Diabetes Open Hours: Fitness for Everybody

0:00 [Music] hello and welcome to diabetes open hours 0:05 your live q a opportunity with experts in diabetes management and care my name 0:10 is Kayla runka and I'll be your moderator for today I would like to start by acknowledging that I'm calling in from Toronto and 0:17 that I'm located on the traditional indigenous territory of the wendat Hoda nashoni anishnabeg and the mississaugas 0:24 of the credit and that Toronto is now home to many diverse First Nations Inuit and metis 0:29 peoples as a health focused organization diabetes Canada recognizes that there is 0:35 systemic racism within and throughout our institutions and that we have the responsibility and the power to create 0:42 culturally safe and appropriate environments of care today's topic is exercise for everybody 0:49 and yes everybody enjoys and is capable of movement in a way that feels good to 0:54 you and while we have experts on the call today this session is in no way meant to 0:59 replace a regular visit with or the information you obtain from your own medical health professional 1:05 today we are very lucky to have Dr Jane Yardley and PhD candidate Jordan Reese with us to answer your questions on 1:12 diabetes and moving your body including how often what types and unique considerations for people living with 1:18 diabetes Yardley is an associate professor of physical education at the University of 1:24 Alberta's Augustana faculty in Camrose Alberta and a member of the Alberta Diabetes Institute she is co-author of 1:32 the 2016 American Diabetes Association consensus statement on exercise and physical activity and diabetes and a 1:39 recipient of the Heart and Stroke Foundation of Canada's Alberta new investigator award 1:45 Jane's earlier work focused on blood glucose responses to resistance exercise and the impact of exercise in the fasted 1:52 State and her more recent work focuses on gender-related differences in exercise behaviors and blood glucose 1:58 responses in people with type 1 diabetes Miss Reese is a PhD candidate in the 2:03 faculty of Kinesiology Sport and Recreation at the University of Alberta her research focuses on physical 2:10 activity and nutritional interventions for adults living with type 2 diabetes Jordan is also a certified exercise 2:17 physiologist through the Canadian Society for exercise physiology and has three years of experience working as an 2:23 exercise specialist in Primary Care before we get started a few housekeeping things please note this session will be 2:30 recorded and may be included as part of our public-facing channels including our website and YouTube Channel please know 2:37 that we will take all measures to protect your privacy and will not be sharing any names or record of the chat 2:43 we ask that any comments or reactions you share be affirming and positive and that you use this time and this feature 2:49 as an opportunity to further your learning engagement and curiosity and support the same in a respectful way for 2:56 others we also encourage you to discuss your learnings with your regular healthcare provider prior to making any 3:02 changes to your current routine and with that are you ready to get started Jane and Jordan 3:09 yes great so perhaps while we wait for the first questions to come in maybe we can 3:16 chat about some of the basics so can we start by just briefly discussing the benefits of moving your 3:22 body regularly for everyone really not just for people living with diabetes 3:29 Jordan did you want to take this letter or do you want me to get things started you can get things started go for it uh 3:35 well the way I would describe this to students in my undergraduate classes is that basically moving the Body Benefits 3:40 every single organ system and part of the body it's good for your muscles it's 3:46 good for your heart it's even good for your digestion your nervous system your immune system 3:51 um it pretty much every part of your body is going to benefit from moving more simply because that's what we're 3:57 designed to do we're not actually designed to sit for long periods of of time and so the more often we move the 4:03 body and often the more vigorously we move it the bigger the benefits to almost every system in the body and that 4:09 includes things like metabolism as well which is why it's very important in the context of diabetes for blood glucose 4:16 management Jordan is there anything you want to add to that I'll just highlight maybe 4:23 um if we go from like a sedentary Behavior to even just small increases in physical activity we can get many of 4:29 those benefits from like 10 minutes at a time of moving our body it doesn't always have to be a significant amount 4:37 of activity we can start small and still see many of those benefits 4:42 that's great actually that leads perfectly into the next question and you know the concept of exercise or working 4:49 out really brings a lot of moans and groans from people we all have busy lives 4:54 um we have multiple priorities that were pulled into on a regular basis so it sometimes feels like fitting in exercise 5:00 is a chore so when we talk about regular physical activity what exactly does that 5:06 mean and is there variance like you just mentioned Jordan for smaller frequent movements versus just the standard 5:13 recommendations that come out of you