September 16, 2025 • 33 mins
In Episode 52 of Think Like a Pancreas—The Podcast, Integrated Diabetes Services clinicians Jennifer Smith and Dana Roseman discuss the critical relationship between nutrition, exercise, and diabetes management. They explore how to effectively manage blood sugar levels during physical activity, the importance of individualized approaches to insulin and exercise, and the role of hydration and nutrition in optimizing performance. The conversation emphasizes the need for planning and understanding one's body to achieve successful outcomes in exercise and diabetes management.
MEET YOUR HOSTSDana Roseman, MPH, CDCES, RDN, LDN, is the Director of Technology and Applied Research for Integrated Diabetes Services. She is a Certified Diabetes Care & Education Specialist and Registered Dietitian with a Master’s in Public Health from the University of Illinois at Chicago, a Bachelor’s in Science from the University of Texas at Austin, and clinical nutrition training from UT Southwestern Medical Center. Diagnosed with Type 1 Diabetes, she has spent nearly 20 years improving diabetes care through technology, research, and patient education—including expertise with insulin pumps, continuous glucose monitors, and hybrid closed-loop systems. Dana serves as Research Information Liaison for the Dallas JDRF, is active on nonprofit boards, and empowers people with diabetes to thrive physically and mentally, making her a leading voice in diabetes innovation.
Jennifer Smith, RD, LD, CDCES is the Director of Lifestyle and Nutrition for Integrated Diabetes Services. She is renowned for her expertise in nutrition, diabetes education, and athletic performance. With a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin, Jennifer is a Registered Dietitian, Licensed Dietitian, Certified Diabetes Care & Education Specialist, a certified trainer for insulin pumps and continuous glucose monitors, as well as a published author. Having lived with type 1 diabetes since childhood, Jennifer offers unique insight into day-to-day diabetes management, pregnancy, sports nutrition, and technology integration.
WHAT YOU’LL LEARN:✔️How to overcome the fear of new exercise routines.
✔️The importance of healthy blood sugar targets for exercise performance.
✔️ To use insulin rather than constantly feeding your insulin.
✔️The value of hydration and post-exercise nutrition.
✔️ Whole foods should be prioritized over supplements for nutrition..
CHAPTERS00:11 Welcome and Introduction
00:59 Fueling for exercise with Jennifer and Dana
03:57 Blood glucose levels impact performance levels
05:34 Fasted Exercise: Strategies and Benefits
07:26 Insulin and Fueling Strategies for exercise
09:51 Understanding your needs for food, insulin, and exercise
13:27 The impact of the type of exercise on your blood sugar levels
17:21 Hydration and Its Impact on Performance
18:44 Fueling tips for endurance athletes
22:51 Low blood volume vs low blood sugar
24:00 Post exercise tips
28:38 The Role of Whole Foods vs Supplements
31:00 Final thoughts on exercise and diabetes management
RESOURCES MENTIONED
Diabetes, Nutrition, and Wellness with Dana Roseman and Jennifer Smith
https://www.podbean.com/eas/pb-njy66-190feba
CONNECT WITH US🔵Website: integrateddiabetes.com
🔵 Follow on Social Media: @integrated_diabetes_services and @ integrateddiabetesservices on Facebook
🔵To work with the Integrated Diabetes Services Team , visit https://integrateddiabetes.com/how-to-start-the-process/ , or email info@integrateddiabetes.com
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Disclaimer
The information contained in this program is based on the experience and opinions of the Integrated Diabetes Services clinical team. Please discuss any changes to your treatment plan with your personal healthcare provider before implementing.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:11):
Welcome to Think Like a Pancreas,The Podcast where our goal is to keep
you informed, inspired, and a littleentertained on all things diabetes.
The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal
(00:31):
healthcare provider before implementing.
Welcome to another fantastic episodeof Think Like A Pancreas, The Podcast.
I am co-hosting with Dana today.
And again, I'm Jennifer Smith.
I'm a registered dietician, certifieddiabetes educator, and the director of
Lifestyle and Nutrition with Integrated.
And we are moving further intoour discussions about nutrition,
(00:53):
centering hopefully around exerciseand fueling and knowing your needs
and everything today, right Dana?
Absolutely.
Happy to be on again with Jenny.
I'm Dana Roseman.
I'm also a registered dietician andcertified diabetes care and education
specialist with Integrated and Directorof Technology and Applied Research and
(01:14):
an avid exerciser and definitely loveto talk about how to help people manage
their blood sugars around exercise 'causeI don't know, I think so many people
are afraid of having lows associatedwith exercise and really just avoid it.
Or, you know, the irony is they don'tmaybe try new things because I think
new exercise really impacts your bloodsugars so much more than just kind
(01:38):
of what your body is already used to.
So I think exercise is a limiting factor,unfortunately, for so many people.
Yeah, and I mean, and within diabetes,I always think of it sort of like a a
three-tiered management approach, right?
You've got insulin, um, andyou've got exercise and you've
got food sort of like this.
Those are the main three mm-hmm, variablesthat we all try to adjust around and
(02:01):
adding exercise in and changing itup, as you said, can be hard with
diabetes, but really valuable in sortof longevity in your long run of life.
You walk every singleday, that's fantastic.
Good for you.
But your muscles get a little bit boredalmost with the same kind of thing.
Right.
So changing it up, um, can be really,really beneficial, especially if you're
(02:23):
looking for toning and loss or maintenanceor whatever your goal kind of is.
And then of course, I thinktrying to find exercise that
ages with you gracefully, right?
Yeah.
And if you were a runner before andnow maybe you have some back problems
or knee problems and now learninghow to walk and include some strength
training, you know, to stay protectiveof your bones and also keep insulin
(02:44):
resistance and insulin sensitivity high.
Yeah.
Um, that strength training pieceI think is really important too.
It is.
And then the, you know, the fueling aswithin the topic of nutrition becomes
the other concern when we're exercising.
And what I often find is, peopleare so concerned about low blood
sugars, that there is oftenan overage of calorie intake.
(03:08):
Mm-hmm.
So that lows don't happen, and thenthat leads to frustration, especially
if you're really trying to maintain,you know, or what you've gotten
to, what you've achieved, right?
Or lose weight.
Or gain some weight or gain some muscle.
I mean, there's nutrition and fuelingstrategy for each of those pieces.
Absolutely.
And if we're constantlydumping in extra food.
(03:28):
Well, but I would also say I don't like toexercise with an elevated blood sugar that
Me either.
just makes me foggy and you know,you're just not going, you know, whether
you're in a competitive sport or justtrying to do your personal best, um.
Right.
You know, none of us feel great whenour blood sugar is so elevated and
kind of feel sick to my stomach ifI'm exercising with a ton of food
on board too, if I'm being honest.
(03:49):
Yeah.
And the highs certainly don't, from aperformance standpoint, whether, again,
as you said, you're just walking, ordoing something that's really more
of an endurance and a performanceathlete, blood sugar really does have
a kind of a, a range that you willperform the best within they found.
Absolutely.
And there are some studies out of theBarbara Davis Center, I can't remember
the doctor who did it, but they didsome training with athletes with and
(04:12):
without diabetes to find how theirmuscles performed within glucose ranges.
Yeah.
They really found that anything likebetween about 100 and 180 was really more
the performance, that it didn't fail.
Once you got high blood sugars,what's lacking is the ability
to move the sugar that's high.
Mm-hmm.
Into the cells.
'cause there's not enough insulin there,
(04:33):
right.
To do so, right?
Opposite.
Obviously low blood sugars arejust, there's nothing there
for your muscles to utilize.
Right.
Right.
