Ginger Vieira, T1D Fibro-celiac, Author, Content Creator

[00:00:01] Rob Howe: Welcome back to another episode of Diabetics Doing Things. We're telling the amazing stories of people with diabetes from all over the world. We've also had a nice run of diabetes creators on the podcast, and today is no exception. You know her as Ginger Vieira, T1D Fibro-celiac on Instagram, and you've probably seen her on different platforms like T1D Exchange and Beyond Type 1 over the years. Ginger, welcome to the podcast. You're an author and an awesome person with diabetes, who I'm excited to say that I know in person as well.

[00:00:34] Ginger Vieira: Yeah, we finally met in person. Thank you so much for having me on, Rob.

[00:00:38] Rob Howe: It's my pleasure. And today we're going to be talking about your latest book. It's salient for today's conversation, but it's a very straightforward title, Exercise with Type 1 Diabetes, which, as we know, is a challenge for many people.

[00:00:53] Ginger Vieira: It's pretty complicated, yeah.

[00:00:55] Rob Howe: And there's a lot of things to balance. And, you know, we're balancing things in and out in our day to day life anyway. And where I want to start the conversation is something that when I'm having one on one conversations with either parents or caregivers or people with diabetes, I try to zoom out and normalize the challenges. because let's just be honest, in the U.S. right now, 40% of the U.S. population is overweight. It's kind of our thing. And there are a lot of things that prevent even normal non-chronic illness-having folks, able-bodied people, from getting to the gym or establishing an exercise routine that don't include hypoglycemia or didn't bring a site change and have to go home or just not feeling up to it, feeling burned out from riding the roller coaster of diabetes throughout the day. And so I try to make sure that if you're able to show up, even if you scratch your yoga class because you had a low blood sugar, or even if your site got caught up and pulled out or kinked or occluded from working on your lower body weights, you shouldn't beat yourself up about it because there's a lot of barriers that are in the way of people getting to the gym anyway. So if you're out there with diabetes and you're having problems, I see you. And that is definitely

[00:02:10] Ginger Vieira: something we want to talk about today. Yeah, I mean, well said. There's so many factors to think about in order to exercise successfully. And even just the basic 20-minute dog walk can become a mess if you don't understand the variables that are happening before, during, after that dog walk. And so non-diabetics have no idea how hard it is for us to even just go for a walk and just that constant fear of lows and then frustration and the lows don't happen. And then you go high and it's like, why'd that happen? And what I really love explaining is why it happened. And there's actually like logical exercise physiology science that explains exactly why it happens. And once you understand that, it's a little easier to not get so mad and to just look at the factors and say, what can I do differently next time? And that's honestly what my book is obviously about is how to prevent those fluctuations. But it starts with a mindset, really, you know, stepping back and saying, there's a reason behind this. And I can understand that reason and put in some of the work, of course, to understand it and prepare for it.

[00:03:24] Rob Howe: I love that. And I'm real excited to dig into like the tactics. But you talked about the mindset and curating that mindset. So let's zoom out a little bit and talk about your journey to creating that mindset for yourself and also just your life with diabetes and how, you know, from the time you

[00:03:39] Ginger Vieira: were diagnosed, like how you got to where we are today. Sure. I mean, I'll tell you, like within the first week I was diagnosed, what I realized quickly is that it all comes down to the fact that everyone in life has challenged it. I was diagnosed at 13. I actually diagnosed myself at a school

[00:03:57] Rob Howe: health fair and would you believe me and i mean wait wait wait wait wait wait okay okay this because i've heard i've heard self-diagnosis stories before and they're all very interesting but okay

