Exercise is the double-edged sword of type 1 diabetes management. Though there may be zero doubt about exercise’s comprehensive health advantages, the actual practice of exercise will be exceptionally difficult for blood sugar management. Diabetes, to place it simply, can smash your workout, and exercise can change a gentle blood sugar day right into a roller coaster.

The Type 1 Diabetes and Exercise Initiative (T1DEXI) was founded to assist individuals with type 1 diabetes get exercise and blood sugar management right. It’s the most important real-world study of exercise in type 1 diabetes yet performed, and has been designed to drill deep into the info for insights that regular people can put into practice.

Mike Riddell, PhD, a professor of kinesiology and health science at Toronto’s York University, helms the initiative. Dr. Riddell and his team recently published their first evaluation of the brand new data, and it’s chock filled with high-quality observations that regular individuals with diabetes can put into practice. He was kind enough to walk Diabetes Day by day through the work.

Listed below are a few of the key takeaways:

Exercise affects us all in a different way — really, really in a different way

It’s difficult to overestimate just how variable the effect of exercise is. Your diabetes experience might be radically different from another person’s.

Riddell’s work has generally confirmed what we already knew in regards to the impact of exercise on blood sugar — namely, that exercise tends to cause blood sugar drops, and that cardio causes larger drops than high-intensity or strength-building exercises. But it surely’s one in every of the primary efforts to evaluate the dimensions of variability.

The brand new evaluation showed that half-hour of aerobic exercise caused a median blood sugar drop of 18 mg/dL, and resistance training caused a drop of 9 mg/dL. Riddell doesn’t want you to deal with those numbers:

“I don’t prefer it when researchers show averages, and make us consider that we individuals with diabetes should behave like the common. We actually don’t.”

The more essential finding was that margin of error was vast. Aerobic exercise caused a drop of 18 mg/dL plus or minus 39 mg/dL, meaning that almost all participants fell somewhere inside a really wide selection of -57 mg/dL and +21 mg/dL. A sizeable minority had much more extreme responses than that.

The upshot is that the common experience is practically meaningless to anyone person. It form of mocks the thought of ordinary management recommendations. All we will really say is that your response to exercise could also be unique, and that you just’ll must test your blood sugar.

Remember, these are real-world numbers, they usually include all the messy variables that go into diabetes management — differences in insulin use, carb consumption, baseline glucose level, and so forth. Your blood sugar behaves very in a different way during a jog when you chugged a Gatorade before starting. Should we assume that some people experience extreme blood sugar effects due to their other management habits?

Riddell told me that his team is working on a brand new evaluation, as yet unpublished, that can likely show that surprising blood glucose effects are sometimes consistent inside anyone person. This accords with my anecdotal understanding: I even have an acquaintance with type 1 diabetes who needs to make use of insulin immediately before a workout because her blood sugar levels at all times go up during cardio. (Mine at all times go down; if I were to make use of rapid insulin before a jog or hike, it could put me within the hospital.)

“Clearly some people have an increase, even with aerobic exercise.”

The wealth of recent data allowed Riddell to isolate recent aspects explaining these inconsistencies.

“What’s novel is that since the database is so big, we will start to grasp why there’s variability. And what we found was pretty startling.”

Surprising blood sugar variables

Most of us know the fundamentals. Carbs make your blood sugar go up, insulin makes it go down, and exercise can supercharge your insulin sensitivity, causing any insulin “on board” in your body to have an especially powerful effect. Adrenaline, meanwhile, can spike your blood sugar, which causes some athletes to experience blood sugar rises during essential competitions.

T1DEXI has revealed some recent variables of which we were previously unaware:

• People in good condition experience larger blood sugar drops during exercise.

This was a counterintuitive finding, in no way what Riddell expected. You would possibly have thought that frequent exercises were more inured to extreme blood sugar effects, but the reality was precisely the alternative.

Riddell speculated that “people who find themselves fitter — they’ve a bigger muscle mass, they use glucose more efficiently — they need to use up the glucose within the bloodstream more quickly.”

The more you’re employed out, the more glucose-lowering advantages exercise might need.

• Individuals with lower A1Cs experience larger blood sugar drops during exercise.

One other counterintuitive result! “If you may have the next baseline A1C,” although you may have more room for improvement, “you truly drop less.” Riddell suspects that “may be because individuals with the next A1C have less insulin sensitivity, but we don’t know.”

Nevertheless, this was one other finding suggesting that the glucose-lowering power of exercise just gets higher the more you engage in it.

Any style of exercise improves time-in-range over the subsequent 24 hours

Riddell told me that the strength of this effect was “really quite startling.”

“On days by which volunteers did half-hour of exercise, their time-in-range was significantly better in comparison with sedentary days. Much, significantly better. We’re talking about 5 to 7 percent higher.”

If the study produced a single piece of evidence that everybody with type 1 diabetes needs to be exercising usually, this was it. Work out today — any form of exercise — and luxuriate in steadier, healthier blood sugars tomorrow.

“I feel it might need to do with a short-term improvement in insulin sensitivity, but we don’t have the mechanisms sorted out yet.”

“Slightly little bit of work pays off in the long term. Do as little as half-hour, you possibly can expect to see an improvement in time-in-range.”

Morning exercise leads to the steadiest blood sugars, by far

Exercising within the morning, before you eat breakfast, would be the best strategy to lock within the glucose-lowering advantages of exercise while reducing your risk of hypoglycemia.

“I feel that’s critical. That is actually a secure time of day to be exercising. Hypoglycemia is an enormous threat whenever you exercise later within the day.”

There are probably several aspects at play. For those who work out before you eat breakfast, you won’t have any mealtime insulin in your system. Morning exercise may counteract the blood sugar’s natural tendency to rise within the morning, often known as dawn phenomenon. Even absent those aspects, this time of day seems to simply be more conducive to regular blood sugars.

“We’ve a few of the most effective biostatisticians working on this data, they usually’ve convinced me that point of day is independently an element, independent of insulin on board.

“It’s a secure time of day to get a little bit of exercise in, as in comparison with later within the day, whenever you’re more insulin sensitive and you would possibly have more mealtime insulin circulating.”

Takeaways

Recent research from the Type 1 Diabetes and Exercise Initiative shows that exercise improves blood sugar levels over the next 24 hours, and that the more you exercise, the more powerful its glucose-lowering effect.

Exercise can have an enormous immediate effect on blood sugar levels — an effect that is very personal and varies widely amongst individuals. The morning, before breakfast, appears to be the safest time to exercise, resulting in the steadiest glucose concentrations.

It’s essential for everybody with type 1 diabetes to know the way their bodies reply to several types of exercise in order that they’ll take part in this vitally healthy habit without undue risk of hypoglycemia.