know Health Canada oh that's a great question I think maybe 5:20 just to start we can differentiate between what physical activity is versus 5:26 what exercise is because we often use those terms kind of interchangeably 5:31 so when we're thinking about physical activity it's any movement that we're 5:36 kind of doing throughout our day that increases our energy expenditure so we're Contracting our skeletal muscle uh 5:43 we're moving our body we're increasing our energy expenditure above being sedentary versus exercise where that's 5:52 more of a planned activity there's a little bit more structure to it perhaps we're engaging in it with kind of a goal 5:59 in mind we want to improve our health our fitness so those are kind of the two different areas that we think of although there is 6:06 some overlap between those but in terms of increasing our overall physical 6:12 activity throughout the day I know time is a huge barrier for many people and 6:17 when we think about like our 24 hour clock eight hours is kind of sleep maybe we're 6:23 working for eight hours and then we have family care chores that 24 hours gets 6:28 eaten up quite quickly so if you can think about ways to fit activity into those things that we're 6:35 already doing throughout the day like transportation is one way we can kind of increase our activity 6:42 um thinking about small mini movement breaks during our work day can be really small things strategies that you kind of 6:49 incorporate into the things that you're already doing Jane did you want to add anything to that 6:57 yeah there were a few questions about this during the pandemic of course because a lot of us were working from home which decreased naturally physical 7:04 activity levels because we weren't even walking to our car or from our car to our office 7:10 um and so there were a lot of little things that could be done throughout the day just to make sure that you are 7:15 standing up and moving um which can now be incorporated into an office space as well 7:20 um keeping water on your desk is a good idea but if you want to be be sure that you're going to get up more often 7:26 keeping it in a smaller glass ensures that you know you have to get up and fill it more often and of course the 7:32 more of those you drink the more often you have to get up and use the washroom in that regard if you're in a building 7:38 with more than one washroom you can walk to the farthest one just to get in a few extra steps a bit more movements while 7:44 you're up and out of your desk already same thing with that with foods make sure you're not leaving those at your 7:50 desk because then there's absolutely no reason for you to move when you're hungry so if you are at home make sure 7:56 those Foods stay in the kitchen kitchen which forces you to get up and move when you actually want to eat or again in an 8:02 office environment if there is a kitchenette or a fridge or anything like that leave your food away from your desk 8:08 so it forces you to get up and move and then you know a lot of people drop their kids off at school when it's only a few 8:14 blocks away it's definitely a good idea for everyone to to walk those couple of blocks if it's possible I know schedules 8:21 are sometimes tight and weather is sometimes not very friendly but that is another idea that can 8:28 automatically get a little bit of physical activity into the day oh my gosh I just want to ask you for 8:34 more tips now I think all of those are very applicable for me I have a massive jug of water sitting on my desk and if I 8:40 had a smaller cup I would be up a lot more often than I am right now um that's great thank you for that 8:47 um when we think about the recommendations for physical activity again we'll get into diabetes specific 8:53 but for the general population it is still five times a week 30 minutes a day 8:58 for the you know cardiovascular workout um can you talk a bit about that as well 9:04 as the different types of exercise we're to be getting on a regular basis 9:11 sure I can go first and then Jane can maybe add if that works um so we can break exercise down into 9:18 those different types maybe the most common one that we'll think of or first thing that comes to mind is aerobic 9:24 exercise so that would be things like going for a brisk walk maybe cycling swimming where 9:31 we're doing kind of a repetitive movement or a period of time of about 10 minutes or more so we're moving our body 9:38 continuously we're working our cardiovascular system that would be what we call aerobic exercise 9:46 um there's also something called resistance exercise or strength training where we're looking at kind of lifting 9:54 weights or moving our body against a resistance helping to increase our 9:59 muscle strength and endurance and these are both very important types of exercise and is recommended that we do 10:07 both if possible and then there's also anaerobic or 10:12 interval exercise so it's similar to aerobic exercise but at a higher 10:17 intensity so we're working harder for a shorter period of time 10:23 so those are kind of the three different types perhaps add on to that does she have 10:29 something to add I'm just going to expand a little on some things 10:35 um the higher intensities uh we've actually got a lot of data showing right now that uh there are huge benefits you 10:42 get a much bigger bang