[00:04:08] Ginger Vieira: walk me through what went down at this health fair so it's seventh grade health fair they do it every year and my i was in the seventh grade and my classmate was doing his project on diabetes there was no type 1 or type 2 it was you know seventh grade diabetes poster and i was we were working on our posters and I had not been feeling well ever since my whole family got the flu about three weeks before that and they all got better and I just didn't and looking back I had all the classic symptoms but it's like oh well her vision got blurry she needs glasses like some of us all you know I'm the youngest of six kids so it's like oh she needs glasses half of us already have glasses oh she's losing weight well she's 13 but I lost like you know 10 pounds in two weeks kind of thing. And we don't know why she's drinking water in the middle of the night out of her hand like a maniac. But who knows? She's 13. And of course, she's tired and doesn't want to go to school. She's 13. So until finally, I was like, I really don't feel good. Because I did say to my mom, I think I had diabetes. I saw it on the poster at school. People like not making fun of me, but they're like, yeah, Ginger, yeah, right. You know, like kids at school who's heard me ask my classmate like, wait, what is that? Because I had all the symptoms on his poster. And a week later, I finally burst into tears and my mom took me to the doctor and it was, you know, my blood sugar was like 600 or something. And I spent several days in the hospital and felt real sorry for myself for a few of those. And by the end of my hospital stay, I can honestly remember just realizing like, oh, John had brain cancer. Like my classmate, job and you know he had to deal with that and my friend went through some major trauma as a child and my other friend lost a parent and this friend deals with this and this friend has hemophilia and this friend has leukemia I was like well it actually looks like nobody gets it easy so here's mine right and I lost the hospital with that mentality and so I really think no matter what you're trying to accomplish as a person with diabetes if you're still stuck and feeling sorry for yourself you will have a hard time accomplishing anything. I totally agree. It's something that I've been

[00:06:18] Rob Howe: reading about and thinking about a lot lately are toxic beliefs that we sort of inherit. And this is even outside of people with diabetes, but I think especially inherent for those of us with a chronic illness. But a toxic belief that many of us have is that life should be easy. and that life is unfair right and and i think it isn't life isn't fair like or the belief being that life should be fair and i think you know that's something where if you just allow yourself the space to not be perfect or not be easier or accept that life is difficult and there are challenges sort of one after another yeah and you know with diabetes it's really easy to find those challenges sometimes. They're day-to-day, meal-to-meal, exercise-to-exercise. Hour by hour. Yeah. But if you don't judge yourself with those, you just accept that that's how it is. You're much easier to kind of grow through that and just accept that, hey, I can still love myself even if my blood sugar didn't do what I thought it was going to do. I can still show up for myself in my life and move forward. And I think because so many people's diagnoses are so different and kind of run this huge variance across a huge spectrum, if you don't have a great diagnosis, it sometimes sets you back years and for some people decades because they're not able to sort of take ownership or grow into that mindset of, you know, this is going to be difficult and we need to celebrate small wins instead of just getting, you know, fixated on being perfect all

[00:07:52] Ginger Vieira: the time. Yeah. And when you're stuck in that self-pity mode, you also stop looking for answers. so if you're just getting mad that your blood sugar didn't go the way you wanted during your walk you're not looking for a solution so remove the self-pity and what you're left with is curiosity you're like why did that happen what can i do differently next time and i think that is honestly one of the most important ingredients to thriving not to having perfect blood sugars but just to live a life that you're enjoying and, and doing things you want to do with diabetes

[00:08:29] Rob Howe: along with the ride. Totally agree. Okay. So let's get into exercise because you are, you're an athlete in many ways. I honestly, I saw a video of you from a few months ago where you were skipping rope, running on a track. And I was like, if there's, if I have one weakness in exercise, it is skipping rope. My entire life is just like, it doesn't come naturally to me, I don't really like it. And it's like, you know, it's hard. I'm big and a little bit lazy. Big guys can be can be lazy, especially athletes, because we get by on our like, you know, kind of God given gifts occasionally. And so I saw you skipping across the track and I was like, wow, Ginger would kick my butt running around a track skipping that rope. And you and you made it look so smooth. So how do you know, talk to me about your journey as an athlete, because you've also been, you know, a powerlifter, a bodybuilder. You've done a lot of different things.

