Diabetes Deep Dives: Exercise Sport and Diabetes

0:00 foreign hello and welcome to diabetes deep Dives0:05 my name is Candace and I'm from diabetes Canada if you are new to my video series thank you for joining us if you have0:12 been enjoying this series welcome back our diabetes deep Dives video series is designed to go beyond the surface of0:19 General diabetes education information we hope to spark continued interest and learning to leave you with practical0:25 tips and tools that you can easily use we drop a new video every month so subscribe to our YouTube channel and0:31 click on the notification Bell to be notified about new content you can also check us out on social media to find out0:37 when the next one will be posted on our YouTube channel thanks to those who have subscribed and supported our video series0:45 for this episode on exercise Sport and diabetes I'm very excited to share with you that our guest speaker is Chris0:51 Jarvis a former Olympian rower who has been living and competing with diabetes he is also the founder and executive0:58 director of I challenge diabetes a non-profit that focuses on creating opportunities for people with type 11:04 diabetes of all ages to overcome challenges and find support1:10 Chris will be sharing his experiences of developing A playbook of sorts that helped him manage his diabetes while1:16 competing and participating in his Sports and Adventure challenges1:21 after watching this video we hope that you will understand the different types of exercise involved in Fitness as well1:27 as training for sport how the body's physiology is impacted by exercise the1:33 potential benefits of exercise and the challenges with managing diabetes while training or competing in sport1:40 how technology can support your diabetes management during exercise and what to look out for1:45 and how training for a sport can build resilience in the face of diabetes stigma1:51 well this is a very interesting topic we recognize that the content in this video may not be relevant for everyone and1:57 will depend on what your experience with diabetes is and what devices are available to you where you live if you2:03 have specific questions about your diabetes management please reach out to your health care team2:08 these videos are for educational purposes only the content discussed in this video is not intended to be medical2:15 advice and to the extent that medical advice is required you should consult with a qualified medical professional2:20 the information discussed in this video cannot replace consultations with a qualified Healthcare professional to2:27 meet your individual medical needs the views and opinions expressed in this video are those of the speakers and do2:34 not necessarily reflect the views or positions of diabetes Canada as always we hope that this video Sparks2:41 your interest in learning more about diabetes management and now over to Chris my name is Chris Jarvis and I have been2:48 living with type 1 diabetes for 28 years and gotten into some pretty extreme exercise myself2:54 some of you might think of rowing as a type of sport that you float around3:00 in a boat but I got into this Sport and got pretty competitive and got pretty3:06 fit that's me there training for the Canadian Olympic team I have been able to row for Team Canada as well as bring3:14 back gold from Rio de Janeiro and you know this is a sport that has3:21 not only pushed me with my diabetes but torn my entire body to shreds as I trained for seven hours a day over 703:28 kilometers every day but I've also done a lot of other things I have been lucky enough to bike across3:35 Canada raising money for a cure I have been able to join a team of type ones3:40 and race in the Canadian Death Race 125 kilometers of running up and down some3:45 mountaintops as you can see there 17 000 feet of elevation change3:51 um all done in 24 hours uh I have also been able to do lots of3:57 leisurely fun uh trips with our adventure team with I challenge diabetes4:03 um and some of those Adventures have led to some extreme places like the West Coast Trail which I've hiked eight times4:09 and completed with a group of type 1 diabetics as well I have4:15 um pushed my own boundaries uh completing some mountaineering with uh4:21 a role model that I've looked up to with my diabetes and that pushes our bodies in so many different ways when we're4:27 doing different types of sport and so I just thought I'd give you a little bit of a background on some of the things that I have done4:35 so getting back into it if you're pushing your body it doesn't need to be something extreme but doing intense4:43 physical exercise can push our bodies and we need to learn about how to manage our diabetes in the midst of that and4:49 our bodies are the best way to give us feedback on that so I've got a few topics for you to speak to today in our4:56 Deep dive and I wanted to speak to you about um a training Playbook something that5:02 I've learned to use to adjust from play to play on how to make a quick change in5:07 my diabetes management and that all stems back from how sport affects our blood sugars and the physiology that5:13 we're looking at so we'll give a little uh dive into that we're also going to look at the the pros of how exercise has5:19 helped but also some of the challenges that we face um the stigma and the mindset and the5:25 resiliency that we gain and the technology and the tips and tricks that I have for