I started three years ago when I was approaching 16st and realised something had to change…A friend helped me work up a program. He was very clear that to make any difference I needed to exercise for a minimum of three times a week, for at least twenty minutes and that I should get a heart rate monitor to measure that I was exercising at the right level.
I am a big fan of the heart rate monitor as it ensures that you don’t overdo it to start with. I am convinced that many people think they must make a big impact at the start of their exercise program and go for a decent first run that leaves their muscles hurting the following day…requires a day off and then the next run hurts even more! By using a monitor you can get into it gently…by walking or run/walking if necessary...it’s a sustainable way of getting going…and I still use it for every run.

Motivation

It is key to have an outcome goal for your exercise... What do you want to happen as a result? Lose weight…feel fitter...complete an event...achieve a level of performance? Improve your blood sugars…Or something else…?
If you have a goal then it helps you keep exercising. Mine is to keep my weight down and feel fit. This has allowed me now to go no more than a week at any time over the last three years without running and most weeks to run three to four times. I even surprised myself by running three times a week before work (which requires getting up at 6am!!) so I can spend more time with my family in the evenings.

Pumped up Running!

Having been diabetic for 11 years. I have opted for short-acting insulin before meals, combined with long-acting overnight, for most of that time. I appreciate the flexibility of activities, timing and food-types that this regime allows me. It means I fit my diabetes around my life rather than vice-versa. It also allows the opportunity to exercise in a variety of ways without diabetes presenting anything more than a consideration.

My typical insulin requirements are:
Day time (Humalog):
Breakfast (apple & banana): 2-4u
Lunch (sandwich & crisps): 4u
Dinner (pasta/curry/roast): 8-14u
If I have a pudding, or a particularly large portion for dinner my dosage may increase by up to 50%.
Night time (Humulin I*):
after a typical day of moderate activity: 18-24u
*from time to time I take a small dose of Humalog as well, if my blood sugar is a bit high ie greater than 9 mmol/l.
Height: 6’2”, weight: 14st 8 lb
My preferred form of exercise is running, although I also enjoy cycling. In either case the major concern as a diabetic is the endurance factor – maintaining blood-glucose at a safe level, and an adequate level for my energy requirements. The following is with reference to running; as a rule I find the energy demands from running are up to 50 % greater than with cycling.
As a simple rule I undertake 3 kinds of running:

a) short runs (4-8 times a month)

b) long training runs (1-3 times a month)

c) very long (event) runs – these are rare

In all cases above I try to avoid running less than 2-3 hours after taking insulin, so that ‘insulin uptake efficiency’ is not a complicating factor.

a) Lasting 20-45 minutes I will generally run quite quickly (for me! – 8 to 9 minute miles), often off-road and over hilly terrain. Typically I do not find that over the exercise period low blood sugar is a concern. Preparation will consist of a check to ensure my blood sugar is between 7-10 mmol/l, and consumption of a Mars Bar or approximately 200-250 ml Lucozade. For blood sugars outside of that range I will adjust my initial glucose intake accordingly, by up to +/- 100%. Although I take ‘emergency’ glucose tablets with me, they are rarely needed. Upon return my blood sugar is normally 5-9 mmol/l and the ‘honeymoon’ effect of exercise on my blood sugars will last for 8-12 hours afterwards, meaning I reduce insulin dosage by up to 50%, or eat up to 50% more.

b) Long training runs would generally be 1 hour – 1hour 50 minutes. I would typically run more slowly, at about 10 minute mile pace. Preparation is as for short runs, but hydration and re-stocking with glucose are further considerations. I have tried drinking orange juice and water (50/50) en route which provides excellent salt and water replenishment, but generally needs to be supplemented with a couple of glucose tablets every 20 minutes. Alternatively a brief stop after an hour or so and a (330ml?) pouch of a proprietary energy drink will suffice. Frequently after such a run the ‘honeymoon’ effect will last for up to 24 hours (in a diminishing capacity) and for even a substantial meal such as a baguette and crisps I may not take any insulin at all if eating within a couple of hours of return. Night time insulin requirements will generally be reduced by up 50 %.

c) I have run a couple of half marathons and a full marathon. For such distances, preparation and management are the same as above, but it is imperative to maintain hydration and fuel intake for the duration. Hydration is essential and I plan to experiment with adding sugar to my orange juice / water mix for a single source of hydration and fuel. Experience so far is based upon simply extending my management for longer runs, but in practice I find the body ‘settles’ after an hour or so and while I think hydration needs decrease as I sweat less, digestion can become harder. Experiences of having drunk too much lead me to believe that over an hour, little and often is the best approach for hydration; fuelling requirements remain the same. Potentially a greater factor than the distance covered, is the time on your feet. I completed the London Marathon in 5 hours 18 minutes – no records broken then! But I was running all the way and on my feet for all that time. My body went way past anything it had experienced before and ‘hit the wall’ at about 3 ½ hours. Little can be done to address this, what a diabetic can do is ensure that diabetes doesn’t further complicate matters. Following the management outlined above, my blood sugar level after the marathon was 11 mmol/l – about right for endurance sport in my view.