[00:09:17] Ginger Vieira: I actually was never an athlete as a teenager I dabbled in everything and it was terrible at all of it and it wasn't until my like junior year of college maybe where I had been the year before that eating and kind of drinking like a normal college kid gained a bunch of weight felt miserable and was just like rough and I just don't feel good and I spent that summer between my junior and senior year exercising, just like teaching myself basic weightlifting and walking everywhere. And this is my mini me back here. Go read a book, kid. No, go read a book. Thank you. No summer camp this week. School starts next week. And by the end of that summer, I had lost 10, 15 pounds. I had some noticeable muscle definition just from doing very basic stuff. And I was also eating healthier. So I stopped eating gluten all the time, which I was doing. I have celiac. And I got to a point where I was like, okay, I've taught myself some stuff, but I want to learn more. And I ended up at this gym near my college, hired a personal trainer, ended up, I dabbled in bodybuilding for a little bit, but the whole, I never competed because this stage thing and bodybuilding doesn't motivate me. I just don't care about the getting really cut tan thing. And I know lots of awesome people do that.

[00:10:47] Rob Howe: I relate. The tan on the day of thing kind of freaks me out a little bit.

[00:10:52] Ginger Vieira: I've supported many friends through it, but it doesn't inspire or motivate me personally. And what I really love, though, is powerlifting, which is where you train to lift something as heavy as possible once in a pinch press, squat, and deadlift. And I didn't have a CGM since way back in the day, or I wasn't eating an insulin pump either because I didn't even have health insurance for several years. But I kind of had to teach myself diabetes management within that because the blog world was just getting started and doctors were not helpful. And I ended up setting like 14 amateur drug tested records within a few years. And I had a blast. I learned a lot about myself. It gave me a confidence I'd never really had before and what my body can do. Right. And it also immersed me in this fitness world. And I became a personal trainer and a yoga instructor. And I was, you know, graduating from college with a writing degree. But I learned, like, I got to be around all these people who made fitness their priority every day. And I'd never been around that. And it was awesome. And it is, you know, like, defines me today. all my closest friends are people I met in that world. And we just, like, you just, it normalizes structuring your day around making sure you got the exercise you wanted to get in.

[00:12:18] Rob Howe: And there's a real community factor around it, right? Yeah. Pushing yourself. And, you know, I think too, like you said, you know, competition didn't necessarily resonate with you, but if you can find a way to motivate yourself to return to training and to, And just, you know, I think like sometimes that whatever the saying is that we're the sculptor and the marble, you know, like we're returning to ourselves and like always a work in progress. And if we can find a way to, you know, return to that, I think it's such a good thing that I think I also had to learn because I think people like you said something earlier that you weren't an athlete as a young person or coming up in school. And I think people sometimes assign stories to themselves. Like I'm not something.

[00:13:04] Ginger Vieira: I'm not good at exercise because I wasn't good at team soccer and team basketball but I can tell you I'm really good at lifting weights which might sound silly but like there's a mechanism and understanding of how your body works and it was like whoa this is my sport like my body gets it and I was able to do it at a level that most people couldn't you know my best bench press was like 190 pounds I lifted 300 pounds 260 squat and I'm five foot two and I was much heavier than And it was a lupier gal than I am today. But, you know, it's you can still find like what your body can do. It doesn't have to be the high school sport.

[00:13:44] Rob Howe: Absolutely. And I think, you know, there's the Nike campaign is like if you have a body, you're an athlete. And, you know, I think that's, you know, such a, you know, for somebody who, you know, maybe wasn't good at team sports or maybe wasn't physically mature enough or just didn't resonate with them when they were younger. It's never too late to find your version of whatever that may be. I think of even my mom, I'll give my mom a shout out because I love her to death and she's my idol. But, you know, really till her late 50s, she she's a tall woman. She's six foot and she yoga was hard for her. And so she started a practice and now there isn't a day goes by that she doesn't do some sort of yoga movement. And, you know, she's a yogi, you know, found yoga in her late 50s, early 60s. And so, you know, I think it really is never too late to continue to evolve and especially in, you know, the exercise world. So whatever resonates with you, like keep searching, keep finding it.

