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Sports and Exercise from March 16, 2005
Welcome to CWD's Sports Corner chats with Rich Philbin. Rick's uses his experience in sports medicine and diabetes to help kids and adults with diabetes to do their very best in athletics. Be sure to visit the Sport Corner for great articles about diabetes and sports.
Moderator (server) Wed Mar 16 08:00:00 PM EST 2005
Our Spring Into Fitness - Sports and Exercise chat with Rick Philbin starts at 9pm Eastern.
Our Spring Into Fitness - Sports and Exercise chat with Rick Philbin starts in 10 min in the 'Sports and Exercise' room.
Hi room.
Hi everyone!
is Rick here yet?
wow a new room!!!
Hello everyone~My name is Susan DiVito, I am a RN and I work with Rick Philbin who will be "on" shortly!
hi Sue!
cool when did u make a new room???
i too am an RN, and I am in medical school, Sue. are you a CDE?
Good evening, Everyone! Jeff Hitchcock asked me to please step in and welcome everyone to this evening's chat. So glad I got here before Rick.
see ya
Meghan, Rick will be along soon~word has it that he is stuck in a bit of traffic~gotta LOVE D.C.!
Commander, this is a special chat about diabetes and sports. It will last from 9-10 p.m.
Commander, Rick will be on!
Sue, I am here
hi Laura!
Rick, That was quick!
Hi rick!
Hey everyone! Let's talk sports and/or exercise.
Hey Meghan!
Hi Meghan.
Welcome, Rick! Catch your breath. Thank you so much for leading our CWD chat tonight about Exercise and Fitness... and SPRING! (hmmm - it's still snowing in Michigan)
Rick - I have a hockey question (as always). You up for it?
I have a question about different types of exercise and why my BG does different things. With anaerobic, My BG tends to go up, and with aerobic, it tends to go down....does it have to do with different sources of energy?
Does anyone have any questions?
Meghan, You are correct. Many times with high intensity exercise BGs tend to go up. Aerobic exercise tends to bring BGs down. It also has to do with how much insulin is on board...
Sam has two things he struggles with:
1. Dropping too low before a game (i.e., starting at 150 or so, and by the time warmup is over, he's 70 and dropping; then he stuffs carbs and feels sick);
2. Still dropping down to 40's around midnight or so after he's played hockey that night. This happens even with a snack and turning basal down 30%. So, we turn down even more - and then the next night he doesn't drop at all, but is high instead. There doesn't seem to be any consistency with it. I know Sam feels horrible - and out of control. Suggestions?
I would recommend to test two times prior to a match. Once at 1hr and another at a 1/2 hr to see if you see a pattern and you also have time to make adjustments... You may want to try to be up closer to 175 to see if that helps. Testing a lot around changes is alway recommended.
Billetdeaux, My husband is a varsity hockey coach of a pumper. He finds that his player's Bsugars vary between practices-goes low and the actual game-tends to have highs...is that your case?
Also-the player checks his blood sugar during the game when they cut the ice between the second and third periods
When does Sam turn down his basal rates? We recommend at least 90 mins prior to the game because that is the approximate time his insulin will peak...
why do I seem to have trouble with lows immediately after exercise and even 18 hours later? I thought that if I would eat after running or dance that that should take care of any lows that may happen....
I did get Sam to eat a more complex carb + protein type of small meal prior to games like you suggested last summer - that has helped.
Sue - yep, Sam can be well over 300 after a game. Interestingly, a few weeks ago, he was playing in a championship tournament. It was down to the last 2 minutes, they were down by a goal, and the coach sent Sam on the ice (he's a defenseman). I knew he was high high high from looking at him. Slow response, glassy look on his face. I couldn't believe they sent him out - he knew his bg was nearly 400.
Sam checks bgs frequently before and during the match. In between shifts, Neal has his meter ready for him.
Rick, I don't think he turns down his basal before a game...
Meghan, It is common for BGs to drop after exercise. Some people will drop 4-6 hrs afterwards but others up to 36hrs. That is why it is recommended to snack but it will also replace glycogen stores that are lost during exercise.
Hello
Is the coach involved~ does he know the importance of treating high, lows and how old is Sam-what level does he play?
Hi Becca!
gotcha.
