Interview with Jennifer Okemah, MS, RDN
As a registered dietitian, CDCES, and long-distance bicycle owner for the JDRF Journey to Treatment Program, Jennifer Okemah is a wealth of knowledge on balancing blood glucose throughout athletic pursuits. Right here, we’ll be taught her ideas and tips as a board-certified specialist in sports activities dietetics, that can assist you keep on prime of your recreation.
What’s your best-kept secret for maximizing time in vary with T1D throughout train?
“There are two issues I at all times ask a consumer with T1D: What’s your insulin on board (IOB), and what’s the route of your steady glucose monitor (CGM) arrow? This data provides the predictive nature of the science behind glucose administration,” defined Okemah.
“Understanding how a lot IOB you could have is so vital. Whilst you can train with IOB, realizing what your glucose is, the place your arrow is pointed, and the type of train and period — will likely be a highway map for managing your exercise.”
“In the event you’re on a number of every day injections with a syringe or sensible pen, there’s extra work that goes into determining IOB than for somebody on an insulin pump,” stated Okemah. However consistency with train and administration habits will assist to enhance your time in vary throughout train.”
Is “carbohydrate loading” in or out with T1D? And the way typically ought to I be consuming?
“Carbohydrate loading is out with T1D,” stated Okemah definitively. And right here’s why.
“Once I work with T1D athletes or those who wish to begin understanding, I speak to them by way of ‘being a human being,’ not with a ‘diabetes first’ mentality.” That stated, “No matter your particular person objectives are, consuming additional carbs — past human capability — isn’t helpful for anybody.”
“With carb loading, you run the danger of hypoglycemia,” defined Okemah. “Having extra carbs, past the capability of what your liver and muscle mass can maintain, isn’t useful for somebody with T1D. It’s going to value extra insulin, and it really works towards the explanation you’re exercising within the first place — which is to burn off glucose.”
Right here’s the factor. Your liver and muscle mass retailer glucose within the type of glycogen. “That’s not a ‘T1D’ factor, it’s a ‘human being’ factor,” stated Okemah. “As soon as these storage amenities are full, it takes insulin to entry them. So, if glucose ranges are operating exceedingly excessive, which means glucose isn’t within the tissues.”
“That’s why glucose time in vary issues. While you’re in vary, you could have gasoline (glycogen) within the storage tanks, which implies gasoline is obtainable. Having T1D doesn’t help you fill your storage tanks much more. With T1D, you possibly can’t carb load with out including extreme insulin and altering the paradigm.”
Then again, “It doesn’t profit anybody to be on a low-carb eating regimen both as a result of it adjustments the gasoline supply — much like a hybrid automobile when it switches from electrical energy to gasoline,” stated Okemah. “With the human physique, probably the most environment friendly gasoline supply for train is glucose.”
What function does hydration play in glucose administration? Ought to I be ingesting electrolytes?
“Hydration is large for muscle and electrolyte coronary heart conduction. It additionally helps with managing glucose ranges,” defined Okemah. “Being correctly hydrated means you’re urinating commonly, which helps to launch glucose when it must be.”
“In your CGM, dehydration will likely be uncovered as excessive glucose. That’s as a result of dehydration concentrates glucose ranges. As a T1D athlete, preventing hyperglycemia and dehydration could have a destructive impression in your exercise.”
“In the event you want so as to add one thing in, I like to recommend electrolytes, resembling Nuun tablets,” stated Okemah. “However you gained’t at all times want them.”
“I have a look at that kind and period of train. Which means, in case you’re merely doing a treadmill exercise for 30 to 45 minutes, there’s actually no want for electrolytes,” stated Okemah. “You get loads of electrolytes from meals. However I sometimes counsel rehydration with electrolytes in case you’re exercising past 60 minutes.”
How a lot ought to I devour throughout train?
“I wish to gasoline you want a human being — which means, anybody who’s exercising must gasoline their muscle mass — T1D or not. You’ll want electrolytes, hydration, and carbohydrates as your ‘clear’ gasoline,” stated Okemah.
“With T1D, you’ll want to concentrate to IOB, before everything. You want to know in case you’re feeding the IOB or needing carbs for the precise train,” defined Okemah. “That helps with making administration changes.”
As a normal rule, it’s OK to train with IOB, defined Okemah. “I gained’t ever say ‘don’t train in case you have insulin on board,’ as a result of it stops folks from exercising altogether,” stated Okemah. “As an alternative, I say, ‘When you’ve got IOB, then right here’s your train plan.’ It’s all about maintaining observe of IOB and fueling correctly for the perfect train expertise.”
In different phrases, “Your gasoline plan will likely be completely different with IOB, nevertheless it mustn’t deter you from exercising,” stated Okemah.
Meals as Gas: Why select processed glucose boosters (bars, gummies, drinks) versus entire meals?
“I’ve a T1D consumer who eats KIND bars whereas exercising. In the event you’re fueling with advanced carbohydrates like that, your entry to gasoline within the brief time period gained’t be there. That’s as a result of it takes longer to interrupt down protein and fats,” defined Okemah.
