When you’re confused about conventional diabetes wisdom, or you’re too hairy to make your infusion sites stick, who you gonna call? Yup, you guessed it: you can call on us at our weekly, quirky diabetes advice column, Ask D’Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois. 
{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}
Sysy from Virginia, type 1, writes: I was diagnosed with type 1 seventeen years ago, so a lot of what I was told back then doesn’t apply now. One thing I was wondering is… I was told back then that when my blood sugar was over 250 I should NOT ever exercise. What’s the new information about this? Thanks in advance!
Wil@Ask D’Mine answers: You can safely get a cute little road-construction sign tattoo on your thigh that says “No exercise when high.” That hasn’t changed and it never will until the cure.
Here’s why: First, muscles in action use more fuel than muscles just sitting there watching TV or waiting for someone to bring you a beer. Second, when we type 1s are high it’s generally because there’s a shortage or absence of insulin. Without insulin the muscle cells can’t make use of all that sweet sugar floating around in our blood, so they go to Plan B and start burning fat reserves for fuel. Third, burning fat creates nasty oily smoke, like the kind you get from burning tires, called ketones—the driving force behind our much-feared diabetic ketoacidosis (DKA) comas.
So if you’re high and the body is shifting from burning sugar to burning fat, and the ketones are beginning to build up in the blood, the absolute last thing in the universe you want is more ketones, right? But if you start using your muscles, they’ll need more fuel, 
burn more fat, create more ketones, and possibly move you rapidly from a mild crisis into a full-fledged life-threatening emergency.
Type 2s don’t need to worry about this as much, unless they’ve been really, really high—like, say 500 or 600 mg/dL—for several days. If you’re a type 2 suffering a garden variety blood sugar excursion from the all-you-can-eat pasta bowl at the Olive Garden, then exercise can actually help bring you back down. That’s because type 2’s almost always have some insulin to play with and aren’t DKA prone. So getting those muscles moving will help vacuum up the excess sugar.
But for us type 1s: No workin’ out when high.
Now, how’s your blood sugar, Sysy? Really? OK, just stay right there on the couch and I’ll go fetch you that beer…
Evan from New York, type 1, writes: I’m not going to beat around my bushy beard on this one: I have such an amazingly hairy abdomen that I could easily serve as a werewolf extra on the set of those Twilight movies (ugh…). This leaves me a narrow hair-free vertical corridor about five inches wide on either side of my abdomen. As I use both a wireless insulin pod (Omnipod) and a CGM (Dexcom), I currently have a severely limited space for infusion sites (trust me, I’ve tried other parts of the body and they are a definite no-go).
I understand the detrimental effects of not adequately rotating your infusion sites, so I’ve been considering shaving clean a good portion of my abdomen to provide more real estate to work with. My question is, is there any chance that the hair follicles under the skin might interfere with the operation of an insulin cannula or CGM electrode? For instance, what if a cannula was inserted through or into a hair follicle? Would it still be able to deliver insulin effectively? I know the follicles become even more of a problem after shaving (especially for the first time). Can I confidently go ahead and shave off my stomach ‘stache in order to give my infusion sites some lebensraum?
Wil@Ask D’Mine answers: Get out the razor, my friend. And you should take that job with Twilight, there’s good money in movies! By the way, no need to be shy about body hair, to the best I can tell after extensive research, about 49% of chics dig werewolves (49% dig vampires, and the remaining 2% say they have better things to do than think about either). Oh, and while I was wasting my time trying to find out those statistics, I stumbled across this quiz you can take to see if you’d make a better vampire or werewolf. To my surprise, I’m the werewolf type. But it’s possible that the quiz is off, not taking into account the whole diabetes-and-blood thing.
So, true confession and risking TMI: I’ve got a pretty good winter coat of hair, too. Not quite so thick as you’re describing, but there’s very little real-estate on my epidermis that doesn’t have some hair growing on it. My solution for years has been running 
an electric razor over key parts of my body every morning. I personally keep my upper arms hair-free for Dexcom sensors, and a wide patch of stomach free on either side of my bellybutton for pump infusion sites. Done right, it still can look pretty natural, and hasn’t affected my part-time job as a member of the Chippendale Dancers in any way whatsoever.
As to hair follicles, go get a magnifying glass and look at your skin where you’re wearing your sites now. See all the little dots? Yep. Those are follicles. Odds are that with about a quarter of your insertions you’re skewering one of them as it is. No worries. Your gear will still work fine. Any pore on your body is a hair follicle.
In terms of the mowing job ahead of you, I’d advise you to use some sort of electric clippers or bread trimmer to cut the longer/thicker hair first, then get down to the skin with a blade. Give the skin a couple of days to un-freak out, then keep it shorn with an electric shaver.
With your Dex, as you’ll probably wear it for the recommended 13 days… What? No kidding? OK, I’ve just been told you’re actually only supposed to wear those bad boys for seven days. Who knew? Only people with good insurance, that’s who. Anyway, you’ll get some hair growth under the transmitter during the wear period, and you’ll probably want to use some Uni-solve to get the gunk off the new hair growth before you shave the site clean again.
Oh, and I just got an email alert saying that zombies are cutting in on both werewolf and vampire popularity. Given all the gear I need to stay alive, I feel a bit like a zombie sometimes. Maybe I can find a zombie quiz somewhere online…
Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.
What are you brave, brave boys thinking? Go for the goo – rip those hairs out with the best wax you can find. There’s a lot less rash, itch and nastiness – and the sites stays clear of hair for a lot longer than it does with shaving – as smooth as the proverbial baby’s backside so to speak.
