Exercise & activity

0:03 [Music] 0:09 my name is Dr Jane Yardley um I'm an 0:11 associate professor at the University of 0:13 Alberta Augustana faculty uh and I'm 0:15 here to talk a little bit about the ups 0:17 and downs of exercise with Type 1 0:21 Diabetes by the end of this presentation 0:23 I'm hoping you'll be able to describe 0:25 the difference between aerobic and 0:27 anerobic 0:28 exercise to explain potential insulin 0:31 dosage adjustments and carbohydrate 0:33 intake for different types of exercise 0:35 and maybe to provide some noninsulin or 0:38 carbohydrate recommendations for 0:40 preventing lows and highs with 0:43 exercise to start let's have a look at 0:45 exercise metabolism where do the fuels 0:48 come from where are they stored and when 0:51 are they used the first thing to keep in 0:53 mind is that just about anything that 0:55 you eat can become a fuel for your body 0:59 it gets broken down down into 1:00 carbohydrate lipid and protein all of 1:03 these can be used to create something 1:05 called a denin triphosphate which is 1:08 basically the energy currency for muscle 1:11 contraction these fuels are stored in 1:13 various places in the body bats are 1:16 stored in adapost tissue so anything 1:18 that's soft and Squishy is basically 1:20 where you're storing your fat there's 1:22 also a little bit stored in the muscle 1:24 and this can be used as a fuel source 1:26 during endurance activities and there's 1:29 usually a tiny bit in the blood and this 1:31 is often in transit either coming from 1:33 the gut to go to one of the storage 1:35 areas or going from one of the storage 1:36 areas for to the muscle for 1:39 fuel carbohydrates are generally broken 1:42 down into glucose and then get stored as 1:44 glycogen and you can see here that the 1:46 vast majority of that ends up in the 1:48 muscle it's important to remember that 1:51 once it goes to the muscle it can't 1:53 leave it's essentially locked in place 1:56 and then it can only be used for muscle 1:58 contraction when it goes to the liver it 2:01 can come back out again afterwards when 2:03 the conditions are right that can be 2:05 released from Storage to help prop up 2:07 blood glucose levels when they drop and 2:10 you'll see that there's a very very 2:12 small amount of glucose that actually 2:13 stays in the blood we usually use the 2:16 analogy of a teaspoon of sugar in about 2:19 five liters of blood it's a very small 2:21 amount and it's usually kept in a very 2:22 tight 2:25 balance in terms of exercise itself we 2:28 tend to class things as aerobic or 2:31 anerobic aerobic exercise is usually 2:34 rhythmic and repeated uh using the big 2:37 muscle groups so things like walking 2:39 swimming cycling dancing these are all 2:42 examples of aerobic 2:44 exercise and to keep them on the aerobic 2:47 end of the exercise Spectrum we say that 2:50 you need to be able to sing or talk 2:52 while you're doing the 2:53 activity all of these activities can 2:56 also become anerobic if you increase the 3:00 intensity enough so anerobic activities 3:02 are ones that are very high intensity 3:04 and if we want them to be purely 3:06 anerobic on that really high-intensity 3:08 end they tend to only last a matter of 3:11 seconds and as a result we can often 3:13 perform them intermittently with some 3:15 rest or uh lower intensity activity 3:18 recovery in between example of Anor 3:21 robic activities would be things like 3:22 sprinting weightlifting or other 3:25 explosive movements uh like Plyometrics 3:28 would be another example of a type of 3:30 training that's used often for 3:32 sport the important hormones when it 3:34 comes to managing energy and glucose in 3:37 general during exercise and at rest well 3:40 insulin is going to be the first one 3:42 this hormone helps store glucose in the 3:44 muscle in the liver and also in fat 3:46 cells when it's naturally produced it 3:49 has a very short halflife what that 3:51 means is that the insulin in the body is 3:54 constantly being replaced and degraded 3:56 so that when there is an adjustment 3:58 needed for the amount of insulin to be 4:00 in circulation it can go up or down 4:03 fairly quickly the halflife is in the 4:06 matter of minutes which means that 4:07 minutes from now half of the insulin in 4:08 my body will be gone and it will be 4:10 replaced by new insulin if I need to 4:12 keep those insulin levels 4:14 High when we put it in the context of 4:17 synthetic insulin the halflife is quite 4:20 a bit longer here we're talking hours 4:22 and so that means that it can take 4:24 several hours for insulin levels in 4:26 circulation to change and that becomes 4:27 important when we start looking at the 4:29 context of 4:30 exercise glucagon on the other hand 4:32 helps release energy from storage and 4:35 mostly here we're talking about glucose 4:37 being released from the 4:39 liver and the last hormone that's really 4:41 important is epinephrine otherwise known 4:44 as adrenaline and this is a survival 4:46 thing that allows us to um access fuels 4:51 in large quantities often during an 4:53 emergency or during really high 4:56 intensity exercise because that is 4:57 viewed as a major stress on the body 5:01 now if we look at the different types of 5:03 exercise in terms of intensity and we 5:05 look at the different types of fuels we 5:07 can see that there's a difference in the 5:08 sources that the body wants to tap into 5:11 during these activities on the left here 5:14 you can see that fat is actually the 5:16 primary source of fuel which surprises a 5:19 lot of people because we do know that 5:21 with type 1 diabetes there's usually a 5:22 big drop in blood glucose levels during 5:25 aerobic 5:26 exercise the reason for that is that 5:28 glucose is actually the secondary source 5:31 of fuel for this type of activity and 5:33 you'll notice that you're not actually 5:35 going to be using any of those large 5:37 storage areas you're you're just taking 5:38 that glucose from the blood that 5:41 teaspoon of sugar in five liters of 5:43 blood and this is why we see blood 5:45 glucose levels drop really quickly now 5:47 if we're talking about high-intensity 5:49 exercise then we're tapping into the 5:51 muscle glycogen the liver glycogen 5:54 that's 99% of what your body has stored 5:56 in terms of glucose and this is the 5:58 reason why with high intensity 6:00 activities we don't usually see blood 6:02 glucose levels dropping quite as quickly 6:04 and if we do see a drop in glucose 6:06 levels often times it's after exercise 6:09 because whatever we take out of glycogen 6:11 to fuel these activities it needs to be 6:14 paid 6:15 back if we want to look at it in terms 6:17 of what's supposed to happen with 6:19 insulin and glucagon and glucose if the 6:22 pancreas is working properly insulin 6:24 usually drops pretty quickly at the 6:27 start of exercise this is because the 6:28 nervous system detects that there's 6:30 movement happening or is you know 6:32 causing that movement um and influences 6:36 the pancreas to slow down the release of 6:39 insulin when that happens it stops the 6:44 um the blocking of of glucagon because 6:46 when there's a lot of insulin out 6:48 glucagon can't be released and here we 6:51 see that there's a really big ratio of 6:54 glucagon to insulin during exercise and 6:57 that usually ensures that glucose is 6:59 being released enough from the liver to 7:01 make sure that you've got uh stable 7:03 glucose levels for up to 90 minutes to 2 7:06 hours of 7:08 exercise if we look at this in the 7:09 context of type 1 diabetes because we 7:12 know that that synthetic insulin lasts 7:14 way longer we often don't see a change 7:16 in insulin during exercise and sometimes 7:19 we actually see an increase because 7:21 there's more uh blood flow to the skin 7:23 and it causes that absorption to speed 7:25 up and when that happens it actually 7:28 prevents GL Lon from being released 7:30 because the cells in the pancreas are 7:31 right next to one another and it's an 7:33 antagonistic relationship and high 7:35 insulin usually means that it's going to 7:37 stop that glucagon release so what we 7:39 end up seeing then is a a big drop in 7:41 glucose during exercise with aerobic 7:45 activity but as soon as we add anerobic 7:48 activity it often slows that down and 7:51 this was a really nice study performed 7:52 about seven years ago where the same 7:55 group of participants came back to the 7:56 lab twice and performed 6 minutes of 8:00 exercise and what you can see right away 8:02 we'll just put these up here is a big 8:05 drop in glucose during that uh that gray 8:08 bar