It’s 10:30pm and I have finally made it onto the train home after a long day of meetings and customer entertainment in London. Looking at my wrist, I realize I have walked 15,000 steps between stations and meetings. Although I wouldn’t call this a typical day, it is not unusual and, whilst I am one of those people who get stir crazy when they don’t exercise, I know it both helps and hinders my health with regard to diabetes.
I am getting ahead of myself. Let me make my introduction before I go on. Nearly thirteen years ago, I had a typical type 1 diabetes diagnosis: lethargic, thirsty, dying for a wee all the time, … All the expected type 1 characteristics except I was in my mid thirties and no one else in my family had diabetes.
Sport has never been a major part of my life but I have always been active – I would walk to the shops and cycle to school; I would walk to the bars and cycle to university; more recently, I have both walked and cycled to work. Over the years, I have picked up more activities such as hiking up and down mountains, a bit of mountain biking, climbing … mostly in the security of a climbing centre … and I am a regular gym visitor. I will never run a marathon, be a (senior) sprint champion or play for a basketball team but I do not sit still.
Like many, when I was first diagnosed, there was a lot to get my head around and apprehension around the impact of exercise on my blood glucose levels (BG). I was afraid of having a hypo at any time but particularly when surrounded by strangers in a gym or halfway up a climbing wall. So, apart from a 26 mile night time sponsored walk which I had already registered for, during the first few months of type 1, my exercise regime took a breather … although I still walked more than 30 minutes to walk and back every day.
Over the months, I got fed up with sitting still and started to return to the gym and climbing centre. At the time, I was on a basal bolus insulin regime. I got used to knowing that my BG would always rise after about an hour on the climbing wall but would fall overnight. I knew that the initial rise whilst doing my cardio at the gym made the resistance training harder. I got used to this and just realized I had some limitations but I was happy I was able to do more exercise than most people of my age and I managed my night time lows with a reduction in my basal dose.
Nearly 12 years to the day of being diagnosed, I changed from basal bolus injections to an insulin pump. I was not an instant convert as I found it ugly and cumbersome to wear … probably due to being smaller than most pump wearers. Understanding the pump gave me the flexibility for more granular changes to my basal insulin, I persevered.
When I went climbing, I was able to increase my basal. This stopped my high BG after an hour up the walls. Afterwards, I reduced my basal and was less likely to hypo through the night.
I started doing something similar at the gym so my BG was at a reasonable level when I finished my cardio and started the resistance training. Within two months, I had more than doubled some of the weights I was lifting and I was feeling great.
As the cardio had less effect on my BG, I started doing more. My lung capacity improved. I was able to cycle at a higher resistance for longer. I was able to do high intensity training on the cross-trainer for longer. I was feeling good. Until …
My increased fitness and longer high intensity exercise lead me to use my insulin more efficiently and need less. After a few months of increasing my cardio, I realized my BG was falling too low and, once again, I struggled with the resistance training. This time it was not because my BG was too high but it was because my BG was too low.
Again it was time for a change to my insulin dosage. No longer did I need to increase my basal before I went to the gym: now I needed to reduce it. After a few months of reducing my basal, I now remove my pump for an hour: I need no insulin. I was back to increasing my weights and feeling good again. In fact, now, I add a little bit of cordial to my water to maintain my BG levels.
We are all encouraged to exercise whether we have diabetes or not. But diabetes certainly adds the challenges. Especially, when things do not stay still … learning how to manage BG is a continuous exercise in its own right. I may be tired tonight, but I am glad I can walk 15,000 steps in a day without any struggle. But, please, don’t tell my DSN about the heels and pointy toes on the boots I am wearing … I never suggested I was a diabetes footwear role model.