“Vitamin suggestions are 10 to twenty grams of carbs per hour whereas exercising. However I don’t put that on folks with T1D who’re consistently watching their CGM knowledge,” stated Okemah. “I simply need folks to remember they should gasoline past what their glucose signifies.”
“There’s an enormous profit to gummies and sugary electrolyte drinks resembling Gatorade and Cytomax as a result of they’re fast-acting,” stated Okemah. “Throughout train, it’s the one time that I would like you to consider meals otherwise. These merchandise have their place, and their performance is smart. Whereas they aren’t meals, they do the trick throughout an occasion — as do potato chips and pickles.”
“I would like you to love your gasoline, and a combination of savory and candy is gratifying,” stated Okemah. “Afterwards, entire meals could have their place in your restoration meal.”
Whereas the main target appears to be on carbs, the place do fat and proteins slot in?
“I have a look at vitamin and athletes in three classes: pre-event, throughout, and post-event,” defined Okemah.
“The human physique is so environment friendly — we create glucose out of the whole lot, and we’ve been doing it for 10,000 years,” stated Okemah. “However throughout an occasion, proteins and fats are going to confuse the gasoline system. That’s why we use carbs as gasoline throughout train. They’re probably the most environment friendly gasoline supply.”
“Throughout lengthy train periods, your calorie stage will go down, as will your insulin wants — and the advantages of train enhance.”
Why is glucose administration throughout train completely different for every individual?
I don’t need folks with T1D to overthink train. You don’t have to be fasting or train at particular instances of the day — it is best to simply train,” defined Okemah.
“One factor is for certain, I don’t need folks to take the standard quantity of insulin throughout an occasion,” emphasised Okemah. “Throughout this time, you possibly can burn by means of glucose with out bolusing insulin — muscle tissue will suck it up like a dry kitchen sponge.”
Furthermore, the advantage of train is that you just’ll be utilizing much less insulin. “So, must you take insulin (as typical) for a peanut butter and jelly sandwich?” Okemah says, “No, no, no!”
“Everyone seems to be a bit of completely different, and I take pleasure in serving to folks discover area of interest meals that work for them. And I’m going to let you know, arms down, bananas are at all times concerned,” stated Okemah with a chuckle.
Can I nonetheless train if my glucose is excessive?
“That relies upon,” stated Okemah. “There are such a lot of elements to work by means of with excessive glucose ranges, so that you’ll have to troubleshoot first. Is there an issue together with your pump, insulin, or website? What do your CGM arrows should say? Do you could have ketones in your urine?”
“Maybe you wish to have your glucose in a sure vary earlier than train, and it’s larger than that, nevertheless it’s not horrible. Hydration is one thing you are able to do. I wish to ensure you’re hydrated so that you will be protected throughout train. It’ll additionally provide help to to pee out additional glucose,” defined Okemah.
How do you retain a cheerful intestine throughout train (when consuming all through)?
“There are two classes of meals that may irritate the intestine: these with excessive fiber and people with an intense glucose supply,” defined Okemah.
“Excessive-fiber meals are harder to digest. And in case you eat a gel or a GU, these merchandise require dilution. In the event you don’t drink water, they’ll pull water from elsewhere in your physique. This ends in a disturbing ‘slew’ of fluid in your abdomen — and an sad digestive tract.”
“Though Shot BLOCKS, gels, and protein bars are good, they’re designed to be chased with water. This manner, your abdomen contents will not be so concentrated that it requires gastrointestinal fluid for dilution.”
How do you coach somebody who avoids train as a result of they should eat a lot (throughout and after bodily actions) — in order that they really feel it’s not helpful?
“One of many essential ideas I speak to folks about is ‘feeding insulin’ — if that’s what’s happening, there’s one thing incorrect with administration calculations,” defined Okemah.
“I would like you to gasoline like a human being as a lot as potential. And sure, this implies whenever you eat, typically you’ll have to take insulin for it, as a result of even with out diabetes, a functioning pancreas is at all times at work within the background,” stated Okemah. “However you shouldn’t should really feel such as you’re robbing a sweet retailer. In the event you’re doing that, one thing wants adjusting.”
Let’s discuss 10-second sprints to lift glucose — is that this an actual factor?
“Sure, it really works for a bit of bit — in case you have glycogen shops in your liver and muscle mass. Even leaping jacks will doubtlessly increase your glucose in case you have gasoline shops, nevertheless it’s very momentary,” stated Okemah.
“Take into accout, you’re depleting glycogen storage (your gasoline tank) by doing this, so that you’ll nonetheless desire a carbohydrate supply to stop your glucose from crashing even additional.”
Jennifer is an entrepreneurial registered dietitian and diabetes educator pushed to seek out options to constructive and guided look after folks with diabetes. She owns a multidisciplinary/multi-site, nationally recognized apply within the Seattle space. A self-professed power volunteer places her on the highway (literally) with the JDRF Journey to Treatment program as a fundraiser, rider, and part of the medical employees.
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