that we can see the one that drops 8:10 all the way down there that is just 8:12 straight running treadmill running at a 8:14 straight intensity for 60 minutes but 8:17 this one up here at the top where it 8:18 says the Lu bro intermittent shuttle 8:21 test here the participants jogged a 8:23 little bit ran a bit harder walked a 8:26 little bit threw in some Sprints um it's 8:28 a test that involves a lot of different 8:30 intensities but definitely throws in 8:32 some very high intensities uh in that 8:34 cycle and you can see that there's a 8:36 much smaller drop in glucose as soon as 8:37 you start adding those high-intensity 8:40 activities what does this mean for 8:42 adjusting insulin and taking 8:44 carbohydrates around 8:46 exercise I'd first like to point out 8:48 that all of the recommendations that are 8:50 listed in this presentation come from 8:52 this one paper that was published in 8:54 2017 if you have not seen this paper 8:57 it's easy to access uh you just need to 9:00 make a free account for yourself at The 9:01 lanet Diabetes Endocrinology and then 9:03 you can access this paper free of charge 9:07 and it has a lot of recommendations for 9:10 what to do during different types of 9:12 exercise and it describes why you want 9:14 to do those 9:16 changes first off for insulin what this 9:18 publication recommends is that if you're 9:21 using multiple daily 9:23 injections that the basil rate can be or 9:25 the basil dose sorry can be reduced by 9:27 20% before exercise if exercise isn't 9:31 happening on a daily 9:33 basis it can also be considered to 9:35 decrease the post exercise basil dose by 9:38 20% um and if there's Bolis insulin 9:41 taking prior to exercise if there's a 9:43 snack or anything um that that Bolis 9:46 insulin can also be decreased or in some 9:48 cases perhaps even 9:50 eliminated with insulin pumps we have 9:53 really good evidence to show that if the 9:55 basil rate is decreased 90 minutes to 2 9:58 hours before exercise ex that it does a 10:00 very good job of slowing down those 10:02 drops in blood glucose during exercise 10:05 those reductions can vary from 50% to 10:08 100% we know that disconnecting the pump 10:11 or turning it down to zero uh for 10:13 insulin infusion is safe for up to an 10:16 hour uh but there might be a requirement 10:18 to provide a little bit of a Bolis when 10:20 reconnecting to prevent highs after 10:24 exercise there's also the possibility of 10:26 decreasing the nocturnal basil rate post 10:28 exercise in order to prevent those 10:30 overnight lows with bolus insulin if 10:34 you're in to snack before exercise the 10:36 closer to exercise the less of a 10:38 reduction you need and that's just about 10:39 the amount of time that it takes to get 10:41 into circulation um 30 minutes before 10:44 exercise a 25 to 50% reduction with a 10:47 snack 60 minutes before exercise a 50 to 10:49 75% reduction these again are just 10:52 recommendations everyone's a little bit 10:54 different and sometimes it takes a 10:56 little bit of trial and error to find 10:57 the formula that works for you 10:59 you with hybrid Clos Loop systems so 11:02 these are the pumps that have an auto 11:04 mode on them we know also that that 11:06 exercise mode the temporary Target needs 11:09 to be set 90 minutes before exercise 11:12 just like using a regular insulin 11:15 pump the importance of making these 11:17 adjustments in evance were was really 11:19 nicely demonstrated in this publication 11:22 by a group out of Montreal and what they 11:25 did if we look at the um right hand side 11:27 here reduction at T minus 40 they had 11:30 the participants decrease their basil 11:32 rate on their pumps 40 minutes before 11:33 exercise T minus 20 meant 20 minutes 11:36 before exercise and t0 was right at the 11:39 beginning of the exercise they turned 11:41 down the pump and this is called a 11:43 survival curve and what it is is when 11:45 people are all at a 100 that means that 11:47 nobody's had hypoglycemia each time you 11:50 see a step down that means another 11:52 participant has had to stop exercising 11:55 due to 11:57 hypoglycemia and what we can see from 11:59 all of this is that none of these 12:00 options 0 20 or 40 none of these options 12:03 were able to prevent hypoglycemia in 12:05 100% of the participants after that 20 12:08 to 25 minute Mark T minus 40 was a bit 12:12 more successful but even with that 40 12:14 minutes in advance we're seeing about 12:16 30% of the participants having to stop 12:19 because of 12:22 hypoglycemia where carbohydrate intake 12:24 is 12:25 concerned um aerobic exercise up to 60 12:28 minutes in duration the recommendation 12:31 is to start with blood glucose levels 12:32 between 7 and 10 milles per liter and 12:36 that um carbohydrate might not be 12:38 required if insulin adjustments have 12:40 been made well in 12:41 advance for anything more than 60 12:43 minutes you can plan for 30 to 60 grams 12:46 of carbohydrate per hour over 150 we 12:50 have to be a bit more ambitious maybe 60 12:52 to 90 grams per hour and if this 12:54 exercise is happening when there is high 12:57 insulin circulating 12:59 uh meaning shortly after a meal and 13:01 we've had that full prandial Bolis um 13:04 then it may be necessary to take even 13:06 more carbohydrate than that to prevent 13:09 hypoglycemia with the hybrid Clos loop 13:11 system so if you've got that pump in 13:13 auto mode having a snack um try to do 13:17 that right before starting exercise so 13:19 that your exercise starts before the 13:21 rise in blood glucose starts because if 13:24 your automatic system detects that 13:26 glucose is going up it will try to give 13:28 you more insulin and then that's going 13:30 to increase the risk of going low during 13:36 exercise the higher the intensity uh the 13:39 more likely the the post exercise lows 13:43 so nocturnal hypoglycemia is obviously 13:45 something that we're very concerned 13:46 about with late day high-intensity 13:49 activity the recommendations here for 13:52 the exercise sessions themselves that uh 13:55 there may not be a requirement to reduce 13:58 insulin dosage during the activity 14:01 itself this is extremely individual 14:04 everyone's a bit different it's going to 14:06 depend on the duration and the intensity 14:08 of the activity uh if it's fairly 14:10 intense and fairly short um adjustments 14:13 might not be necessary during exercise 14:16 but it's often a good idea to consider 14:18 basil dose reductions post exercise 14:21 while those G glycogen stores are being 14:24 replenished with the pump and the 14:27 whether it's on autom mode or not 14:29 again reductions might not be required 14:32 um but that post exercise reduction uh 14:36 in basil dose or basil uh rate could be 14:39 a good idea for using an insulin pump uh 14:41 if you're on a Clos loop system it will 14:43 probably make that adjustment 14:44 automatically when in auto 14:47 mode as for Bolis insulin the 14:51 recommendation as of now is that if 14:53 you're snacking before exercise when 14:54 it's going to be high intensity um it's 14:57 possible to give your full Bolis and not 15:00 have too many 15:02 difficulties in terms of feeding that 15:05 type of activity when it's high 15:07 intensity currently the recommendations 15:09 are that the starting blood glucose 15:11 levels can be a little bit lower and 15:12 this is because we do see a lot of 15:14 people actually having glucose levels go 15:16 up during intense exercise um especially 15:18 if it's done in a fasted state so first 15:20 thing in the morning and I'll get to 15:22 that again in a 15:23 minute if it's um longer than 60 minutes 15:27 again there may be requirement for 15:29 carbohydrates here uh but what's most 15:31 important is to make sure that once the 15:33 activity is done that there's enough 15:35 glucose coming into the body that those 15:38 glycogen stores can be replenished um so 15:41 they say that a good uh meal with 45 to 15:44 65% carbohydrate post exercise is 15:47 advisable after a high-intensity 15:49 exercise boat there's also the 15:52 possibility of having a low glycemic 15:53 index bedtime snack uh which means 15:56 something that's going to really slowly 15:57 into the system and try and keep those 15:59 glucose levels stable 16:01 overnight what if you don't want to eat 16:04 carbohydrates and you don't want to 16:06 adjust your insulin well there are a few 16:09 things that you can do that may help 16:12 prevent drops and glucose during 16:14 exercise one thing is to play around 16:16 with exercise order what we've seen in 16:20 some studies is that if high-intensity 