By: Melissa Sattley
Fewer than 20 percent of Americans exercise regularly. What most people don’t know, however, is that if exercise was bottled and sold in pill form its effects would be as revolutionary as penicillin.
In short, exercise can work miracles for people with diabetes – especially people on the pump. Exercise improves BGs, helps weight loss, improves blood flow and reduces the chances of diabetes complications.
Paula Harper, RN, CDE, and president of the International Diabetic Athletes Association (IDAA) agrees that the benefits of exercise are crucial for people with diabetes. “The physical as well as psychological perks are invaluable and there are so many different ways to get the exercise you need.”
Harper has had diabetes for 25 years and has been on the pump for at least half of that time. “For years my UltraLente worked well, then suddenly I started having unpredictable highs and lows.” As a result, Harper switched to the pump for its stability and improved BG control.
So what if you’ve finally switched to the pump and want to start an exercise program? Here are a few guidelines for the first time pumper.
How Much Should I Exercise?
If you’re not Iron Man material and walking the length of the mall is your idea of exercise there’s still hope! Moderate exercise can have just as many health benefits as strenuous exercise. Start with 20 minutes of walking three times a week. For maximum benefit try and up your exercise to 30 minutes three times a week. Then as you feel stronger you can increase the amount of minutes and days that you exercise. When you choose your exercise make sure that it is a continuous and aerobic activity such as walking, swimming, cycling or rowing.
The two most important things to adjust in response to exercise are insulin and carbohydrates. You should always consult with your diabetes health care team about making these adjustments. However, to the right are a few guidelines to follow for insulin and carbohydrate adjustments.
Lowering Your Insulin
What if you want to lose weight while exercising? Then you may want to lower your insulin. Remember, there is always a lag time between the time an insulin is injected and when the insulin level in the blood begins to change. Your type of insulin will determine how far in advance you need to lower your dose.
Here is a general timetable to follow for insulin reductions before exercise.
What percentage should you decrease peaking insulin?
* Tips – Even if you are engaged in intense exercise such as a marathon, the total daily insulin dose cannot be reduced more than 50 percent.
Also remember to test your BGs before exercise, after exercise and at other scheduled times throughout the day. Keep a record of your BGs and insulin measurements for future consultations with your health care team.
The following graph lists the grams of carbohydrate to replace an hour of exercise for people who weigh 100, 150, or 200 pounds. These estimates are generous. In certain cases, you may need less carbohydrate than shown in this table.
Slow & Fast Carbs
There are slow and fast carbs which will raise BGs at different speeds. Before or during exercise, fast carbs can raise low blood sugars. And during long periods of activity, slow carbs can prevent lows. Slow carbs work most effectively when eaten at least 30 minutes before exercise begins, and at about 45 minute intervals thereafter.
- glucose tablets 1 tablet, 15 cal., 4 g carb
- SweeTarts 1 oz., 110 cal., 26.0 g carb
- honey 1 tbsp., 60 cal., 11 g carb, 0 fat
- Corn flakes 1 oz., 110 cal., 24.4 g carb, .1 fat
- Raisin Bran 1.3 oz., 115 cal., 27.9 g carb, .7 fat
- raisins 1/2 cup, 250 cal., 68 g carb, 0 fat
- regular soft drinks – Coca Cola 6 oz, 72 cal., 19.0 g carb, 0 fat
- apple juice 10 oz., 148 cal., 37 g. carb, 0 fat
- GatorAde 8 oz., 50 cal., 14 g carb, 0 fat
- PowerAde 8 oz., 70 cal., 19 carb, 0 fat
- PowerBar 1 bar, 230 cal., 45.9 g carb, 2.5 g fat,
- GlucoBar 1 bar, 110 cal., 22 g carb, 0 fat
- oatmeal 1/3 cup, 99 cal., 18.6 g carb, 2 g. fat
- Swiss muesli 1 oz, 102 cal., 20 g carb, 1 g fat
- Cheerios 1 oz, 111 cal., 19.6 g carb, 1.8 g fat
- fruit – banana 1 fruit, 120 cal., 28 g carb, 1 g fat
- Fig Newtons .5 oz, 60 cal., 11 g carb, 1 g fat
- cookies – ginger snaps 5 cookies, 100 cal., 16 g carb, 3 g fat
- brown rice 1/2 cup, 109 cal, 22.5 g carb, .9 g fat
- candy bars – Snickers 1 bar, 278 cal., 36.8 g carb, 13.6 g fat
* Tip – If you find that you often need more carbohydrate for exercise or if you have frequent insulin reactions due to your exercise regimen you may want to consult your doctor about lowering your insulin dose.
Jill H. Sax RN, CDE, recommends that new pumpers not exercise or at least drastically limit their exercise the first week that they wear their pump. This allows time to adjust to the pump and to the proper basal dosages before an exercise regime is begun.
Also, if you have diabetes complications such as: retinopathy, nephropathy, or damaged heart and blood vessels you should consult with your physician before exercising. One reason is that exercise increases blood flow which can damage already weakened blood vessels.
Nerve damage also poses another risk. An athlete may be unaware of foot pain because of neuropathy. However, this doesn’t mean you should stop exercising altogether. Instead, consider different kinds of exercise such as water aerobics or bike riding which are easy on the feet. Also, consider being fitted for better shoes and make sure socks or shoes aren’t causing calluses.
It’s Never Too Late
Remember there’s no time like the present to enjoy a bicycle ride or a walk in the neighborhood.
Every morning, Paula Harper wakes at 4:30 a.m. and while the rest of Phoenix, Arizona is sleeping she hikes up a mountain near her house to watch the sun rise. Harper says she wouldn’t give up her morning hike or her pump for the world. “I owe my good health to them.”
Pump technology has improved so much in the last ten years, that pumps are now lightweight and easy to wear in most sports – even swimming. Disetronic makes a waterproof pump and MiniMed’s pumps can be made waterproof if used with a special case.
“My first pump was the size of a brick,” says Jill Sax, “It was heavy and obvious. Thankfully, things have changed and there’s no reason why the pump should get in the way of any activity.”
Exercise chart and portions of this article used with generous permission from Stop the Rollercoaster by John Walsh PA, CDE, Ruth Roberts, MA and Lois Jovanovic-Peterson, MD. To order Stop the Rollercoaster call Torrey Pines Press at (800) 988-4772.