I was trying hard to figure out what was going wrong with my appointment at Joslin. I went through a minor saga to get approved to visit an exercise physiologist, and I had arrived with a bunch of thoughts and questions about how to get the most out of my training within the constraints of diabetes. But it wasn’t going the way that I had hoped.
Specifically, I wanted to share some of my recent BG readings during exercise and to get answers to these questions:
- How do I better balance food, bolusing and exertion so that I have fewer surprise events like in New Bedford?
- I would like to start in the 100-150 range and end there, too. What changes can I make to do that?
- How long before i start working out should I eat so that the carbs affect my blood sugar at the right time? 15 minutes? 30 minutes? Longer?
- How often should I eat while training?
- Since I train a lot, how do I keep my energy up? Am I depleting my glycogen stores? What’s a good way to replace them?
- Any tips for doing a triathlon?
- How can I get better results from my CGM when I’m running?
I did get a couple of concrete tips and the promise of some e-mailed reading material, but mostly I heard a lot of “Yeah, that’s tough” and “uh huh.” The appointment wasn’t really going anywhere for me; I know that everybody’s diabetes is different, but I also know that people can do what I’m hoping to do.*
Then — almost at the very end of the appointment as the exercise physiologist was going back and forth to the printer to get me some materials — he handed me a copy of the DESA Challenge newsletter with Ginger Vieira on the cover.
“Hey, I know that person. Well, virtually know her. She’s great!”
“Really? So you probably know all this stuff already.”
“Kinda. I’m here to find out how to get the most out of my limited training budget, so that each of my workouts are as productive (diabetes-wise) as they can be.” I was sure I said something like that at the very beginning of the appointment.
“Oh, you need a coach.” I did my very best to keep from growling. (People who know me know the growl I’m talking about.) That kind of expert coaching advice was why I was there.
That’s when I realized that we had a mismatch in experience and expectations. I don’t think he knew how much I already knew about exercising with diabetes and that I was there mostly for fine-tuning. And I didn’t know until I got there that they weren’t really oriented toward supporting athletes with diabetes.
Now, I did get some useful advice, but I had to push back on a few things, sharing my concerns that if I ate more and took more insulin beforehand to cover it, I would see even larger drops in my blood glucose. I seem to be very sensitive to insulin when I’m active at all. I also said I wasn’t satisfied with the 70-100 mg/dL downward changes during exercise after he said that my exercise results sounded “great.”
So I’m frustrated. I like a lot about where I am with exercise . . . especially in the mornings, but I’m having difficulty tackling that last 20% of the athletic experience. I just wish I had correct expectations up-front so that I wouldn’t have had to take off work and travel into the Fenway area on the day of the Red Sox home opener only to have a less than excellent experience.
Ironically, the most concrete, actionable piece of advice I got was to connect with specific athletes with diabetes online, including a couple that I’ve already talked to. We don’t have medical degrees, the same knowledge about what’s in the research literature, or anywhere near all of the answers about why things work the way they do, but we seem to have a ton of insight into what might work and what certainly hasn’t worked for us.
Nevertheless, I’m also going to send in some of my exercise data, as requested — I actually brought in descriptions of four recent workouts, although we didn’t go over them — and see what happens. Nothing ventured, nothing gained and all that.
After getting home this afternoon, I took a much needed run to unwind (and because my training plan said to). As if to underscore the reason why I sought out extra help, my BG dropped 130 mg/dL on a rather short, relaxed 3-miler. Next time will be better.
* — I was super unhappy (and it probably showed) when he suggested that the Team Type 1 rider who told me this was certainly doable — since it was possible for him — might not be telling the truth. You don’t badmouth my role models without proof.