But you're right.
I mean, in terms of performance andwhat you really aiming to get out of
the exercise, we still need to manage ablood sugar that's in a healthy target.
Right.
And I think to your point, I mean,I think even athletes who are super
(04:55):
dedicated, are wearing continuousglucose monitors to find that peak
range of what feels great to them.
And I certainly havethat when I'm exercising.
Clearly not, you know, at a high level,but you know, I have that level that
I wanna kind of achieve and stay at.
Honestly, my body is used to exerciseand if it's not something new, if I don't
(05:15):
have a lot of insulin on board and Ihaven't eaten, which I'm not afraid to
do 'cause my body's kind of used to itand I think over time that's achievable.
I just don't, I, I think a lot oftimes people are nervous and don't
feel like that ever is achievable.
Right.
And it does start out with,I know you and I are both a
fan of fasted exercise, right?
Get up first thing in themorning, get some good water
(05:36):
in, and go do whatever it is.
Yoga.
Mine's coffee.
Or coffee.
Exactly, yes.
Get that in, some hydration.
Hopefully a little more waterthan coffee, but you know.
Yeah.
Or go for a walk or go for a run or abike ride, or Pilates, whatever you're
gonna do in a fasted state, as you said,without excess insulin on board from
bolusing, and nothing for your digestivesystem to be working on, many people
(06:01):
can get through a fasted exercise withpretty stable looking blood sugars.
You might actually even finda little bit of a nudge up.
Yep.
And then the exercise actuallybrings it down to a nice coasting
place that you feel stable at.
Yeah.
And I, one thing I've, I've found quiteoften with a lot of people using these
automated insulin delivery systemsis they just try to sneak in some
(06:22):
carbs right before their exercise.
But of course their blood sugarstarts to rise and what is
their automated system doing?
It's dumping a bunch more insulin.
And so not only are they having a dropfrom exercise maybe, but also from that
increase of insulin delivery and so.
Right.
Yeah, I really, um, I have, I guess, maybetrained enough that, that it's comfortable
(06:43):
for me to do fasting activities.
And it takes testing, right?
Yeah.
I mean, the exercise adjustments thatI do have to put in place are really
centered along, um, my experimentationwith that particular activity.
Mm-hmm.
You know, I can get up inthe morning and I can take a
really nice, good, steady walk.
And not have to adjust anything.
(07:04):
Whereas on my mornings where I take areally long run, I do have an adjustment
that I set within my insulin deliverysystem so that it can accommodate
and keep me steady and stable andhealthy, and not have to be eating.
Three bags of gummy bears along the way.
Right.
Which is just nobody wants to be doing.
Nobody wants to do it.
Unless you want gummy bears, right?
(07:25):
Yeah.
Um, right.
But then, you know, youknow, the adjustment period.
I think a lot of times people thinkabout, oh, I'm walking out the door for
my run, or I'm walking into the gym.
Let me set that temporary adjustmentto my insulin, but you know, that's an
hour and a half, two hours too late.
Um, and I think that's oftentimessomething that people don't consider.
(07:45):
I think I say this 12 times a day,that there's nothing spontaneous about
diabetes management and exercise is justanother piece of that in the planning.
Yeah.
Right.
So I, I find that people kindof make adjustments right
as they start to exercise.
As you said, it's too late.
It's too late even if youconsider 10 to 15 years ago
when there were no AID systems.
(08:07):
Right.
Nothing that was helping you, even, thatrequired some ahead of time preparation.
Um, I know my constant exercise timeat that point was always the afternoon
because that's when I had time.
That's when I could get to the gym.
I was done with my day and I alwayshad to prep by having a snack timed
to when I would get to the gym,depending on the kind of exercise.
(08:30):
Now I don't have to have a snackif I plan ahead the right way.
Right, exactly.
And it is just the planning.
So I know a lot of people, theyjust only have time to exercise
after work or late in the afternoonafter class or whatever that is.
And I do find that to be alittle bit of a trickier time.
You've got mm-hmm, insulin onboard from lunch, you've, you know,
(08:51):
obviously not fasted the whole day.
And you've got some insulin onboard and, and food and some maybe
insulin sensitivity changes in theafternoon and so I do think that
takes a little bit of strategy.
It does.
I mean, and along with it, I think theother confusing part, if you are trying to
strategize with food, which can be done.
Absolutely.
(09:11):
I think it means though that you haveto factor in what are your needs, right?
So that you can say, well, I alwayslike to have this kind of a snack
before I head into a workout.
I feel better.
I feel more energized.
I feel like I've got morepower or whatever it is.
But that snack should be factored intoyour overall caloric need for the day.
(09:31):
Right.
Right?
Not that you're doing this as anoverage to take care of insulin because
then you're just feeding the insulin.
Exactly.
And Yeah, and then potentiallyhaving a crash afterwards with,
with all that insulin on board.
Right.
Do you feel like there's different,I guess, fueling strategies
that you talk to people about?
(09:52):
You know, being a dietician, we getasked lots and lots of questions
Yeah.
That are all within the realm of diabetesand insulin and management, but we
also get the nutrition pieces of it.
Like,
yeah,
what do I really need?
But I, but I think that'sthe question to ask, right?
Is really, what do I really need?
Because am I exercising for wellness,for weight loss, for muscle tone?
I mean, if it's 30 minutes.
(10:13):
You probably don't need a bunchof supplementation, right?
Right, right.
You're not going to fatigue all of yourglycogen stores in 30 minutes and so,
I do think that a lot of times peoplejust think about, you know, these
pre-workouts and post-work workouts,and it's so complicated, which maybe
those do have a place in your workouts,but it's not a foregone conclusion.
(10:34):
Right.
I don't think that you alwayshave to have something beforehand.
Right.
I always feel like it's value, it'svaluable for somebody who's using insulin
to try to consider talking with aneducator who is actually a dietician.
Mm-hmm.
To get a feel for what are you, whatare you trying to achieve and what do
you feel like is standing in your way?
(10:55):
And a lot of times it isa food, it's a food piece.
Because I think we've lost today, aswe talked about last time, we've lost
the understanding of the good nutrientswe're supposed to be taking in and
the quantity of them, because we'rereally just focused on counting our
carbs and dosing the insulin for it.
Yeah.
Right.
And not considering theprotein and the fat.
(11:15):
Absolutely.
Right.
And so, I mean, to your point, if,if someone's having an endurance
workout or if they're training for,you know, a marathon or, or something
long-term, we absolutely have to getnutrition in piece to fuel the engine.
You know, I, I work with a lot of peoplewho have these a hundred miles, you know,
rides, bike rides, and, you know, that'sgonna be a completely different approach
(11:35):
than someone who is training for, youknow, a sprint or something like that.
Or just a daily walker.
And that's what they like.
Right.
And that's what seems to be working, theirneeds are gonna be very different age.
Whether you're male or female, fromthat aspect and hormones and all of
the things they do make a very bigdifference on what your overall needs are.
(11:55):
And then your adjustment strategyneeds to be centered around that
type of need and the type of exercisethat you would really like to do.
You know, somebody who's lifting weights
mm-hmm.
May have some supplementary things thatthey're aiming for in, in order to gain.
I know, I think it, you said yourson, you told me once, uses some
supplementary things to help gainthat real muscle build, right?
(12:18):
Mm-hmm.
And even some of those couldhave impact on blood sugar.
Right.
For sure.
And I think, but the biggest takeawayis, especially around those workouts,
is just limiting the amount of insulinonboard walking into a workout.
Yeah.
I mean, if I had one takeawayfor people, that would be it.
