how was it possible? I could, I could give you her entire litany of what she did throughout her life couldn't think of her name. That's ridiculous.

Jennifer Smith, CDE 6:38
I actually am very, very proud. Because my husband is like the trivia man. He knows. Like, he knows. He can look at somebody be like, he did this. And he did this. And this is his name. And like the song that I I'm like, I know the song. I tell you all the words and the group is hmm, I don't know who the singer is.

Scott Benner 6:57
I'm worried that I didn't go to Olivia Newton. John. I was just trying to think of like people who used to make VHS tapes of them working out in leotard. So you would work out in your living room. But but so the point is, is that you're there's two different kinds of exercises you might get involved in. And they have two different impacts. Is that correct? Yes. Okay. So aerobic exercise may make my blood sugar drop down. Yes. And weightlifting and resistance stuff could make my blood sugar go up? Correct. Okay.

Jennifer Smith, CDE 7:30
In fact, the anaerobic or the weightlifting resistance. The heavier the load, the more that you're doing in that is more of an adrenaline kind of released, right? It's the more pumping kind of and so that can be the reason it's causing a rise in blood sugar. And the others, typically, aerobic, whether it's running or jumping on the trampoline, and a trampoline and the past couple of years. I've heard more comments about trampoline, blood sugar than any other sport for kids.

Scott Benner 8:07
I think they cuz I think it's the, it's kind of what I was bringing up at the beginning. Like your kid is like eight. And they're like running, you know, sitting down watching TV, and then all of a sudden, they look up like a puppy that saw something, jump on the trampoline now. And then they run outside and do that. And you're like, Wait, stop.

Jennifer Smith, CDE 8:27
We just hit they're all shiny dangly objects. That's what it is. They're they're here, you they look content. And then they're like, Oh, look at all it is. It's like a puppy. It's like it, there's a squirrel over there. So there's

Scott Benner 8:39
these two situations, you might fall in one, you know that soccer practice is at six o'clock. And you can prepare for it in one way and to have your kids start chasing each other around the house and run up and down the stairs 75 times 45 minutes after they ate with a bunch of active insulin inside and your blood sugar tax. Right, right. So no one tells you about that when you're diagnosed with diabetes.

Jennifer Smith, CDE 9:03
No, not at all. And if you are, again, in the kid category, or even the teen category, and teens are very much in that sedentary might move up, somebody comes over. It's the same really. And so you have to consider those really, like quick spurts of activity could be lengthy. They could be 10 minutes and your kid is done. And they're like, I want to sit down and read a book again. Right? So paying attention in those times, can give you like future vision then to what to maybe do. But it's it's all learning. Really. It's it's paying attention. It's not going to be perfect. Don't expect it to be perfect. Know that you have the tools to manage and some idea that if something's planned, you can try to accommodate and see how it works out. If something's unplanned, one of the best things is just making sure you got some carbs to manage. Because that's all you can do to fix it.

Scott Benner 10:07
Yeah, I. So kind of the way I think about it is, you ever see those beach houses up on the stilts? Okay? Those people said, I know that one day water is going to come rushing in here. And I'm gonna put my house up where the water can't get to it. And I think it's water. But I don't understand how to say. So that's fine. It's pre planning, right? Yes, somebody else built their house in the ground, the water comes rushing into the house goes back out into the ocean. They're like, I don't know what happened. What happened? You didn't plan very well. So the way I see all this is not that Arden doesn't have fluctuations around exercise if she's not prepared for it. But rock solid settings, and rock solid understanding of how to Bolus for meals so that you don't end up with a lot of insulin. In the body. It's not accounted for correctly for need. So if if Arden does not prepare to like, go downstairs and get on the treadmill and run she will get low? Absolutely, absolutely. Well to Yeah, but she'll get low like 66. And then she'll need something and it'll bring her blood sugar back up. She doesn't go from like 95 to 20. Like it's not like some crazy drop, because she won't go running when she's got meal insulin active, because she knows better at this point. Right? Right, because that's going to make her blood sugar low. So I think most of activity is not having active insulin, or cutting your Basal, if you're on a pump in a way prior to the activity, where you kind of create one of those black holes so that the drop, can't drop, because there's nothing there to pull it down, because we call it a drop. But it's not really a blood sugar drop in this scenario. It's a poll. But that doesn't make any sense, right? Well, I

