Ask D’Mine: Know Your Glucose, Hardcore Workout Friends

Step right up, please, to our new diabetes advice column, Ask D’Mine.

Send us your diabetes questions! No matter how simple, strange, or possibly silly they might seem to you. There’s no such thing as a dumb D-question, they way we see it.

“Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com” (or you can send us your queries via Twitter)

By now you’ve gotten to know him, and we hope you love him like we do: your host, veteran type 1, diabetes author and community educator Wil Dubois.

Na Eun from Pennsylvania, type 1, asks: When my blood sugar is low, should I have something sugary like a candy bar, or just something high in carbs like a Clif Bar?

Wil@Ask D’Mine answers:

Do you want me to tell you the truth, or do you want me to tell you what you want to hear? The right answer is neither.

OK, pocket check! Everybody pull out your emergency glucose!

I’ll put money on the fact that 90% of you aren’t carrying the “proper” sugar for a low. Why? Because you should be carrying glucose, not sucrose, not fructose, not dextrose, not lactose, and most certainly not high fructose corn syrup. You are all sooooooo busted.

OK, here’s the deal, glucose is the sugar your body runs on. Now, your body can do a pretty darn good job converting any other kind of sugar into the right stuff, but it takes a little time. I submit that when your blood sugar is low, time is the one commodity that you simply don’t have.

Neither candy bars or Clif Bars have glucose.

And on top of that, many “sugary” candy bars are not only made of the wrong sugar, but also have other counter-productive ingredients, at least when it comes to correcting low blood sugar. For example, a great many candy bars contain chocolate. Yum. But chocolate contains fat. Fat actually slows down the absorption of carbs into your system, slowing down the recovery from a low. There are a lot of good reasons to eat a candy bar, but a low blood sugar is not one of them.

For lows you should use glucose and only glucose. In solid form, glucose comes in pasty-tasting chalky tablets that are usually 4 or 5 carbs a piece and “bits” for the sub-compact PWD that are one carb per bite. Personally, I prefer my glucose in liquid form, and generally carry a couple of two-ounce bottles of the stuff, which contains 15 carbs in a couple of swigs. Fast to ingest. Fast to hit the system. No blah chalky mouth. But one warning: open the safety seal in advance. Shaky hypo-hands won’t be able to. The top lid will keep it from leaking and unscrews easily when the you-know-what hits the fan.

Oh, and glucose also comes in pastes and jells for little children or for your loved ones to use on you if you are too low to swallow but aren’t unconscious enough yet for a glucagon shot.

So why do so many of our kind hit the candy, the juice, the cereal, or the all-you-can-eat midnight buffet when we are low? Mainly, because we have an excuse to act badly. And because glucose is boring. My liquid only comes in Lemon Lime and Berry Burst. Not very inspiring flavors, and I’m sick to death of both of them. But this is medicine. I just try and be grateful that it’s not cod liver oil. Also, glucose is expensive — well, more expensive than candy anyway. But if your glucose spending is really having a big impact on your disposable income, your insulin therapy probably needs adjusting.

And of course, another reason not to carry candy is that you’ll probably eat it when you don’t need it. I’ve never heard of someone getting the munchies for their glucose tablets.

This would probably be a great time to review The Rule of 15.  This rule states that when your blood sugar is low, you should ingest 15 carbs, then wait the longest 15 minutes of your life, and check your blood sugar again. If it’s going up, even by only a little bit, stop! You are done. There is absolutely no need to eat five bowls of Fruity Pebbles on top of those glucose tabs.

If you’ve had a really bad low, some solid food is in order, but it should be properly bolused for. Yeah. I hear you. Shooting insulin as you climb out of a low sounds crazy, but if you are eating you need insulin, otherwise you’ll end up on the other end of the spectrum in an hour or two: on top of the world, but not in a good way.

Tracey from Oklahoma, type 1, asks: How can you find a T1 specialist who supports diabetics doing endurance sports (marathon, triathlon, etc.?). I’m having a tough time.

Wil@Ask D’Mine answers:

First off, let me be clear: you’re making all of us couch potato type 1s look bad, damn it!

So even though I think you endurance sports types are not doing the rest of us any favors {wink, wink}, and even though and even though once my wife reads this she’s going to realize that there’s no reason I can’t carry out the trash, I’m going to help you out anyway.

Here’s the secret truth: diabetes doesn’t need to slow you down. T1s climb mountains, serve in combat, fly planes, win Olympic medals, run, swim, bike, and do just about every other crazy-ass sport you can imagine. But you do need an enlightened and experienced doctor and/or coach to get you there.

Actually, Amy’s written a lot about this topic here at the ‘Mine. For example, please see the three-part guest post series by some of the country’s top experts on diabetes and exercise here, here and here.

As you might gather from those posts, a great place to start is with Fit4D, the country’s premiere personal exercise coaching service for people with diabetes. It is run by David Weingard, a type 1 who’s committed himself to “navigating the challenges of this condition” for hardcore-workout-types.  He’s a veteran of numerous running events and triathlons — including the infamous Ironman! — and also a really nice guy. If his team can’t help you, we’re not sure who can.

Other great places to check in are:

• Insulindependence, a diabetic athletes’ organization with both an online social network and a physical network of local workout groups
• DESA, the “official” Diabetes Exercise and Sports Association, offering local chapters, meet-ups, and conferences around the country
• Diabetes Training Camp, which was featured in Newsweek a couple of years ago. This “boot camp” for diabetics is run by Matt Corcoran, another hard-core T1 athlete who happens to be and endo and CDE as well.
  

Also check out the series of books by diabetes & exercise specialist Sheri Colberg-Ochs, including the Diabetic Athlete’s Handbook — very handy.

If you like cycling, there’s also Team Type 1. They are a disgustingly athletic, driven, active, healthy, and all around too-perky group of young men and women who like to push the boundaries. (Amy loves them)

And you could also touch base with my D-Buddy Ginger Vieira over at Living in Progress. She’s a world champ weight lifter, health nut, fitness coach, and a T1 sister who can probably bench press me. Just don’t arm wrestle her for the dinner check and you’ll be fine. Like the Team Type 1 crowd, rather than letting diabetes slow her down, she’s out to prove that anything is possible.

So you can see, there’s no shortage of resources here!

The main thing I want you to remember is that blood sugar and exercise can be both poison and antidote to each other. Any exercise, especially endurance sports, can absolutely cause blood sugar problems, especially on the low end. I urge you to get a Continuous Glucose Monitor, learn it, and use it. And I want you to get into this one step at a time. Learn how your body responds to activity and food intake. This can be done safely, but you need to take your time, get the right help, get the right gear, and do it right.

Now. Where the heck did I leave the TV remote? Oh crap. It’s on the other side of the living room. Well…. I guess this program isn’t all that bad…