Staying in Range While Exercising

May 9, 2024
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Alex St. John
Alex has completed a BSc in Kinesiology from the University of Ottawa (Ottawa, Canada), and an MSc in Diabetes Medicine from the University of Dundee (Dundee, Scotland). His MSc thesis involved determining the most salient barriers to physical activity in the T1D population, and how different factors, such as age, social support, disease-specific knowledge, and self-efficacy affect participation in sport and exercise. Outside of academics, Alex enjoys several strength sports (powerlifting, stone-lifting, and strongman). He was also the 198th person to lift the famous Dinnie Stones in the Scottish Highlands in June 2022 (415lbs & 318lbs per hand).

As someone who studied the barriers to regular physical activity in T1D in grad school, staying in range while exercising has come up time and time again as one of the most commonly reported barriers to physical activity/exercise in those with T1D. The regular hormonal adaptations to blood sugar changes are disrupted in T1D, which can make staying in range during exercise all the more challenging (1). Fear of going low is a big one that can prevent so many of us from feeling confident to exercise(2). And when it comes to resistance exercise (weights, machines, bodyweight exercises) there is also a risk of going high!

Keeping Blood Sugar In-Range

Exercising with diabetes may seem like a balancing act – and that’s because it is! It’s largely a trial-and-error process for most people, and what may work for you might not work very well for your diabestie.

Something that can really help you in your balancing act is an automated insulin delivery (AID) system like the Medtronic 780G system. A frequent problem when exercising in higher intensities (think HIIT, heavy weight lifting, or sprinting) is your blood sugar creeping up into the high range. This is the body’s normal response to increased energy needs at a faster rate (your liver begins to break down its glycogen stores – think of glycogen like an external battery for your phone, a concentrated source of energy in an easily-stored format) into glucose which is then released into the blood to eventually be used by our muscles – for those wondering about a reason behind this rise. It’s not always easy to catch this blood sugar rise during exercise, so using an AID system that can sense this uptick for you and automatically give you a correction bolus ! And the MiniMed 780G system can do this every 5 minutes for you while you’re focusing on tracking your reps, sets, rating of perceived exertion (RPE), or deciding which song to choose for your PR attempt! The system also lets you set a temporary sensor glucose target (Temp target) of 150 mg/dL to help prevent you from going low if that is something you struggle with.

The beauty of a system that can give you correction boluses automatically is that it will continue to work even after you’ve left the gym, so you’ll never forget to bolus for your carb-heavy post-workout meal that your muscles are now primed for (in terms of insulin sensitivity, your muscles often act as a glucose sink following exercise3). The MiniMed 780G system algorithm can continue working for you in the background in the time after you finish your workout when individuals tend to be more more insulin sensitive (for up to 48hrs3)!

I personally suspend my insulin pump, even for strength training, and typically need about 60-75g carbs/hour of exercise to stay in range (sometimes even more on my high volume lower body training sessions). But this is simply what I’ve found works best for me as a 6’5” 300lbs strength athlete. I always bring multiple sports drinks in my gym bag, various bags of candy, hydration powders (with sugar) to mix with water, and I’ve always found that a higher dose of caffeine before my training session has helped me stay in range.

I’ve been lifting since 2010 (gotta love basement home gyms), and I was diagnosed with T1D in 2013. So far, I haven’t had a low blood sugar that I wasn’t able to fix myself while at the gym! And you can certainly avoid that too! You just need to find the strategies that fit your lifestyle (whether that be your favourite type of activity/sport, the time of day you enjoy exercising, the way you prefer to eat (macronutrient composition of your diet), and the way you manage your diabetes). There are tons of resources out there like our Resource Hub, and social media is packed with great information (as long as you know what you’re looking for, and are cautious with any influencers selling quick fixes!). And if you want to learn more about the MiniMed™ 780G system you can visit www.medtronicdiabetes.com/780G