16:22 exercise is performed right before 16:25 aerobic exercise that it can actually 16:27 slow the drop and glucose during that 16:29 aerobic exercise and that's exactly what 16:31 we see see here we had participants do 16:34 45 minutes of weightlifting which is the 16:36 dark circles up top before doing 45 16:39 minutes of running and you can see 16:40 there's even a slight increase in 16:41 glucose when the Run starts um and it 16:44 drops um about 30 minutes 45 minutes 16:47 into this run whereas if this P person 16:50 had or these participants when they 16:52 started with just running first there 16:54 was a big drop in glucose right off the 16:56 bat um and then it was stabilized ized a 16:58 little bit more by that weightlifting 17:00 afterwards so playing around with 17:02 exercise order if you're starting your 17:04 exercise session and your glucose levels 17:05 are a bit higher than you would like um 17:08 maybe the aerobic exercise portion could 17:09 come first and if you're starting in 17:11 there a little bit lower and you're on 17:13 that borderline between should I have 17:15 some carbohydrates or should I just see 17:17 how it goes um maybe starting with that 17:19 higher intensity exercise first could 17:21 help stabilize things for a little bit 17:23 longer over time of course all of these 17:25 recommendations come with that warning 17:28 to 17:29 keep an eye on your glucose levels um if 17:31 you're using a CGM check often uh and if 17:34 not uh make sure that you're using your 17:36 glucometer to check from time to time to 17:38 make sure you're in a safe exercise Zone 17:41 a final 17:43 recommendation and this is one that has 17:45 been getting a bit more attention 17:47 lately is to do your exercise in a 17:49 fasted state it almost seems 17:51 counterintuitive to think if I haven't 17:54 eaten anything do I really want to 17:56 exercise but what we've learned about 17:58 type 1 diabetes and exercise is that 18:00 when um people have fasted overnight and 18:04 go into exercise they're seems to be a 18:07 tendency for glucose levels to go up 18:09 rather than down and here we've got two 18:11 studies showing this where the fasted 18:14 exercise are the open squares um on the 18:17 left this is a study with weightlifting 18:20 on the right it's a study with 18:21 high-intensity intervals and you can see 18:24 pretty clearly that with morning 18:26 exercise glucose goes up for most people 18:29 whereas the same people doing the same 18:31 exercise at the same intensity in the 18:34 afternoon are experiencing drops in 18:37 glucose and a lot of that has to do with 18:39 just having less insulin in circulation 18:41 in the morning if you're doing your 18:43 exercise before you've made any um 18:46 adjustments to your insulin before you 18:47 have had anything to eat there's no 18:49 Bolis insulin on board um there's 18:52 actually a tendency at that time of day 18:53 to also have higher cortisol and growth 18:56 hormone which are two other hormones 18:57 that help uh regulate fuel selection 19:00 during exercise um and it probably 19:03 causes a bit more of a Reliance on fat 19:05 during these activities than 19:07 carbohydrate which may play a role in 19:09 sparing some of that glucose one thing 19:12 to keep an eye out for with fasted 19:13 exercis is that we do see pretty 19:15 consistently high blood glucose levels 19:18 after exercise so there might be a need 19:20 for some um adjustment symbolis um 19:23 insulin after the 19:26 exercise hopefully that's given a few 19:28 ideas on ways that exercise can be 19:37 managed

0:03 [Music] 0:13 hello I'm lbna Aslam I'm thriving while living with type two diabetes I'm 46 0:19 years old and my journey with diabetes has been filled with challenges and triumphs I've always been an active 0:24 person but in 2002 my life took an unexpected turn when I sustained a final 0:30 cord injury this meant I would be using a manual wheelchair as my Mobility device for the rest of my life just 2 0:37 years later I gave birth to my son in 2004 followed by my daughter in 2006 0:44 balancing parenting immigration and living with a disability proved to be a complex equation I had to compromise my 0:51 physical activity leading to overwhelming stress in 2014 I received 0:57 my diagnosis of type 2 diabetes with which presented a very unique conflict 1:03 my eternal optimism clashed with my sweet tooth over the years I settled 1:08 down in my new home in Canada my kids became more independent and I realized it was time to prioritize my health 1:15 today I find joy in occasional swimming regular wheeling in my neighborhood 1:21 seated yoga sessions and working out using my handback exercise machine 1:27 regularly and I listen to music when I do that thank you for letting me share my journey of self-discovery resilience and 1:34 learning to find the right balance in life it is my pleasure to introduce the speakers for today's session on exercise 1:40 snacks and staying motivated to move your body Dr Jonathan little is a 1:45 professor in the school of health and exercise Sciences at UBC Okanagan Dr Little's lab seeks to better better 1:53 understand the biological factors that lead to development and progression of type 2 diabetes and how exercise and 1:59 nutrition ntion can be used to prevent treat and even reverse type 2 diabetes 2:04 Dr little is a known expert around the world with respect to health benefits of 2:11 high-intensity interval training HIIT and has helped Pioneer the exercise snack approach with funding from 2:18 diabetes Canada Dr Little's team is translating the exercise snacks program approach from Lab to real world with 2:26 goal of helping type 2 diabetes become more active and improve their overall health Dr 2:33 Hashim Islam is post-doctoral fellow in the exercise metabolism and inflammation 2:38 Lab at UBC Okanagan his research broadly focuses on the Mecha on the mechanisms 2:44 that underpin chronic inflammation with type 2 diabetes and the 2:49 anti-inflammatory effects of exercise and nutritional interventions Hashim is 2:54 also coordinating an upcoming multi- Center trial exploring how exercise snacks can help people living with type 3:01 2 diabetes become more active in their day-to-day lives improve their Fitness and better control their but blood sugar 3:07 throughout the day joining them are John Farrell and tiffanie bridges John is a 3:13 member of diabetes Canada's people affected by diabetes advisory Council and team diabetes alumni member and a 3:21 successful Marathon learner who will Who is living well with type two diabetes and Tiffany is a nurse triathlete 3:28 endurance athlete who not letting type 1 diabetes stop her from anything over to 3:33 you John to kick things off hi my name is John frell and I'm 3:39 living with type two diabetes have been for approximately 10 years however my journey with diabetes actually began 17 3:46 years ago in 2006 when my son Ryan was diagnosed with type 1 diabetes so for a 3:52 number of years I was a caregiver I was shuttling Ryan two and from appointments with his en chronologist helping him 3:59 with uh counting carbs and other Mysteries of the diabetic treatment the technology at the time of his diagnosis 4:06 required him to be awakened nightly for a correcting insulin shot boy if times 4:11 changed during this time I also had blood tests where it was determined that I was in fact heading for type two 4:18 diabetes with higher than normal blood sugar while I was a very active teen and played on all School sports teams my 4:25 working life took over my overall personal care I worked long hours at a desk ate Meals On The Run and found 4:32 little time for exercise does that sound familiar having lived through what ran had to contend with I had a chat with 4:39 myself and made some immediate changes in my lifestyle I started to exercise I 4:44 was told one of the ways to burn off excess sugar in my blood was to increase my heart rate through exercise so like 4:52 the movie with the El brick road I started at the beginning I started walking I started with a Brisk three to 4:58 four times a week for about 45 minutes my Apple watch recorded my heart rate 5:04 and yes indeed it was going up when I exercised I repeated this exercise for about four to five weeks but I found it 5:11 was getting harder and harder to keep my heart rate up guess what I was getting in better and better shape and my finger 5:17 pricking proved that my blood sugar levels were also declining I also started losing some of my excess weight 5:24 it did take a while to see results and there were times when I wondered if this was the right thing