Thanks for answering my question, Wil! I have stuck with that recommendation over the years but lately have noticed that a lot of type 1 kids exercise over 250 and so I started wondering if I just had outdated information. Thanks for your response, I think it’s a crucial thing to clear up. Oh and thanks for the beer!
Thanks Will for clearing things up for us old timers and bringing it home in a new way!
It’s not only chicks who dig guys with body hair. Just saying’…
Between my scoliosis, my post-pregnancy stretchmarks, and being relatively small, I also have challenges finding suitable places to insert the infusion set and the sensor.
Took the quiz: vampire.
Mary, I found out from a Medtronic representative that it’s OK to use the part of your belly where you have pregnancy stretchmarks. She said they aren’t really scars, just stretched out skin, and that the cannula goes below them into normal subcutaneous tissue. I did try that, and it worked OK for me. If you decide to try it, though, maybe better to be cautious and check BG often for the first few hours. Good luck!
I understand the 250 rule, and generally follow it. But I have violated it on several occasions. I work out a lot, participate in triathlons and running races, etc. Race days are a significant challenge, and my blood sugar does not always “play nice” like it usually does in training due to nerves. So when I see a high # pre-race, or post swim (if the wait is long and I’ve been disconnected longer than planned) I usually bolus and soldier on. Not ideal in terms of performance or anything else, but so far I have survived without pulling out of a race. Also, if I know that a high is a timing issue — ie. run got delayed longer than planned after I reduced a breakfast bolus — I will usually head out and BG will drop quickly. All that to say I think the rule is good, but if we’re testing (and/or CGMing), and in touch with how our bodies respond, may not be hard and fast in all circumstances.
Someone else sent me the “don’t exercise if you’re over 250″ info about two weeks ago. Here’s the problem – I exercise fairly hard (burn about 500 calories in about 30 minutes) on the eliptical machine – and I can EASILY drop 200 points during that time. So I generally break out the apple cider and licorice, wait until my sugar is sailing past 200, and then start exercising.
Not sure why I drop so quickly, makes me feel sometimes like I’m defeating the purpose when I have to stuff sugar into myself prior to exxercising.
Do you pump? Have you tried a very low temp basal?
In the 25 years I’ve had T1, I’ve generally used exercise to bring down a high (anything from 180 to 400, and usually in combination with a correction bolus). I find that I feel better and better as the exercise session progresses, and that I’m back in range much sooner than I would be by just waiting around for insulin alone to do the trick. I’ve never had DKA or felt worse afterward.
Anyway, I’m confused, because the ketone explanation makes sense in theory. If you’re not yet producing ketones when you start exercising (despite being high), does that change the guideline? (I’ll confess I never bother checking for ketones. I just hydrate and, if possible, exercise.)
@Hannah B, I’m not sure but since exercising while so high can encourage ketones to form, it seems a bit risky. I mean I understand why sometimes someone would exercise with a high but in order to lower chances of ketones being formed, the rule is no exercise over 250. (At least, that’s what I gather)
@Scott, I’d soooo recommend you Ginger Vieira’s book “Your Diabetes Science Experiment” because it goes into tons of helpful exercise, insulin, and diabetes info. I use shots and take my Lantus from 20 units to 16 or 15 on days I exercise a lot and honestly, it covers me through exercise and I avoid all lows. Even better, a temporary low basal rate on a pump helps, too, as someone mentioned. It’s just not the best workout when we do it while high.
I am not a doctor of any kind, but my understanding, as Will briefly implies, is that the issue is not hyperglycemia but rather hypoinsulinemia– that is, problems occur when you exercise without sufficient insulin in your body, regardless of your blood glucose levels. The warning about exercising while high seems to come from the fact that if your blood glucose is really high, chances are you don’t have enough insulin in your system. In other words, not exercising when hyperglycemic gives you a wide safety margin from inducing ketoacidosis by exercising without enough insulin. So, in theory, if I know my body and I know that though I am high, I don’t have ketones, I’ve administered insulin, and I should be heading down soon enough, I can and will exercise to speed the descent. It’s a bit of a risk, but not much if I am sure I have insulin that will take effect shortly. From “Exercise and the Management of Type 1 Diabetes” (Steppel and Horton, 2003, http://www.springerlink.com/content/mpk18mj60x481073/):
“In a setting where insulin levels are very low or absent (i.e. a diabetic patient in poor metabolic control), any level of exercise can induce formation of ketones and hyperglycemia. As exercise begins, peripheral glucose uptake is impaired by lack of insulin, hepatic glucose production is stimulated and lipolysis is increased. This combination of responses causes the already elevated blood glucose to continue to rise. Clearance of ketones is thought to be defective and contributes to the rapid rise in serum ketones [32]. Because of this phenomenon, it is generally recommended that patients check their blood glucose levels prior to exercise. If the glucose level is greater than 250 mg/dl, they should then check either urine or serum ketones. If ketones are present, they should delay onset of exercise until they have taken supplemental insulin. They can then take part in exercise once ketones have disappeared and glucose levels have fallen.” (p. 358)
In any case, though, drinking a beer when high is probably not the wisest idea… Maybe get Sysy a glass of water instead?
Thanks, Karmel! That info’s very interesting and makes sense. I guess that by the time I’m actually out the door to exercise, my correction bolus has already kicked in and/or I have enough insulin on board to prevent ketones. Like Carol, above, I work out a lot and would be really bummed, after all the prep for a particular workout/event, to have to bail!