Training with diabetes

[thrivebodybalance]

As I expressed briefly in the introductions board, I am not a diabetic, but am a physical trainer and nutritional consultant that is preparing to move towards training diabetics to help minimize related health risks, and help my clients manage their blood sugar. I have come here to get the experiences and opinions of new and experienced diabetics so that I can ensure I give my clients the best help possible. I am also here in the hopes to offer any of my own expertise that any of the forum members may be curious about. I am several months from taking on diabetic clients, and am not yet a diabetic specialist in any way, so may seem ignorant on certain aspects of diabetes.

I do have various specific questions I am looking for input on from diabetics, as well as some endocrinologists and diabetic specialists I am corresponding with, but because I wish to learn everything possible that may end up making me a better trainer for my clients, please feel free to add anything remotely related you think would help from your experiences or knowledge base.

Also, please say what type of diabetes, if you inject, and any related health variables if you are willing to share, that may be pertinent to your response! Feel free to answer some, all, none, or bring up something else entirely, I know I am asking a lot of questions.

To start the most general:

-For those of you who have or do exercise with diabetes, are there any general tips you have for people wanting to exercise in making sure they don't go hyper or hypo during/after? Also any other tips for any diabetics that are about to start an exercise regimen.

-What have your favorite activities been (be it based on enjoyment and or related results) when it comes to exercise to manage your condition?

-What have you specifically not liked, or not found helpful?

-What have you found of all your exercising experience to have helped the most with your health and condition, and in what ways?

-Have you used a trainer before (be it as an outpatient in some kind of physical therapy, diabetes clinic/hospital, or just in a gym), and what did you think of the experience? Was your trainer knowledgeable with diabetes? Was he/she helpful to your health and diabetes in particular? What was your favorite thing about working with a trainer, and what did you dislike/want to change about it/the trainer most?

-What kind of changes have you seen from exercise on your overall health and condition, including any changes on injection amounts/frequency, resting glucose, and any other specifics if you are willing to share), be it on your own or with a trainer.

-If exercise is part of your treatment, what has made you decide to include it, and how happy are you with it so far? If it is not part of your treatment, is there a reason it is not? If it was but is no longer, what made you decide to stop, or stopped you from continuing?

-What have been the greatest difficulties in training for you? How did you overcome, manage, or get by with these difficulties?

-specifically how do you manage your injections or other medications during or around sessions?

-On a different track of thought, what is your nutritional regimen like if you have one, and what do you think has made the biggest differences for better or worse?

-Are you seeing a dietitian or other nutritional consultant, and what do you like/dislike about them and or the process?


So that’s what I'm most curious about off of the top of my head, but would love any additional input as to what might make for a better experience for my clients, myself, and the safest and greatest results. I really appreciate all input given, and those who took the time to read such a long post!



To health and happiness.

 

[Elc1112]

Wow. That is a lot of questions! I think what you're doing sounds great so I hope that the below helps...

I have type 1 diabetes and was diagnosed when I was 6. I'm now in my late twenties. I inject four times a day. As well as diabetes I also have coeliacs disease, which means that I am allergic to gluten. Other than that I am (touch wood) pretty healthy.

I exercise at least five times a week - for health and because I enjoy it (much as I sometimes moan about it!). I run, cycle, go spinning, attend body combat and body pump classes. I also go to the gym and use the various machines etc. although I find I get more from the classes (I need somebody shouting at me to make sure I really push myself!).

I had an operation last year and was unable to exercise for four months. Nr only didn I feel unfit, but I felt generally tired and down on the dumps. I realise that some of this may have been post op blues, but I believe that a large part of it was due to lack of exercise. I also found that not exercising caused my weight to shoot up considerably. Like many insulin dependent diabetics I find it difficult to lose weight. This can e very frustrating and is something that has not been understood or even acknowledged by personal trainers that I have seen in the past.

Right, onto your questions:

I always test my sugars before I exercise. Most GPs will tell you not to exercise if your sugars are above 15 as the exercise can sometimes cause them to rise even further. If I am completely honest I don't always abide by this rule, although my sugars do not generally get this high. If my sugars are high and I decide to exercise I make sure I have gallons of water to hand. I will always have lucozafe or glucose tablets or something sugary with me in case mt sugars drop. If my sugars are toward the low end of the normal range before exercise then I will usually have either some lucozade or a banana. It really depends how my levels have been throughout the day. If, for example, they are 6 then I will probably have half a banana before going into the gym. If, however, they have been running high during the day ad have suddenly dropped to 6 then I will be much more cautious. No hard and fast rules, just common sense. Wong diabetic or so long I just don't even think about it half the time! Main advice I would give is to make sure you have stuff with you (in case of high or low sugars) and make sure your gym buddy, instructor, trainer etc is aware.