Jennifer Smith, CDE 12:01
think what I've seen in a timeframe, which might make sense for again, more newly diagnosed is the common time period when you haven't accommodated before more spontaneous exercise. Whether it's insulin or extra food, or however you're going to do it, if you haven't accommodated 15 to 20 minutes into movement, that aerobic is a drop zone, and again, not dropped, like over a cliff, it's you might have been floating along pretty stable. And it's definitely going to start nudging down, right. Yeah. So that's a timeframe at least that may give a little bit of reference to people who are new to trying to figure out what to watch for,

Scott Benner 12:44
right. And I think if you find yourself in a scenario where blood sugars are dropping and rising, and you don't understand why you're going to be more susceptible to a problem during exercise as well, right? It just really did strike me as I just said that. Calling a blood sugar drop a drop makes it feel surprising, the word usage makes it feel like it's unknowable, it just happened, it just dropped out of nowhere, like those are the phrases people use. But that's not really the case. In most situations, it's you have some active insulin, it's, it's taking sugar out of your blood, your blood sugar number is falling because of that, then suddenly you start exercising. And there it is. I mean, I would think that if you made me just give one piece of advice, I'd say do not exercise, aerobic ly with active insulin on board.

Jennifer Smith, CDE 13:37
And if you do know how much carb you may need to cover, the active insulin that's there with, again, spontaneous activity and whatnot in kids is pretty much the whole day, I would say to what you can play on in schools and that kind of thing. But if it's spontaneous, and you've got active insulin, because you didn't plan to go out and jump on the trampoline with four friends after lunch, you got this insulin, it's going to need some additional food beyond what it was given to cover. Yeah, because the exercise is mobilizing that insulin faster

Scott Benner 14:09
and not just in a situation where you unexpectedly find yourself doing something but what happens when you eat dinner and then go to baseball practice. Right, right. Like that's what here's a plan. Yeah, there you go. You can also you have to sort of understand Jenny mentioned adrenaline a little while ago. Baseball is a good example. Because it's not a ton of running around for the most part, right? But people will say how come my kids blood sugar gets high in a baseball game, but not at a baseball practice. And it could just be because there's no competition at the practice. They don't feel a sense of competition. So there's no adrenaline rise. These things take time to figure out honestly do but I and I'm not just self promoting here. But if you listen to the Pro Tip series, that should teach you how to keep things more stable. And then you should have an easier time being able to see what's going on in these situations so that you can adapt to them. Absolutely. Some stuff from people here, how do I adapt existing routines and lifestyles for diabetes, like swimming, summer camping, hiking, that's what we're talking about. It might be what you're eating, you might eat something with more protein in it more fat in it to hold your blood sugar up longer. You may do Temp Basal decreases before activity to help that, again, all that's in those episodes. But I just think it's important for people who are newly diagnosed to understand that it's going to happen because people don't tell you that and no, then there you go. Right. So

Jennifer Smith, CDE 15:48
and then it's scary. It becomes scary, because nobody told you to expect that this activity that your kid loves to do, but it's sporadic is going to do this versus this.

Scott Benner 15:59
And you see this this feedback from the person said, My son was in baseball and swimming, when he was first diagnosed, the doctor flat out told me he would have to rethink the sports he was playing. And that crazy for things that would work around his diabetes. While we were learning how to manage the disease. I was led to believe he could not live a normal life with sports. Oh, but of course, he

Jennifer Smith, CDE 16:23
could oh my gosh, I'm, I feel so bad that they were told that Yeah, that's really

Scott Benner 16:29
terrible. It really is. Meanwhile, the tight end for the Ravens has type one diabetes, and you have type one diabetes, and you run for some reason I don't understand why. And it's so to a lot of other people right there professional has been professional baseball players on this podcast, who have type one, it is very doable. But you need to, you need to do the things you need to do that you you have to have your basil, right, you have to understand how to Bolus from meals, you have to understand the impacts of different foods. And now you have to add understanding how to keep active insulin away from certain activities. Or you if you become a bodybuilder, you might find yourself bolusing before you workout,