for your buck doing a shorter more intense or interval type workout where you go of intense for 10:48 a short period of time and then recover for another couple of minutes and then go back and do that again so it's a very 10:54 effective way to improve Fitness and metabolism and that goes for you know 10:59 people without diabetes and people with diabetes uh personally I'm a big fan of 11:05 what we call resistance exercise which can come in the form of weight lifting resistance bands body weight exercises 11:11 anything where the muscles are working against some form of resistance um and I'm honestly a True Believer that 11:17 everyone male female all ages diabetes no diabetes should be doing some 11:23 resistance exercise throughout life because it is the best way to keep your joints strong to keep a good range of 11:30 motion which usually translates into better functional mobility as we get older and what that means is when you're 11:36 getting into that you know sixth seventh eighth ninth decade of life you're able to get out of a chair you're able to put 11:42 things on a high shelf you're able to get up and down stairs get out of bed use the bath without assistance and 11:48 those are all really important things to be able to do and we know that they're all much easier throughout life if we 11:54 take the time to do strength exercises on a regular basis from an early age 12:01 all right thank you so um Dr Yardley you mentioned people with 12:06 diabetes and so is one of these types of activities more beneficial for people 12:12 with diabetes than the others and if so does it vary based on whether you have type 1 or type 2 diabetes 12:21 um any type of movement is beneficial I think that's one thing we have to say right off the bat um you're better to move than to not 12:27 move and each type of activity that we've mentioned aerobic resistance high intensity interval each of them has 12:34 their own set of benefits and the one thing that I always bring up is that enjoyment is key 12:41 because if you hate that type of activity you are never going to do it or if you do it you will do it rarely and 12:47 begrudgingly and it's it's just not going to help quite as much there won't be the level of enthusiasm that you need 12:53 um and so what I tend to say is that any exercise is good exercise and good exercise is the exercise that you enjoy 12:59 and you are more likely to do in terms of benefits it really just depends what 13:06 type of benefit you're looking for if you're trying to prevent cardiovascular disease then it's very important to do 13:12 exercises that will improve your cardiovascular fitness so your heart and your blood vessels respond really well 13:18 to aerobic exercise high intensity interval exercise but also resistance 13:23 exercise and in terms of functional mobility as I just said that high intensity and resistance exercise is a 13:30 really good idea in terms of blood glucose management I'll let Jordan talk about type 2 diabetes in type 1 diabetes 13:37 we don't really have a lot of evidence that any type of act activity is going to be better for lowering hemoglobin A1c 13:45 we know there's a high risk of hypoglycemia with type 1 diabetes which is a major barrier to activity and that 13:52 aerobic exercise is actually what confers the highest risk of hypoglycemia 13:57 so we see less of a risk of that big drop in blood glucose with the high intensity interval exercise and the 14:04 resistance exercise so if it's blood glucose and avoiding hypoglycemia that 14:09 you're most concerned about the more intense those exercises are usually the less likely you are to have those lows 14:16 during an activity Jordan yeah I'll just add on to that in terms 14:22 of type 2 diabetes so there's quite a bit of evidence to support both aerobic 14:27 and resistance exercise for improving blood sugars in adults with type 2 14:33 diabetes perhaps there's more research looking at aerobic exercise in lowering 14:39 our A1C or blood sugar and they recommend accumulating about 150 minutes per week to see meaningful 14:47 reductions in our A1C or blood sugar and we can see those reductions even similar 14:53 to some types of diabetes medication so it can be quite significant if we're 14:58 engaging in that regular aerobic exercise and we're consistent with that and then we know that if we add on 15:06 Resistance exercise to that there's additive effects to that so we'll see 15:11 greater reductions in our A1C and then along with all the other benefits that we can get with that resistance in terms 15:18 of building more muscle improving our strength and endurance as well so 15:23 there's quite strong evidence for blood sugar management with aerobic and resistance exercise 15:30 we will definitely talk more about blood sugar management and exercise we do have 15:35 a couple questions in the chat that I do want to get to so the first one is um what are the risks of inactivity 15:42 specifically for people living with diabetes and perhaps you've kind of 15:47 touched on it but maybe you could add a little bit more to that question 15:53 certainly I can start off so yeah there's more and more research looking at sedentary behaviors and we now 16:00 actually have our Canadian population 24-hour movement guidelines so previously we're more focused on kind of 16:07 exercise alone now we're thinking about our movement kind