And not totally limiting the insulin,it's just we don't wanna walk into
(12:38):
a workout with, you know, a tonof insulin onboard that we know is
gonna become supercharged is how it
Right.
And it may be a ton of insulin forone person and not for another.
Right.
Right.
You know, all of our insulin needsare really different and so you
may be able to walk into a workoutwith a half a unit on board.
Yep.
But typically you need10 units for a meal.
Right.
Whereas somebody who only needsone unit for a meal, a half a
(13:01):
unit is gonna be a large amount.
It's huge.
To have on board.
Absolutely.
It's all individualized is reallykind of the structure of it.
Right.
And that is so true.
'cause I think so often on socialmedia or even in magazines or
articles, you know, people kindof apply that one size fits all.
And with type one diabetes, youjust cannot do that around exercise.
(13:23):
No.
You know, I would say that a lotof people, uh, also get frustrated
when they work out and it's weighttraining and their blood sugars go up.
And I think that so manypeople don't realize,
yes.
Sometimes you do have to take insulin forthat rise, or have that weight training
session be followed by cardio so thatyour blood sugars naturally come down
(13:45):
afterwards, even, you know, kind of theorder of operations can make a difference.
And can make a difference then indeciding about, you know, snacking
or any of that intake that youmaybe had in your plan before.
And if you don't want to, that's a great,it's something I learned years ago was
mm-hmm, workout with your weights first.
Yep.
(14:05):
First, absolutely.
It's just a natural rise.
Even if it's slight enough, you often,and there are studies about it too, I
think Kathryn actually shared a studya couple of years ago with us about
workouts with the cardio followinga weightlifting session, and while
you do see a decline, it's not adecline that requires use of food to
(14:27):
stop it, um, and it's a lot smoother.
And again, then you don't haveoverage of calories that you
really didn't wanna take in.
Right.
So I do feel, I mean, so many peopleare burdened by the just pure amount
of calories they feel like they haveto eat walking into a workout and
mm-hmm, I don't know if you, if yousee this with kind of new exercises,
(14:47):
but our body does have a reallystrong response to that new activity.
You're just not used to it, and soyou're, you know, working harder than
you otherwise would, you know, sixmonths or 12 months into your training.
But I think that initial start wherepeople have such variability of their
blood sugars, it's such a barrier.
It is and you always over preparefor what you don't want to happen.
(15:10):
I mean, I myself, in anything new,a couple of years ago, I started
doing really early morning yoga.
I hadn't, I've done yoga before,but it was always in the afternoon
in which I had a specific plan for.
I had no idea what it was gonna do,so I adjusted my insulin this way, and
I even ate a little bit of something.
I mean, it was minor, itwas like five grams of carb.
(15:30):
But,
yeah.
Boy did I not need thatin the morning time.
It was like I found that Icould just go in flat, stable.
Right.
No adjustments, no food, nothing needed,and drink my water and it was fine.
And, and be fine.
Yeah.
I think I've shared this with youbefore where I have the biggest
struggle is pickleball, and I don'teven consider that like a massive
(15:51):
part of my exercise program, butit's usually later in the afternoon.
It's usually social.
I have insulin on board and, andI, you know, don't wanna interrupt
the game with three other peopleby having a low blood sugar.
And so that is where I struggle.
Find myself tempted to overdo the carbson that and then I just have to remember,
(16:12):
you know, we're gonna be chitchattinga good part of that pickleball time, so
Right, right.
You know, maybe notoverdo the carbs so much.
Yeah, I know.
I started playing our tennis courtsacross the street from our house.
They laid pickleball on top of it,uh, so that we could all do that.
And we, last summer we got pickleballstuff to use with the boys.
And I know the same thing likewith little kids versus just
(16:35):
going with my husband, right?
It's a very different workout.
Kids.
The ball is constantly not in action.
And it is a little bit moresocial in a very different way.
So I realized very quickly I needno adjustments for this whatsoever.
Right, right.
Versus, um, I used to do a ton of tennisor play a ton of tennis and, um, and
(16:56):
that I, that took a strategy that took,you know, long time with hydration.
I needed a lot of carbohydrateintervention just between sets and
so, you know, that was a completelydifferent approach than, than
maybe pickleball on a social level.
Yeah, I know some people areprobably like, well, I'm not
social with my pickleball.
I play intensely.
And I know that that also probablyneeds some intervention too.
(17:17):
And hydration.
Right.
And I, I think you bring in hydration.
It's a good point because a lot ofpeople don't think about hydration
in exercise, and especially with theendurance athletes that I've worked with.
Right.
It's a big piece.
We talk about all of the macronutrientsneeding to go in during endurance
exercise, but hydration is a key toactually allow the gut to get those
(17:40):
nutrients into the system for the muscleper, muscle performance to happen.
Right.
And prevent cramping.
Um, and you know, from a nutrientstandpoint too, I think there's often
a misunderstanding with enduranceathletes who have diabetes about
how much to adjust insulin becausethey know that fueling is important.
(18:01):
They're trying to think, youknow, like an athlete, right?
Right.
They say, My muscles need this, butI don't know how to put it in so
that my blood sugars also behave.
And I found myself that it needs tobe really timed using exercise watches
that have a timer set so you knowwhen to take your fuel, how much fuel
to take on average, how much carb isoften based on your endurance time,
(18:26):
as well as your body weight and how
and how you're trained.
Right.
How perform, yeah, how trainedyou are, how you know how your
muscles are actually working.
So it takes a little bit of finessing.
Yeah.
And practice and consistency for sure.
Yeah.
And also for the longer distance, I guess,active people it also takes finding the
(18:46):
fueling sources that work for your gut.
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And now back to our program.
Right.
That you're not gonnabe uncomfortable with.
(19:29):
Yeah.
Right.
Um, 'cause there are a lotof options out there, but not
everything works for everybody.
Absolutely.
And I, I do think those areindividualized for sure.
And some of those have just so muchsugar that it's just not comfortable.
Right.
Yeah.
Yeah.
And kind of doing it alittle bit goes a long way.
Especially if you'vereduced your insulin, right?
Because there's so many people whosuspend their insulin or take their pump
(19:53):
off or really decrease how much they'retaking ahead of a, of a workout and then,
you know, they, they take so much fastacting sugar and then, you know, you're
just kind of sky rocket.
Yeah, I've actually, I mean, from anendurance standpoint, I've found the
little amount of reduction from a basebasal concept and then not bolusing
(20:14):
as you time your fueling intake iswhat tends to work the best overall
because then again, on a gut level,you're really not even absorbing
everything that you end up taking in.
Right.
And so if you reduce too much,you're ending up sitting high.
Yes.
It's really kind of remarkable once wecan kind of get somebody comfortable
(20:36):
with just small adjustments and theynotice how much better they feel and
how much their performance improves.
Right.
That can be a big changerin terms of exercise.
Yeah.
Even one, even one active time that you'veplanned it out and it really got you where
you wanted to be and you could also feelhow good the workout actually, like how
(20:59):
your performance was, is enough to say.
It's almost like a positive like checkor a pat on the back like, I did this.
I can totally this that.
Right?
'Cause you feel good about the workout.
It's not that you feel bad from justhaving an elevated blood sugar or a
severe low that just kind of wipesyour energy, but that adrenaline
and the endorphins from a goodworkout kind of take the place of it.
(21:21):
Yeah.
Do you, I mean, in terms of thehydration piece too, is there a go-to
amount that you often tell people toconsume during or before or even after?
I mean, I think that, you know,just exercisers who are wanting to
stay fit, you know, their hydrationcan be pretty easy to manage, but
(21:44):
Right.
