Managing T1D – An exercise in staying active

Dr. Michael Riddell on T1D and exercise

Dr. Michael Riddell, stress and exercise researcher

 

Living with type 1 diabetes (T1D) doesn’t mean you need to be afraid to push your physical limits, says Dr. Michael Riddell, a JDRF-funded stress and exercise researcher. He ought to know. Diagnosed with T1D at age 13, Dr. Riddell has always lived a very active lifestyle including mountain biking, basketball, and running. He’s even ventured to push his own physical limits by climbing the snowy peaks of Africa’s Mount Kilimanjaro and trekking Peru’s Machu Pichu trail.

As someone living with T1D and a parent of an adolescent with T1D, Dr. Riddell recognizes that there are still many misconceptions about exercise and T1D. One of the biggest is that all forms of exercise cause blood sugar levels to drop.

“Up until about 10 years ago, I honestly thought that this was the case,” admits Dr. Riddell.

Because of this misconception, “many parents believe their kids can’t play strenuous sports like hockey or basketball, or that they’ll never be able to safely ride a mountain bike, but the truth is, there are really no limits to what you can do. You can be an Olympian, a competitive swimmer, or a long-distance runner – you just have to learn how to exercise safely."

“We are now discovering that very intense exercise often causes large rises in blood glucose and that different types of exercise can have different effects on glucose levels,” says Dr. Riddell. 

For example, aerobic activities (running, walking, and hiking) typically lower blood sugar, whereas anaerobic exercise (short bursts of intense physical activity, such as weightlifting or sprinting), or exercise performed under competition stress, can actually raise blood sugar levels.

The reasons for this effect are not entirely clear, but they may be related to the body’s primal ‘fight or flight’ response. When people are under physical or psychological stress, the body releases hormones like cortisol, adrenaline, and noradrenaline that cause glucose levels to rise in order to provide a quick burst of energy.

Dr. Riddell on an expedition to Kilimanjaro in support of type 1 diabetes research

Because people with T1D are unable to produce insulin to offset this effect, their blood sugar levels can remain high for a prolonged period.

“We often worry about our numbers (our A1C and our blood sugar) and we think that’s going to predict how long we live and how healthy we are, but performing regular exercise is equally important. By doing at least 150 minutes of physical activity per week and ensuring it includes both aerobic and resistance exercise, you’ll live longer and have fewer complications,” says Dr. Riddell.

JDRF PEAK Program

Although exercise-related blood glucose highs and lows can’t be prevented, understanding more about the effects of different types of exercise will help better manage them. This was the impetus for the creation of the JDRF PEAK Program.

Sponsored by Novo Nordisk, the T1D Performance in Exercise and Knowledge (PEAK) Program is an international JDRF educational initiative slated to launch globally this month; it will arrive in Canada in November 2017. Dr. Riddell is a member of a multidisciplinary team working to design a program that will provide people living with T1D the tools they need to better manage their disease, including access to international educational events hosted by global experts and online materials.

The program also focuses on educating health care providers on how to better manage their physically active T1D patients, and includes information on nutrition, insulin dose adjustments, monitoring glucose levels, and the amount of exercise necessary for optimal fitness and health.

Helping to control hypoglycemic events

As anyone living with T1D knows, hypoglycemia happens when insulin levels aren’t properly regulated. But what is not commonly known is that it’s also caused by an inability to regulate glucagon – a hormone that helps boost blood sugar.

Another aspect of Dr. Riddell’s research with Zucara Therapeutics is the development of an experimental drug aimed at improving the body’s glucagon response to low blood sugar. The drug is a peptide that appears to turn on the pancreas’ ability to release glucagon during hypoglycemia.

Currently in the animal testing phase, Dr. Riddell and his team hope to begin human trials within three years.

For more information about exercise and T1D, visit:

  • JDRF PEAK: Provides education and support to those with T1D who would like to engage in exercise
  • ExCarbs: Helps people with diabetes using insulin to feel comfortable taking up exercise
  • Getting Pumped: An insulin pump guide for active individuals with type 1 diabetes
  • Diabetes Motion: Provides practical guidance about blood glucose management

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