for me 5:30 there were times I was discouraged but with continued support from my kids I was not going to stop I just needed to 5:37 find the right gear to move forward and I found it my walking routine uh kind of 5:43 plateaued and my heart rate had evened out but I wasn't at the level I wanted 5:48 so I tried something else in the neighborhood where I walk through there are a number of Street intersections one 5:55 day I challenged myself to run between intersections stop and rest wow I could 6:00 do this not having run or jog since high school this was the beginning of my running career each exercise period had 6:08 me running further and further from that day forward I learned to extend my running after a walking warm-up in a 6:15 typical 5K walk I was now running four plus kilometers my father-in-law once told me 6:21 that the most important part of a car are the tires and this translates into running or walking you need the 6:27 appropriate Footwear they do not need to be expensive Ultra athlete shoes but places like Running Room will get you 6:34 outfitted with new shoes my feet were well cushioned and protected a t-shirt 6:39 shorts and a running jacket added to my wardrobe Ryan and my daughter Caitlyn 6:45 started to run with me I was now a runner and we would run the route several times per week I started this 6:51 program alone and now I had two partners other than my iPod while I cherish the 6:57 company of my kids while running I was worried that either I would not be keeping up with them or vice versa they 7:03 could not keep up with me either could be problematic it took some sorting out 7:09 but we managed I also found that the Running Room also offers free running classes for every level of Runner 7:16 whether you're preparing for a race or not they meet weekly and you run with a group of people just for the fun of it 7:23 they continues to be an option for me John Stanton the founder of The Running Room is quoted as saying it starts with 7:29 running for a minute and escalates quickly to a 5k then 10K a half marathon 7:35 and then a full Marathon says you become a lifelong Runner I have have a 7:40 competitive nature and we've always looked for a challenge it presented itself in 2007 when Caitlyn and I 7:46 registered for our first organized race it was a CIBC Run for the Cure in Ottawa 7:52 we talked throughout the race and we made it clear that we would stop and rest if either of us was tired however 7:59 the adrenaline we both felt carried us non-stop from the beginning to a hug and fested finish so 16 years have come and 8:06 gone I'm now 64 I have continued to run and have joined with both kids in a number of races Ryan and I joined then 8:14 the team diabetes and raised over 45,000 for diabetes research over a 10-year 8:20 period we have run in Munich revic Edinburgh Grand Cayman Jamaica and 8:27 Bahamas according to my Apple watch I've completed over 2,300 training runs and 8:32 I'm closing in on 20,000 kilometers since I started tracking my runs these include three marathons 29 and a half 8:39 marathons and a host of 10ks and 5Ks and over 150 timed races I have never 8:45 thought of giving up running as I continue to enjoy the benefits I am much Slimmer my A1C is manageable and my 8:53 stress level is lower and I'm a happier person I have good days and not so good days I've had my share of strains and 9:00 pulled muscles but everyone I meet through the running Community share the same issues the running Community is 9:06 filled with people just like you so start small running works for me but it 9:12 may not be your cup of tea the important thing is to stay active and to keep 9:17 moving thanks for listening to my journey and now we'll pass things over to Dr little and Dr 9:24 Islam thanks John my name is Jonathan little and I'm a professor at University 9:29 of British Columbia at the Okanagan campus in Colona oh sorry and I'm uh Hashim Islam 9:36 and I'm a postdoctoral fellow in uh John's lab here at UBC Okanagan I'll just start with a few 9:43 disclosures I have research operating grant funding from the Canadian Institutes of Health research diabetes 9:49 Canada nerk and uh various other Charities and 9:56 organizations I don't have any specific disclosures I think that that will affect anything I I talk about today but 10:01 I am the chief scientific officer for a charity called The Institute for personalized therapeutic nutrition and I 10:07 hold shares in a private company that is trying to develop non-invasive metabolic 10:12 monitoring devices but today we're going to talk about exercise and Diabetes particularly exercise in type 2 diabetes 10:19 um and I guess we'll start off with just uh big picture reg uh overview of how 10:26 your blood sugars are regulated we know that in Di diabetes the disease is diagnosed high blood sugars um so you 10:35 know what happens hash when uh when you eat some some carbohydrates what happens 10:40 to your blood sugar levels and how's it regulated yeah sure so so when we eat a meal typically it'll be a you know a 10:47 mixed meal it'll have some carbohydrates and proteins and some fats um so when we 10:52 ingest and and digest that food our our intestines will kind of um extract the 10:59 the glucose or carbohydrates um from that fruit so it'll break down that ingested carbohydrate into into glucose 11:06 or simply known as sugar um and this will cause our um blood sugar to go up 11:11 so if you were to take you know a finger prick um within an hour or two after a 11:16 meal you would notice that it would be um elevated and that's because our body is broken down that dietary 11:23 carbohydrate um and now our blood sugar is going up and so we have lots of sugar available for our tissues you know take 11:29 up and use for energy or um you know store for later on when we might not be 11:34 eating um now when our blood sugar goes up our body needs a way to deal with 11:40 this spike in blood sugar because as I'm sure most of you know um our blood sugar needs to be maintained in kind of a 11:46 narrow range um so the way our body deals with blood sugar or specifically increases in blood sugar after meal is 11:53 through a hormone called insulin so what insulin does is is when your blood sugar 11:59 gets high or increases after a meal it will um signal to our pancreas to 12:06 release this hormone called insulin and what insulin does is going to cause the 12:11 uptake um and you know either storage or or utilization of that blood glucose um 12:18 into the various tissues of our body so again when we eat our blood sugar will rise and that'll signal our body to kind 12:25 of increase the production of this hormone called insulin um and that's going to allow or signal to our tissues 12:32 to take up that blood sugar from our from our blood and in turn that's going to lower our um blood 12:38 sugar um so you know that's that's after we eat a meal and we're not eating all 12:45 day right so there's going to be periods in between meals um when our blood sugar 12:50 might start to come down and this is when um that sugar that we've you know taken up into our tissues is stored is 12:57 now going to be able to be released and um you know taken out by other tissues like our brain and stuff um to be able 13:04 to use for for energy um and the way that happens is through a hormone that 13:10 is kind of the opposite of insulin it's called glucagon so when we're fasted and when we're not eating our body is going 13:16 to sense that you know there's no food coming into the body and we need to release some of that stored substrate 13:22 and that's when um our pancreas is going to release this hormone called glucagon and again as mentioned glucagon is kind 13:29 of the opposite of of insulin so whereas insulin promotes you know the uptake and 13:35 and storage or utilization of glucose glucagon is going to break down some of that uh stored um glucose and release it 13:43 into our blood so that it's available um for our body so this is kind of how you know our blood sugar fluctuates over the 13:49 day during periods of you know eating and in between meals when we're fasting 13:55 and how those two key hormones kind of regulate uh blood sugar over the course of the day so did I did I miss anything there John or no I I guess want to add 14:02 just maybe to so to summarize there we we eat some food if it has carbohydrates blood sugars going up our pancreas 14:08 senses that says hey produce some insulin tells our tissues to take that glucose up it comes back down if we 14:14 haven't eaten for a long time like after an overnight fast for example glucagon would would be higher which is telling 