1. Briscoe VJ, Tate DB, Davis SN. Type 1 diabetes: exercise and hypoglycemia. Appl Physiol Nutr Metab. 2007;32(3):576-582. doi:10.1139/H07-025
2. Dubé MC, Valois P, Prud’homme D, Weisnagel SJ, Lavoie C. Physical activity barriers in diabetes: Development and validation of a new scale. Diabetes Res Clin Pract. 2006;72(1):20-27. doi:10.1016/j.diabres.2005.08.008
3. Teich T, Riddell MC. The Enhancement of Muscle Insulin Sensitivity After Exercise: A Rac1-Independent Handoff to Some Other Player? Endocrinology. 2016;157(8):2999-3001. doi:10.1210/en.2016-1453

Thank you to Medtronic for sponsoring this article!

Important safety information: MiniMed™ 780G system with SmartGuard™ technology with Guardian™ 4 sensor

The MiniMed™ 780G system is intended for continuous delivery of basal insulin at selectable rates, and the administration of insulin boluses at selectable amounts for the management of type 1 diabetes mellitus in persons seven years of age and older requiring insulin as well as for the continuous monitoring and trending of glucose levels in the fluid under the skin. The MiniMed™ 780G system includes SmartGuard™ technology, which can be programmed to automatically adjust insulin delivery based on the continuous glucose monitoring (CGM) sensor glucose values and can suspend delivery of insulin when the sensor glucose (SG) value falls below or is predicted to fall below predefined threshold values.
The Medtronic MiniMed™ 780G system consists of the following devices: MiniMed™ 780G insulin pump, the Guardian™ 4 transmitter, the Guardian™ 4 sensor, One-press serter, the Accu-Chek™ Guide Link blood glucose meter, and the Accu-Chek™ Guide test strips. The system requires a prescription from a healthcare professional.
The Guardian™ 4 sensor is intended for use with the MiniMed™ 780G system and the Guardian 4 transmitter to monitor glucose levels for the management of diabetes. The sensor is intended for single use and requires a prescription. The Guardian™ 4 sensor is indicated for up to seven days of continuous use.
The Guardian™ 4 sensor is not intended to be used directly to make therapy adjustments while the MiniMed™ 780G is operating in manual mode. All therapy adjustments in manual mode should be based on measurements obtained using a blood glucose meter and not on values provided by the Guardian™ 4 sensor. The Guardian™ 4 sensor has been studied and is approved for use in patients ages 7 years and older and in the arm insertion site only. Do not use the Guardian™ 4 sensor in the abdomen or other body sites including the buttocks, due to unknown or different performance that could result in hypoglycemia or hyperglycemia.
WARNING: Do not use the SmartGuard™ feature for people who require less than 8 units or more than 250 units of total daily insulin per day. A total daily dose of at least 8 units, but no more than 250 units, is required to operate in the SmartGuard™ feature.
WARNING: Do not use the MiniMed™ 780G system until appropriate training has been received from a healthcare professional. Training is essential to ensure the safe use of the MiniMed™ 780G system.
WARNING: Do not use SG values to make treatment decisions, including delivering a bolus, while the pump is in Manual Mode. When the SmartGuard™ feature is active and you are no longer in Manual Mode, the pump uses an SG value, when available, to calculate a bolus amount. However, if your symptoms do not match the SG value, use a BG meter to confirm the SG value. Failure to confirm glucose levels when your symptoms do not match the SG value can result in the infusion of too much or too little insulin, which may cause hypoglycemia or hyperglycemia.
Pump therapy is not recommended for people whose vision or hearing does not allow for the recognition of pump signals, alerts, or alarms. The safety of the MiniMed™ 780G system has not been studied in pregnant women, persons with type 2 diabetes, or in persons using other anti-hyperglycemic therapies that do not include insulin. For complete details of the system, including product and important safety information such as indications, contraindications, warnings and precautions associated with system and its components, please consult: https://www.medtronicdiabetes.com/important-safety-information#minimed-780g and the appropriate user guide at https://www.medtronicdiabetes.com/download-library

 

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