of throughout the day 16:12 how much time are we spending in sedentary behavior and what are the risks of that so there's evidence to 16:19 show that more time in that sedentary Behavior where we're maybe sitting watching TV or sitting in our car or 16:26 sitting scrolling on our phone those types of activities increases the risk of things like high 16:33 blood pressure obesity or insulin resistance it has an impact on our mood 16:38 as well so it can impact many different aspects of our health and there's more of an emphasis on 16:45 breaking up that sedentary time um every 20 to 30 minutes just a small get up go to the washroom come back to 16:52 your desk just to kind of get our body moving and break it out of that sedentary Behavior 16:58 I think kind of the average adult in Canada spends at least 10 hours in that 17:04 sedentary Behavior and the recommendations are to try and keep it below eight 17:10 so thinking about how can we create more movement within our day 17:17 and I guess the one thing I can add to that specifically in the context of type 1 diabetes is that we have we have 17:22 population level studies that show that those who are more active actually live quite a bit longer and have fewer 17:30 complications or if they develop complications that they progress more slowly so people who are inactive are 17:37 more likely to die prematurely to have problems with heart with the cardiovascular disease 17:43 um and also to experience more diabetes related complications and to have those 17:48 complications develop more quickly okay maybe I'll start with you Dr Yardley then because the next question 17:55 is for those people that are currently physically inactive and living with diabetes are there recommendations on 18:02 where to begin and how to kind of um get started and then stay motivated and 18:09 again I would just like to add that this session is in no way meant to replace the conversation you need to have with 18:16 your regular medical providers so we will definitely answer that question but definitely have a touch point with your 18:23 care provider on that as well well this this comes into the realm of of exercise psychology and physical 18:29 activity psychology um so I'm not going to pretend to be an expert in this but 18:34 um what we always say is you know think about what do what you enjoyed as a kid kids are naturally fairly active and if 18:42 you think back to to what you did as a kid whether it was you know riding a bike or swimming or playing soccer with 18:48 your friends out on the street um if there were activities that you once enjoyed there's a good chance that you're going to enjoy those again 18:54 remember that you're not going to be able to jump into them quite the way that kids can because they're also just 18:59 more able to adapt and and usually a little bit fitter because of their higher activity levels 19:05 um so you know number one start slowly be forgiving to yourself uh if you can 19:12 afford it I sincerely recommend employing a personal trainer you know we 19:18 will hire experts for almost every aspect of our life and our health we'll go to dietitians we'll we'll go to 19:24 ophthalmologists podiatrists think of a personal trainer as being a health expert along the same lines somebody who 19:31 can give you some tips some tricks some programs some help to get started some guidance to do so in a slowly and and 19:38 Progressive Way where you won't get injured and you'll be able to keep enjoying those activities for the rest 19:44 of your life Jordan do you have anything you want to add to that yeah I think um we all know that 19:51 physical activity has benefits and I'm sure a lot of us have tried to engage an activity in the past and maybe we did it 19:59 for a week or so and then we fell off the wagon there so thinking about perhaps what has stopped you in the past 20:05 what were some of the barriers that you came across was it time was it too 20:10 expensive there's lots of reasons why we won't engage in physical activity so 20:16 thinking about some of your personal barriers and how you're gonna kind of problem solve around those ahead of time 20:21 it could be perhaps setting up your Runners and your clothing the night 20:27 before have them ready to go by your bag to take to work and then you're gonna go for a lunchtime walk for example so 20:34 you're setting yourself up for success in little ways I think that can be really helpful in getting started and 20:40 starting to build that confidence as you're newly engaging in an activity 20:46 I love that I think confidence is a big thing too especially if you're just starting out on on a physical activity 20:52 program and I also would love to say that my massage therapist who's obviously on her feet all day long 20:59 um so she doesn't want to go for a walk or a run or a bike when she's standing but she starts her day by dancing to one 21:06 or two of her favorite songs and she ends her day that way as well and I love that idea so happy to pass that on for 21:12 anyone listening right now excuse me so specifically let's talk about people 21:18 living with diabetes and um let's start with those I use the phrase type one but um let's just talk 21:24 about people who are taking insulin because there is both type 1 and type 2 that use insulin to help maintain their 21:31 blood sugar so are there special considerations