14:20 uh our bodies produce some glucose so that we can maintain our blood sugars I guess maybe just what are uh some of the 14:26 key tissues what's the key tissue that takes the glucose up out of the bloodstream and what's the key tissue 14:32 that releases glucose into the bloodstream hash yeah it's a great point I forgot to mention but um so thanks for 14:37 pointing that out but but one of the main sites for for glucose uptake and storage um within our body is our muscle 14:45 right so our scal muscle so you know our quads or biceps um our chest or back so 14:50 on and so forth all the scal muscles in our body they have you know these large storage sites for for glucose it's 14:56 stored in the form of a molecule called called GL glycogen so that's kind of the storage form of glucose within our body 15:03 so that's kind of the main tissue where um you know that glucose that we ingest is stored now there's also a significant 15:11 amount of glucose that's stored as glycogen within our liver and the liver is really the the key tissue that plays 15:17 a role in um releasing um that stored sugar you know periods of fasting in between meals and 15:24 particularly um during the overnight fasted state so okay so so muscle the 15:30 key tissue that takes it up liver the key tissue that kicks it out I think we'll probably get back to uh to to 15:36 muscle and how to engage muscle uh uh in a little bit um okay well and obviously 15:42 this is um you know the diabetes dialogue so um just to cover I know probably some of the the listeners or 15:49 Watchers are more experts uh in in diabetes than uh than we are um persons 15:54 with lived experience would know this uh more than us but just to to highlight the differences between type one and 16:01 type 2 diabetes so hasha mentioned that blood sugar that's floating around I've heard it you know you only have one or 16:06 two teaspoons of of actual sugar folding in your blood at any one time so our bodies are are normally very very good 16:13 at trying to tightly regulate how much sugar is available um in the blood and 16:19 and type 1 diabetes of course is the situation where it's autoimmune disease 16:24 so our own immune system has attacked the beta cells in the pancreas so someone with type 1 diabetes does not 16:30 make insulin has to take insulin either through a pump or through shots in order 16:37 to to be able to regulate their blood sugars right um type 2 diabetes is a 16:42 little bit different right and and that's the case where the insulin isn't working very good so kind of the signal 16:49 isn't getting through and then you know eventually or later on then the the pancreas starts to fail and and 16:55 individuals uh May Fail and individual uals with um type 2 diabetes would then 17:01 also have low insulin and maybe the need um for for taking insulin uh shots so 17:08 those are the two main types of diabetes obviously we've got gestational diabetes and and L and other um diabetes but but 17:16 the main uh type one and type two are are are a little different in that but 17:21 they also can be kind of the same so um that concept of of insulin resistance 17:27 when I was talking about the type two diabetes the insulin doesn't work as well to Signal our muscles to take up 17:33 the glucose that also happens in type 1 diabetes too right so so um individuals 17:39 with type 1 diabetes can also be insulin resistant and I think that'll be important when we talk uh a little bit about exercise how you might be able to 17:46 overcome or circumvent uh any insulin resistance so all right so uh yeah I was 17:52 just going to jump in there is one you know is one more common than the other maybe which one's more prevalent and 17:58 effect you know a larger proportion of the population yes so yeah great great 18:03 point just to to highlight that so type one diabetes is probably about 10% of of 18:09 the people diagnosed with diabetes in in Canada so there there's over 3 million individuals um who have uh diabetes in 18:17 Canada about 10% are type 1 and about 90% are type two diabetes and obviously 18:23 both both conditions have have been on On The Rise um over the years but type 2 diabetes is is a condition that has been 18:29 on the rise uh even more um it's linked the main risk factors would be age so as 18:35 you get older your tissues tend to become insulin resistant um and and that can contribute to your risk for um type 18:43 2 diabetes and then uh diet uh overweight or obesity status and 18:48 physical activity or exercise are other major um risk factors uh and we're going 18:53 to focus on on the physical activity or exercise aspect today so I guess with that why why is exercise good for someone 19:01 with with diabetes either type one or type two sure yeah so so you know I think exercise is one of the most 19:07 powerful things you can do for your body in general and you know diabetes is is no exception so exercise is very 19:14 powerful um health effects for people living with you know both type 1 and type two diabetes so again I just want 19:22 to remind you that when we eat a meal our blood sugar goes up and the hormone insulin is going to you know clear that 19:29 blood sugar from our blood into our tissues predominantly scal muscle which is one of the main storage sites for um 19:36 sugar in our body now as John mentioned you know people living with diabetes their tissues might be resistant to the 19:42 effects of insulin meaning that you know when when our pancreas releases insulin 19:48 it will go to our muscle and our liver and other tissues but those tissues won't respond to the insulin as much so 19:54 in the case of our skeletal muscle um our insulin might not not be able to promote the uptake and storage of 20:00 glucose in our muscle as effectively in in people living with diabetes and this is where exercise comes in because when 20:08 we exercise you know we contract our muscles and the really cool thing about exercise muscle contraction during 20:14 exercise is that um that'll promote the uptake of glucose into our muscles 20:19 independent of insulin so um you know there's Transporters for glucose in our 20:25 muscle and normally it's insulin's job to you know activate these Transporters 20:30 so they can take up um blood glucose but again in people who are insulin resistant insulin might not work as well 20:36 but exercise does the same thing it's also going to you know activate these uh glute four Transporters they're called 20:44 um in our muscle and that's going to allow our muscle cells to to take up that um blood sugar um during the actual 20:51 exercise build so this is kind of the you know immediate effect of exercise so you know while we're exercise izing 20:58 we're activating those glute four Transporters in our muscle and independent of the effects of insulin 21:04 that's going to cause you know our blood sugar to drop because it's going to get taken up um into our muscles does that 21:10 sound yeah so so you're so it's almost you know not tricking but it's almost like you're circum you can circumvent 21:16 the insulin resistance and use muscle contraction to cause that the same kind 21:21 of or similar molecular Pathways which then get glucose to go into the muscle 21:27 and just a fun fact we've been uh Canada has a long history of of great diabetes 21:32 researchers obviously with with Banting and Best a lot of that research was actually done at University of Toronto by uh a research Niro clip to show that 21:40 those glute four Transporters not to get too much into the the molecular details those glute Transporters it's really cool you have a pool that responds to 21:48 insulin and then you have a separate pool like a different group of those glute for Transporters that responds to 21:54 muscle contraction and exercise so the the insulin ones aren't working but the exercise ones work just fine in people 22:01 with type one and type two diabetes so so you can of uh use exercise as your 22:07 your uh as a supplement um for um insulin to to tell the tissues to take 22:13 up glucose which is pretty cool yeah and that's going on during the exercise belt itself right so it's kind of an 22:19 immediate effect of exercise so while you're exercising you're Contracting muscle and all that good stuff is 22:24 happening to allow um your muscle to take up that glucose but what's really cool is that um when you exercise it 22:32 also sensitizes your muscle to the effects of insulin for up to you know 48 22:37 Hours 2 days after the exercise Bel right and what this means is that after you stopped exercising now when you eat 22:44 your next meal and your blood sugar