I like that Sam uses food to keep his BGs up because it is important to have fuel (i.e. carbs) for the activity.
Sue, the coach has been working with Sam for nearly 4 years. The Assistant coach is my husband. I'd like to say that yes, they know what they are doing, but I was furious that they put Sam on the ice with a nearly-400 bg. I honestly think that's dangerous. I don't think you can respond as quickly as you might need to with a bg that high.
I won't do any exercize if I am over 250
Got to love the game of hockey and our hubbies who coach-IS your husband the D coach and at that door?
Also - he's 15. Plays Bantam AA travel this year. Moving up to Midget A this spring (now).
Rick, when he starts to drop prior to a game, he panics. Eats/drinks everything in sight (gatorade, tons of glucose tabs). Doesn't give it time to work because he feels the time pressure - he needs to be on the ice with his team. That's one of his most frustrating times.
Rick, if I lower my basal for exercise I then go high after my exercise, so now I don't mess with basals and eat, something I did not want to do when I started pumping,I have now raised my basals after exercise to try to correct this, is that an option
BGs above 240-300 with ketones or just above 300 is not recommended. The chances of going into DKA is much higher.
Can using your brain a LOT (as in studying heavily) consume glucose at about the same rate as exercise? I tend to have a LOT of lows around exam time.
just thought I'd drop in for a while. Sean just finished
basketball a few weeks ago first year with the pump. He had better bs levels this year and now we are waiting for baseball season to start. He started the pump last year June 1st at the beginning of baseball. So hopefully this year goes well.
and how much do you recommend lowering your basal for exercise?
Becca, That is a good rule to follow. Make sure you drink a lot of water to help clear ketones...
Sue - Hubby runs the offense lines. Luckily. :) However, he keeps an eye on Sam's bg and should know better about putting him on the ice when high or low.
Sharon, YEA for basketball, that's my sport. I am glad things are going well.
Rick, I start producing ketones at 300+ but I just feel my strongest to either run, or bike 250 and below (feel the best between 130 and 170)
The parents of a boy (age 10) that I coach in baseball tell me that soccer tends to give him high BG and basketball tends to give him low BG. Why the different response to what seems to me similar exertion levels ?
Reese, After checking with your health care team a good starting point is 50%. The time may vary depending on the type of exercse and how long you are going...
Sharon, where will Sean wear his pump on his uniform? Last year I heard of a few kids sliding right onto the pump and smooshing the screen!
Bill...in the "thick" of the game...anything is possible! How about the D coach is he aware thAT HE SHOULDNT OPEN THE DOOR AT ANYTHING OVER 250!
Becca, Your 130-170 range is good. I try to be at 150 prior to playing basketball.
rick when you lower your basal for basketball and go into playing at 130 do you still have to eat during the game?
John, That is strange because you are correct that they use similar energy systems. Does he play longer or start out faster comparing one against the other?
He wears the pump on the waistband of his pants on his non
sliding side. Between his sliding shorts and pants so it is on the inside of his pants More toward his back than on the side. Worked last year and I am hoping it will work again
a few years ago, in college, i had an incident where I started my last season of field hockey (varsity college) and we had 3 practices a day in addition to running and lifting...I had perfect sugars, but I ended up in DKA anyway. The answer I got is that it was a bad insulin vial. my sugar was never really over 200...
Nope. The D coach is the type who puts the wrong shifts out - or has the wrong number of players on the ice - keep track of Sam's bg? No way. But Sam and Neal should have an agreement that beyond a certain bg level, being on the ice isn't safe. Or... Maybe MOM should sit on the bench.
hi
Bill...Keep score or run the clock...this way YOU would have a say...ask me how I know!
I'm not sure. I'll ask them. I assume baseball is easier to maintain steady BG ?
HI stacey!
Stacey! Hi!
did momma laura treat you ok???
Sharon, I have used and recommended for contact sports a pad cut out to the size of the pump. Another pad (not cut out) over top of the other pad with the pump inside. An Ace bandage or secured in biker shorts will help protect the pump.
yes....I had a wonderful weekend
Rick, with summer coming and and the use of the beach increasing...do you recommend the untethered method?
Stacey - I made Meghan test her bg a lot, and I taught her how to cook. And neither of us worked out all weekend...