You know, I live in Texas and sowe just got through the hot months,
but if someone's cycling outside orrunning outside, oftentimes I'll have
people weigh themselves before andafter that long workout, and then
they know how much water they lost.
And then, then you can use that as a toolfor supplementing kind of going forward.
To me, that's, that's a greatway to really define it and
(22:06):
give people an actual number.
And this is a good point to bringup too, in terms of hydration,
depending on where you live, right?
I mean, even in the reallyhot Midwest summer times
Yeah.
That we can have up here, I always, Ipay attention to not only that, weight
before and weight after if I'm doingsomething lengthy, but also ,the notice
(22:27):
of almost like the salt that's on your
Oh my goodness.
Yeah.
And your clothes.
Yeah.
I had somebody a couple of weeks ago whowas just offhandedly commenting about like
this white thing that was on his clothesand I was like, you know that salt?
So we really need to focus onquite a bit of supplementation
(22:48):
in terms of electrolytes.
Electrolytes.
Yeah.
Yeah.
Um, and you know what, one thing thatdoes come up, maybe sometimes in older
patients is just the difference betweenlow blood from a lack of volume in their
blood to low blood sugar, and reallynoticing that dizziness and hydration is
so key to preventing, preventing that.
(23:08):
In addition to making sure if you'rewearing a CGM that that continuous
glucose monitor is accurate becausehydration can affect that too.
Yeah, I think that's a, it's a greatpoint because again, I encounter so
many people who don't, they, they stillthink of it as a blood glucose value
coming from their cgm when it isn't.
Right.
It's not blood glucose,it's interstitial glucose.
(23:30):
Right.
And as you said, if we are not wellhydrated enough, there's no way that
that interstitial glucose value isgoing to be accurate, nor is the,
I guess the way that it is flowingin terms of those data points.
Right.
It's going to be a bit morejumpy, especially depending
on the CGM that you're using.
Right.
Which we've all had those jumpy ones.
(23:53):
Yeah.
Um, so they're just all really valuablethings to um, kind of keep in mind.
Yeah.
If, if only it were simpler, but, um, butwe do need to make sure the technology
is working the best that it can andthat, you know, we consider the engine
that's running our, our body in terms of,
yeah,
the effectiveness.
And like after.
I think another piece to exercise is theaftermath of exercise and the adjustment.
(24:16):
Sometimes we often think in terms of.
I burned off this much, you know, all ofour pedometers and all the things that
collect all of our data about heart rate,and you've burned this many calories.
And sometimes we get into the thinkingof, well, I've burned this much so I can,
so I'm gonna go eat that much.
I can afford this much more now thatI've worked this off and again, with
(24:38):
diabetes and managing our own insulinuse, rather than it being put out by
our beta cells and our body really finetuning it for us, it can get mismatched.
So again, it can lead to a little bitmore overage if we're not careful.
Right.
But another thing about post-exerciseis, you know, depending on how somebody
(24:58):
is managing their diabetes, if it'san automated insulin delivery system
and you're continuous glucose monitorspredicting that you're dropping during
that activity just from exercise, well,it's suspending a good amount of insulin.
And then if you sit down for asmoothie or kind of a sweet treat or.
You know, meet somebody for,
for lunch.
(25:18):
A snack after.
Yeah.
Yeah.
And, and you have all ofthat suspended insulin.
Well, holy smokes.
You're gonna again go right backup and that, that yo-yo is so
frustrating or that variability.
And that's where really knowingyour system and understanding
how your AID system, if youare using one, works for you.
Because you may have nailed the workout,you may have stayed very nice and
(25:41):
stable, maybe you're now kind of dippingand the system is suspending, but if
you've adjusted your insulin duringyour workout and now you're coming into
a meal or a snack or something, you'relikely to need for that insulin to now
ramp back up in effect, because you'vetaken away right during the active time.
(26:02):
So that pre bolus canbe so, so, so important.
But I think a lot oftimes people get nervous.
I'm more insulin sensitiveright after a workout.
I don't wanna take a pre bolus.
I'm nervous about the timing andjust that, that practice and kind
of figuring out what works foryou as an individual is so key.
Yeah.
Again, experimentation kind oftakes, it's really important.
(26:24):
I know with morning time work workouts,I don't see this much anymore, but is
summer is just kind of coasting down now.
Yeah.
There are a lot of times in thesummer months with the nicer
weather that I am definitely moreactive into the evening time.
Mm-hmm.
Um, it's not my exercise.
Time per se, but it is more active withkids and biking and swimming and whatever
(26:46):
we end up doing until eight o'clock atnight and I end up finding that I need
to navigate an additional adjustment,whether it's a temporary adjustment to
my target blood sugar or whatever, sothat overnight my system doesn't keep
giving at the rate that it thinks it needsto because that's what the setting is.
Right, right.
And even those kind of lowimpact activities, you know,
(27:09):
whether it's throwing a ballor even gardening, you know?
Yeah.
I oftentimes have to makeadjustments for being active.
It's not necessarily exercise, but Ineed to make sure that maybe, I like to
raise my target, like what you just said.
I mean, to me that's kind of a great hack.
I don't need necessarily less insulin, butI want maybe a cushion against having a,
(27:29):
a drop, you know, while I'm outside beingactive, but it's not really exercise.
And again, knowing how those things impactdecreases the need for excess food that
you don't technically want to eat or needto eat, making your meals, then more what
you really do wanna put in your body.
Right.
It goes back to, um, yeah, wedon't wanna feed the insulin.
(27:52):
And I think so many people don't kind ofstop to think, am I feeding the insulin?
And, and you know what we mean bythat is your insulin intake is higher
than what you really wanna be eating.
And if that's ever the case, then weneed to reevaluate the insulin for sure.
Right.
And we're all, we all change, youknow, as we get older, what we
did in our teen years were, orour early twenties or whatever.
(28:16):
It may shift and change by the timeyou're in your mid thirties and
definitely in your forties and nowyou're in your sixties, and all those
strategies that you have will needreevaluation and adjustment, and our
technology changes too, so we have to
absolutely.
Readapt to whatever's new inthe algorithm that we're using.
(28:36):
Right.
Is there anything, I guessany other touch points about
nutrition and exercise that we...
I would just say that, you know, Ithink it also stands to take a moment
and recognize how much supplementationor extra products you are having
to take in and supplementation inand of itself is not a bad thing,
(29:00):
mm-hmm.
But, you know, we kind of wanna approachfood from a whole food approach, not
necessarily the store, but you know, soI guess one thing in terms of exercise,
I think too many people can get tooclose into the weeds or, or really
trying to maybe not use whole foods as anapproach to their nutrition for exercise.
And, and that's a missed opportunity.
(29:21):
Mm-hmm.
It is.
Uh, and from a, from a micronutrientstandpoint, it's a, it's a
definite missed opportunity.
You know, the, the aisles at the grocerystore astound me with the buckets.
The other day, I, we were, wewere someplace and the protein
powder bucket was, it was probablya foot across and a foot tall.
(29:47):
I like, like I stopped and did adouble take at the thing on the shelf.
I was like, who needs that large of asupplement container when there's a wealth
of food that you could also be eating?
Right?
It made me chuckle.
I was like, you gotta be kidding me.
Now I do think that protein powdersand protein supplements can be
(30:08):
extremely useful for a wide group
100 percent.
of individuals.
And the timing of that can be reallyimportant in terms of muscle building and
mm-hmm
strength training, but I guess, youknow, we don't wanna rely exclusively
on packaged products that are in abin that are as big as your head.
Yeah.
There's a time and a place for them.
Right.
A hundred percent agree.
(30:29):
I mean, I have protein powder.