[00:14:38] Ginger Vieira: And it doesn't have to be extreme for you to be an athlete. You just need to do it regularly. Today, I cannot do what I, so I ended up, I believe, triggering fibromyalgia in a body that's obviously prone to autoimmune disease, right? so I ended up having really debilitating spasms and cramps in most areas most joints of my body especially my neck and my wrist and I had to stop all intense exercise all I did for a couple years is walk my dogs and I just was like I think I just need to let my body calm down and then I literally had to start rebuilding a tolerance for exercise and I was using five pound dumbbells it I felt like I was doing nothing, but it was the most I could do because if I did anything more, I would also be exhausted on top of the pain, like debilitatingly dysfunctionally exhausted. And so I had to start tracking all those triggers that made me feel terrible. And then eventually I started jumping rope five minutes a day and five minutes became 10 minutes and I was not good at it. I tripped over the rope all the time. People are always saying to me, I can't do that. I couldn't either. You have to pick it up and practice until suddenly your brain gets the rhythm and you can jump rope like Rocky Balboa. But it did not come easily to me. I just practiced every day for five minutes until I can be a reset.

[00:16:00] Rob Howe: I love that you talk about and normalize the beginning of things because I think in today's culture, especially, but especially around work. So this is kind of like my lens of it. We expect people to come out of college and be great managers with no training. And we judge ourselves really hard because we just think, well, they should know. And it's not the case. You have to learn those things. You have to be taught those things. And I think about, you know, adults starting new things like jump rope. If you go into it knowing that you're not going to be good right away, you're not setting an unrealistic expectation. You can get comfortable with tripping over the rope. You can get comfortable with finding the rhythm. You can celebrate going two minutes without tripping over it and saying, wow, okay, like now let's, let's try two more.

[00:16:43] Ginger Vieira: Yeah, or just take some pride in tripping over it for five minutes, but at least you showed up for five minutes. And I promise if you just keep doing it, eventually your brain will figure out a little rhythm. Let's put that, let's put that.

[00:16:56] Rob Howe: There is power and consistency, real, real power. Well, I love how this conversation has gone. And thank you so much for kind of leading a little context into your journey as well. But there are three big topics from your book that I want to make sure that we discuss today. So number one is insulin on board. So we know as people with diabetes, in order for us to process carbs and to attach that insulin to glucose in our cells and keep our blood sugars in range, we've got to have insulin. but it also stays in your system depending on what insulin you're using for some cases quite a while and it also varies from person to person so yeah there you go you're using Afrezza so for somebody out there you know let's let's talk about insulin on board let's and let's talk about it related to exercise because i think this is something like you talked about going for a walk that yeah a little bit of insulin on board going for even a short walk can have a pretty dramatic

[00:17:54] Ginger Vieira: impact on your blood sugar. Huge. Yeah. If you don't understand the concept of insulin on board yet, that is where you need to start with your exercise education. Because the amount of rapid acting insulin that you have on board before and during any type of exercise is going to hugely determine whether your blood sugar is going to tank or spike. And most people struggle with hypoglycemia first during exercise. So insulin on board means if I ate at noon and I took insulin for, let's say it was an apple and peanut butter. Let's say I took two or three units of Novolog for that very large Honeycrisp apple. If I want to also, I feel like I'm an only apple worth buying. If I want to exercise at one o'clock, I now have that bolus I took at noon going into like full action by one o'clock. So if I didn't reduce, probably significantly reduce my bolus at noon, I'm definitely going to go low during the exercise between one and two o'clock because the insulin is on board for a minimum of three hours. Some people like to say it's five hours. That three to four hour window is key. Yes, Novolog, yes, Humalog can stick around for five, but that three to four hour window I think is the easiest one to keep track of and you have to think back to when you ate and when you're going to exercise and we'll get to the idea of exercising before you eat in a second but the other thing is if you're on an insulin pump there's another factor of insulin on board that you can manage that you need to manage which is your basal rate and you can't think about your basal rate when you start exercising you generally need to think about it at least an hour before exercising because the insulin you got in your basal rate between 11 to noon is going to kick in between 12 and 2 o'clock is when it's going to be hitting you the most, right? So you have to plan ahead. And depending on the type of workout you're doing, the length of workout, the intensity of that workout is going to affect how much you need to reduce your insulin on board. So a lot of preparing. When you explain that to a non type 1. I mean, they don't even know what to make of that.

