If there is such a thing as a legendary diabetes educator, then Gary Scheiner is it. I've had the pleasure of meeting with him at various diabetes events, and let me tell you, just sitting down to breakfast with this guy is an education.
Having recently returned from the Diabetes Exercise & Sports Association International conference in Toronto, Canada, I find myself inspired by the athletic accomplishments of so many people with Type-1 diabetes. What's even more inspiring than their ability to compete in (or simply complete) so many challenging events is their ability to manage blood glucose levels under some of the most demanding conditions. We're talking about mountain climbers, Olympic swimmers, Ironman Triathletes, cross-country cyclists and champion bodybuilders, just to name a few. Definitely inspirational stuff.
What leaves me less than inspired is the continued lack of attention given to physical activity in determination of insulin doses. We all know that physical activity impacts insulin's effectiveness and blood glucose levels. But think about it:
Which blood glucose meter has an easy method for entering physical activity into the meter's memory? Which pump incorporates an exercise adjustment into the dosing process? How many logbooks have designated space for recording physical activity? How many downloading programs include physical activity in the reports/displays?
Since its inception, the American Diabetes Association has proclaimed Insulin/Medication, Food/Carbs, Exercise/Physical Activity and Blood Glucose Monitoring to be the cornerstones of diabetes management. Plenty of attention is given to adjusting insulin based on carb intake and blood glucose levels, so where's the beef when it comes to adjustment for physical activity?
Like many of you, my exercise varies from day to day. I experience major blood sugar drops during certain forms of exercise, mild rises from others, and delayed drops following prolonged/intense activities. Even at work, physical activity plays a role. When I spend lots of time sitting at a desk, my blood sugars tend to run higher. When I'm up and moving around a great deal, they tend to run lower.
Because physical activity affects both hormone levels and the body's sensitivity to insulin, adjustments need to be made.
When activity increases, mealtime bolus insulin usually needs to be reduced. When activity decreases, boluses need to be increased. It's a lot to think about! And that doesn't even touch on necessary adjustments to basal insulin during and after heavy exercise.
The trouble is, short of thinking about it constantly, we just don't have very good tools for making these adjustments.
Wouldn't it be nice if the logbooks included with each meter had space to record physical activity? It would be much easier for us (and our healthcare teams) to determine appropriate dosage adjustments. Same with the blood glucose meters, continuous glucose monitors, and downloading/analysis software.
And wouldn't it be just wonderful if pumps incorporated an activity multiplier into the bolus calculations? How simple it would be to add 20% to a bolus if an "evening in front of the computer" is planned, as opposed to a 33% reduction for an after-dinner bike ride.
At this point, we have two jobs to do:
1. Talk to the representatives of the device companies (pumps, meters, CGMs, software) about taking physical activity seriously when designing their products and accessories.
2. Until that happens, THINK ACTIVITY every time you make an insulin dosing decision. Sure, it's one extra step. But it's easier than counting carbs, and you learned to do that, didn't you? I sure hope so! (If not, I know a great book you can order: The Ultimate Guide to Accurate Carb Counting. Author's a genius, and an all-around good egg. A bit preachy, but a good egg.)
Nice to know that Gary also offers his special brand of diabetes education consulting remotely, via phone and Internet, from his practice Ingegrated Diabetes Services outside Philadelphia, PA.