goes up and then you know your insulin goes 22:49 up to try and clear that blood glucose now your muscle is going to be more sensitive um to the effects of insulin 22:55 so again in people who um may be experiencing in insulin resistance um when they've exercised that insulin 23:02 sensitizing effect of that exercise boat is going to be now present and insulin is going to work better for up to two 23:08 days after the after the acute exercise B which again highlights how powerful the effects of exercise are for for you 23:14 know people living with with a type two diabetes yeah and and I'm sure people with type 1 diabetes can can see that 23:21 they know that they have to adjust their insulin dose often after exercise or if they've exercised uh the day before yeah 23:28 um so that's obviously that's cool when you hear people talk about that it's a very direct way see the ins sing 23:34 effective exercise so so you have benefits immediately or right away while you're exercising and then you have 23:40 benefits for the next uh you know one to two days with this insulin sensitizing effect so that's really cool I I I 23:45 noticed you didn't mention uh weight loss or anything like that there and I think that's a powerful message that you 23:52 know you don't have without weight loss yeah you can have some of these you know effective exercise 23:58 on you know glucose uptake in your body so so so it's almost like every Bel of 24:03 exercise you do is like a dose of medicine it lowers your glucose and sensitizes your your muscles um for for 24:10 the next day or so yeah so kind of kind of knowing this John like you know how exercise impacts blood sugar control 24:17 both during and for two days after the exercise about so so how can people 24:22 living with diabetes both type one and type two kind of take advantage of this information and you know implemented 24:28 into their lives to experience the benefits of of exercise yeah great question and and I and I love talking 24:34 about this and obviously you know both of us are passionate about about exercise but um this is where knowing a 24:40 little bit of the physiology you can then use exercise to to your advantage um to help your blood sugar so the the 24:48 first one that I always recommend as a great tool we've done some research as 24:53 of others on this is postmeal walking or postmeal exercise so again and if you 24:58 think of the the physiology we talked about there you consume a meal your 25:03 glucose is going up insulin is produced it's not working that well in someone 25:08 with type two diabetes but the exercise and the muscle and and those glute Transporters work just fine so you go 25:15 out for a a light easy walk 15 to 30 minutes after a meal that will blunt 25:21 that blood sugar Spike and improve your overall glucose control and there's really cool uh studies on this post meal 25:28 walking or or it doesn't have to be walking but but it's a e postmeal walking easy postmeal exercise in order 25:33 to sign kind of tell your muscles to take up the glucose uh while it's rising so that's one thing you can do and if 25:40 you have a continuous glucose monitor or prick your finger you can often see this um pretty clearly you you have a meal 25:47 prick your finger your your glucose might be at 9 or 10 you go for a 15 minute walk and it's down at uh six or 25:54 or seven it's very powerful to see so so I think timing exercise after your meals is one key thing and then the other um 26:02 point is that because that insulin sensitizing effect lasts for one or two 26:07 days the concept there of of making exercise part of your regular routine right thinking of it as you know a dose 26:14 of insulin sensitizing medicine that you would have you would do every uh one or two days and that's why the diabetes 26:20 Canada guidelines State um you know they they suggest or state no more than 2 days off in between uh exercise boats 26:28 and and that's because of that powerful profound effect of every boat of exercise and and I always also like to 26:34 point out to to individuals that that idea that every boat of exercise you do sensitizes your muscles um for the next 26:41 one or two days um should tell you like hey even if you have an exercise for uh 26:47 you know it's always tough to to stick to exercise and I we'll talk about that later but if you have an exercise for a 26:53 couple of weeks or a couple of months or a couple of years if you go out for for that walk if you do that hike if you do 26:59 that exercise you're going to get the benefits you don't need to exercise you know and and lose weight and have all 27:05 these uh different um adaptations uh every boat that you do counts and if you 27:11 if you get out there you're going to get that that dose of insulin sensitizing exercise yeah it is it is kind of you 27:17 know like taking a medicine as soon as you take it the effects will still be um present now you mentioned timing it 27:22 after meals John and and obviously some people living with diabetes will have access to a continuous glucose monitor 27:29 so they can see when their blood sugar goes up but is like what would you say is the optimal kind of window of time 27:34 where you'd want to time your exercise after meal I know that it might differ between different people but yeah 27:40 there's been a little bit of research on on that and and generally the suggestion there is about 15 to 30 minutes after 27:46 your meal to to start your walk and and again the studies differ obviously but but as short as a 15minute walk okay 30 27:54 minutes after a meal right I don't think you need to get that exact in it um but but that would be my suggestion 28:00 CU it's about 30 minutes after a meal when sugar starts to really rise and and then you can kind of knock down that 28:05 Spike by uh by going for that walk okay no thanks for clarifying so that's all 28:11 great like as you can all probably tell exercise is very powerful effect for 28:17 blood glucose regulation but um what's challenging for most people I is is 28:23 being able to get enough exercise in their day you know I'd say you half of the Canadian population is classified as 28:30 um being insufficiently active meaning that you know there's the Canadian guidelines for physical activity that 28:36 say you should get you know approximately 150 minutes of you know moderate to vigorous activity per week 28:42 this would be you know like a 30 minute exercise session every day for five days of the week would get you there but you 28:49 can as John mentioned also accumulate this in shorter bels of exercise so we 28:54 know that exercise is good for diabetes but we also know that most people find it hard to achieve enough exercise um 29:03 and you know some of the the common reasons people say that they don't achieve enough exercise time is a big 29:10 one you know um with work family life all the other responsibilities over your 29:16 day you know it's hard to carve out a specific you know amount of allocated or dedicated time to get that out of 29:23 exercise and so time is you know one of the most often cited barriers that we see in in research studies for not 29:30 achieving enough exercise obviously most people like we're in a laborary now we have treadmills and bikes behind us but 29:37 um most people don't have exercise equipment you know available in their homes or um very accessible so that this 29:44 is another key barrier that prevents people from from achieving you know that 29:49 that recommended about of weekly physical activity and again going to the gym to access those fac facilities 29:56 further as time and then goes back to that first barrier which is you know not enough time to to get get exercise and 30:03 of course you know gy memberships and stuff or even buying your own equipment it's it comes with Associated cost so 30:09 people aren't active but there's you know there's reasons for that you know timing access to gym facilities and cost 30:17 being some of the major ones so um yeah and I think also I think we'll get to it 30:23 uh in the next part but but uh individuals can often feel maybe a little uncomfortable or you don't feel 30:29 like uh uh you you fit in you don't you don't want to go to the the gym environment when you're just starting 30:35 out um there can be some some stigma or or that involved and uh I I think uh 30:42 we've got some funding from diabetes Canada to try to uh to help overcome some of of these barriers so um you know 30:49 this concept uh which we'll talk about of exercise snacks but but yeah how how can how can you overcome some of these 30:56 barriers or what might be a