What Causes Stress and Relieves It at the Same Time?

For me, one of the few things related to my diabetes that induces stress yet also is something so very necessary for me is exercise. I love going to the gym, to a spinning class, or even (yes) a cardio workout class (which is often 20 women, a gung ho aerobics instructor, and me).


The classes are great because they are an hour of intense exercise and push me more than if I were to try and get that level of workout in on my own. I feel wonderful after a hard workout. The exhaustion reminds me of running cross-country or of cycling competitively in college.

Yet preparing to go to the gym, as well as the few hours I’m there and then the hours following an intense workout, often causes me great anxiety. I know, I know: Hundreds if not thousands of professional athletes out there with diabetes handle it just fine. And, also, there are thousands of people with diabetes who exercise at levels way beyond what I do at the gym three or four times a week.

But that’s them. It doesn’t necessarily lessen my fear of hypoglycemia.

Maybe I just don’t know enough about living with Type 1 yet. You have to remember that I’ve yet to, um, celebrate(?) my one-year diagnose-iversary. I tell myself that, in time, I’ll figure out better ways to handle it. I keep thinking there’s a way to do something prior to working out that would help keep my blood glucose levels elevated (around 150 mg/dl), but not too high. Eat more? Remove my insulin pump sooner?

See, I’ve fallen into an exercise routine that’s far from ideal, yet it is working. I’ll disconnect my insulin pump about an hour before I go to spinning class (I’m taking these classes in the evenings now, instead of the mornings). It will have been several hours since lunch, up to five hours, so on the way to the gym I’ll drink a bottle of Gatorade or eat a PowerBar. I’ll warm up for about 20 minutes on the bike and try to ensure that my blood glucose is above 150 mg/dl before kicking up the intensity.

I may be able to make a change for the better—but the unknown, what might happen if I screwed up, and the consequences of hypoglycemia keep me keeping on with my own status quo. But with a blood glucose level too high, there’s a risk of hyperglycemia. And then there’s worry because I’m still not sure when I’ll hit my second low (it’s not as pronounced when I exercise at night as it is when I exercise in the morning).

But I’m handling it. And I know experience will help, as will talking to other people with diabetes who exercise often. Sometimes I feel as if it might be a good thing to hit that low threshold, to see how far I can go. Although I know (I know) it’s never smart to flirt with hypoglycemia. Yet there’s a part of me that wants to know just how far is too far.

But I’d never intentionally push it to hypoglycemic levels. And so I’ll have to continue to wonder if, when I check my blood glucose 40 minutes into a 60-minute class and it’s at 110 mg/dl, it means I’m heading down into a low if I keep up the intensity. I’ll have to estimate how much Gatorade or other carbohydrate drink to take in. When I check my blood glucose level and it’s around 80 mg/dl (toward the end of a workout) does that mean I should stop exercising? Or, can I just ease off a bit, load up on some carbs, and continue on?

Will there ever be a point at which I’ll be able to exercise and not think about my diabetes?

Probably not.

I’ll confess that before writing this week’s entry, I didn’t go to any of the forums or do Web searches about this issue. Yeah, I’ve read about it before. I know there are many places to go for advice on how better to ensure that I have adequate carbs on board for high-endurance activity. But this is me being lazy, passive-aggressive toward diabetes. It’s easy to stick with what works. I know I’ll figure it out eventually. Heck, I may even get some comments on this post that clue me in.

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  • Jason

    As a recently diagnosed type-1 like yourself, I have the same questions. I’ve been trying to start a cardio workout regimen, but the last 2 times I’ve gone, I’ve been flirting with hypoglycemia. It’s not that I’ve gone in casually, without thought or preparation. It’s more that there’s not a lot of information on the web for how to do vigorous exercise with diabetes. Skirting hypoglycemia and the adventure of adjusting basal levels that night is sketchy.

    I just started on the pump a week ago, so being able to stop or lower my basal rate instantaneously will help a lot. However, what are safe target BGs to shoot for during exercise? I started out targeting the beginning of a workout at 120 and rising. Still, not quite right, but trial and error is definitely no fun.

    Would be great to find some solid strategies for cario workouts for us insulin-dependent diabetics.

    Love your posts — so nice to hear another newly-diagnosed T1 going through the same stuff.

  • Eric L

    Hey Jason,

    Thanks for the nice words. After I wrote this post last week, I decided to experiment more with my routine. In addition to disconnecting the pump about an hour before working out, I found that eating a Clif Bar (around 35-40 g/c), WITHOUT bolusing for it, about 45 minutes before intense exercise begins gives me a good base to help complement the 80 or so carbs’ worth of Gatorade or other carb drink I hydrate with during my hour of spinning, etc.

    I always target at least 150 mg/dl before exercise and I don’t worry at all that it’s higher than my average target of 120 mg/dl. I don’t worry when it’s near 200 during a workout, either. (But I’m not going to want to go much over 200 during a workout.)

    I’m also finding that the more intensely and consistently I exercise, the more my insulin takes effect–I’ve actually lowered my basal doses through the pump slightly over the past week, and I may have to do it again.


  • Diaraj716

    Interesting reading. I never worry about a low DURING exercise because the harder I workout, the more my Sugar goes UP. A Cliff Bar or Gatorade would make me skyrocket!! My problem is that I’ll be OK for about 2 hours after the workout, then BAM! I’ll drop 50 points in 15 minutes, out of nowhere. Like today, I ran 5 miles this morning, ate breakfast with enough insulin to offset breakfast at 8am. I was 102 at 10:40, then in the low 50’s around 11. What a confusing disease (Type 1 dx 7-16-2007)

  • Margi

    Ah, exercise… I used to jog ~3mi and my blood sugar levels would drop ~80pts. That’s changed. Walking has a moderate effect right then, but not in the long term (hours later). With bike rides, I undershoot by 1-2 units, follow my carb:insulin ratios, eat, ride for ~1 hour (med. intensity), and at the end my levels are okay. Recently, I’ve been swimming 45min M-F. I’ve had to decrease my AM and PM Lantus by 1-2 units. It’s hard predicting where my levels will be (dawn effect?), but my rule of thumb is to eat ~15 g C if <120, jump in the pool if 120-220, and if >220 I inject 1-2 units of Humalog depending on the level and how long I anticipate swimming. I’ve seen my post-swim numbers decrease by ~90pts, be practically the same, and increase by ~30pts (am still working out the kinks). I notice a slight effect on my after breakfast and before lunch numbers, but there’s a much more obvious response following lunch and I’ll see lows if I’m not careful with my carb:insulin adjustments.

  • Dani

    I have also found it VERY helpful to exercise at least 2 but preferrable 3-4 hours after having a meal (its the quick acting insulin that gets me). If I excersize within 1-2 hours after a meal with quick-acting I drop like a rock when i start up my Zumba (dance fitness) – 100 pts in 10 minutes a few times. But if I haven’t had a meal for 3-4 hours and I have a snack I can start out my workout and end almost in the same place – very dramatic difference. I also test about every 10 minutes because there seems to be always something new and nothing I can totally rely on.