Balancing Blood Sugar Levels With Exercise

Mari Ruddy, a triathlete and founder of the Red Rider Recognition Program and Team WILD (Women Inspiring Life with Diabetes), says, "It's not really about blood sugar management, it's about insulin management, which ideally results in good blood sugar management."

As a child, Mari watched her athlete father struggle with managing his type 1 diabetes with very little knowledge or support from the world. He was regularly taken to the hospital with extreme low blood sugar issues. These incidents almost always coincided with exercise, whether planned or spontaneous. From her eyes as a child, it seemed that no matter what her father did to be proactive, things went wrong and she feared for her father's life. As a result, when Mari was diagnosed with type 1 diabetes at age 16, she was afraid to push her body to the limit for fear of suffering deathly consequences.

This led to poorly controlled diabetes until I was 35, when I finally found an endocrinologist and a coach who worked together to walk me through my fears. They provided intensive support and education about how I could exercise and manage my diabetes successfully. It turns out that exercise and movement is a key to living well in general and with diabetes in particular. . . . What I know in my heart is that every woman alive who sets her body, heart, and mind to it is an athlete. I want to help her figure out how to take it from an idea to an everyday reality. Diabetes can be an opportunity to learn about oneself.

Ann Rosenquist Fee says timing is the tricky part:

The other night, I asked my son if he wanted to play racquetball at the Y, and he said yes, so when we had dinner, I ate without taking any short-acting insulin first. When we were ready to leave, I called the Y to reserve a court, but the receptionist said all the courts were booked for a handball tournament.

For my son, no big deal, he could live without racquetball that night. For me, though, it was the big deal that drives my exercise practice: I'd loaded up on carbs without any NovoLog, so I had to get moving whether the courts were open or not, or else spend the night sitting around in the 200s looking forward to a shitty A1c.

I went to the Y by myself and did 30 minutes on the elliptical, which is what I usually do a few nights a week at the right time after the right amount of carbs. Or I walk the trails in our town, or bike, or I use my weighted Hula-Hoops in the basement. It's nice when the timing works out to play with my kid, or walk with my husband or a friend, but diabetes trumps having an exercise partner.

Or maybe diabetes is my exercise partner. Even if the racquetball courts are closed, or my husband decides he's too "in-his-slippers-already" for the Y, or my friend who walks the neighborhood after dark decides she's staying in that night, my untreated 200 mg/dl is still there, urging me on.

I should think about it like that. Like a partner. A blood-sugar-shaped coach. Skinny and rude like a syringe, with little syringe-cap-orange sweatbands and leg warmers. Barking her mean little bark like, "I don't care that the courts are closed. You're above 200. Get out the door. Get moving. Keep moving. And I'll see you after dinner tomorrow."

Melinda Law has had type 1 diabetes for 50 years, and exercise has been an integral part of her life. She says:

I go to the gym 2-3 days a week, at 5-6 a.m. I do aerobics for 30 minutes, either the stair climber, bicycle, or treadmill, and then I do weights and machines for 30 minutes and make sure I work up a sweat. It's a lot of fine-tuning, but I have my basal down to 0.50 per hour. The glycogen gets released 2 hours later so my basal is up to 0.60 2 hours later for 2 hours, then back down. The other

2 days I take off the pump and swim, and am in the pool for 45 minutes. It always makes me feel better. As soon as I start doing anything, I feel freedom, whether it's ice-skating, motocross, skiing, swimming, running, road racing, trampoline, bicycling, or any other physical activity. For a long time, I was very discouraged because I could not figure out how to exercise without having my numbers go too low. I was constantly asking and just started slowly but surely figuring it out. I always test before and after. Always.

As a kid, there wasn't anything I did not do. I ran, played baseball, basketball, football, volleyball, punchball, stickball, tennis, horseback riding, swimming, water skiing, sailing, hiking, you name it, I did it. I taught horseback riding and jumping and was on the team in college. Skiing got me through law school, since I went every other weekend. The funny thing is, I see myself as uncoordinated and gawky, not athletic at all. I love to use my body, but don't see myself as an athlete. It was drilled into my head at a very young age to exercise every day to bring down blood sugar. I was outside running around as a kid, for

3 hours a day no matter what.

