FUDiabetes

Exercise Strategies -

Well, I for one have been following the swimming thread and have been learning and I would like to start a thread to discuss what the successful strategies are for different types of exercise.

The strategy that was taught to us by our CDE was to raise the blood sugar with carbs before and during, and try to anticipate the drop. This works, although the drawback is you often end up really high when trying to follow this advice.

For baseball (2-3 hours long) which includes short bursts of high intensity exercise and long periods of medium to low intensity exercise we have been using 50% basal and then testing every 30 minutes and adding insulin or sugar when needed. This has worked well.

In the swimming thread the approach, which I am assuming works well for all long duration endurance sports, is to try to enter the activity at a normal safe blood glucose with as little onboard insulin as possible, thereby preventing the activity from dropping your blood sugar.

What other approaches do people use that work?

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A lot of different ways to do it, but it really depends on the sport. That advice may work well, but it may not be the absolute best.

So depending on the sport, here are a few general ways that it can be done (and then we can get into baseball specifics):

Feed the basal - you have a certain amount of basal running that may drop you low, but you are able to take frequent small amounts of carbs. This is good because the carbs provide energy. This is something that can be used for a long bike ride or run, as long as you have carb access. But you need the discipline to make sure you keep taking the carbs throughout the activity.

Fuel the activity - you take small amounts of insulin at specific times, and then take fuel for that. This is more for things where you NEED fuel, like 2 hours runs, and can’t rely on muscle glycogen alone. The problem with it is making sure the insulin you take matches the fuel amount.

BG prediction - starting with low IOB and low enough basal and high enough BG to make sure you don’t drop. This is for times when you can’t fuel and take insulin. This is what Daisy Mae is doing because it’s hard to take fuel and insulin while swimming! This is kind of what your CDE is suggesting

But…for baseball, there are several advantages you have. The dugout time gives you an opportunity to correct. Many times during a game. The downside is that they may not be predictable - if the other team is shelling your pitcher or the other team’s pitcher is shutting you down, you may not have a lot of time in your dugout compared to field time.

Another possible advantage in baseball is the ability to take carbs on the field. Catcher right? How much access would he have to a Gatorade bottle? Or some small candy in his pocket? As much gum chewing as baseball players do, seems like getting carbs throughout the game is not too difficult, right?

Here is where the feed the basal approach may be useful for baseball. As long as you have reasonable access to carbs, they can be taken as needed. Some games will be more intense, will need more. Other games will require less. But feeding what you need is easy.

If you can take carbs reasonably well, within a reasonably predictable time, you can manage this way.

I would encourage every dugout break to include a BG test, as long as he is not needing to head directly to bat. And dugout breaks give him a Gatorade opportunity. Also, I can set you up with some easy testing tools for that.

Don’t view it as managing 2-3 hours. Just manage it by innings. Always try to stay level until the next inning break. Even an occasional walk to the mound for a pitcher “conference” could be an opportunity to take a piece of candy if needed.

Yes, I like the names you give them. We are feeding the basal. So we changed from 100% pump basal to 50% Lantus and 50% pump basal, then when warmups start he removes his pump. We try to get him to the game with a bg around 120-140, although we have managed as low as 90 and as high as 200. Then prior to the start of the game he tests and then gives insulin or carbs, or nothing depending on the result.

He then tests every other inning and continues to adjust. With that strategy we have prevented all but one low during the season (and the low was in the second game of the day during a hot tournament weekend where they played 7 games in three days). The other nice part is he can be disconnected from the hardware, which is good, because we trialed a few omnipods and both of them failed during play.

That has worked well. Now what would we do for extended bike riding, I am guessing Feed the basal since eating is allowed.

Another thing worth mentioning - baseball is not a game that requires a meal beforehand to play at your best. It is not the same as a basketball or soccer game that requires glucose uptake from the blood to be able to fuel the activity.

The short bursts of energy that last less than 10 seconds use the phosphagen system (ATP and CP - adenosine triphosphate, creatine phosphate). Unless he’s hitting a lot of doubles or triples, he’ll mostly stay inside the ATP-CP system.

So eliminating IOB is certainly something that is doable. If you can schedule meals at least 4 hours before the game when possible, that would make BG during the games a bit more predictable. Do you try for something like that?

Most of his games are at 6:00 pm, so we could not feed him, but he plays better if we eat dinner at 4:00, it is certainly something worth trying. We may not feed him for a couple of games and see if there is a difference. On the weekends, it isn’t possible since the games get scheduled all over the place. This weekend he has a 9:00 am and 12:00 pm. So he will be warming up and playing from 8:00 - 11:30 and 12:00 to 2:30. Tough to make that work for a 14 year old.

this is exactly what my endo and cde told me to do. it was impossible. i would eat a chocolate/peanut butter protein bar and wait about 1 - 2 hours for my BGs to go up to 200, and then would head for the pool. i was told that i should not begin swimming until i was at least 180. i didn’t want to have and IOB before working out, so i skipped lunch and just had an early bfast. i would drop from 200+ to around 60 in the course of a 1 hour swim.

it wasn’t until i met with eric that i learned that i was swimming with plenty of IOB–namely my basal. and that’s where my journey began. thats how the “swimming thread” started. its been one heck of a ride, and it continues to be…every day.

don’t give up. you’ll figure it all out. just remember : exercise? eric is your go-to guy :blush: .

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