for people who are taking insulin that need to be considered when 21:38 they are exercising or starting a program uh definitely uh insulin is the main 21:45 reason why blood glucose levels will drop really quickly once exercise starts and so it really helps to plan in 21:52 advance when you know you're going to be doing activities and that can even include things like gardening or walking 21:57 to the grocery store you have to remember that these are still physical activity and they're still causing muscle contraction so for anyone who's 22:04 using insulin injections it's recommended that the the dose be 22:10 decreased prior to exercise if it's a long-acting insulin that you're using only long-acting insulin there are 22:16 recommendations of about a 10 decrease either the night before or the morning of the day that you're planning on being 22:21 active if you're using fast acting insulin at meals you can decrease that 22:28 fast acting insulin they say up to 50 or 80 percent depending on how close your 22:33 meal is to the activity that you're going to be doing really try to avoid doing activities when your insulin is 22:40 going to be peaking and we know that for most of the faster acting formulations now that's somewhere around 30 to 50 22:46 minutes 30 to 60 minutes after injection for insulin pumps the recommendation is 22:53 usually to decrease the infusion rate and that can be 50 to 80 percent I've even seen some recommendations as high 22:59 as a hundred percent depending on the activity and the timing of that activity and we want to be doing that about 90 23:05 minutes to two hours ahead of exercise if it's impossible to decrease insulin 23:11 in advance and that happens for some people because you just you know all of a sudden it's like oh hey I've got time I'm going to go do something active now 23:17 and if that's the case um making sure to have some fast carbohydrates around an accessible in 23:24 case those blood glucose levels drop pretty low using continuous glucose monitors we know is a very successful 23:31 tool to help at least know where blood glucose levels are and be vigilant of 23:37 them dropping so that we can preempt the low glucose and my personal favorite one 23:43 that's been coming out a bit more in the research lately is actually fasted exercise for people who are using 23:49 insulin injections or insulin infusions um there tends to be a lot less insulin in circulation if exercise is performed 23:57 first thing in the morning before breakfast so no snacks no boluses get out of bed and get going and in addition 24:04 to the lower insulin there are other hormones things like growth hormone and cortisol that are a little higher in the morning which will tend to promote fat 24:12 as a fuel source rather than glucose and that means that glucose levels will actually tend to stay pretty stable or 24:18 even increase a little bit for most people if they're doing that exercise before their breakfast but again always 24:24 be vigilant keep an eye on what's going on and if you have that continuous glucose monitor keep it nearby 24:31 okay great so assuming that um you know people that are taking insulin 24:36 um keep something close by um have something available because lows 24:43 tend to be the biggest risk I'm assuming four people on insulin biggest risk and also uh biggest 24:50 barrier to being Physically Active fear of hypoglycemia is consistently listed as the number one reason why people with 24:58 um well type 1 diabetes for sure but I would think that that also extends to individuals with type 2 diabetes who are 25:04 using insulin Jordan um let's talk about people who are not 25:09 on insulin anymore and maybe some oral medications are just managing with diet and lifestyle 25:16 um can you speak about you know the same thing um some of the risks if there are any um 25:21 and maybe even some of the barriers because I'm assuming um you know moving when you live in a larger body can also be a bit of a 25:28 complication for some people in terms of their motivation to get out and be active as well yeah certainly so with type 2 diabetes 25:35 or people who are just taking oral medication or managing with um just diet and exercise alone the risk of 25:42 hypoglycemia is quite low but there still is that fear some people 25:47 hear the risk of hypoglycemia and diabetes more coming from that type 1 diabetes Community I think a lot of 25:54 people with type 2 have that fear of becoming hypoglycemic um so maybe clarifying that the risk is 26:01 quite low and individual is taking oral glucose medication and also uh like it's a disease of 26:09 hyperglycemia or high blood glucose and when we're engaging in regular activity it helps to lower that but the risk for 26:16 hypoglycemia is low so that's kind of just some education around that I think 26:21 is helpful for people with diabetes in terms of the timing of exercise 26:28 depends what your I guess goals are so typically with type 2 diabetes after 26:34 someone has a meal we'll see a postprandial increase or a spike in blood glucose after they have a meal and 26:41 that could be a very effective time to exercise for this population to help kind of balance out that Spike to reduce 26:49 those hyperglycemic Peaks throughout the day so there's this idea of exercise 26:55 snacking and type 2 diabetes or maybe we can't fit in like a 60 Minute