Annie Berger, who played Division 1 soccer in college, says that when she's doing something intense, she will test her blood sugar level before, during, and after exercise.

I've learned that there are certain activities that make me drop quickly, some that make my drop hours afterwards, and some, such as competitive sports, that actually cause me to go very high because of all the adrenaline. Depending on the activity, I will often eat at some point, whether it is right before, in the middle of, or after exercising.

Getting Low While Exercising

Getting low while exercising happens to everyone at some time or another. I remember running on a treadmill in the gym one summer when it was too hot to run outside. My kids were unhappy in the Kids' Club there. I promised them that we would only stay for 1 hour and I knew they were looking at the clock. This was my only chance to run. But I could feel my blood sugar dropping, and I had to stop mid-run to prick my finger. I was 40. Determined to get some exercise, I pulled out my bag of Skittles and ran while I chewed, all the while trying not to fall off. Was it worth it? I'm not sure. It wasn't the first time I've had to eat on the run and it won't be the last. Melinda Law says:

When I exercise, I always, always, always carry something with me. At the gym and swimming it is easy because I throw GUgel or the little chewy things in my bag. When I run, I usually put them in my shorts pocket.

Lesley Hoffman Goldenberg always has a tube of glucose tablets with her.

I place them on the machine when I work out. If I go for a walk in the park, I always bring a little wristlet or an equally cool (or uncool) fanny-pack-type thing to hold all of my diabetes goodies.

Judith Jones Ambrosini never leaves the house without her number one favorite sugar fix, the classic candy Chuckles.

Each Chuckle contains 9 carbs. The packet comes in five flavors: wild cherry is my favorite. Two of these candies taste great and usually do the trick of bringing up a low by 40 points. One pack of Chuckles fits nicely in any pocket. I don't like to carry things, so pockets are always a priority for me when buying clothes.

Managing Diabetes During Competitions

Cheryl Alkon says that when she was training for a triathlon, she was upfront with her coaches about diabetes.

They told me they'd do what they could, but had only worked with type 2s before. I was always on top of things (i.e., I always had the juice box on me if needed), and nothing ever happened during that training period (i.e., no blackouts, no terrible lows I couldn't handle, etc.) At the end of the training period, they actually singled me and another woman out (a cancer survivor) for an award for training with additional health challenges, and I had mixed feelings about it. My first thought was, "Oh, really?" I managed everything just fine. I don't need a special mention for that! But after talking about it with a therapist I was working with at the time (also [with] type 1 [diabetes]), she said, "Actually, that was pretty impressive that they recognized what you were dealing with. You shouldn't discount it," which I suppose is true, but overall, I feel like I manage things pretty well every day, and I don't really see anyone giving me an award for that. It's just the way I live my life.

Jennifer Ahn, member of Team WILD, says:

It's a great way of sharing ideas and experience [about] diabetes with exercise together. On the training groups that are not diabetes related, I do tell the coach and teammates about my diabetes so they are aware if I have issues with my blood sugars.

Annie Berger was a very athletic teen when she was first diagnosed.

One of my motivators to get out of the hospital was actually to go to a soccer tournament. My coach of that team was a doctor, so he handled it well. I don't remember telling my teammates, I think my coach must have done that. I think people reacted well because they went off of how I acted. They were of course concerned for me and always helped if I went low, but no one treated me that differently. I remember my high school soccer coach being scared at first and not knowing how to handle it, but we figured out together how it affected me and both learned quickly that it didn't need to be a big deal. That coach was also my high school lacrosse coach, so that made things easy. I think my college soccer coach was intimidated by my having diabetes. I think she thought I couldn't handle playing in games. When I played more and more in my sophomore year, she saw that I could handle it just fine. It was a learning process, but she learned how to handle it. I've never had issues with any of my teammates. They were always very supportive.

Seeking Motivation

Kathleen Fraser was invited to be the inspirational speaker at a camp for families affected by type 1 diabetes.

When they reached out to me, I thought, "Me, an inspirational speaker? What could I possibly say that would inspire parents and children with diabetes?"

