Recently on the DiAthlete Facebook Page I shared information ‘from the horse’s mouth’ on my experiences and knowledge regarding type 1 diabetes and the effects in sports and exercise. Through Aerobic and Anaerobic exercises, there are different occurrences that can take place – and therefore, different methods of control to take on!
Life with diabetes should never be allowed to hold you back from doing what you enjoy in life, performing to the best of your abilities and living life to the fullest. From experience I have built up the education for control in sport that I have today, so I hope this might help you – and to think, I once got awarded a ‘Double E’ grading for GCSE Science… but life with type 1 diabetes taught me what I know!
As you might have figured through here by now, I am a long/ultra distance runner. I endure challenges to battle my diabetes with an aim to succeed in order to help inspire you – as it is my sincere belief that this medical condition cannot prevent us from any accomplishment in life, no matter how crazy!
Ultra running, along with the likes of long to middle distance runs, cycling, swimming and even walking, all register under AEROBIC exercises. Motorsports will largely offer a similar effect, as although you are not physically burning glucose, the heat and intensity of it will decrease blood glucose at a similar rate. Other sports such as Tennis, Boxing and Weightlifting, can also offer a similar effect – with a combination of both aerobic and anaerobic.
THE EFFECTS OF AEROBIC EXERCISE:
Aerobic exercise is energy being released with oxygen for cells from glucose – meaning that with the body burning energy at a consistent rate, with say what I do in ultra running, glucose are consistently being burned up too. With diabetes this of course means that our Blood Glucose Levels will therefore decrease.
For me I have been there over the years, on the ground, face down, shaking through the serious effects of almost worst case hypos. I’ve been a runner for 8 years. And through it I have learned. I never had the advice or support from professionals when I first started up, I was just a kid keen to get out there and take the fight to my diabetes. I succeeded in that, yet, had many lessons to learn along the way – which I did. And that has only developed my knowledge. If you haven’t ever had your back up against the ropes, then how will you know how to fight your way off of them? That’s diabetes in my opinion.
I have tested my body out like a test dummy to learn more about my condition. I found in aerobic exercise, swimming to be the more rapid glucose level decreasing exercise, where your entire body is constantly in use – this may alter with different forms of swimming but the front crawl particularly requires a full body effort. Secondly, long distance running burns up energy at a more gradual rate but with a constant decrease. You work your whole body once again, the legs working the most but with the arms pumping and the mind focused. And thirdly, in my research, cycling decreases levels very consistently as well, with the legs working at a higher rate than running but not the full body motions.
Aerobic exercise brings about higher risks to low blood glucose levels DURING exercise. This can also repeat post exercise in the hours to follow, going on the amount of energy burned up. The answer: prevent the hypos!
HOW TO KEEP CONTROL DURING AEROBIC EXERCISE???
Don’t get disheartened if a hypo does take place during exercise and absolutely do not let it prevent you from participating!
Learn from it. Why did this hypo happen? That was what I was asking myself back in 2009 when I attempted to run around the Isle of Wight and found myself on the floor to end the first day of a hilly 70 mile weekend. It cost me big, I fell behind on time on my challenge – a year later though, I came back and completed it.
I figured the need to include more carbohydrates, as I was taking on quick acting glucose through fruit every hour but it often wasn’t enough for the level of endurance I was taking on. I then identified other areas from hourly consumption of carbohydrates (I aimed for 30gs per someone weighing 70kgs), to the most important finding: the level of insulin in my body.
Firstly my intentions was to decrease the quick acting insulin before runs, my Novo Rapid injections before a morning meal and not taking any quick acting for snacks during the exercise. I found this may be better for short distance runs of half an hour to an hour. However, being out there all day running ultras – it was the background rate of Basal insulin which was key. Taking a split dosage of Levemir the first step forward:
Having it split whilst being on MDI meant more flexibility for sports. In aerobic runs, I found my Basal to have a great effect and required much less insulin. I reduced my daily basal insulin by 50% for my ultra running events, where I was on 14 units and 14 units a morning / evening split, I decided to alter to just 2 and 12 units for a ultra day. This will alter with every exercise for every person, but the key is figuring out how much the lower or increase by through testing your blood glucose levels regularly!
I feel for those on an insulin pump, the accurate working out of hourly carbohydrates is more important, as well as lowering the quick insulin rates.
For me, whilst enduring the challenge of running 30 miles a day for 30 days in 2013 across the UK, I then found what worked best for me on MDI was adding a third injection of basal insulin on a split dosage and timing it to perfection: if I injected my evening dose at 10pm, then when running at 9am the next morning some of that evening dose would still be active. Come the afternoons, with only 2 units in my system, despite the exercise the blood glucose levels would increase – as there was no basal insulin in the background. So I added another unit for the afternoons and then had my evening dosage a little earlier.
My main message is, your diabetes is yours; it is your responsibility and you’re the boss of it. It is great to get advice and we have a positive community to help each other. But if you want to try something a little difference, go for it. If you believe that a tweak here and there might work better, try it out, test your blood glucose levels and see the results. You live, you learn, you improve. This week I’ll also post about anaerobic exercise – which surrounded my childhood years!
Anaerobic Exercise and Type 1 Diabetes
Following on from the last post on aerobic exercise, here shares some experience and advice in facing other forms of endurance. Anaerobic exercise largely consists of exercises surrounding speed and power, with high intensity in shorter durations. Sports such as Football or the majority of activities in Athletics are good examples of anaerobic exercise, which has a reverse effect on diabetes blood glucose levels.