Jennifer Smith, CDE 17:15
correct, absolutely anaerobic exercise, can for many people, not always, but it can depending on the length and the weight. And you know, all of that it can drive blood sugar's up again, when it's going to be based on on your response, it could be that you start out in a really great place. And by the end of your lifting session, you're riding high or you're kind of nudging up, essentially. But overall, you have to just pay attention to you. Some of the lifters that I've worked with have taken a Bolus at the beginning of lifting session to accommodate and avoid and avoid arise. Some of them have set a temporary basil to accommodate for that. Some of them end up doing a little bit of both anaerobic and aerobic exercise, knowing that their blood sugar is going to get driven up by weights, they end up allowing that drift to happen to a certain point, and then following it with aerobic exercise, which they know is going to navigate it down and tends to kind of smooth things a little bit more on the back end rather than a dramatic drop, like we often see with cardio. Yeah. So

Scott Benner 18:24
you also have to, you know, when we talk about mixed meals, right, like it's easy to pick one food and Bolus four. But what do you do when you're having meatloaf and mashed potatoes and applesauce and these all have different impacts. Also, you could head out into the backyard to move a pile of rocks, which you would think well that's lifting except what if the pile of rocks is 45 feet from so now you're lifting and then you're walking, right and then you're lifting and you're walking, you're you're having two different impacts, you could end up doing something like that in the backyard for example, and it not looking on your blood sugar like anything happen, because you could be getting a pull down from the aerobic and a push up from the anaerobic and this all you know what I always say the podcast makes things seem simple, but Jesus. But it's very doable. And I think that's the important thing. But everything starts, in my opinion with understanding how insulin works, like with Absolutely. Well thank you very much. I appreciate course, always I'll talk to you soon.

A huge thank you to Jenny Smith for being here with me again today. And I'd like to remind you that you can hire Jenny integrated diabetes.com. I'd also like to thank Ian pen from Medtronic diabetes. If you're looking for an insulin pen that does more, you're looking for the in pen in pen today.com In a few moments, I'll tell you a lot about the show, but one of the things I'll tell you is how to find the series. So if you've just stumbled upon this one, and you'd like to find the rest, there's a way to do that. And I'll be telling you about it in just a second.

If you're into helping people, especially people with type one diabetes, I'd like to ask you to go to T one D exchange.org. Forward slash juicebox. When you get there, fill out the survey completely. And you've helped somebody, all you need to be is a US resident who has type one diabetes, or is the caregiver of someone with type one, t one D exchange.org. Ford slash juicebox. Join the registry, complete the survey, help someone with type one diabetes, help yourself perhaps, and support the Juicebox Podcast, you will do all of this in the fewer than 10 minutes that it will take to go to that link and complete the survey. The survey is very simple, you will know all the answers to all the questions. It is also HIPAA compliant, and completely anonymous, T one D exchange.org. Forward slash juicebox. There are links in the show notes of your podcast player and links at juicebox podcast.com. To all of the sponsors. And to T one day exchange, when you take the time to click on my links or to type them in a browser. You're telling the sponsors that you came from the Juicebox Podcast, and that is a wonderful way to support the show. Are you looking for a vibrant and intelligent community around diabetes? look no farther than the Facebook page, the private Facebook page for the Juicebox Podcast. It's called Juicebox Podcast type one diabetes. The group has over 28,000 members. And those members are responsible for between 70 and 110 new posts every day, on the Facebook page. Every conceivable conversation around diabetes is happening at Juicebox Podcast, type one diabetes on Facebook, you're gonna see great questions, thoughtful answers, and supportive people. No matter if you're an adult living with type one diabetes, or the caregiver of someone with type one, this group is for you. Doesn't matter if you eat low carb, or high carb or somewhere in between your questions and thoughts are welcome on our Facebook page. I hope you check it out. Last little bit if you're looking for the diabetes Pro Tip series, or the defining diabetes series or any of the other multitude of series that exists within the podcast, you can find them in a number of ways. They are at juicebox podcast.com. They are at diabetes pro tip.com. And if you belong to the private Facebook group, you can find them listed in the featured tab. Now if you're enjoying the podcast, please consider sharing it with someone else that helps the podcast grow more than anything word of mouth is definitely how the show has become what it is. If you have already shared it with everybody you can think of and you've bought it on the pod or index comm or supported one of the other sponsors. You've done the T one D exchange survey. And now you're looking for another way to give back to the podcast. Super simple. A five star rating and a thoughtful review in whichever audio app you listen in would be amazing. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.