strategy or some strategies to overcome that yeah so again those three key barriers that I 31:03 highlighted you know time access to gym and facilities and as John mentioned you know stigma um we think an approach to 31:11 overcome some of these bar simult simultaneously um is an approach called 31:16 exercise snacks so first of all what are exercise snacks so exercise snacks um 31:23 are very short bouts of vigorous activity so the way we Define them and the way you know studies in the in the 31:30 research literature have kind of defined them is you know one minute or less 31:35 belts of vigorous exercise vigorous you know it gets your heart rate up gets you're breathing hard you know you feel 31:41 like you're exercising if you were to rate it on a on a scale of 10 it' be like five or six out of 10 um so there 31:47 are these short vigorous bels of exercise perform sporadically over the day you know three to five times over 31:53 the course of the day so um they don't have to be performed at a specific time 31:59 of the day they can be very kind of random or sporadic so you can whenever you get time over the day you can get up 32:05 and do a one minute exercise snack um and then this still allows you to get 32:11 some vigorous exercise into your day without having to go to the gym without having to plan you know a structured 30 32:17 minute session um of exercise into your daily lives and of course you can do this in your home you can do this in a 32:24 private space so some of that you know stigma that people might feel going to the gym or something that's also um kind 32:30 of reduced um I I bet you they would also help break up your sitting time 32:36 which we know are sitting for a long period of time in our society is common so we've been sitting here for probably 32:42 15 20 minutes so why don't we we should probably do an exercise snack yeah all right you go first okay sure I'll uh 32:49 I'll demonstrate an exercise snack here so a really really simple one that 32:58 you know I like to do is um just call the what would you call it running in 33:04 place or change your direction run so essentially what you do is just you'd you'd run back and forth again we're 33:10 aiming for a minute so if you have more space you can use more space but Johnny 33:16 timing me here yeah I got a timer 15 seconds in oh 15 seconds in all 33:22 right so yeah just back and forth again you want to be as vigorous as you can so 33:28 and I can already feel my kind of breathing going up am I 30 seconds in yet you're 30 seconds now okay so 30 33:35 seconds in and you know what if you've done 30 seconds of aerobic activity you might want to switch it up with some you 33:40 know resistance Bas activity so I'm going to go body weight squats getting hard to talk doing this 33:47 exercise snack and then lunges so they're very versatile right you can mix in different 33:54 things what do we at John 10 more seconds 10 more 34:03 seconds all right you're making me feel bad I feel like I should do a uh snack too we got my heart rate up to 100 beats 34:09 per minute there so not bad for one minute okay so I'm wearing dress shoes I'm maybe not as prepared as uh hash for 34:17 for doing an exercise snack but this is the beauty of them is that you can do them um with any clothing on almost 34:23 anywhere you don't really sweat in in a minute or uh and you can feel good so I'm just 34:29 going to do some side to side lunges which I could do at my desk I 34:35 could do it in front of the couch I could do it while I'm watching 34:42 TV and then maybe my knees are starting to hurt a little bit I don't oh that that feels not good so then maybe I 34:47 might go in a plank maybe I try 34:53 to do some mountain climbers now I'm starting to breathe heavy almost 35:00 there 15 seconds to a minute and then I might finish off with 35:06 some squats with the overhead get some more muscles engaged get more muscles 35:13 engaged and there you go that's one minute exercise nice 35:18 work I didn't think we were going to be exercising today in uh in this talk yeah 35:24 so again you can kind of see um from both of us demonstrating an 35:30 exercise snack that they can be fairly practical you can do them wearing more casual attire like me or even you know 35:37 um more formal dress clothes like John and and you know you can kind of mix them up you know add in movements that 35:44 you like and you know some people might have a bad knee so they might not like body weight squats but some of the other 35:49 exercises might appeal more to them so they're very versatile they're time efficient they can be done without the 35:55 use of um any kind of special um exercise equipment and that's kind of what makes them really attractive as a 36:03 physical activity um strategy for most people who again site those barriers of time access and uh stigma for not 36:11 achieving enough physical activity yeah so um we were fortunate enough to to get some funding from 36:18 diabetes Canada um in order to try to test this out in people living with type 2 diabetes so we've got that study uh 36:24 just going to start uh in the new year um where we'll be testing out in the 36:29 real world uh whether people living with type 2 diabetes um are can do these 36:35 exercise snacks and then we'll test what it does to their blood sugars using continuous glucose monitoring how it 36:40 affects their Fitness how do they feel when they're doing them um and we're really excited to to see the results um 36:48 that that study will happen here in Colona as well as with uh Professor Martin gala's lab in McMaster University 36:55 so both Hamilton and Colona we'll have sites and we'll be testing out um this kind of concept of exercise snacks for 37:01 the first time in people with type 2 diabetes so stay tuned it always takes longer than you uh want so a couple of 37:09 years before we we'll know the results of that but it's something that I think everyone watching today could start 37:14 incorporating into into their lives uh if they wanted with any sort of movement activity that that they find uh 37:21 enjoyable and that they can do and John mentioned in the real world so I think 37:26 so far we we've done these exercise snacks in the lab right so we we've gotten people to come in and we've got 37:33 them to do you know either an exercise snack using stairs or maybe a quick exercise snack on a bike so we've 37:39 measured these things in the lab and see how it impacts their you know blood sugar blood insulin so on and so forth 37:46 their Fitness um under controlled laboratory settings so I think this is a really novel aspect of the study is 37:52 we're we're taking the exercise snacks approach from the laboratory to to the real world right CU if we want people to 37:59 experience and benefit from this um it needs to be implemented in people's day-to-day lives whether that be at home 38:06 work school wherever you might be so I think that's a really cool um kind of aspect of this intervention yeah totally 38:12 and and two things there so one of the real world aspects is is we're we've helped develop an app and a online 38:18 platform for people to be able to track and then there's videos giving them suggestions for exercise snacks and that 38:24 sort of thing so that's one area where where we may be able to to make it more in the real world cuz obviously yeah you 38:30 don't want to be coming into the lab multiple times a day the whole the whole idea is you can do this anywhere the 38:35 other thing you mentioned I forgot my favorite exercise snack is is stairs you know this is an easy way to incorporate 38:41 some vigorous exercise in your day my office is on the third floor here and uh instead of taking the elevator I go to 38:47 the stairs and all all the you need to do in our studies that we've done we just tell people to ascend to the stairs 38:53 as quickly and safely as possible so you don't need to Sprint all out you're just saying hey I've I've encountered 38:59 something that can incorporate some some vigorous exercise I'll do a stair climbing snap just pick up the pace 39:04 right that's that's all and and we just published a cool study showing that people in the workplace that work in in 39:10 office Towers um can do this and incorporate it and uh when they do exercise snacks on those days their 39:17 sedentary and sitting time is is reduced so it does look like there there are some benefits and we're getting there um 39:23 in terms of of testing this out in the real world yeah and the and the sitting like the breaking up the sedentary time 39:29 is is a really powerful aspect of the approach because we know