My favourite exercise is cycling. During the summer I will often do 50 plus miles on the weekend. I dot ind this exercise to be any more beneficial to the management of my diabetes than other exercises, I just enjoy it. I'm typically a fan of high intensity sports/workouts. I dot find that I get much - nor do I enjoy - low intensity workouts such as yoga or Pilates. His is purely personal preference though.

The exercise that I do keeps me healthy. If I don't exercise then I adjust my insulin and I don't find thy this has a direct impact upon my diabetes. I do, however, feel better when I am exercising regularly and, with all the potential complications that diabetes can bring, it seems only sensible to stay as fit and healthy as possible!

I have worked with personal trainers in the past. Always through a gym or privately. I haven't found any that are particularly knowledgable about diabetes. I haven't found that this has deterred from the training plan itself, but it has sometimes been difficult to explain why I am sometimes unable to exercise, why I need to take a break or why I don't lose weight as easily I other clients. I've enjoyed working with trainers who can incorporate a range of exercises into my routine - outdoor sports, classes, gym workouts etc. The trainers that I have found the least helpful are those that advocate x sessions a week in the gym doing x minutes on this machine, x reps here etc.

I've always exercised quite a lot so it's difficult to say what tw main changes are in terms I insulin requirements. I do have I adjust my insulin depending on what exercises I am doing, but not by much. I also have to think about how many carbs I am going to have to eat to cover any given workout. The main benefit to me is the 'feel good factor'. Exercise makes me feel better, it's a good source of stress relief, I enjoy it.

Never experienced any real difficulties when it comes to training. I can be a pain if I want to go out running and have to carry tuff in case my sugars are too high, stuff in case they drop etc. I don't feel, however, that my diabetes has ever sipped me from training and I don't intend to let it do so in the future.

I follow a low carb diet. If I am exercising I will usually need more carbs to compensate. I monitor my sugar before and after (sometimes during depending on the length of training session) and take action as and when needed.

I don't see a dietician but I have in tw past through the NHS. Didn't find the session useful and I discarded a lot of the advice as I don't feel that it was right for me. It would be useful to did a trainer who understood diabetes and could recommend appropriate and linked meal plans.

Anyway, I hope that this helps. Please excuse the typos - small keys and big thumbs! Any other questions then please ask

Emma

 

[thrivebodybalance]

Even after years of exercising as enjoyment, vacation, and now health and profession, I can tell you we’re all entitled to complain about it!

Metabolism is highly complicated, more so in those on medications and with various conditions. A quick list of variables that can affect it just through hormone regulation include: stress, radiation, sleep, medications, conditions, current weight, current diet and dietary composition, chemical exposure, mental state (mood), exercise type intensity and frequency, time of day, body composition, genetics, age, health of many specific organs, etc. etc.

I can identify on the post op down time as well. A couple years ago I was in a taekwondo competition, and blocked hard into a kick, snapping my ulna. I was out of exercise for 4 months (the fiberglass cast was far too hot to allow me to exercise, I’m heat intolerant) and then business needs kept me very busy. I was out of action for more than 6 months and gained at least 20 pounds! It definitely makes you feel near sick for the fatigue, among other things.

Aye, exercise, especially at higher intensities, can raise BG as the body floods the blood with sugar so that muscles and organs can use it for activity. The more intense the exercise, the more glycogen and glucose is put into the blood stream.

I’m a big lover of cycling myself, being one of my favorites, though I’m dying to try kayaking! A lot of people certainly have similar preferences, but interspersed high and low-moderate intensity tends to work for everyone so they get a bit of whatever they need without overdoing it as appropriate case to case. (I do live by yoga too though! My girlfriend is a yogini though, so it comes with the territory).

Aye, exercise even if you don’t need or use it for diabetes, as is more likely with type one, there are so many complications that can be far worse, and exercise is the magic bullet for most of those.

Unfortunately most trainers the world over are poorly trained, mostly reading a book/online materials and taking a test and then starting. Luckily I have a far better background and aspirations in research/future degrees. Sadly when it comes to specific conditions and diseases that are so exercise and nutrition linked, many trainers still don’t bother to do their research! Doctors too! And in general most of them, due to bad education and the cookie cutter systems they are taught with, tend to be very by the book, when every client is different (part of why it appeals so much to me).


I do really appreciate the input! Thanks for taking the time to answer and contribute Emma!

 

[Daibell]

Hi. Good to see a trainer on the forum seeking and offering advice. My feedback as a Type 2, one of the 20% who aren't overweight or insulin resistant. I make this point as the range of diabetes types is a continuum and not just the two types we all know about. Not being overweight or insulin resistant my gym regime 3 times per week is not to reduce weight but maintain muscle tone, flexibility and possibly produce a bit more insulin and/or use up some of the spare glucose in my blood one way or another. In answer to some of you questions:

1) For those who are on insulin and new to Gliclazide tablets then use of a meter before and after may be essential until experience is gained in the risk of hypos. Gliclazide prods the pancreas to produce more insulin. Going hyper during exercise is very unlikely and would need to be severe anyway to be noticeable?