I do, but there's a use for it andI've strategized around when and why.
Absolutely.
Um, and I still eat an apple as well.
Right.
Or the cucumbers in mygarden or whatever it is.
Right.
Because you can't, you can'tsubstitute that true food for
the vitamin or the supplement.
(30:49):
Yeah.
And um, I know we could probablydo a deep dive into supplements
and vitamins and minerals oneday, and maybe we need to do that.
Yeah, that's a good one.
That would be a goodconversation to have for sure.
No, yeah, so I mean, big takeaways.
Know your activity that youare doing or you wanna do.
Make your adjustments well in advance.
Aim for as little insulinon board as possible.
(31:12):
Probably a little bit more emptystomach, well hydrated, but not
really much food, kind of on boardthere to disrupt what you're trying
to do or trying to get from else.
Right.
And I would say, and if the barriersseem insurmountable, then seek help and
Right.
Because you know, everyonecan and should be able to
exercise safely and confidently.
(31:33):
And if that's not a place whereyou're at, then we can definitely
help with that for sure.
Absolutely.
And we, yeah, we are skilled atthat, so come give us a chat.
That's right.
We'd be happy help.
Well thanks Dana.
We'll chat again.
Yeah, this is fun.
I know.
I look forward to it.
Thanks for tuning in to ThinkLike A Pancreas--The Podcast.
(31:54):
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(32:14):
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(32:56):
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(00:31):
healthcare provider before implementing.
Welcome to another fantastic episodeof Think Like A Pancreas, The Podcast.
I am co-hosting with Dana today.
And again, I'm Jennifer Smith.
I'm a registered dietician, certifieddiabetes educator, and the director of
Lifestyle and Nutrition with Integrated.
And we are moving further intoour discussions about nutrition,
(00:53):
centering hopefully around exerciseand fueling and knowing your needs
and everything today, right Dana?
Absolutely.
Happy to be on again with Jenny.
I'm Dana Roseman.
I'm also a registered dietician andcertified diabetes care and education
specialist with Integrated and Directorof Technology and Applied Research and
(01:14):
an avid exerciser and definitely loveto talk about how to help people manage
their blood sugars around exercise 'causeI don't know, I think so many people
are afraid of having lows associatedwith exercise and really just avoid it.
Or, you know, the irony is they don'tmaybe try new things because I think
new exercise really impacts your bloodsugars so much more than just kind
(01:38):
of what your body is already used to.
So I think exercise is a limiting factor,unfortunately, for so many people.
Yeah, and I mean, and within diabetes,I always think of it sort of like a a
three-tiered management approach, right?
You've got insulin, um, andyou've got exercise and you've
got food sort of like this.
Those are the main three mm-hmm, variablesthat we all try to adjust around and
(02:01):
adding exercise in and changing itup, as you said, can be hard with
diabetes, but really valuable in sortof longevity in your long run of life.
You walk every singleday, that's fantastic.
Good for you.
But your muscles get a little bit boredalmost with the same kind of thing.
Right.
So changing it up, um, can be really,really beneficial, especially if you're
(02:23):
looking for toning and loss or maintenanceor whatever your goal kind of is.
And then of course, I thinktrying to find exercise that
ages with you gracefully, right?
Yeah.
And if you were a runner before andnow maybe you have some back problems
or knee problems and now learninghow to walk and include some strength
training, you know, to stay protectiveof your bones and also keep insulin
(02:44):
resistance and insulin sensitivity high.
Yeah.
Um, that strength training pieceI think is really important too.
It is.
And then the, you know, the fueling aswithin the topic of nutrition becomes
the other concern when we're exercising.
And what I often find is, peopleare so concerned about low blood
sugars, that there is oftenan overage of calorie intake.
(03:08):
Mm-hmm.
So that lows don't happen, and thenthat leads to frustration, especially
if you're really trying to maintain,you know, or what you've gotten
to, what you've achieved, right?
Or lose weight.
Or gain some weight or gain some muscle.
I mean, there's nutrition and fuelingstrategy for each of those pieces.
Absolutely.
And if we're constantlydumping in extra food.
(03:28):
Well, but I would also say I don't like toexercise with an elevated blood sugar that
Me either.
just makes me foggy and you know,you're just not going, you know, whether
you're in a competitive sport or justtrying to do your personal best, um.
Right.
You know, none of us feel great whenour blood sugar is so elevated and
kind of feel sick to my stomach ifI'm exercising with a ton of food
on board too, if I'm being honest.
(03:49):
Yeah.
And the highs certainly don't, from aperformance standpoint, whether, again,
as you said, you're just walking, ordoing something that's really more
of an endurance and a performanceathlete, blood sugar really does have
a kind of a, a range that you willperform the best within they found.
Absolutely.
And there are some studies out of theBarbara Davis Center, I can't remember
the doctor who did it, but they didsome training with athletes with and
(04:12):
without diabetes to find how theirmuscles performed within glucose ranges.
Yeah.
They really found that anything likebetween about 100 and 180 was really more
the performance, that it didn't fail.
Once you got high blood sugars,what's lacking is the ability
to move the sugar that's high.
Mm-hmm.
Into the cells.
'cause there's not enough insulin there,
(04:33):
right.
To do so, right?
Opposite.
Obviously low blood sugars arejust, there's nothing there
for your muscles to utilize.
Right.
Right.
But you're right.
I mean, in terms of performance andwhat you really aiming to get out of
the exercise, we still need to manage ablood sugar that's in a healthy target.
Right.
And I think to your point, I mean,I think even athletes who are super
(04:55):
dedicated, are wearing continuousglucose monitors to find that peak
range of what feels great to them.
And I certainly havethat when I'm exercising.
Clearly not, you know, at a high level,but you know, I have that level that
I wanna kind of achieve and stay at.
Honestly, my body is used to exerciseand if it's not something new, if I don't
(05:15):
have a lot of insulin on board and Ihaven't eaten, which I'm not afraid to
do 'cause my body's kind of used to itand I think over time that's achievable.
I just don't, I, I think a lot oftimes people are nervous and don't
feel like that ever is achievable.
Right.
And it does start out with,I know you and I are both a
fan of fasted exercise, right?
Get up first thing in themorning, get some good water
(05:36):
in, and go do whatever it is.
Yoga.
Mine's coffee.
Or coffee.
Exactly, yes.
Get that in, some hydration.
Hopefully a little more waterthan coffee, but you know.
Yeah.
Or go for a walk or go for a run or abike ride, or Pilates, whatever you're
gonna do in a fasted state, as you said,without excess insulin on board from
bolusing, and nothing for your digestivesystem to be working on, many people
(06:01):
can get through a fasted exercise withpretty stable looking blood sugars.
You might actually even finda little bit of a nudge up.
Yep.
And then the exercise actuallybrings it down to a nice coasting
place that you feel stable at.
Yeah.
And I, one thing I've, I've found quiteoften with a lot of people using these
automated insulin delivery systemsis they just try to sneak in some
(06:22):
carbs right before their exercise.
But of course their blood sugarstarts to rise and what is
their automated system doing?
It's dumping a bunch more insulin.
And so not only are they having a dropfrom exercise maybe, but also from that
increase of insulin delivery and so.
Right.
Yeah, I really, um, I have, I guess, maybetrained enough that, that it's comfortable
(06:43):
for me to do fasting activities.
And it takes testing, right?
Yeah.
I mean, the exercise adjustments thatI do have to put in place are really
centered along, um, my experimentationwith that particular activity.
Mm-hmm.
You know, I can get up inthe morning and I can take a
really nice, good, steady walk.
And not have to adjust anything.
