Fitness training: ADA recommends

The American Diabetes Association gives good advice on how to avoid low blood glucose (hypoglycemia) during exercise.

Blood glucose measurement

Timing: Exercise 1 to 3 hours after a meal. Blood glucose is at its highest.

Insulin peak: Don't exercise when your insulin injection is peaking. If using rapid-acting or regular insulin, this means avoiding sports in the first 1 to 2 hours after injection.

Adam Morrison

Insulin absorption: Exercise increases blood flow, which speeds up how fast insulin works.

Duration and intensity: If your activity is moderate to high intensity, or if it's moderate and long, consider decreasing the insulin dose that's working while you exercise.

Blood glucose response: Build up knowledge and experience of how your blood glucose responds to different types of exercise. Monitor blood glucose (BG) often: before, during, and after activity.

Insulin injection

BG stable or dropping: If you are going to be doing demanding exercise for a long time, check your BG 1 hour before you begin, then check 30 minutes before to find out if your blood glucose is stable or falling.

Eating during exercise: you might need to eat during or after sporting activity if you work out hard, or if it lasts longer than an hour.

Length of BG reaction: You can have a blood glucose reaction up to 24 hours after exercise, depending on how hard or long your workout.

Diabetes advice

By Alan L. Rubin MD, Type 1 Diabetes For Dummies gives clear, easy-to-understand explanations and advice on living with type 1 diabetes.

This is an excellent choice for busy parents of kids with type one diabetes.

Missy Foy: ultra marathon runner

Running on beach

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David Weingard talks T1DM

Missy Foy is an elite athlete with T1DM who competes in one of the most demanding disciplines on earth: ultra marathon racing. On her superb blog and website, she explains in detail how she lives and trains with diabetes. Here is an extract in which Foy explains her daily training and treatment.

I use an insulin pump along with Lantus. Usually, in the middle of the summer and sometimes in the middle of the winter, I'll switch from relying mostly on an insulin pump to relying mostly on injections.

The main reason for this switch is because of how the weather extremes ruin my insulin in the pump cartridge during these times of year.

Sometimes I switch from one insulin delivery method to another for a more personal reason (for example, injections because I'll be on the beach in my bathing suit; the pump because I'm at a dinner and don't want to pull out a needle).

I use about 20 units of insulin per day, sometimes more, sometimes less. I don't use much insulin with the basal rate on my pump because I use Lantus along with my insulin pump.

I take 7 units of Lantus in the morning, 1.5 units at about 2:30, and 2 units at bedtime. I have pronounced dawn phenomenon and the pump works best for that because I can change the delivery rate to compensate.

With Lantus alone, I have to get out of bed within 9 hours of my bedtime shot and get another shot of Lantus (and sometimes a half unit or so of Humalog) or my blood sugar will start climbing rapidly (it can jump from 90 to 250 in 90 minutes in the morning).

My insulin dosing is completely intertwined with my training. I run every morning and I run most afternoons.

As my training and level of fitness increase during a season, I can cut back on my basal rate (or Lantus) but not by much (maybe a unit or so during the day).

The biggest difference I experience is in the timing of meals and boluses. The more mileage I run and the better my fitness, the longer the time needed between a meal/insulin and my training run in the afternoon. My morning runs are not affected as much (the dawn phenomenon).

A typical day:

  • 5:30am, bg 67, Lantus 7 units, Humalog 1 unit, coffee
  • 8:00am, 10 mile run easy
  • 9:20am, bg 114, Humalog 2 units, scrambled eggs and cheese
  • 11:30am, bg 146, H 1 unit
  • 2:40pm, bg 102, L 1.5 units
  • 4:15pm, Half Met Rx bar
  • 4:30pm, 5 mile run
  • 5:15pm, bg 100, Humalog half unit
  • 6:30pm, Humalog 4 units, dinner
  • 8:45pm, bg 119
  • 9:15pm, bg 137, L 2 units

I usually check my blood sugar eight times each day, but have checked it a lot more.

I feel more comfortable micro-managing my blood sugars. Despite the fact that there really isn't any scientific data that proves that this level of micro-managing is beneficial, I feel better about my control (and my mental health with respect to diabetes is very important to me).

When I don't run, my meal-time insulin needs go up. For example, the same breakfast without running might require 4-5 units of Humalog.

In the afternoon, I absolutely have to eat something before I run or I will bottom out (and sometimes I still need a little bit of carbohydrate gel if I run more than an hour).

One very important item that I want to mention is that I absolutely always wear an ID anklet that states that I am a diabetic on insulin and I always carry a packet of carbohydrate gel whenever I go running. Carbs -- donâ't leave home without them!

By David Hay Jones. With thanks to Missy Foy. Please visit Missy Foy's training blog.

(Fact-checking: This information has been double-checked against The American Diabetes Association recommendations in its American Diabetes Association Complete Guide to Diabetes: The Ultimate Home Reference from the Diabetes Experts and Alan L. Rubin's Type 1 Diabetes For Dummies, both of which are excellent resources.) Thanks also to the New York Times.