Thursday, June 28, 2012

The Idoitic nature of diabetes and exercise.

One of the primary issues that I, personally, have with my diabetes is the fact that I lead an active lifestyle.  I expect that concept may be especially hard to wrap your head around for those of you who are more familiar with type 2 diabetes, however to those of us dealing with type 1 this irony is all the more frustrating.

Without the pregnancy factor, diabetes creates many issues for exercise because of the body's use of glucose for fuel.  When we exercise, our body burns whatever sugar is in our system to keep us moving and when it runs out of excess glucose it then turns to burning fat for fuel.  In a diabetic body, however, when the body runs out of glucose to burn and swaps to burning fat, the remaining active insulin in your system (which is working far more efficiently because of your exercise by the way) has nothing to counter-balance its effects. This means that you become hypoglycemic... I'm sure everyone has heard of someone or another passing out as a result of exercise, this is as a result of that imbalance of insulin to glucose-fuel.

That being said, prior to exercise a diabetic has to get their blood sugar up high enough (pre-pregnancy I'd ideally shoot for the 180s-190s) to counter balance this fuel usage and insulin efficiency.  I've found that if I get my sugars up high enough for a run that I can typically run about 2 miles before my sugars are back into the 70-80mg/dl range.  If I wish to run more than 2 miles (which I typically do), then I must ingest even more sugar.   When I ran my half marathon back in December I consumed four 12 oz water bottles of orange juice (12 oz of oj has roughly 57g carbs) - aka a ludicrous amount of sugar - in order to complete the 13.1 miles and my blood sugar still went low after the race was over (56 mg/dl).  Good thing they had food waiting for me, eh?

There is a huge community out there of type 1 athletes struggling with their blood sugar's impact on their individual sports.  Fortunately it is not a be-all, end-all problem and we each seem to come up with our own ways to balance insulin dependence and activity.  I've been quite inspired by several many of the endurance runners who blog about their experiences and the challenges they've faced... I'm hoping that I'll be able to step up and do a marathon at some point and join the ranks of the serious "insulin powered" runners.

Unfortunately, for the time being, I've been benched.  Exercise during pregnancy is already restricted to some extent (whether women listen to their OB's advice or not is another topic), but insulin dependence and pregnancy significantly restricts what exercise is safe.  There are two main factors I now must consider:

  1. To start with, as I mentioned previously, I cannot let my blood sugars get too high during pregnancy without running the risk of causing damage to the baby.  So instead of letting my sugars get up to 180 like I did before, I have to keep them at or under 120 mg/dl which means that hypoglycemia as a result of exercise is far more likely to happen and far more quick to happen than previously.  
  2. On top of that, I cannot let my heart rate go above 140 beats per minute or exercise for more than 30 minutes at any given time.  This is because the oxygen my heart and lungs require to function at higher heart rates would deprive the blood going to the baby of necessary oxygen which, worst case scenario, could a) deprive the baby of oxygen or b) cause the temperature of the womb to rise enough to cause the baby distress. 

Obviously, I feel that fetal distress and birth defects are worth skipping the extra mile of running or sit up, but that does come with a different set of knock on issues.  Like I said in my initial blog post, I've been struggling with the "fat girl" identity since high school and the concept of putting on weight (pregnancy-induced or not) is very uncomfortable for me.  According to my perinatologist,  I've put on an appropriate amount of weight so far, but with such an intense insulin usage I cannot control the excess weight gain as a result of my exercise restrictions... In order to get my sugars up high enough to work out, I typically must ingest about 130 calories of carbs (ie: 8 oz of milk or 5 starburst or 3 oz of soda, etc) and in the 30 minutes of approved exercise time I can typically burn only 160-200 calories due to the heart rate restrictions I must adhere to.  Anyone who can do basic math here can see that the number of calories ingested to number of calories burned don't tend to work out in favor of weight management.

HB argues with me that the action of exercise is worth the effort even if the purpose of exercise isn't achieved... I admittedly can see his point in terms of heart function and continued active lifestyle, however the frustration of balancing diabetes, pregnancy and exercise is enough to make any type 1 woman who is given a hard time about excess weight gain come to tears.  In any pregnancy - high risk or not - doctors recommend gaining between 25 and 35 lbs because that is all that is necessary for the baby, but more insulin means more glucose storage and more glucose storage means more fat and more fat means higher weight... not exactly an easy cycle to wrap one's head around.

I know that pregnancy is ephemeral and with the help of Sean T (by the way, I LOVE HIM) and a half marathon or two I'll be back in my original fighting shape after the baby is born.  Between now and then I'm not sure how I'm going to find a balance to the sick-cycle of insulin and weight gain, but I expect I'll have a few emotional break downs and extremely self-conscious moments about my weight.  I will need to keep reminding myself that "the baby comes first" (obviously) and that a more simple day of balancing "just" diabetes and exercise is at the end of the tunnel.

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