(07:04):
Whereas on my mornings where I take areally long run, I do have an adjustment
that I set within my insulin deliverysystem so that it can accommodate
and keep me steady and stable andhealthy, and not have to be eating.
Three bags of gummy bears along the way.
Right.
Which is just nobody wants to be doing.
Nobody wants to do it.
Unless you want gummy bears, right?
(07:25):
Yeah.
Um, right.
But then, you know, youknow, the adjustment period.
I think a lot of times people thinkabout, oh, I'm walking out the door for
my run, or I'm walking into the gym.
Let me set that temporary adjustmentto my insulin, but you know, that's an
hour and a half, two hours too late.
Um, and I think that's oftentimessomething that people don't consider.
(07:45):
I think I say this 12 times a day,that there's nothing spontaneous about
diabetes management and exercise is justanother piece of that in the planning.
Yeah.
Right.
So I, I find that people kindof make adjustments right
as they start to exercise.
As you said, it's too late.
It's too late even if youconsider 10 to 15 years ago
when there were no AID systems.
(08:07):
Right.
Nothing that was helping you, even, thatrequired some ahead of time preparation.
Um, I know my constant exercise timeat that point was always the afternoon
because that's when I had time.
That's when I could get to the gym.
I was done with my day and I alwayshad to prep by having a snack timed
to when I would get to the gym,depending on the kind of exercise.
(08:30):
Now I don't have to have a snackif I plan ahead the right way.
Right, exactly.
And it is just the planning.
So I know a lot of people, theyjust only have time to exercise
after work or late in the afternoonafter class or whatever that is.
And I do find that to be alittle bit of a trickier time.
You've got mm-hmm, insulin onboard from lunch, you've, you know,
(08:51):
obviously not fasted the whole day.
And you've got some insulin onboard and, and food and some maybe
insulin sensitivity changes in theafternoon and so I do think that
takes a little bit of strategy.
It does.
I mean, and along with it, I think theother confusing part, if you are trying to
strategize with food, which can be done.
Absolutely.
(09:11):
I think it means though that you haveto factor in what are your needs, right?
So that you can say, well, I alwayslike to have this kind of a snack
before I head into a workout.
I feel better.
I feel more energized.
I feel like I've got morepower or whatever it is.
But that snack should be factored intoyour overall caloric need for the day.
(09:31):
Right.
Right?
Not that you're doing this as anoverage to take care of insulin because
then you're just feeding the insulin.
Exactly.
And Yeah, and then potentiallyhaving a crash afterwards with,
with all that insulin on board.
Right.
Do you feel like there's different,I guess, fueling strategies
that you talk to people about?
(09:52):
You know, being a dietician, we getasked lots and lots of questions
Yeah.
That are all within the realm of diabetesand insulin and management, but we
also get the nutrition pieces of it.
Like,
yeah,
what do I really need?
But I, but I think that'sthe question to ask, right?
Is really, what do I really need?
Because am I exercising for wellness,for weight loss, for muscle tone?
I mean, if it's 30 minutes.
(10:13):
You probably don't need a bunchof supplementation, right?
Right, right.
You're not going to fatigue all of yourglycogen stores in 30 minutes and so,
I do think that a lot of times peoplejust think about, you know, these
pre-workouts and post-work workouts,and it's so complicated, which maybe
those do have a place in your workouts,but it's not a foregone conclusion.
(10:34):
Right.
I don't think that you alwayshave to have something beforehand.
Right.
I always feel like it's value, it'svaluable for somebody who's using insulin
to try to consider talking with aneducator who is actually a dietician.
Mm-hmm.
To get a feel for what are you, whatare you trying to achieve and what do
you feel like is standing in your way?
(10:55):
And a lot of times it isa food, it's a food piece.
Because I think we've lost today, aswe talked about last time, we've lost
the understanding of the good nutrientswe're supposed to be taking in and
the quantity of them, because we'rereally just focused on counting our
carbs and dosing the insulin for it.
Yeah.
Right.
And not considering theprotein and the fat.
(11:15):
Absolutely.
Right.
And so, I mean, to your point, if,if someone's having an endurance
workout or if they're training for,you know, a marathon or, or something
long-term, we absolutely have to getnutrition in piece to fuel the engine.
You know, I, I work with a lot of peoplewho have these a hundred miles, you know,
rides, bike rides, and, you know, that'sgonna be a completely different approach
(11:35):
than someone who is training for, youknow, a sprint or something like that.
Or just a daily walker.
And that's what they like.
Right.
And that's what seems to be working, theirneeds are gonna be very different age.
Whether you're male or female, fromthat aspect and hormones and all of
the things they do make a very bigdifference on what your overall needs are.
(11:55):
And then your adjustment strategyneeds to be centered around that
type of need and the type of exercisethat you would really like to do.
You know, somebody who's lifting weights
mm-hmm.
May have some supplementary things thatthey're aiming for in, in order to gain.
I know, I think it, you said yourson, you told me once, uses some
supplementary things to help gainthat real muscle build, right?
(12:18):
Mm-hmm.
And even some of those couldhave impact on blood sugar.
Right.
For sure.
And I think, but the biggest takeawayis, especially around those workouts,
is just limiting the amount of insulinonboard walking into a workout.
Yeah.
I mean, if I had one takeawayfor people, that would be it.
And not totally limiting the insulin,it's just we don't wanna walk into
(12:38):
a workout with, you know, a tonof insulin onboard that we know is
gonna become supercharged is how it
Right.
And it may be a ton of insulin forone person and not for another.
Right.
Right.
You know, all of our insulin needsare really different and so you
may be able to walk into a workoutwith a half a unit on board.
Yep.
But typically you need10 units for a meal.
Right.
Whereas somebody who only needsone unit for a meal, a half a
(13:01):
unit is gonna be a large amount.
It's huge.
To have on board.
Absolutely.
It's all individualized is reallykind of the structure of it.
Right.
And that is so true.
'cause I think so often on socialmedia or even in magazines or
articles, you know, people kindof apply that one size fits all.
And with type one diabetes, youjust cannot do that around exercise.
(13:23):
No.
You know, I would say that a lotof people, uh, also get frustrated
when they work out and it's weighttraining and their blood sugars go up.
And I think that so manypeople don't realize,
yes.
Sometimes you do have to take insulin forthat rise, or have that weight training
session be followed by cardio so thatyour blood sugars naturally come down
(13:45):
afterwards, even, you know, kind of theorder of operations can make a difference.
And can make a difference then indeciding about, you know, snacking
or any of that intake that youmaybe had in your plan before.
And if you don't want to, that's a great,it's something I learned years ago was
mm-hmm, workout with your weights first.
Yep.
(14:05):
First, absolutely.
It's just a natural rise.
Even if it's slight enough, you often,and there are studies about it too, I
think Kathryn actually shared a studya couple of years ago with us about
workouts with the cardio followinga weightlifting session, and while
you do see a decline, it's not adecline that requires use of food to
(14:27):
stop it, um, and it's a lot smoother.
And again, then you don't haveoverage of calories that you
really didn't wanna take in.
Right.
So I do feel, I mean, so many peopleare burdened by the just pure amount
of calories they feel like they haveto eat walking into a workout and
mm-hmm, I don't know if you, if yousee this with kind of new exercises,
(14:47):
but our body does have a reallystrong response to that new activity.
You're just not used to it, and soyou're, you know, working harder than
you otherwise would, you know, sixmonths or 12 months into your training.
But I think that initial start wherepeople have such variability of their
blood sugars, it's such a barrier.
It is and you always over preparefor what you don't want to happen.
