A few years ago, I jumped into road cycling without knowing a single thing about riding bikes. I had to learn how to balance, how to use the brakes, how to change the gears, how to adjust the seat to the correct height, how to keep my neck from hurting–amongst many other things.
On top of that, I had to learn how to ride with diabetes. How do I keep from going low? Where do I wear my pump so that it’s not in the way? How do I carry enough supplies on this bike to help me through the mileage? I asked around, got advice from some other team members who have diabetes to see what they do, asked my nurse practitioner for some pointers.
My biggest takeaway? Everyone. Is. Different. I had to adjust my bike to fit me. What worked for other team members did not work for me. Just like I had to learn to ride a bike, I had to start from ground zero in terms of diabetes management.
Maybe you’re on a similar path. Maybe you’ve taken up a new activity, or maybe you haven’t quite figured out your diabetes with an old activity. Let’s dive into some tips and tricks of the trade to help you along the way.
Communication Is Key
First and foremost, please reach out to your diabetes provider to get advice about a new exercise regimen or to talk through any problems you’re having during exercise. You are not expected to do this on your own! Your provider may have some great tips; plus, they’ve learned a lot from other patients’ experiences. Don’t be afraid to speak up and tell them what works and doesn’t work–learning how to manage your blood sugars during exercise may take some trial and error, and they are there to help! If you’re finding that your provider is not an expert, find someone who is. Ask to speak with a diabetes educator, dietician, or sports medicine expert to optimize your success.
“If you’re finding that your provider is not an expert, find someone who is. Ask to speak with a diabetes educator, dietician, or sports medicine expert to optimize your success.”
Pumper Tips
- Use a temporary basal rate. All pumps have the option to decrease or increase your basal rate by a certain amount (example – 20% less during the time you are exercising). These slight increases or decreases can help stabilize blood sugars while you’re active.
- Cut your bolus. Some people find that they can reduce the amount that they bolus with a pre-workout meal in order to prevent low blood sugars during exercise.
- Pro Tip: remember that some exercises, especially competitive sports, can cause the blood sugar to increase due to adrenaline and stress. Adjusting basals and boluses may take some trial and error!
- Plan any reductions in insulin prior to starting exercise. This may even mean 1-2 hours prior!
- For Automated Insulin Delivery (AID) systems, try exercise mode. Exercise mode will tend to keep the blood sugar target at a higher level (like 150 mg/dL instead of 110mg/dL, for example) and won’t give aggressive auto-corrections, which means you’ll be less likely to go low.
- Pro Tip: Exercise mode works well for some but not others–you may have to test it!
- Disconnect altogether. Some people find that by disconnecting their pump, they receive less basal, and therefore decrease low blood sugars.
- Pro Tip: do not disconnect for more than 1-2 hours. Missing out on your basal for much longer will increase your chance of high blood sugars and/or ketones.
- For contact sports (like football or wrestling), or sports where your pump site could fall/get knocked off (like swimming or getting sweaty while running), consider pump site placement on your body. Should you consider shots for your matches/games? Maybe you need to place the pump in a specific area of the body to avoid contact?
- Consider extra tapes or adhesives to keep the pump in place while moving and sweating. There are tons of companies out there who make custom overpatches for each type of pump. Again, you may have to find one that sticks best for you!
CGM-er Tips
- Take advantage of the custom alarms you can set with your CGM system! During times of heavy exercise, consider setting your low threshold higher (example–if your low alarm is usually set to 80 mg/dL, consider setting it to 90-100 mg/dL) so you’ll have more time to react and hopefully prevent a low blood sugar.
- Log your exercise in your CGM app. Even though this is an extra step (who has time for that?!), it is super helpful in looking for patterns. You and your diabetes provider can look back and see what blood sugar patterns may have been connected to exercise.
- Pro Tip: log everything you can–food, intensity, and duration of exercise. You may not need to do this forever, but when you’re starting a new activity, this information is gold!
- Stay hydrated. You have to replenish your fluids and electrolytes, but did you know that being dehydrated can cause inaccurate CGM readings?
Injector Tips
- Work with your diabetes provider to adjust your basal insulin (long-acting insulin) on the days when you know you’ll be active. Reducing your overall basal may help to prevent lows that occur during and after exercise.
- Pro Tip: Because exercise can continue to affect your blood sugars for hours after completion, be sure to keep some extra low snacks around.
- For unplanned exercise, bring extra snacks and low supplies along. Unfortunately you don’t always know when you’re going to be more active, which means you can’t reduce your insulin doses ahead of time. In these cases, it’s best to bring some extra things along! In addition to your glucose tabs, juiceboxes, and fruit snacks, pack your ready-to-use glucagon kit (emergency low blood sugar treatment). While we hope that you won’t have to use it, exercise (especially new activities) can lead to some unexpected low situations.
- Consider your supplies. How long will you be active? Will you be stopping for a meal? Do you need to bring your injection supplies along? How will you keep your insulin cool while exercising?
- Inhaled insulin. Using inhaled insulin, like Afrezza, can be a helpful tool in your exercise routine because it works quickly and leaves your body quickly. This means that you won’t have insulin on board for hours after using it. Consider utilizing this for your pre-workout meal/snack, or for quickly bringing down a post-workout high blood sugar.
Tips for All
- Get advice from your healthcare team and diabuddies, but remember that your body may be different than others’.
- There will be highs, there will be lows. We talk a lot about low blood sugars during exercise, but having highs is not optimal either! Remember to bring your low supplies but also consider what you would do if your blood sugar was elevated. Do you need to pack your rapid-acting insulin pen or Afrezza? Do you need to pack some extra pump infusion sets?
- Stay hydrated! For exercise-sake, our bodies absolutely need fluid replacement. However, dehydration can also lead to blood sugar fluctuations that we can avoid by staying hydrated.
- Stop when you need to. Sometimes you’re going to want to “fight through” and forget about blood sugars. It’s not worth it.
- Enjoy what you’re doing. Find an activity that you love. Movement helps our bodies in so many ways (especially having diabetes), and it’s so much easier to move when you’re happy!