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10 ways to get type 1 diabetes, exercise and you on the same page

It's no secret: Exercising with type 1 diabetes can be really hard, frustrating and, sometimes, downright impossible. Unfortunately, there isn't a silver bullet or an instruction booklet when it comes to diabetes and exercising. Like much of our diabetes management, we figure out things as we go along.

Exercising is no different.

In the spirit of figuring things out, I want to share some of my experiences with exercising. By no means is the list below medical advice or the holy grail of exercising with type 1 diabetes. It is what I've figured out, sometimes the hard way, and--hopefully--what I've learned may be of use to you.

Deciphering type 1 diabetes, exercise and me

1. Test your blood sugars often. I have to test often while exercising. Any sort of physical activity introduces new variables into the mix. I count on information from my meter to keep me ahead of what's happening with my blood sugar.

2. Use traditional fingersticks. I love my CGM device, but it often doesn't track well while I'm exercising. To have reliable information while making decisions, I do a good old-fashioned fingerstick test.

3. Keep good records. Yes, keeping records is a pain. On the surface, it seems I don't get much benefit from records while I'm exercising, and that's partially correct. Where these records prove their worth is when I'm adjusting my strategies for future exercise sessions.

4. Make basal-rate adjustments 60 to 90 minutes before exercising. I often need a lot less insulin while I'm active, and using an insulin pump gives me the flexibility to adjust my doses for what I need. The key for any adjustments in my basal rate is that it needs to happen about 90 minutes before the activity starts. Any sooner and the adjustment won't have time to affect my blood sugar.

5. Watch insulin on board. Any insulin on board from a prior bolus gets supercharged by physical activity. If I have a significant amount on board, I almost always need to consume carbs to prevent a low blood sugar. This point is such a big deal that I often plan my meals around anticipated exercise. With my basketball in the afternoon, I get up early enough to eat a good breakfast and let most of that insulin wear off before playing.

6. Have low treatments available. I must have stuff to treat lows with me. I don't care how well I plan, or how conservative I am with everything, lows happen with exercise.

7. Use mini-corrections. Inevitably, I experience some highs while exercising. Maybe I overtreated a low, or was a little too conservative with something. Who knows? Highs happen -- my pancreas is broken. When my blood sugar is high during exercise I often feel sluggish, uncoordinated, stupid, and unable to perform how I'd like to.

But because activity does so many funny things with my insulin, I have to remember to be conservative with the correction dose, otherwise I'll be fighting a low pretty soon too. I never take the full recommended correction dose while I'm exercising or shortly after.

8. Have the right fuel. Did you know that even a non-diabetic athlete needs to consume carbs during physical activity to perform well? This one totally depends on what I'm doing. If I'm playing basketball or going out on a long bike ride, I need to fuel myself in order to perform.

In fact, when I did my 100-mile bike ride earlier this year, I needed to eat about 60 grams of carbs each hour. I was running 50% less basal insulin all day, and didn't take even a drop of bolus insulin for those carbs each hour. I biked for about 9 hours straight and had blood sugars between 97 mg/dl and 177 mg/dl for the whole ride. It was fantastic.

The metabolic bump I get from exercise far outweighs the relatively little amount of calories I consume to keep going. Even treating a low, which frustrates so many, doesn't undo the benefits of exercise (as long as I treat within reason).

9. Accept there are going to be bad days. There are days where diabetes simply does not cooperate with my intentions to exercise. Even when I follow my plan, doing all of the same things that work on different days, I get results that are so far out of what I expect that I either exercise, knowing I won't perform well, or just bag the idea altogether.

These are the days that frustrate me the most.

10. Do something fun. I found an exercise I absolutely love. Basketball. It has taken years of experimenting with my blood sugar, food and insulin to get where I am today, and even with all of that, as I said above, there are still days where it doesn't work. But you know what? Basketball is so fun for me that I'll do whatever I need to do.

As you can see, exercising with type 1 diabetes requires significant work and effort. This list could easily be twice as long and still not cover everything I do to keep diabetes out of the way of my exercise. Keep at it--figuring things out is half of the battle.

About Scott K Johnson

Scott K. Johnson was diagnosed with type 1 diabetes in April of 1980. He has been writing about his struggles and successes with diabetes since late 2004. Currently blogging at Scott's Diabetes (scottsdiabetes.com), and contributing to many diabetes related projects, Scott stays busy connecting with others living with diabetes.

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