The most poignant moment came at the end of my talk when a mom asked me my motivation for doing triathlons. Without hesitation I said, "Because I have diabetes and I can." It was so simple, the most natural response, and in my mind, it said it all. There was peace in the room and knowing looks on the faces of the parents. It was as if this hard, cold classroom filled with strangers was transformed into a warm, cozy living room with friends and family. They knew right then and there that all would be okay for them and their children. They were now in on the coveted secret: Diabetes doesn't have to stand in your way of accomplishing your goals and fulfilling your dreams.

Yes, having diabetes makes it harder, but in all honesty, not any harder than it is to live with diabetes each and every day. It's an integral part of who I am, and the challenges I face as a woman living with diabetes enable me to say with confidence that I am stronger and more resilient because of diabetes and because of my athletic journey with diabetes.

Through exercise, I have learned more about myself as an individual, a woman, and a person living with diabetes.

I now know that I can do anything. I no longer question if I can overcome a new challenge from a diabetes perspective. I have the knowledge and support to figure it out.

The journey to educate myself started with Team WILD (Women Inspiring Life with Diabetes). Through Team WILD, I was able to get the information I needed about what it takes to be an active and healthy person. Before Team WILD, I looked at myself as a person with diabetes first and a human being second. Now I know what nutrition my body needs to stay active and fit, first and foremost. Through the support and education of WILD coaches, medical staff, and teammates, I can not only swim, bike, and run safely and successfully but I can also hike, do yoga, Pilates, and even take long, leisurely walks in the park with confidence and security.

Having more diabetes management tools in my toolbox gives me the confidence to be fully engaged in life. I do triathlons because I have diabetes. I get out there every day and exercise because I want to be stronger and more in touch with my body. I feel empowered and powerful.

Linda Frick enjoys walking a few miles on the beach every Sunday with her husband and friends.

I also belong to a gym and walk on the treadmill for 30 minutes and then work the resistance machines for another 30 minutes. I try to go twice a week, but often, my fatigue gets in the way.

Sadly, I have to say that I have never been motivated to exercise. I was 8 when I was diagnosed and, of course, it was easy to get daily exercise at that age. I was not interested in sports as a child, so did not compete in any organized youth sports. As an adult, the only thing that motivates me is my own vanity (yes, that's what I said—vanity!). Diabetes does not motivate me to work out and sweat. My appearance, how my clothes fit, and how I feel do motivate me however. My body metabolism slowed way down when I turned 50 and, ever since, exercise is a must in order to keep my weight under control.

Andie Dominick, author of Needles, says one of the reasons she is such an avid exerciser is because of her diabetes.

I believe it has helped me maintain good circulation and blood sugar control after 30 years of type 1 diabetes. I rode RAGBRAI (bike ride across Iowa, about 500 miles) seven times. Two years ago, I walked a 26-mile marathon. I walk on the weekends with friends instead of going out to eat or have drinks. Most of my family's activities are centered around exercise. In fact, if we want to go to dinner, we walk there. The neighbors joke about seeing us walk everywhere.

Challenges to Exercising

Linda Frick's biggest challenge is energy level and age.

There is not enough time to work out prior to going to work and when I get home at the end of my day, I'm tired and just want to relax and enjoy my home and family. So I have to stay focused on my appearance as my reason for pushing myself. It does seem to work for me. I've invested lots of money in clothes for my job and if they don't fit, I'm in big trouble. It's either starve or work out and I usually choose the latter.

Lesley Hoffman Goldenberg says being spontaneous is a challenge.

I work 30 blocks from where I live, which is about a mile and a half. If it's nice out and I have some time to kill, I love taking a brisk walk home because it's a great way to end my day. Unfortunately, I can't make the decision right when I leave work like most people. I have to start planning in the afternoon because I could need a snack, set a temporary basal, or not walk at all because my sugar is too high, and

I'd have to stop to use the bathroom every few blocks. I hate that spontaneity cannot be a part of diabetes. It's good because I'm a big planner, but it gets annoying sometimes.

I also find it challenging to check my sugar if I'm using a cardio machine that involves my whole body. Usually, I can balance and it totally works out, and I've got it down to a science. But with certain machines, I lose my balance or drop a testing strip (at a $1 per strip) and I just get frustrated.

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