walk but 27:01 if you could fit in 10 to 20 minutes after each meal that could help to kind of reduce those spikes and glucose that 27:08 we see throughout the day that could be one kind of strategy to break it up into smaller chunks 27:15 um the idea of fasted exercise in type 2 diabetes is maybe less studied but 27:21 perhaps there could be some benefits over the long term if we're regularly engaging in fasted exercise 27:28 when we think about diabetes like how it develops typically we have excess 27:33 storage of fats in our organs in our muscle and when we engage in regular 27:40 fasted exercise perhaps we might see the fuel source coming from those stores in 27:46 our organs so that could be one method as well but less research in that area 27:52 in terms of exercising in a larger body it's finding movement that feels good 27:59 for your body so there's research on aquatic exercise in terms of reducing 28:05 joint pain and feeling like it's easier to move in the water there's less risk 28:10 of kind of rubbing of the skin which can be quite painful as well so finding 28:16 activities that feel good for you and water could be one kind of option for 28:21 sure right I'm assuming that would apply to as we age as well when our joints and 28:27 and body parts are starting to get a little bit more um less fluid and more painful certainly 28:35 yeah with osteoarthritis especially in the lower limbs aquatic exercise can be very beneficial 28:41 and things like riding a bike I'm assuming would also fall into that category where it's not 100 weight-bearing yeah less of an impact 28:48 for sure with cycling we have another question in the chat about specifically longer periods of 28:56 exercise so if you're doing multi-hour exercise or training for an event 29:02 um any suggestions for drinks or products that would contain electrolytes 29:08 and glucose for people living with diabetes I know it's not probably a 29:14 topic area that you tend to cover but um I thought I'd ask because it's there 29:21 um so what I'm speaking from now is mostly personal experience and not actually from from the research 29:27 perspective uh I mean what we do know from the research perspective is that if you want something that's going to be 29:32 absorbed quickly uh and appear in the bloodstream fairly quickly that a lot of these commercial products are designed 29:39 to be um used by different Transporters in the gut more than one type of Transporter in the gut and so some of these commercial 29:45 products are extremely effective for maintaining energy throughout longer 29:50 amounts of exercise when we say longer amounts of exercise normally for anything up to 90 minutes you don't 29:57 really need a lot in terms of supplementation uh 90 minutes whether you have diabetes or not is usually the 30:03 the point at which you start needing to to take in a little bit of carbohydrate and potentially electrolytes depending 30:10 on the temperature electrolytes aren't always necessary unless again you're talking about really long amounts of 30:16 time at relatively warm temperatures um and you know in in terms of the 30:23 amount of carbohydrate intake uh there's a guideline of one gram per kilogram of 30:29 body mass per hour but at the same time there are studies showing that once you 30:34 get sort of Beyond 60 grams per hour that you start to see a lot of upset 30:40 stomach and problems digesting and especially that gets worse is the 30:45 intensity of the exercise gets worse so a lot of this is going to depend on how 30:50 long what type of activity it's easier to eat while on a bike than while running for example just because of the bouncing that happens in the gut 30:58 um and and how much performance you know you're expecting to get out of your body but in terms of commercial products 31:05 um there are so many out there and the tip is usually try lots of different things in training and don't do anything 31:11 new on race day so if you know which event you're going to participate in check to see what's going to be 31:17 available at the aid stations on the course and see if that's something that your body agrees with if your body 31:23 agrees with it then continue to train with it if it doesn't find something else but make sure that you are carrying 31:28 your own supplies on race day so I can't really give specific product information 31:34 because that's really not my area but those are sort of some general guidelines for distance training yeah 31:40 and great great advice um on that note though how big of a role does hydration play in 31:48 um exercise and people living with diabetes 31:54 um I'm gonna just Hazard a guess here that it's probably more important for people with type 1 diabetes then type 32:00 two simply because there's a higher risk of hyperglycemia so high glucose during 32:05 competition just because of adrenaline um so if you're still talking sort of racing and training at higher 32:11 intensities um there is there's a tendency for sugars to kind of creep up over the course of events 32:18 um and the longer that that sugars stay high the more likely that you will be dehydrated because your body tries to 32:24 flush it out in your urine um and so especially on on warm days because we also know and I'm again 32:31 mostly speaking from the perspective of type 1 diabetes here um we know that there are some minor 32:36 