that now as we dive on in5:32 here talking about intense exercise um there's four main components that we're addressing physiology the5:38 technology that supports us our mindset and the pros and cons of doing it5:46 so the first part here is to talk about the physiology and the5:51 type of exercise and there's been a lot of research done on this we know that there are generally a few different5:57 kinds of exercise so you get your strength training that's building up your muscle mass as a general thought6:03 aerobic that's building up your your lungs so that it can handle a lot of uh6:08 heavy breathing and then your anaerobic is when you're not actually using your breathing to power your exercise so it's6:15 very short bursts of exercise whereas aerobic could be long hours of exercise6:21 uh even in the five minute range would still be aerobic exercise but your6:26 breathing is doing the most of the energy uh component for that then you've got your flexibility and balance6:32 training that's still a type of physical exercise that we want to be doing and when we think about the research into6:39 diabetes and how this impacts us mostly we try to associate a type of6:45 exercise with the um the corresponding physiology so as6:52 you see here we're looking at sprinting up at the very top that's going to be an anaerobic exercise and what that arrow6:59 is trying to say is that sprinting might push your blood sugars up weightlifting is on the up side okay and7:07 then you've got mixed Sports which might be more in the middle so basketball soccer you're thinking7:13 about bursts of exercise that also have stopping points first7:19 stop first stop so those are from from our7:26 um hypothetical you know from our our research side might say that it is a7:31 more balanced approach versus as it shows here a bicycle ride is going7:38 down and a jog is going down um and so that's because there might be7:44 less stopping and starting from a hypothetical situation now I say hypothetical because I think all of7:51 these exercises should comprise all of the types of exercise if you want to be7:57 a good Sprinter you don't just do Sprints if you want to do the maximum push in your weight lifting then you're8:04 probably going to want to do a whole lot of other strength training activities than just maximal efforts8:10 so for example when I was weight training I would be doing two to three reps to try to build up how much maximum8:16 could I push but I'll also be doing exercises with 12 reps 18 reps8:22 and um and so because I was a rower I would also do uh weightlifting with a lot more reps as well sometimes uh8:28 bursts of of sets were a drop down from 20 reps of one dropped some weight off do another 15 reps drop some weight8:38 Etc so there's lots of different kinds of weight training is my is my point there um and so especially when you get into8:45 different sports you know hockey would be one of these ones that is trying to say a straight line approach or even a8:52 spike approach but that's not going to be every time you play hockey in fact we often talk about how8:58 practices vary greatly from a competition or a race or a game9:05 depending on the sport and so those psychological components start to play a factor9:12 um and they start to influence what happens with their blood sugars as well so while this is still a very valid uh9:19 tool that we can look at here to see what what is the general concept of a9:24 sport if we dive into something like cycling I have seen many times when I9:29 was to get on a spin bike that within 15 minutes my sensor readings would change9:35 from upward arrows to downward arrows so when you see something like this9:42 you know I would show you a snack over here is something that I would do to try9:48 to prepare my body so that my blood sugars wouldn't drop into a low and then I would wait until I see those9:54 arrows going up to protect myself and then I would start my cycling exercise and then as you can see as I finish my10:02 blood sugars start to taper off of course you can start to perfect this so just thinking about this type of10:08 reading and using um your body and learning about your activity this could be any activity for10:15 you and if we take that snack and we say did this snack work you can see that my10:21 blood sugar Rose and then it also descended and if my blood sugar stayed in the right target range at the end10:28 that tells you I took in a right about the right amount of carbs and now if we look at it and say could I10:35 do any better then maybe I want to move my uh my snack a little bit later in the game so the10:41 same blood sugar profile but just demonstrating that if I ate that snack 15-20 minutes later maybe my SM my Spike10:48 wouldn't have gone quite as high and so that's a great way to work within your blood sugars learning your sport10:54 that yes cycling is going to drop my blood sugar based on what my readings show but that snack is a little bit too11:01 early in order to stabilize my blood sugars and we can see some very stable blood sugars when we get practicing and11:08 doing the same amount of sport we should also be a little bit safe when we're trying a new sport and so if you saw11:14 your blood sugars Spike up and stay there you know don't beat yourself up because that's a safe way to start a new11:20 exercise and maybe after a few times if you see the same Trend then you might want to back off and not eat as many11:26 carbohydrates