John, You may be correct as long as you are not cutting back on insulin (if that is the case) like you would with basketball.
rick, thanks for the heads up. His sliding shorts are like biker shorts so it does help hold it pretty tight.
As he gets older I'm sure it will become more of an issue.
But he is only 9 and plays against 9 and 10 year olds.
John, in highschool and then at uni, with soccer I was drinking gatorade spiked with Karo to prevent lows, for I would always durring half time be in the 40's and 50's. But with competitive swimming, I was the other end.. 200+ and they would only allow me 3 events (100 free, 100 back and 500 free or the 400 IM)
Ok, Sue... I'll bite. How DO you know? (sounds like an experience to share to me!)
Meghan, That is something Steve Edelman, an endocrinologist with Type 1 diabetes has done. Basically he uses about 70% of his basal with glargine and the other 30% through the pump. He can keep his pump off for several hours while he is boating and swimming. I would not recommend anyone doing that without consulting your doctor...
Bill...Iknow that all 3 coaches would put my "sweet pumper friend" on the ice at any number, so consider me the "watch dog"!
Becca, Maybe you found swimming more stressful since it's more individual pressure ?
Becca, Many competitive sports cause BGs to go up due to the hormonal activity. Drinking a lot of water and maybe even some stress release activities prior to and during activies will help...
We just got back from jesses D support group.. 2 hrs of laser tag... and he didnt go low, only went to 91, which is good... I've figured it out... 60% decrease starting an hr before the sport... and only bolus him for 75% of his food. He does this for gym and basketball too... then he keeps lifesavers in his pocket for a quick pick me up...
Sue/Rick - I guess I wonder about this short term high bg, though. I'm sure it's adrenaline causing it - it's not longterm and comes down fairly easily after the game; so would you pull all diabetic athletes from the middle of their sport for an adrenaline-induced high? I remember Gary Hall, Jr saying that he was well over 300 in the few seconds it took him to complete a race. Adrenaline. So, do you stop the sport right then and there - and treat - or do you stop for a second, treat, and then go right back in.... ???
Last summer with the pump start we turned down the basal rate to 60% for 1 hour pregame, during the game and 30 minutes after for a total of 4 hours. He always ran high.
During basketball I did not turn it down at all and he had good numbers but would have lows hours later. Never predictable. I am going to start baseball and not turn down the basals to see what happens then adjust as needed.
Sharon-good thought , you always have to start with a base line and work it from there
300 BGS... That is a good question which may have a couple of answers. If I had a 300 BG prior to an event I would want to know that 30 mins before not just before. I would give some insulin and drink water. If just before I would see it come down to say 240 I would go ahead and compete...
Sharon, It sounds like you have a good plan. I'll bet you experimented with it until you found out what works best. Test, test, and test...
My daughter is newly diagnosed type 1, and she plays indoor soccer, she is 11. I found right after her games she is quite high, do we treat that or wait 30 minutes?
sue, thanks. I hated him being high all the time, but we were just starting the pump. Now that I've had a year I am more willing to adjust and try things to see how it works.
Stacey, You are right on target. Sometimes you will hear 50% of pregame bolus but 75% sounds like it works for you. Remember this is an individualized disease...
Ok, Rick... but what if your bg was 170 prior to the event, and then 20 minutes into it, you were 300 from the adrenaline? That's the situation I'm asking about. Stop, treat, and wait? Or stop, treat, and get back into the game right away...
this may sound weird....when I run a treadmill, my sugar stays pretty good till after I am done, and when I run on a road (outside) I tend to start going high...and the longer I go, the higher I get...is this just something that deals with intensity of exercise?
I also am not good about checking before I run...I "just do it" and deal with the consequences...
meghan- maybe you're getting dehydrated???
Nataliesmom, I would first check with your health care team but if her BG comes down within 30-60 mins into a better range I probably would not treat it with insulin. If it takes 3-4hrs I probably would but always snack once it gets into a good range. The snacking help prevent lows and also restore glycogen lost during exercies.
i have honestly never thought about that. in which situation...on the road or on the tready?