that being sedentary and sitting for too long is an 39:35 independent you know risk factor for type two diabetes type 1 diabetes and 39:41 bad blood sugar control so that's I think really an important added benefit of the approach so we've talked about a 39:47 lot of good things about exercise and again both John and I are are firm Believers in exercise but again like as 39:54 with anything there there's always going to be um some considerations or some potential 39:59 risks associated with it so John what are some potential you know considerations or risks that people 40:05 living with type one or type two diabetes might want to take into account when they start you know engaging in 40:11 exercise or even exercise snack yeah of course and and so you know hopefully if you've understood the the physiology a 40:17 little bit we talked about today and people living with type 1 diabetes um know this risk of hypoglycemia or low 40:23 blood sugar can always be U the case and again because your muscles are are sucking up the the glucose so 40:31 particularly in type one diabetes or if you have type two diabetes taking insulin if you have too much insulin on 40:38 board at the same time then your muscles are taking up the glucose you can have the risk of hypoglycemia so so 40:43 individuals may need to adjust their their insulin uh dose you and I are not medical doctors or diabetes Educators to 40:50 be able to do that so you need to work with your your doctor and be mindful of that but but that's where taking finger 40:56 glucoses before and after um partic if you're uh trying to to figure out that 41:02 that balance um in people with type two diabetes the risks of 41:07 hypoglycemia with exercise are much lower um than type 1 diabetes again except if you're type two diabetes 41:14 taking insulin and there's one other type of drug a sulin ara drug which has some risk of hypoglycemia so so anyone 41:21 on on those medications I would say definitely speak with your doctor your diabetes Ed Ator and and be monitoring 41:28 with with finger Pricks um before and after your exercise Bel and and and as with anything it's kind of a risk 41:34 benefit Balancing Act Right John of course yeah so so the you know exercise has a multitude of benefits Beyond just 41:41 your blood sugar um and and we know that so you know the the risk yeah always uh 41:47 anything in life has has that risk benefit it's also important to point out you know in in the guidelines we suggest 41:53 that someone living with diabetes starts out with low to moderate exercise if you 41:58 if you haven't been exercising for for a while you know get used to it get that the a little bit of Fitness first before 42:05 you start adding in you know the hard the vigorous the really long type of exercise um and that just makes sense 42:11 and and again with the exercise snacks we're talking about they're they're relatively new so we don't know exactly 42:17 where they fit in but they're very short but they're done at a hard effort so so right now we're suggesting that you know 42:24 you wouldn't jump in and be doing hard effort exercise day one you would want to to uh develop some Fitness First and 42:32 always before you start something new or something uh really vigorous you want to check in with your healthare provider 42:38 get the clearance make sure hey with my medications my history all all my things okay to do this exercise exactly so I I 42:46 guess uh we're probably about time to wrap up here but uh maybe we should do some take home points here has yeah so I 42:53 know we covered a lot of information so I'll try and summarize it in a few kind of key take-home points so again 43:01 exercise has powerful health benefits for um glucose control and that's you know both immediately during the 43:08 exercise Bel so while you're exercising you're Contracting those muscles you're you're you're allowing your tissues to 43:14 take up that blood glucose um but also again as we mentioned for up to two days 43:19 after the exercise Bel so again those two things highlight how powerful exercise can be for for managing your 43:26 blood sugar um and again what we're really excited about is this new exercise snacks approach but that might 43:31 be a very practical um accessible way for people living with diabetes to um um 43:37 you know control their blood sugar over the day and also break up their sedentary time potentially even improve their Fitness so so we think exercise 43:44 snacks could have a multitude of Health boosting effects Beyond just blood sugar control um and again as John nicely 43:52 covered at the end here you know it's always about weing weighing the risks and benefits but as I'm sure we've 43:58 convinced you all that the benefits of exercise far outweigh any potential risks but again it's always important to 44:05 check with your physician build up slowly as you would with any other exercise program um and make sure you're 44:11 performing the movements correctly and safely and just kind of listen to your body see how you're feeling and um um so 44:17 on and so forth um and I just want to end up by end off by reminding you that 44:23 we'll be available from 215 to 315 um in the diabetes dialogue rooms tomorrow on 44:29 November 18th um to answer any questions and we can talk a little bit about some of the stuff that we covered here 44:35 today okay well thanks hasham that was fun and we'll turn it over to Tiffany 44:41 and she's going to tell you more about her journey uh with type 1 diabetes and exercise thanks for joining us 44:47 thanks hi my name is Tiffany Bridges I'm a triathlete endurance athlete and nurse 44:53 and I'm not letting type 1 diabetes stop me having just crushed my very first 44:59 70.3 mile Triathlon I'm here to tell you a little bit about my journey with diabetes and 45:05 exercise you might be wondering how my fitness journey began it helped that I 45:11 was already somewhat of an active person to begin with I swam a lot as a kid 45:16 volleyball track but nothing serious until 2014 when I started running thanks 45:22 to the Learn to Run program from The Running Room and it basically evolved from there at the beginning of course 45:28 there were a few challenges the main challenge I found was trying to fit training into an already packed schedule 45:35 I quickly learned that if I wanted to work out I had to plan and make it Priority yes right in the calendar along 45:42 with family commitments housework and professional work etc soon after I started working out 45:49 more regularly I saw major benefits that help keep me going I saw huge benefits 45:55 not just in my type 1 diabetes but in my mental health as well I find I am much calmer clearheaded I sleep better and my 46:03 energy is better if I haven't done a workout that day for whatever reason I 46:08 notice a huge difference I feel way more tired and lethargic so if I don't have 46:14 any training or workouts on a day I make sure to at least go for a walk so I get those benefits that I 46:21 enjoy regular activity does require motivation what I find motivates me is 46:27 being part of a group or a community I'm lucky enough to be part of an amazing team of endurance athletes called LP 46:35 endurance just having that support of people doing the same challenging thing 46:40 you are and having them cheer you on even on those sessions that you are suffering through makes a huge 46:46 difference so if you don't like getting out and moving your body on your own look for a buddy a neighbor or a group 46:53 in your community to help hold hold you accountable and get started and keep going my words of wisdom for those just 47:01 starting out is be patient with yourself and your body start slowly and try to 47:07 notice the progression over time don't get discouraged you will get there and just be consistent and for those who are 47:14 active and are looking to challenge themselves a little bit find that challenge you're passionate about and be 47:20 sure to find the balance of not pushing yourself too hard in a way that puts you in danger 47:26 just like those starting out slow and steady and monitor your progress as we all know diabetes is a big balancing act 47:34 so make sure you're paying attention and learn how to adapt plans don't always go the way you want particularly in sports 47:41 and exercise so don't stress about it and again consistency is key so thank 47:48 you for listening and I hope you enjoyed the session today please join myself and 47:53 the other speakers on November 18th from 2:15 to 3:15 p.m. in our diabetes 47:59 dialogue room to have your questions answered see you 48:07 [Music] then