impairments in being able to cool the body for people with type 1 diabetes and so it's really important to maintain 32:42 hydration during those events little trick from somebody who's done a lot of distance stuff when you go through those 32:49 Aid stations grab two cups of water one for you one over your head that helps you cool things down a little bit as you 32:55 keep on going I'm sure Jordan has some stuff to add to that yeah I'll just add similar for type 2 33:02 diabetes there's a reduced capacity to dissipate heat so it is really important 33:07 if you're going out for a walk and it's 30 degrees to ensure you're well hydrated for that 33:13 and as well if you're engaging in activity and you're starting that activity with high blood sugars so say 33:19 you test your blood sugars and they're around 16 recommended to stay very well hydrated during your exercise session 33:27 um so it does apply to both type 1 and type 2. 33:32 great um we have one more question so if anyone else listing has further 33:39 questions please feel free to put them in the chat so we can answer a few more of those but I will ask this uh sort of 33:46 one last one and that is for people that have been regular regularly exercising 33:54 um is it worthwhile to change up your activities um with respect to whether it's you know 34:00 diabetes management or otherwise doing the same things over and over again does it kind of reduce the benefits that you 34:07 see from the activity that you're doing 34:13 I can start so I think we can look at this question in a few different ways 34:18 one of them is are you bored with your activity you're bored with your activity 34:23 you're not enjoying it anymore you're less likely to do that activity so keeping things kind of fresh and trying 34:30 new things can be a helpful way to stay active over the long term in terms of health benefits if we're 34:38 regularly engaging in the in an activity we'll get those health benefits our body 34:43 will adapt and that activity will become easier over time so for example if we're 34:49 lifting weights um we start to get stronger that weight becomes easier we do need to think about 34:56 increasing the intensity of that but if we're thinking about 35:02 health benefits you can kind of engage I think in the same activity and get those health benefits perhaps we're not going 35:09 to see an increase in performance over time if we're not kind of challenging our body and progressively overloading 35:16 it and increasing kind of the intensity or volume of the activity but overall 35:22 for health benefits if we're just regularly engaging in activity we'll get those but maybe Jane wants to add 35:28 something to that as well I think I would Echo a lot of the same thing that you know if you're loving it 35:33 and you want to keep doing it keep doing it um in terms of improving Fitness we 35:39 normally need to see some changes in the program from time to time to stimulate new adaptations but at the same time if 35:46 you're looking at this in the context of managing say insulin different 35:51 activities are going to need different insulin adjustments and so changing that routine can sometimes lead to frustration because it will also change 35:59 the way that blood glucose responds both during and after the activity so you kind of have to weigh up you know as 36:05 Jordan said if you're getting bored with your activities then yes A change is a great idea and if you want to to stretch 36:13 yourself to push yourself you know maybe you want to do a 5K race that you've never done before for that you will have 36:20 to have some progression and even some periodization those are two words that a 36:25 trainer would introduce which essentially means building on cycles of training so that you get the right 36:31 amount of recovery and the right amount of stress on the body to get better um but you know if if you do a half hour 36:37 walk every day and you want to keep doing that half hour walk every day that half hour walk every day is going to help you stay healthy and mobile for 36:43 sure great and I know um uh Jane you mentioned this earlier 36:49 about checking your blood sugars before you exercise um for people that maybe are not your 36:56 you know going to the gym or exercise class kind of people but more having a walk or or a bike or something through 37:01 their neighborhood um is it recommended to test your blood sugar beforehand or does it depend on 37:07 your blood sugar and sort of what your normal pattern is it's always a good idea to know where 37:13 you are at in terms of blood sugar levels if you're about to go out and be active 37:19 um you know if you know when you're going to be active you you want to aim to be somewhere in the 8 to 10 millimole 37:25 per liter range for any type of aerobic activity whether that's a walk or a jog 37:31 um we have a lot of studies showing that if you start a lot higher it just means you're going to drop faster um but it's always recommended to know 37:39 where you're at before you go out and it's even a really good idea to know what direction your blood glucose levels 37:45 are moving in um so if you're not wearing a continuous glucose monitor and you're using 37:50 synthetic insulin for example because those are the the things that are going to be the biggest risks it's a good idea 37:55 to check you know maybe two or