Meghan, Sometimes it is the adrenalin "rush" Think about it on a treadmil...blah. Out on the road, the difference is looking around dealing maybe with cars, etc Somewhat like a games practice sessions compared to the intensity of a game
The best answer is stop, treat and wait... In the real world unless forced to most kids will not wait. If that is the case push water, test within 20-30mins.
hydration must be a key in this. One of the CDE keeps telling me to push the water into Sean. How much water should a 9 year old drink during summer/ baseball?
i don't really "feel and adrenaline rush" but i do know about the "runner's high"...same hormones or different?
oops..meant "Feel an adrenaline rush"...
Ok. We'll try that. Treat, hydrate, let him back on the ice, test in 20 minutes. If it doesn't work, we'll have to recruit Sue to run the clock...
Sharon, The general recommendations around activity is 16oz and hour prior, 8 oz 1/2 prior, 4-6 oz every 15-20 mins during...
Meghan~Same hormones just different circumstances
gotcha
WE have found that after most exercise her number are low within 90 minutes. Would treatment with insulin be wise if that is the case?
Sharon, I don't find that baseball affects my daughter that much. No constant running, etc. Soccer and tap dancing are the only ones I do differently right now. Treat her for highs during game/dance, then give her temporarily low basal around bedtime for two hours.
Bill...where do you live, what state?
I guess I should tell you she is on Humalog at meals and Lantus at night, no pump (yet)
Nataliesmom, Whether she is on a pump or shots it may be wise to decrease insulin prior to and yes even after if she has low BGs. I will decrease my insulin by 50% for 6-8hrs after exercise...
Yea but sean is on the infield, sometimes pitching or catching. Involved it it all. And he does not stand still when he's outfielder either. Always moving, backing up the infield etc. The most he sits still is when his team is batting and he does not get up.
I see Rick, thanks.
so if I do an untethered thing, and I turn my basals down, would I need to decrease my Lantus as well? or just turn down the basals?
Sue - I'm in Michigan, outside Ann Arbor.
hey all
Rick thanks for the guideline for water. They all just kept telling me make him drink. He would but them he had to run to the bathroom when his team came in to bat. Maybe this will work out better.
Megan, Email me and I will send you an article on this... rick.philbin@animascorp.com
Hi Monkey!
hi sue
Amber is on injections...she sometimes goes low about 1hr after gym and sometimes she doesn't. Why? Could it be just the amount of energy used differs from each class?
In sleep, after play of her games, or strenous exercise in general, she is waking and is not sure why, she is not sweaty, would that be a low?
Oh by the way...hi everyone
how old were you when you were dxd
I still have the one you sent me a few months ago on the untethered regime...is this one different?
Hey Melanie, Do you play any sports?
Hello. This all seems so confusing. How does one go about figuring out whether to give carbs, how much, when? Or turn down basals-how much, when and for how long?
Rick..anyway you can hook me up with the "Lara Takes Charge" book. I requested it via email but since I am from Canada I was denied. It looks like a great book for my little daycare kids to read so they understand why Amber is being tested..etc.
what pump does amber have melanie
Monkey are you asking me?
Michelle, The general rule is to eat 15 grams of carbs for every 30-60 mins of exercise.
Michelle, I have wondered that too. when DOES one lower basals vs. giving food?
My daughter Amber is hoping to join soccer this year. She also loves to give the boys a run for the money in gym class and on the playground...gets that from mom
Rick, If I am not low to start, can I just decrease my basal and not eat?
Melanie, Email me with your address and I will send you one. rick.philbin@animascorp.com
Monkey...Amber is not on the pump though after playing the game "Pump Expedition" online she is a bit more curious.
better go all
good night
Meghan, Yes, but I like to eat to have energy to exercise...
We were taught that but now the Dr doesn't want us to just fill him with carbs and start lowering his basal.
Thanks Rick...I'll do that.
my big fear is weight gain....I see it as taking in 100 or 200 extra calories and having to work that much harder to burn those calories.
Dylan is going to start playing hockey this summer. Do we plan to turn down basals ahead of time and give carbs?
Michelle, It is all about BALANCE!
Is Billetdeaux still here?
We are just about at 10:00, which is the official close of this chat. I want to thank Rick for leading the chat this evening, and also for his wonderful input to CWD in so many other ways. This chat room will stay open for another half hour or so if you'd like to continue to talk. Not sure if Rick is able to stay on or not...