A little thing known as ‘the adrenaline effect’ will cause blood glucose levels to actually rise during exercise, through the sudden bursts or alteration in movement. This causes the liver to react and release more glucose into the bloodstream, therefore increasing the levels. When you consider the 100m sprint, you might have warmed up, psyched up and then be static until suddenly then bursting into full speed. This would possibly be enough to trigger the liver glucose release. In a sport such as Football it is furthermore likely to cause affects, where the game is on going for 90 minutes – you might be walking, jogging and then suddenly bursting into a sprint to chase the ball down. In my football playing years, to my surprise I would quite often come off the pitch with a hyper zoned blood glucose level – instead of what many might think to be the opposite.
Many contact sports have the best of both aerobic and anaerobic. A good example is Rugby: a physical battle on one hand which would aerobically lower blood glucose during play, yet, sudden bursts of energy and quick sprints will fall into play. It can also depend exactly what position you play in – for example in Rugby you have positions for ‘forward packs’ who tend to be the warhorse type of 6ft5 powerhouse figures in a team, that you wouldn’t necessarily want to bump into down a dark alleyway – they are the players engaging more into the opposition with scrums, rucks and mulls. Quite the physical side of the game. Backs play an important defensive role too but are the runners in the team, the players who will receive the ball and burst forward with it. So it is more likely that if an entire Rugby squad had type 1 diabetes, the forward pack would be looking to prevent hypos during the game more than the backs, who might be looking to prevent the hypers!
In football: a striker might be walking about more than any other position, other than a goalkeeper, during a match (should always be on their toes though!). But a long ball might be played forward and suddenly that striker is going to be more required to burst into action and get on the end of the ball with a sprint. Whereas, a central midfielder might be covering a lot more ground, box to box. The differences in game styles could create a difference in blood glucose levels and how the adrenaline effect takes place.
Even in running this can take place, more so in competitive running such as 5km races; when your pace is increasing and there’s that sprint push to finish – same thing! What I found, in perhaps taking a few risks, is the alterations of pace could be a last resort saver. On one occasion I was out a running long distance challenge, which is aerobic, and my blood sugars had gone low. The problem I faced was that 5 miles was still to go. The advisable solution would be to stop – but to me, that’s a feeling of giving up. I was out of supplies and had no money on me, so I decided to change my pace from a consistent rate of running to a mixed pace: jog, sprint, half sprint, walk… just repeated until I made it back home. The result:
1. I made it back home safely – and that’s the important part. It isn’t about taking risks, it’s about finishing what we start and showing that diabetes isn’t stopping us.
2. My finishing blood glucose was 6.5 mmol/l (somewhere around 130 ml/dl – good basically!), it had risen up 3 mmol/ls from when I was hypo during the run with 5 miles remaining!
CRASHING TO A HYPO A FEW HOURS LATER??!!
Energy has still been burned nonetheless! So if the blood glucose levels do find their way up to a ridiculous reading in being hyper during, or just after, exercise, it is very common for the hypo crash to follow it up a few hours later.
This can be a serious problem, suddenly catching you out off guard almost – where you might think about being on the higher side and assume the hypo from exercise isn’t coming. One thing that is important in diabetes is that you always have to be on the ball (no pun intended) and so regular blood tests on exercise days are key. If you’ve put in a hard shift for the team, or pushed the limits down the gym, that crash is likely to occur later in the day, or even during the night.
Repeat hypos can also take place. Although are more common when they happen during exercise. Sports where I mentioned there are a combination of both anaerobic and aerobic exercises, are more likely to be the one’s to cause repeat hypos, which may take place more instantly after the exercise and then come on later again in the evening, and even over the next 48 hours it is definitely advisable to keep close checks on blood glucose levels.
INSULIN AND ANAEROBIC EXERCISE
On Multiple Daily Injections (MDI) as I am, one thing that can frustrate during a competitive sports match is not being able to fully concentrate – which can happen if blood glucose levels are running higher! When playing football, one method I adopted was actually taking, on a split dosage of daily background Levemir insulin for my basal intake, MORE of the basal insulin. I figured simply that when I was coming off the pitch with a blood glucose level in the teen or 20s in mmol/ls, I clearly needed more insulin in the background to counteract that release of glucose from the liver.
Did it work? Yeah. In the game, it did. I used to be a good player and type 1 diabetes didn’t prevent that. I would take an extra unit of background insulin and the results were I’d come off the pitch at a respectable level – meaning I performed with a strong level of concentration. However, there are one or two issues in that:
The HYPO CRASH! If you have more insulin working in the background and have endured a tough session or have been putting the work in on the pitch, on the dance stage, you name it, then that crash is going to come more sooner and more rapidly. So for me, upping the background insulin to maintain better control in anaerobic sports, it meant that the risk of hypo would be more forceful much sooner after the game. A way of counteracting it was the post game sandwiches – eating early, within half an hour, after finishing the games and taking less quick acting insulin with the food.
There isn’t really any MUST DO THIS, MUST NOT DO THAT when it comes to it; glucose naturally being produced internally is difficult to control – whichever way you look at it. For aerobic exercises such as long runs, cycling, swimming, heck even going to a club and dancing all night, you can perhaps prepare better given the fact levels will decrease during, with consistent rates of exercise. When it comes to different exercises and quick bursts in anaerobic forms, this brings up challenges and again, it is your diabetes and your decision to make a few tweaks on – although there is more to think about; by testing blood glucose before, during (where possible) and after exercise as much as possible you can keep on top of things! Learn what levels of insulin are working for both basal and bolus and consider what times are best for meals – particularly after exercise.
Ultimately, diabetes can never stop you in anything if you are determined enough not to let it!