2) I select exercises not specifically related to diabetes but try to use the jogger for cardio/glucose burn and resistance kit for flexibility due to age

3) I don't have a favourite activity but find the jogger helps keep my blood sugar down due to the calorie burn

4) I haven't used a trainer over the years and can't really say how my gym exercises etc have helped with my diabetes except I'm sure my overall blood sugar has been kept down a bit

5) Sometimes my jogging has been limited recently by feet problems having inherited flat-feet and have recently had plantar faciliasis and tarpal tunnel type issues. I suspect these are not diabetes related but I've reduced my statins in case and diabetes is known to cause some foot isssues but I don't have any apparent neuropathy.

6) My nutritional regime is low carb intake and I have low GI, high fibre carbs when I can. I don't worry too much about fats. I guess I have reduced my overall food intake since diagnosis partly due to carb reduction and partly due to the Metformin which reduces the appetite; I also don't get carb 'highs/cravings' any more.

7) I have never been offered or seen a nutritionist. I have very negative views on the majority of nutritionists/dieticians. If the press or corporates are typical then they tend to offer the same, very questionable advice to diabetics as for 'normal' people. First, diabetics don't process glucose properly hence need a diet tailored for that. This means reduced carbs and low GI. The mantra about needing starchy carbs with every meal to keep the brain working is total nonsense. The mantra to keep fats really low is not really relevant for diabetics (or even everyone?) as they provide the calorie intake needed and fats aren't necessarily the cause of obesity; carbs often are. Having low-salt is another boring mantra. When I was young we were drowning in salt in and on food and a few of us survived! The recommended daily calorie intake for most people is far too high unless you work out a lot. So, the challenge for a nutritionist is to research up to date knowledge from across the world that is really evidence based and tailor it to the diabetic bearing in mind that the advice needs to vary depending on the diagnosed type and sub-type and the degree of diabetes; not easy. I think you can help by guiding us on how the bodies metabolism varies with exercise and the key factors which we need to take account of. Thanks

 

[thrivebodybalance]

Thanks for the response and input Daibell!

Unfortunately most health professionals of all types are trained poorly in outdated and inaccurate 'health truths,' which is the same for doctors, trainers, nutritionists, and most all others. As a trainer looking to set up a network of related professionals to refer my clients to I have specifically 'interviewed' numerous professionals in any given field or tried their services so I know they are up to date progressive thinkers that will actually put their mind to an issue instead of just going by the book and by memory. I am going to be a registered dietitian in a few years, at least this is the plan, so have a hell of a lot more nutritional background than most trainers, which gives me the capability to have a bit of an educated perspective on nutritionists and the nutrition industry in general, and I can say it is probably the worst in the health industry.

I would suggest to anyone looking for anyone in any health field to 'shop around' to find some one that fits their preferences, needs, background, and even personality. My partner has undiagnosed, what we believe to be secondary progressive MS, and have had to deal with inferior doctors far too much. What is particularly pertinent in the case of this discussion is in the medical field there is a maxim, which I find highly unethical and inappropriate in the way it is actually employed, or at least the extent to which it is used. "When you hear hoof beats, think horses not zebras." This is a large reason why many people go undiagnosed, or misdiagnosed, because Occam's razor has been taken too far in a place it does not belong. In particular, most medical professionals (but not all) are very book based, do not continue as much education as they should, shun not-traditional schools of thought. This makes many of them minimalists that are very narrow minded, which presents problems for the general public, let alone people with conditions like any chronic or auto-immune diseases, especially neurological problems. If you are a percentage of one of these groups, it becomes exponentially more difficult.

So, my suggestion after all this rubbish, is that if you should find yourself in need of a given professional, educate yourself enough to know if some one is worth your time, and shop around. For diabetic purposes, find a diabetes qualified nutritionist, especially if they are proponents of vegetarian diets, even if you aren't, as they are less likely to be stuck in the current paradigm of medical miss-thought, being more open minded and as I like to say, more like a nutritionists version of a diagnostician instead of a script writer.


So that little tiff of mine aside, I myself have plantar fasciatis, it is a chronic inflammation of the tendons on the bottom of the feet and can be a real annoyance to get rid of, but as far as I know there isn't an extra risk of that through diabetes, but I may be wrong so consult a specialist. Carpal tunnel is indeed an increased risk.

I really appreciate your particular perspective, and am very glad you chimed in! This is all being quite helpful.