The Diabetic Athlete

Because New York winters are cold, rainy, and sometimes snowy, working out in a gym is almost a necessity. Not to mention sunrise near 8am and sunset at 4:40pm is debilitating to the mental game of getting outside before and after work.  However, going from 8+ hours at the office sitting at a computer, talking on the phone and eating – changing gears to workout mode can through you out of wack.

For the diabetic athlete the working out poses an interesting challenge.

• Carbs on Board: Carbs consumed before, during and after the workout
• Insulin on-board: Insulin used before, during, and after the workout

For the insulin pump user there are a handful of key issues to think through:

• Temp basal pre-workout, during workout, post workout (timing and percentages for three distinct stages)
• Optional disconnect during workout

All of these types decisions rest on a few key decisions: your personal insulin resistance, Insulin on Board, Carbs on Board and the type of activity you intend to take on.

The diabetic using Lantus actually might have it a little easier — since the basal adjustments are not a factor until an injection takes place – and you can feed your basal carbs as needed.

For an easy example, let’s say I have no carbs or insulin on board and have a BG of 120. Potentially a perfect way to start a workout, but it still requires a little more work. If I plan to do 30 minutes of reasonable cardio (say 10/min mile pace on the treadmill) and lift for another 30 minutes, I will have a low BG if nothing is done. One option would be to eat carbs prior to the exercise in an amount and time that would counter act the exercise to. A second option would be to run modify the basal 30 minutes prior to the exercise (to artificially increase the BG) and during exercise either disconnect or run another lower basal during exercise. Neither is a foolproof system nor you will find that most pumpers will utilize a combination of the above, since even in our simple example it becomes complex rather quickly.  Especially with disconnecting a pump, because a lack of basal can be debilitating when you reconnect (and somewhat scary if you bolus immediately after reconnecting after a workout to “replace” the basal).