three times over the hour before going out to do your activity because then you'll 38:01 know whether or not your glucose is generally going up or generally going down because there's a difference between being at say 7.5 and generally 38:09 going up when you're about to go for a half hour for 40-minute walk than being at 7.5 and generally going down the 38:16 latter one might mean that you end up finishing that walk early if you didn't bring any snacks with you so yeah 38:22 generally a good idea to be vigilant 38:28 anything to add there Jordan or uh I don't have too much to add in there I would say with type 2 diabetes we're 38:35 not thinking about checking our blood sugars as regularly it's obviously dependent on the individual and what 38:41 their doctor recommends perhaps they're newly diagnosed that might be a time where you're checking blood sugars more 38:47 regularly around exercise but typically we're not as concerned about those lows 38:55 um so just before I ask one last question to our experts um we've popped a brief evaluation into the chat if you 39:02 would kindly take a minute to provide us some feedback so we can continue to learn and grow and better meet your 39:08 needs um also if you have ideas on other topics you'd like to hear more on feel 39:14 free to pop that in the chat as well so my last question is really generic and I will I'll start with you Jordan 39:22 um anything we haven't covered or any parting words of wisdoms or maybe even further tips on getting started on 39:29 increased movement of our bodies for those living with type 2. 39:35 let's say my biggest message is to find activities that you like doing because exercise and physical activity can be 39:42 such a an additive part to your life and it can bring you a lot of benefits in 39:48 terms of mental health can make you feel happier give you more confidence more self-esteem so really seeking out those 39:55 activities that you enjoy doing and perhaps making it a social thing if 40:00 you're struggling doing it on your own it could be something that you could rather than going to a movie with a 40:06 friend you could go and do something active with a friend so finding those things that you'd like to do 40:12 great thank you and Dr Yardley as soon as you asked that question I was going 40:17 to say that the last half of what Jordan said there you know find find what you enjoy doing um which was what she said first 40:23 um but find people you enjoy doing them with um I'm I used to be very good at going 40:29 out and doing stuff by myself when I was in my 20s the older I get the less motivated I am 40:35 um and the more I feel okay I need to meet somebody to do this activity 40:40 um so I have my regular running buddy and and my regular cycling buddies um and if especially if you're not 100 40:47 confident in what you're doing having a group to do it with means you can learn from the rest of the group 40:53 um and for people with type 1 diabetes again because this is the area that I work with the most 40:59 um there are actually groups of very active people with type 1 diabetes who love to share they love to you know help 41:07 people grow and learn how to be more active how to manage insulin and what to 41:13 expect with different types of activities so finding groups like that that can help support you both in terms 41:19 of your movement and in terms of your diabetes management I think can be very important for keeping lifelong activity 41:28 great thank you both so much so we've come to the end of our time 41:33 um thank you everyone for taking time out of your busy schedule to join us today uh sometimes it's hard to take 41:39 time for ourselves and our personal care um but it's so important and um honestly I think the benefits are 41:45 always worth the time put in um if you haven't filled in the evaluation please consider doing so now 41:51 the link can be found in the chat and a very big thank you to Our Guest experts 41:57 today I know I learned a lot and I'm sure all of you did as well without the generosity of your time our open hours 42:05 would not be possible so thank you both and thank you everyone for joining us 42:10 open hours runs the last week of every other month with a different topic and guest experts so be sure to follow us on 42:17 social or visit the website regularly for updates to learn more and stay up to date on Diabetes Canada's work and 42:23 resources you can visit our website at diabetes.ca or check out our social media channels we are on Facebook 42:30 Twitter Instagram and Linkedin you can also call our info team at 1-800banting 42:36 that's b-a-n-t-i-n-g or email at info diabetes.ca with questions 42:42 so join us again in August for our next diabetes open hours the theme will be making technology work for you please 42:49 stay tuned to our social channels and our website for news about the date time and guest expert for our next 42:55 conversation and for those of you who are looking for a more concrete goal to get moving consider joining diabetes 43:01 Canada's lace-up to end diabetes challenge you can find the website 43:06 through diabetes.ca and join the movement to end diabetes and spend your September with people across Canada who 43:13 are challenging themselves and their teams to lace up to end diabetes and with that I thank you again and we'll 43:19 see you next time thank you [Music]