Keeping it personal.

TrainerMy new gym offers a complimentary personal training session when you join, and although I explained to the owner that I don’t usually book those type of things because of my unique health situation, he encouraged me to take advantage of it. He even went so far as to poll his trainers to see if anyone had worked with a Type 1 before. Not surprisingly, no one had, but I truly appreciated his willingness to go the extra mile.

The reason I’ve never worked with a personal trainer is A.) Because they’re expensive and B.) (and more importantly) I’ve never found one who truly understands the unique exercise needs of a Type 1 diabetic. Many, if not most of them have worked with Type 2s because they often see clients looking to lose weight and manage their Type 2 diabetes at the same time, and we know these two things can often go hand in hand. But very few of them understand Type 1 athletes and how they differ. Still though, I booked the appointment and figured I’d get a good workout in. The trainer I met with was cool and knowledgeable. I liked her story too, because she’d taken control of her health and her life after a bad car accident eight years ago. The conversation started off alright regarding me having Type 1,  but then this happened:

“So do you notice any big drops in your blood sugars when you’re working out? Like do you just plummet at any certain time?”

I explained to her that my bigger problem is actually high BGs after intense morning workouts due to liver-induced flushes of glucose with in the inability to counter-regulate them. I told her that I didn’t experience any noticeable drops in blood sugars unless it was an extraordinary workout, like a half marathon and if that was the case I would likely have already lowered my basals in anticipation for the lowered need for insulin.

She nodded with a look of somewhat understanding, but quickly changed the subject.

“It sounds like you have a good handle on you diabetes then, which is great. Is you overall goal to reduce your insulin needs then?”

We talked through that one too, and I let her know that no, I don’t need to lower my overall insulin needs as I’m someone who consistently works out and eats pretty much the same. I added that if my needs ever start to go up that could cause weight gain and I’d like to avoid that. So really consistency is what matters for me, as well as overall health and wellness. Again with the nod and understanding.

I don’t think this trainer had any bad intentions whatsoever. I think she was incredibly smart, fun, good at what she does, well-trained for her profession, engaging, caring, and that she created an interesting workout for me. But there is still a giant bin of nuance that comes with exercise and Type 1 diabetes that is difficult to explain at best, and really not worth bothering with the explanation unless, quite frankly, you’re talking with another Type 1. It’s too difficult to explain that my lack of the hormone amylin is what makes jogging in the morning a high BG situation by 10am or that having IOB can ruin a good weightlifting session if you’re working the muscles you infused or injected in. There’s so many little tweaks and odd things that come along with being a Type 1 athlete that it’s tough to find a non-Type 1 that really gets that and can help you work through it. The best resources I’ve ever had for exercise have been you guys and other people living and working out with Type 1.

So, that’s why I haven’t really ever worked with a personal trainer. That, and back to point A: They’re really freaking expensive!

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Wait, amylin is the reason for post-workout highs? I thought it was glucagon. Teach me!

I don’t think you can really expect ANYONE to know how exercise works with Type 1, even other Type 1s. We’re all different. I go low during bicycling, cross-country skiing, and walking, to the point that I really avoid doing either if I have any bolus on board. Even without bolus on board, I pretty much have to eat 4-16 carbs every 45 minutes or so.

Jogging/running is the opposite: I go high unless I have insulin on board, so I make sure I have at least half a unit going when jogging and running.

So that’s how it works for me, except when it doesn’t work that way. Seems like at least once a year I go high while biking, and not because I’m biking harder/easier/differently. And sometimes I go low when I run. If I can’t figure it out, I doubt anyone else can either!

I go low when I go running while I’m using my pump. If I take a pump break and use lantus then I can run forever and not go low!
I’m jealous that you don’t have lows when you exercise…but not jealous about the after workout highs. The joys of diabetes and figuring out the un-figure-out-able!

Hey AJ! Amylin is the thing that can STOP a post workout high. When you workout, your liver releases glucagon to provide energy for the workout. When you’re done working out and can get energy from food, normal bodies release both insulin and amylin from their beta cells. Insulin, obviously helps remove sugar from our blood stream and converts it to energy. Amylin, however tells the liver, “Hey, stop producing glucagon, we’re done working out here!” Since our Type 1 bodies don’t produce insulin or amylin, it can’t tell the liver to shut up when we’re done working out. Hence, we go high. The only solution for that is to take Symlin, which is the synthetic version of amylin. Which works great, but it’s another injection to take so it can be a little annoying.

Ginger Vieira has a good book called “Your Diabetes Science Experiment” which talks about exercising and weightlifting with T1D. I just finished reading it and I really enjoyed it-some good info 🙂

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