which I'll talk about again in a moment so getting back into it this is uh you11:33 know hopefully demonstrating to you that as any athlete when you think about somebody who's competing at the Olympics11:39 you realize that they're doing a whole bunch of different kinds of sport and adjusting their strategy each time it's11:45 not as simple as some of your friends might think of course but if we keep on working with our tools and our tips and11:53 adjusting our playbook for each of these types of exercise then we might get a11:58 more stable approach in each one of them and each one of them is so important for our health and our and our experience12:06 so this uh chart and this idea of the different types of exercise and how they12:11 affect our blood sugars is really helpful because some of us might be frustrated that you know we're doing something really hard and it doesn't12:18 have as much of an impact as maybe going shopping at the mall or gardening going12:23 for a walk these forms of exercise are really good for us and they are proving this by impacting our blood sugars while12:31 it can be pretty frustrating to have a low blood sugar in the midst of one of these activities we should note that the12:36 more continuous forms of exercise are very helpful for our bodies just the12:42 same as as the ones that push our blood sugars up but you shouldn't be frustrated that a lower form of exercise12:47 that you're not pushing yourself as hard can still bring your blood sugars down it's really about adapting our strategy12:54 so another component of adapting our strategy that came along is called the12:59 x-carb factor and so a scientist came up and we've got charts online that give you some identification but as I13:06 mentioned you really it's your responsibility to try and figure out how much carbs are required for your type of13:12 exercise so this as a concept is taking in this chart might be hard to see but13:17 you can look it up online is that taking your exercise say cycling as we just looked at and determining how hard are13:25 you going and then identifying a certain amount of extra carbs X carbs is the13:31 short form the certain amount of carbs that you might need per hour to manage13:36 that exercise and so you wouldn't take insulin or you would cut this back from your medication13:41 to try and balance out your exercise that way you don't need to treat low blood sugars13:48 so as an example if we are looking at a light form of cycling maybe 20 grams of13:55 carbs is the ideal as you step it up and you go harder maybe it's 30. and if you're going full14:02 steam maybe it's 40. and so you kind of come up with that and that way you've got a plan for each exercise and this is14:09 going to change it's not just per person but it's per exercise now taking that into account we should14:15 also remember that our glycemic index is important so if we have a lower range14:21 blood sugar as we're starting we're going to want to eat higher glycemic index and I won't get into that uh in14:28 too much detail here but the idea being that we can look at our blood sugar levels as they currently are to14:33 determine how fast do we need the energy to come into our body and we can also think about our snacks14:39 if we're doing a long endurance exercise that we might want to have a meal that's going to last longer into our exercise14:47 period so a lower glycemic index meal would help for a long endurance activity14:52 like a hike Like A Long Walk that you're going on or a busy day14:57 okay the last big piece of physiology I want to talk to you about is about the timing15:03 now I like to break my workouts down into different zones and so what I notice is15:11 that leading up to my exercise um as I mentioned in that cycling shot15:16 there I want to get my blood sugars kind of angling up um now that's because I usually do15:22 cardiovascular exercise or aerobic exercise so my blood sugars would trend on the downward side if I didn't do15:29 something to counteract it so this pre-exercise period is something that you work out when you know what your15:35 exercise is doing if you're doing a stressful activity like a game or a race and you notice that your blood sugars15:41 Spike up during that activity then you might want to do uh the opposite where you're being really sensitive about15:48 managing your your diabetes so that your blood sugars don't Spike up on race day15:54 for example versus uh training in training I would be eating my breakfast15:59 about 45 minutes before my exercise and I would take a very small portion of16:05 insulin for that carbohydrate because of the x-carb factor I knew that I needed more carbs for the exercise without16:12 insulin so I would adjust my ratio so that I would get extra carbs for the16:18 exercise for training versus on a race day there were times where I would be uh16:25 watching my blood sugars and taking my insulin and waiting for that insulin to take action and because of the stress16:32 involved in a race day um there were times where I would be waiting for 45 minutes and my blood16:38 sugar would continue to rise without eating any food yet that morning the16:43 stress was pushing those blood sugars up pre-exercise and this can make it really tricky16:49 because then as you get into the exercise things can change and that's why I say the timing so when I shift16:55 into the next Zone and I start getting active as we just spoke about in a race17:00 day format