May is National Exercise Month. Throughout the month the Joslin Blog will be highlighting stories about exercising with diabetes. Be sure to check in each week for updates! This article was originally published on May 27, 2013.
There is no one way to exercise; in fact, there are endless ways to incorporate physical activity into your daily routine. For instance, you can enjoy a walk with your dog, embark a sweat-inducing bike ride or even dabble in some outdoor yoga. While all of these activities are excellent ways to stay active, it is important for people with diabetes– even patients who use an insulin pump – to properly prepare themselves before they engage in any type of physical activity.
With the warmer weather and National Exercise Month in full swing, people are more inclined to lead more active lifestyles, whether it is through structured exercise or simply spending more time outside, according to Howard Wolpert, M.D., Senior Physician in the Joslin Clinic Section on Adult Diabetes and the Director of the Insulin Pump Program at Joslin.
“With the springtime [or] weekend days, people are more active,” said Dr. Wolpert. “Even if they are not actually doing exercise per say, they are burning off more calories.”
As explained by Dr. Wolpert, there are several simple precautions that can be taken before, during and after a workout, which enable people with diabetes using an insulin pump to partake in an aerobic workout session without compromising their overall health.
- Cut back on your basal infusion rate, which is a continuous, small trickle of insulin that keeps blood glucose stable between meals and overnight
- Make sure that you decrease your basal rate well in advance of your workout, or at least one hour before you plan on exercising
- Remember that it takes a much longer period of time for the circulating levels of insulin to drop after you cut the basal rate, which is why it’s important to cut down on basal rates prior to exercise
- It is helpful for people with diabetes to consider the placement of their infusion set when they are choosing their workouts
- People who golf or play baseball and who use the abdomen for placement of their infusion set need to keep in mind that swinging motions can possibility dislodge their infusion sets (If these are your favorite sports, you should think about securing the set with additional tape or changing to another site )
- People who use the buttocks as their infusion site should be careful when using a bicycle
- After exercise, the liver continues to produce glucose even though the muscles no longer need as much glucose, and as a consequence, blood glucose levels may initially increase. A small bolus is often required immediately before or after the exercise session ends to turn off glucose production by the liver
- People with diabetes are more insulin sensitive after exercising, so you may need a smaller bolus infusion for carbs during dinner and a smaller basal infusion overnight
You can also try to complete resistance training before partaking in any type of aerobic activity. While aerobic activity lowers glucose levels and insulin requirements, resistance training – like lifting weights – can have the opposite effects. Therefore, you can utilize resistance training before aerobic activity to increase glucose levels and then after, engage in aerobic exercise to decrease glucose levels, which minimizes the need for snacking in conjunction with aerobic activity.
In general, an insulin pump can serve as an instrument to help you manage weight loss through exercise. People who use manual insulin injections have to schedule workouts after a meal to cut down on their pre-meal dose of insulin. If people without a pump want to exercise between meals, then they will need to consume a snack, which can make it more difficult to lose weight.
“The [insulin] pump is actually a tool that can facilitate weight loss because of the fact that one can cut back on insulin around exercise more easily,” explained Dr. Wolpert. “For the motivated patient [the insulin pump] can be a helpful tool to facilitate weight loss.”
While the pump does have the potential to help motivated people lose weight, the pump can also lead to weight gain for patients who consume excessive food.
“In some people, the issue with the pump is that is so easy to take bolus insulin, so for some people on the pump it is easier to snack and eat extra,” said Dr. Wolpert. “If people are not in control of their eating, the pump in a sense can even facilitate weight gain.”
Although the insulin pump provides people with diabetes with more flexibility when participating in physical activity, it is still vital that all the proper precautions be taken so that the pump can act more effectively as a facilitator of weight loss and exercise.