(15:10):
I mean, I myself, in anything new,a couple of years ago, I started
doing really early morning yoga.
I hadn't, I've done yoga before,but it was always in the afternoon
in which I had a specific plan for.
I had no idea what it was gonna do,so I adjusted my insulin this way, and
I even ate a little bit of something.
I mean, it was minor, itwas like five grams of carb.
(15:30):
But,
yeah.
Boy did I not need thatin the morning time.
It was like I found that Icould just go in flat, stable.
Right.
No adjustments, no food, nothing needed,and drink my water and it was fine.
And, and be fine.
Yeah.
I think I've shared this with youbefore where I have the biggest
struggle is pickleball, and I don'teven consider that like a massive
(15:51):
part of my exercise program, butit's usually later in the afternoon.
It's usually social.
I have insulin on board and, andI, you know, don't wanna interrupt
the game with three other peopleby having a low blood sugar.
And so that is where I struggle.
Find myself tempted to overdo the carbson that and then I just have to remember,
(16:12):
you know, we're gonna be chitchattinga good part of that pickleball time, so
Right, right.
You know, maybe notoverdo the carbs so much.
Yeah, I know.
I started playing our tennis courtsacross the street from our house.
They laid pickleball on top of it,uh, so that we could all do that.
And we, last summer we got pickleballstuff to use with the boys.
And I know the same thing likewith little kids versus just
(16:35):
going with my husband, right?
It's a very different workout.
Kids.
The ball is constantly not in action.
And it is a little bit moresocial in a very different way.
So I realized very quickly I needno adjustments for this whatsoever.
Right, right.
Versus, um, I used to do a ton of tennisor play a ton of tennis and, um, and
(16:56):
that I, that took a strategy that took,you know, long time with hydration.
I needed a lot of carbohydrateintervention just between sets and
so, you know, that was a completelydifferent approach than, than
maybe pickleball on a social level.
Yeah, I know some people areprobably like, well, I'm not
social with my pickleball.
I play intensely.
And I know that that also probablyneeds some intervention too.
(17:17):
And hydration.
Right.
And I, I think you bring in hydration.
It's a good point because a lot ofpeople don't think about hydration
in exercise, and especially with theendurance athletes that I've worked with.
Right.
It's a big piece.
We talk about all of the macronutrientsneeding to go in during endurance
exercise, but hydration is a key toactually allow the gut to get those
(17:40):
nutrients into the system for the muscleper, muscle performance to happen.
Right.
And prevent cramping.
Um, and you know, from a nutrientstandpoint too, I think there's often
a misunderstanding with enduranceathletes who have diabetes about
how much to adjust insulin becausethey know that fueling is important.
(18:01):
They're trying to think, youknow, like an athlete, right?
Right.
They say, My muscles need this, butI don't know how to put it in so
that my blood sugars also behave.
And I found myself that it needs tobe really timed using exercise watches
that have a timer set so you knowwhen to take your fuel, how much fuel
to take on average, how much carb isoften based on your endurance time,
(18:26):
as well as your body weight and how
and how you're trained.
Right.
How perform, yeah, how trainedyou are, how you know how your
muscles are actually working.
So it takes a little bit of finessing.
Yeah.
And practice and consistency for sure.
Yeah.
And also for the longer distance, I guess,active people it also takes finding the
(18:46):
fueling sources that work for your gut.
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And now back to our program.
Right.
That you're not gonnabe uncomfortable with.
(19:29):
Yeah.
Right.
Um, 'cause there are a lotof options out there, but not
everything works for everybody.
Absolutely.
And I, I do think those areindividualized for sure.
And some of those have just so muchsugar that it's just not comfortable.
Right.
Yeah.
Yeah.
And kind of doing it alittle bit goes a long way.
Especially if you'vereduced your insulin, right?
Because there's so many people whosuspend their insulin or take their pump
(19:53):
off or really decrease how much they'retaking ahead of a, of a workout and then,
you know, they, they take so much fastacting sugar and then, you know, you're
just kind of sky rocket.
Yeah, I've actually, I mean, from anendurance standpoint, I've found the
little amount of reduction from a basebasal concept and then not bolusing
(20:14):
as you time your fueling intake iswhat tends to work the best overall
because then again, on a gut level,you're really not even absorbing
everything that you end up taking in.
Right.
And so if you reduce too much,you're ending up sitting high.
Yes.
It's really kind of remarkable once wecan kind of get somebody comfortable
(20:36):
with just small adjustments and theynotice how much better they feel and
how much their performance improves.
Right.
That can be a big changerin terms of exercise.
Yeah.
Even one, even one active time that you'veplanned it out and it really got you where
you wanted to be and you could also feelhow good the workout actually, like how
(20:59):
your performance was, is enough to say.
It's almost like a positive like checkor a pat on the back like, I did this.
I can totally this that.
Right?
'Cause you feel good about the workout.
It's not that you feel bad from justhaving an elevated blood sugar or a
severe low that just kind of wipesyour energy, but that adrenaline
and the endorphins from a goodworkout kind of take the place of it.
(21:21):
Yeah.
Do you, I mean, in terms of thehydration piece too, is there a go-to
amount that you often tell people toconsume during or before or even after?
I mean, I think that, you know,just exercisers who are wanting to
stay fit, you know, their hydrationcan be pretty easy to manage, but
(21:44):
Right.
You know, I live in Texas and sowe just got through the hot months,
but if someone's cycling outside orrunning outside, oftentimes I'll have
people weigh themselves before andafter that long workout, and then
they know how much water they lost.
And then, then you can use that as a toolfor supplementing kind of going forward.
To me, that's, that's a greatway to really define it and
(22:06):
give people an actual number.
And this is a good point to bringup too, in terms of hydration,
depending on where you live, right?
I mean, even in the reallyhot Midwest summer times
Yeah.
That we can have up here, I always, Ipay attention to not only that, weight
before and weight after if I'm doingsomething lengthy, but also ,the notice
(22:27):
of almost like the salt that's on your
Oh my goodness.
Yeah.
And your clothes.
Yeah.
I had somebody a couple of weeks ago whowas just offhandedly commenting about like
this white thing that was on his clothesand I was like, you know that salt?
So we really need to focus onquite a bit of supplementation
(22:48):
in terms of electrolytes.
Electrolytes.
Yeah.
Yeah.
Um, and you know what, one thing thatdoes come up, maybe sometimes in older
patients is just the difference betweenlow blood from a lack of volume in their
blood to low blood sugar, and reallynoticing that dizziness and hydration is
so key to preventing, preventing that.
(23:08):
In addition to making sure if you'rewearing a CGM that that continuous
glucose monitor is accurate becausehydration can affect that too.
Yeah, I think that's a, it's a greatpoint because again, I encounter so
many people who don't, they, they stillthink of it as a blood glucose value
coming from their cgm when it isn't.
Right.
It's not blood glucose,it's interstitial glucose.
(23:30):
Right.
And as you said, if we are not wellhydrated enough, there's no way that
that interstitial glucose value isgoing to be accurate, nor is the,
I guess the way that it is flowingin terms of those data points.
Right.
It's going to be a bit morejumpy, especially depending
on the CGM that you're using.
Right.
Which we've all had those jumpy ones.
(23:53):
Yeah.
Um, so they're just all really valuablethings to um, kind of keep in mind.
Yeah.
If, if only it were simpler, but, um, butwe do need to make sure the technology
is working the best that it can andthat, you know, we consider the engine
that's running our, our body in terms of,
yeah,
the effectiveness.
And like after.
I think another piece to exercise is theaftermath of exercise and the adjustment.
(24:16):
Sometimes we often think in terms of.