the uh the stress of it could change based on the activity so usually17:07 in my warm-up I'm watching and I could see those stress uh hormones pushing my blood sugars up shift very quickly into17:14 a drop and so um that's all I'm trying to identify here is that if you see a shift17:20 that might be because your physiology is changing the stress hormones are being abated because of the activity now it17:26 could be opposite to you and the idea here that I want to present is that you watch the timing of the zones17:32 during your exercise you're going to want to watch what that trend is and then try to come up with an appropriate17:39 counteraction um so in most of my exercise even in in race17:46 day format during the warm-up period would be a dropping blood sugar whereas17:52 just the race alone my races were five minutes long so they're a heavy load of17:58 anaerobic exercise and so that is going to be pushing um all the hormones into that body again18:06 and pushing my blood sugars back up so that's a little shift in my warm-up to18:11 the race period um but in general we're looking at the type of exercise and what's happening with18:18 our blood sugars and then coming up with a plan and then one thing that we noticed is that not only anaerobic18:24 exercises push our blood sugars up but also long cardio periods can do so too in the recovery phase18:31 so in the recovery phase I've got a little wiggly line there and a lot of times people will find that even after18:37 their exercise is over their blood sugars could continue to descend you could continue to drop18:42 and so you want to think about even uh in that aftermath if you need extra carbs to balance out those blood sugars18:49 or a reduction in medication insulin um could help to balance that but in18:55 some cases like I mentioned uh endurance athletes will find what we now call the19:00 Whip and I was experiencing this time time again after my practices especially19:05 in the morning where my blood sugars would go from a sensitive phase where it was wanting to19:12 drop to a spike face and before I even got a chance to eat anything after two19:18 or three hour long practice my blood sugar would spike up and so if you've experienced something like this you're19:24 not alone but that's what we're watching for is when we finish in this into this recovery phase does the trend change so19:32 if you're watching for that that could be in the most immediate time after your exercise between you know right19:38 afterwards to an hour and a half or so before that recovery phase starts to19:44 shift so there's a bit of stubbornness that can happen there that can push blood sugars up and we want to watch for19:49 that phase in the timing and then I've also got delayed or overnight and that's because we should understand that our19:56 bodies are recovering from all this exercise our muscles need to be replenished during the activity our20:02 muscles are using all of their storage their storage inside of our muscles for energy and we need to replace that so20:09 it's a lot easier for insulin to get energy into our muscles during an overnight period or when we're resting20:15 delayed much after our exercise and so that's why a lot of people have experienced nighttime lows after20:21 exercise because our body is just replenishing those muscles and so we need to have a little bit of a careful20:27 approach to the overnight medication that we take to manage our20:33 blood sugars one other thing I wanted to mention about inside of our exercise period is that our body has a20:39 physiological shift usually our body is picking up energy from our intestinal tract from our digestive tract and20:46 trying to bring that into the bloodstream to start to fuel the rest of our body okay and that's when we're20:51 eating food that's where it's getting picked up but when we're exercising our body can learn to shunt the blood away20:57 from that intestinal tract and so what's happening there is that the body knows that it has enough storage in its21:03 muscles as well as in the liver where it stores a lot of energy almost 40 percent of our energy is stored in our liver and21:10 so our body should be producing a counter hormone to insulin called glucagon but in most people with21:17 diabetes that glucagon function is inhibited it's not working properly so that's why it's so hard to treat a low21:24 blood sugar during exercise because the body is breaking it down but it's being21:29 put into our digestive tract and the blood's not going there so this could cause a big challenge for21:36 people who are doing endurance exercise who are doing that aerobic exercise21:42 because the body is trying to pick it up from the liver but there's no glucagon response to pull that energy out of21:48 storage so I often suggest to people to think about delaying the swallowing of your21:56 low treatment and sometimes people will slam back juice or Gatorade really quickly and then get right back into it22:02 and then they end up going low again or staying low and so this is an idea that I could suggest to you is to try to keep22:09 something either gummy even if it is juice or Gatorade that you want to do try to take it a little bit slower because the more you put into your22:15 stomach I've heard from many people who've had three four juice boxes and still their low hasn't come up until the22:20 end of their exercise and then of course it's going to spike up much higher than what we want