Anyway, thanks for chatting everyone! G'night.
Michelle, That is what I do. You basically have three choices to eat carbs, turn down basals, or a combination to the two...
meghan- its me jesse- hihihihihi
Goodnight Laura!
Thanks Rick.
Good night everyone
HI Jesse!
So it is all trial and error to find the right mix?
Informative...thank you.
Since I showed up one minute before the chat I will put in a little extra time
Michelle, This disease is an art not a science
Which just makes it all that more frustrating......
I hate art!
Meghan, Even finger painting?
that gets messy, just like my control....!
what usually ends up happening with Dylan is we under or over treat him for his activity.
how is it one can have normal blood sugars, but in the midst of intense exercise end up in DKA?
Meghan, I think I have heard of some organization called Taking Control of Your Diabetes
speaking about your control.... have u done an A1C lately??? Mommma # 2 speaking!!!
how often does something like that happen?
yes...5.3
waht does that mean, rick?
yea right......
Hi Rick. Sorry I missed the chat. Not much to contribute though since Marissa is not getting too much exercise these days.
Actually, I do have a quick question? How many laps around a standard high school track make a mile? I just got back from soccer practice with non-D Kathryn. Practice field is at a school where there's a track. I hope to walk around the track when it's not so dark. Practice field was lit, but the track wasn't.
it was!
pump will do wonders for that number!
Meghan, The body recognizes exerecises as a stress and releases hormones (i.e. adrenaline, epinephrine, etc) which tells the liver to produce glucose causing BGs to go up.
Rick, Dr. Steve Edelman runs Taking Control of Your Diabetes. He often travels around the country and has what I'll call expositions. Never been, but Jeff has.
I cant believe it....
hI Brenda! Most outdoor tracks are 4 laps to the mile
Brenda, It is good to hear from you. I will get Marissa in Sports Central at the conference in Orlando and make her exercise... 4 times around is a mile...
Thanks Meghan. Practice is 2 hours so I should be able to do 4-8 miles depending on how I feel.
considering I am low a lot...that causes low a1c numbers
that is awesome Brenda!
Brenda, I know Steve very well. He is a funny guy. I like to hear him speak whenever I can...
its also 1/2 of the previous one...
most of the time my fasting BG is about 80....it is the Post prandials that tend to kill me, and when I am not ont he pump, the fastings tend to very high
Rick, she doesn't have too much time with school, work, tutoring, volunteering at the animal shelter, and having a social life!
that is what the lab said....
Well, thanks for being here to answer questions, Rick. I'm signing off to catch up for the 3 hours I was out at soccer.
good night Brenda!
Brenda, Goodnight... I will see you in Orlando this summer! Tell Marissa I said hi!
It was more than just half of the other one, Stacey!
I've got to go to ... and get Jesse to bed... he's watching South Park...ugh.....
Rick...about how fast is your mile time?
good night Mom Stacey!
Megan, In high school my best was 4:50
Rick - see you in Orlando.. You're now officially on Jesse's favorite person list...
what is it now?
Meghan - see you next month-
my high school best was a 5:17...
yup. see you then
Hey Rick, I am a high school wrestler, (yeah your probably cringing) butwhen i go on the mat ill be like 140 where i try to be before a match but when i get off im like 400, i dont want to take insulin before because i dont want to go low, any suggestions?
Rick...I am want to out run you (or a least stay with you) this summer on the fun run....
I want to thank everyone for coming on tonight. I had a lot of fun. And I want to thank Sue for helping me out with the chat. Check out the Sports Column on this site for other tips on sports and exercise.
good night rick....any chance I can out run you?
Brian, Wrestling is a tough one to control BGs. It is such a high intensity sport. How long does it take you to come down after a match?
30 min with a shot
Megan, In your dreams
i am working on it!
Brian, I would not worry about it. My guess is if you tried to go any lower prior to exercise you may run into low BGs... Drink water too afterwards.
okay, thanks
Goodnight everyone...
i run everyday, and can sustain a 7 mph on the tread mil for about 30 minutes.....
good night Rick...see you in Orlando!
thank you so much for coming out Rick!
hey all. any pump users out there
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Last Updated: Friday March 18, 2005 10:50:22
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