I burned off this much, you know, all ofour pedometers and all the things that
collect all of our data about heart rate,and you've burned this many calories.
And sometimes we get into the thinkingof, well, I've burned this much so I can,
so I'm gonna go eat that much.
I can afford this much more now thatI've worked this off and again, with
(24:38):
diabetes and managing our own insulinuse, rather than it being put out by
our beta cells and our body really finetuning it for us, it can get mismatched.
So again, it can lead to a little bitmore overage if we're not careful.
Right.
But another thing about post-exerciseis, you know, depending on how somebody
(24:58):
is managing their diabetes, if it'san automated insulin delivery system
and you're continuous glucose monitorspredicting that you're dropping during
that activity just from exercise, well,it's suspending a good amount of insulin.
And then if you sit down for asmoothie or kind of a sweet treat or.
You know, meet somebody for,
for lunch.
(25:18):
A snack after.
Yeah.
Yeah.
And, and you have all ofthat suspended insulin.
Well, holy smokes.
You're gonna again go right backup and that, that yo-yo is so
frustrating or that variability.
And that's where really knowingyour system and understanding
how your AID system, if youare using one, works for you.
Because you may have nailed the workout,you may have stayed very nice and
(25:41):
stable, maybe you're now kind of dippingand the system is suspending, but if
you've adjusted your insulin duringyour workout and now you're coming into
a meal or a snack or something, you'relikely to need for that insulin to now
ramp back up in effect, because you'vetaken away right during the active time.
(26:02):
So that pre bolus canbe so, so, so important.
But I think a lot oftimes people get nervous.
I'm more insulin sensitiveright after a workout.
I don't wanna take a pre bolus.
I'm nervous about the timing andjust that, that practice and kind
of figuring out what works foryou as an individual is so key.
Yeah.
Again, experimentation kind oftakes, it's really important.
(26:24):
I know with morning time work workouts,I don't see this much anymore, but is
summer is just kind of coasting down now.
Yeah.
There are a lot of times in thesummer months with the nicer
weather that I am definitely moreactive into the evening time.
Mm-hmm.
Um, it's not my exercise.
Time per se, but it is more active withkids and biking and swimming and whatever
(26:46):
we end up doing until eight o'clock atnight and I end up finding that I need
to navigate an additional adjustment,whether it's a temporary adjustment to
my target blood sugar or whatever, sothat overnight my system doesn't keep
giving at the rate that it thinks it needsto because that's what the setting is.
Right, right.
And even those kind of lowimpact activities, you know,
(27:09):
whether it's throwing a ballor even gardening, you know?
Yeah.
I oftentimes have to makeadjustments for being active.
It's not necessarily exercise, but Ineed to make sure that maybe, I like to
raise my target, like what you just said.
I mean, to me that's kind of a great hack.
I don't need necessarily less insulin, butI want maybe a cushion against having a,
(27:29):
a drop, you know, while I'm outside beingactive, but it's not really exercise.
And again, knowing how those things impactdecreases the need for excess food that
you don't technically want to eat or needto eat, making your meals, then more what
you really do wanna put in your body.
Right.
It goes back to, um, yeah, wedon't wanna feed the insulin.
(27:52):
And I think so many people don't kind ofstop to think, am I feeding the insulin?
And, and you know what we mean bythat is your insulin intake is higher
than what you really wanna be eating.
And if that's ever the case, then weneed to reevaluate the insulin for sure.
Right.
And we're all, we all change, youknow, as we get older, what we
did in our teen years were, orour early twenties or whatever.
(28:16):
It may shift and change by the timeyou're in your mid thirties and
definitely in your forties and nowyou're in your sixties, and all those
strategies that you have will needreevaluation and adjustment, and our
technology changes too, so we have to
absolutely.
Readapt to whatever's new inthe algorithm that we're using.
(28:36):
Right.
Is there anything, I guessany other touch points about
nutrition and exercise that we...
I would just say that, you know, Ithink it also stands to take a moment
and recognize how much supplementationor extra products you are having
to take in and supplementation inand of itself is not a bad thing,
(29:00):
mm-hmm.
But, you know, we kind of wanna approachfood from a whole food approach, not
necessarily the store, but you know, soI guess one thing in terms of exercise,
I think too many people can get tooclose into the weeds or, or really
trying to maybe not use whole foods as anapproach to their nutrition for exercise.
And, and that's a missed opportunity.
(29:21):
Mm-hmm.
It is.
Uh, and from a, from a micronutrientstandpoint, it's a, it's a
definite missed opportunity.
You know, the, the aisles at the grocerystore astound me with the buckets.
The other day, I, we were, wewere someplace and the protein
powder bucket was, it was probablya foot across and a foot tall.
(29:47):
I like, like I stopped and did adouble take at the thing on the shelf.
I was like, who needs that large of asupplement container when there's a wealth
of food that you could also be eating?
Right?
It made me chuckle.
I was like, you gotta be kidding me.
Now I do think that protein powdersand protein supplements can be
(30:08):
extremely useful for a wide group
100 percent.
of individuals.
And the timing of that can be reallyimportant in terms of muscle building and
mm-hmm
strength training, but I guess, youknow, we don't wanna rely exclusively
on packaged products that are in abin that are as big as your head.
Yeah.
There's a time and a place for them.
Right.
A hundred percent agree.
(30:29):
I mean, I have protein powder.
I do, but there's a use for it andI've strategized around when and why.
Absolutely.
Um, and I still eat an apple as well.
Right.
Or the cucumbers in mygarden or whatever it is.
Right.
Because you can't, you can'tsubstitute that true food for
the vitamin or the supplement.
(30:49):
Yeah.
And um, I know we could probablydo a deep dive into supplements
and vitamins and minerals oneday, and maybe we need to do that.
Yeah, that's a good one.
That would be a goodconversation to have for sure.
No, yeah, so I mean, big takeaways.
Know your activity that youare doing or you wanna do.
Make your adjustments well in advance.
Aim for as little insulinon board as possible.
(31:12):
Probably a little bit more emptystomach, well hydrated, but not
really much food, kind of on boardthere to disrupt what you're trying
to do or trying to get from else.
Right.
And I would say, and if the barriersseem insurmountable, then seek help and
Right.
Because you know, everyonecan and should be able to
exercise safely and confidently.
(31:33):
And if that's not a place whereyou're at, then we can definitely
help with that for sure.
Absolutely.
And we, yeah, we are skilled atthat, so come give us a chat.
That's right.
We'd be happy help.
Well thanks Dana.
We'll chat again.
Yeah, this is fun.
I know.
I look forward to it.
Thanks for tuning in to ThinkLike A Pancreas--The Podcast.
(31:54):
If you enjoy today's episode, don'tforget to like, follow or subscribe
on your favorite podcast app.
Think Like a Pancreas-- The Podcastis brought to you by Integrated
Diabetes Services, where experiencemeets expertise, passion meets
compassion and diabetes care ispersonal because we live it too.
(32:14):
Our team of clinicians, allliving with type one diabetes,
understands the challenges firsthand.
We're here to help no matterwhere you are in the world.
Glucose management, self-carestrategies, the latest tech,
sports and exercise, weight loss,type one pregnancy, and emotional
wellbeing, we've got you covered.
(32:35):
We offer consultations inEnglish and Spanish via phone,
video, chat, email and text.
Wanna learn more?
Visit integrateddiabetes.com oremail info@integrateddiabetes.com
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On behalf of Think Like a Pancreas--ThePodcast, I'm Gary Scheiner,
wishing you a fantastic week ahead.
(32:56):
And don't forget to think like a pancreas.
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