so that's something that we should be22:27 watchful for and um aware of to try to slow down our low22:32 treatments and keep our energy in our in our mouth um so that we can actually pick up some22:37 of that energy from the gums um which isn't inhibited at all so it's a really quick absorption in our mouths22:44 so chewing on some gummies um there's lots of different products like that energy gels that work really22:50 quickly that are designed for athletes because of this type of symptom even those that don't have diabetes22:56 so that's another idea for you but to just reinforce that these different timing zones can change and make it23:04 pretty complex when we're managing our diabetes but it certainly um is possible if we are putting our minds23:10 to it as I mentioned all these little timing pieces and the physiology pieces we're tracking with modern day technology23:17 these days here I am at the top of one of the mountains in the Assiniboine Provincial Park uh looking at my glucose23:24 sensor and it patches right into a pump and I'm not going to get into all the details of this but as you know there's23:30 multiple different kinds this is medtronics with the smart guard feature that's going to be balancing all of the23:36 changes in your physiology from day to day to adjust your insulin dosages there23:42 are also self DIY versions of this like loop as well as the tandem version with23:50 Dexcom compatibility and you see there there's a little bar right up in this corner and it's dark red and that's23:59 because the pump has shut off the insulin delivery during that period to protect you from a low that's what a lot24:05 of this artificial intelligence is doing at this point combined with the technology of glucose sensing and it's24:12 something that we should be all thinking about in the background is how much active insulin do we have active insulin24:18 is a whole other topic but really it's just saying how much is in our body and how much is going to be24:23 um encouraged by our exercise so when our insulin is stimulated by our24:29 exercise it's going to do more work and so we see that little period there where the insulin is being shut off because24:37 the background insulin is being too powerful or perhaps a bolus of insulin24:42 has become too powerful and so that's uh really where we're thinking about with all these timing features the x-carbs24:49 could also be reduced so you don't have to eat as much carbohydrate you could reduce the insulin in the same amount24:55 they're equal as we work through that and so one thing that I really wanted to25:02 focus in on here because this technology we could talk about all day but one thing that we are seeing is that the25:08 insulin pumps are being reduced in their insulin delivery based on our blood25:13 sugars which is fantastic especially during these aerobic exercises as we spoke of during the evening times when25:20 we're going to sleep this these Technologies are making our lives so much safer as we can sleep peacefully25:26 without low blood sugars interrupting our nights but additionally I wanted to25:32 point out one thing that is sometimes a bit of a problem where we have a correction ratio built into our25:38 artificial intelligence and so if you have a pump that's using the sensor to adjust how much insulin you're getting25:45 certainly it helps protect from lows during exercise as you see here there's a bit of a low blood sugar on the screen25:52 and one thing we got to watch out for is that as we recover from that low if we treat the low and our blood sugar starts25:59 to climb up then the sensor might indicate to the pump that we need a shot of insulin and26:06 it might give us a correction factor and so I really encourage you to check out with your clinician your team if you're26:13 dropping after one of these spikes in the midst of your exercise and having a yoyo effect up and down treating a low26:20 getting back into exercise um having a blood sugar climb up and then a correction bolus from the pump to26:27 bring you back down that's something that I've seen a lot in our programs is people are learning how to use these Technologies and something that I'd26:33 watch out for because if your blood sugar is climbing up quickly as it gets to eight or nine the pump will probably26:40 respond with a correction bolus that could bring you back down very quickly uh sometimes in as fast as 15 minutes26:47 change those arrows from going up fast down to a quick descent26:52 so technology can really help us out but there are also little things that are going to come in and we got to watch out26:58 for those and so I want to make sure we also think about our mindset now as you think27:05 everything in life you know could affect you up or down diabetes is a pretty good27:10 parallel for that so with our technology we've come so far in the last 30 years since I was27:15 diagnosed far more people that I've met that had diabetes a lot longer than that and so27:21 think about that place that you come to and there's going to be great examples of this27:26 um and I'm going to use rowing and so many people don't know what rowing is and it's my Sport and I have people that27:33 come across and interact with me about my rowing in a negative way and it can frustrate me but the same thing is going27:41 to happen with diabetes we're going to have people that don't quite get it that don't realize how much effort we need to put in every day in order to manage this27:48 in order to be at our best in order to get up on top of that and there's a lot of stigma around diabetes for sure27:55 so find that place that you can come to and stay motivated because sitting on28:00 the sidelines at any point because of an illness like diabetes is going to be additional frustration on28:07 top of all the physiological challenges that we have it's the mindset there too so that builds in US28:14 a determination no resiliency and I just encourage you to explore that28:21 and to recognize yourself for it too because if you think the top athletes in28:27 the world with diabetes are going through these same moments that are having the same discouragements it's actually what made me the most proud of28:33 myself when I look back from the Olympics back on all the days of training that I put in28:38 certainly there were lots of training accomplishments but it was really about having that mindset to overcome the28:45 daily obstacles that diabetes brought in the way in addition to all the other training experiences that I had28:51 so when I think about the pros and cons I think that's a great place to start you know we might be thinking about what28:57 we're looking for in life and maybe it's a beautiful view that you're trying to hike towards maybe it's a spot on the29:05 podium or maybe it's just being with your friends at that stage it could be the way you29:11 look at yourself as well looking at yourself and being proud of yourself those are all big Pros29:17 but sometimes we're going to think about ourselves as someone living with diabetes in a negative way because we're29:23 frustrated that we can't do everything without having a blood sugar that goes out of control or maybe we're focused so29:29 much on our blood sugars that we're looking too deeply at that and when I say too deeply if it's29:35 looking at a negative experience and it's changing our lives in a negative way then there's a problem right and so we29:43 have to focus on blood sugars and the food that we eat and the way that we manage it way more than anyone else does29:49 so that's a that's a pretty big challenge but it can turn into a pro right as we29:55 look to overcome that and find the fun out there30:00 so the more we value those positive moments the more energy we have to come through30:06 the challenges and so that's been built up in me and I know looking back from when I was diagnosed at 14 years old30:13 having those challenges present themselves so regularly and having the right support around me to get me back30:19 up that I could enjoy the next experience played a big component in how30:24 strong I ended up getting so I would say one of the biggest Pros is making sure that you can develop that30:31 positive team relationship whether or not that's with your friends on a team in a class or your family and diabetes30:38 can raise a lot of conflicts because this can interrupt not only our sport but also a lot of parts of our lives30:46 but practicing for a sport is very similar to what we're doing with our diabetes management practice practice30:53 practice so I encourage you to get out there and to know that you're not the only one so many people out there across Canada31:01 and across the world are going through this too so I thank diabetes Canada for bringing us together in this deep Dives31:07 and remembering that there are more people out there that are doing your specific Sport and so this is just a deep dive on31:15 exercise and intense training but there might be somebody with your specific sport that you could reach out to I know31:21 I've talked to rowers all around the world hikers all around the world and I have loved those moments so I31:28 encourage you to get connected Beyond this video to use this as a taste test for what you can learn and how you can31:34 grow and I appreciate spending some time with you today thank you and best of luck to you in your training31:40 thank you so much for joining us and Diving deeper into the world of exercise Sport and diabetes again this topic may31:47 not be relevant to everyone living with diabetes but we do hope that you found it interesting and learned something new31:53 please take the opportunity to let us know what you learned what you liked and how we can do better you can do that by32:00 posting a comment in the comment section below or by clicking the link to the feedback survey in the description box32:06 if you have ideas for other topics that you'd like to learn more about you can include that in the comments or feedback32:12 survey as well Chris talked about x-carves as well as DIY automated insulin delivery we've32:19 included links to a resource on x-carbs as well as to our Deep dive video on DIY Aid in the description box as well as32:27 some additional resources related to diabetes and exercise we also wanted to take this opportunity32:33 to let you know about lace-up to end diabetes and encourage you to join the lace-up your way challenge a great32:39 opportunity to get moving create or join a team and support diabetes Canada32:44 for more information about lace-up or anything related to diabetes management please visit our website at diabetes.ca32:51 you can also email us at info diabetes.ca or call our info line at32:57 1-800 Banting that's 1-800-226-8464 and speak to one of our33:04 information and support Specialists who can adjust your needs thanks again for joining us and see you next time33:10 thank you [Music]