[00:20:17] Rob Howe: Yeah. I remember that's the sum of, I try to sometimes just center myself of like, I remember life with diabetes. I was just going on life without diabetes. I was just going off vibes. Just show up, just do it. It's all, it's all auto. It's great. And now, yeah, look at all those things that you're carrying into the workout with you, you know, all of that thought, all of that preparation. And, and that's even just considering like, oh, Hey, your blood sugars are already in range. You know, you may, you know, may be outside of range and that adds a whole other layer of complexity.

[00:20:46] Ginger Vieira: Yeah, we're assuming that what I just explained that you're starting your range. And now let's add a correction factor in there. You can't give a full correction if you're going to go exercise because exercise is going to amplify how much sugar the insulin is soaked up from your bloodstream. So you're going to need less to do the same job. Then you're also adding a meal bolus on there and basal rates. It's a lot to think about.

[00:21:11] Rob Howe: It certainly is. In your book, you talk about, and I think you just made a reference to this as well, like fasted exercise versus eating before. And I think in the book, I'm paraphrasing, but you recommend, just for simplicity's sake, fasted exercise does limit some of those factors that we're talking about, especially bolus insulin on board.

[00:21:33] Ginger Vieira: One of the easiest things you can do to simplify the whole exercise juggling act is to learn how to exercise before you eat. And so fasted, people often think that means not eating till one o'clock. It doesn't have to mean that. It just means that you're timing your exercise for before your next meal. And ideally, at least three to four hours since your last meal. So I exercise a few times a day if I include my gentle dog walks. but I so I I'll give you as an example I wake up try to be in range when I wake up of course like we all do have to adapt and improvise if I'm not and then I immediately walk my dog for about 40 minutes and I'm doing that without eating carbs because I have my long-acting insulin dose I'm not on a pump long-acting insulin dose dialed in so that I can go for a fasted walk at any time of day and my blood sugar doesn't from it that could mean you know if you're tweaking things if you need to reduce your long acting in order for that to be true it could mean you need to start giving yourself more insulin with meals right because it's they all are woven together it's not this black and white that long acting covers basil and meal insulin covers only meals right it's a it's a fabricated, you know, woven mess. So I go for my dog walk. Then I need to think about dawn phenomenon because that could spike my blood sugar, right? It's morning. I haven't eaten. My liver could say, here's a bunch of glucose because you need fuel. You haven't eaten. It's morning. Here's a bunch of hormones to go with it. I take metformin to suppress that. so I don't actually have to deal with that variable now, but I, well, I do a little later in the morning, but not in the middle or before my cardio. But you might find that you need a teeny little bolus, but you start conservative, right? I always encourage people to err on the side of preventing hypos over worrying about highs. We don't want to exercise high, that's not the goal, but the first goal is to not go low because the low stops everything, right?

[00:23:46] Rob Howe: yeah as soon as the low low alarm hits that becomes the main character of whatever you're

[00:23:51] Ginger Vieira: doing yeah you cannot have any fun it stops the party as i like to say so then after my dog walk that's 40 minutes of pretty brisk you know low intensity cardio then i go for a 30 minute jog or i jump rope for 30 minutes or i run to the gym lift weights i run home i live about a mile from the gym and I still don't go low because I don't have any boluses on board from a meal. And I have my background insulin dialed in so that I don't have excess basal insulin on board. And so you can recreate that same fasted environment at any time of day by simply timing your meals. So I used to exercise most intensely at 7 p.m. When my kids were little, I put the babies to bed. I go out to the garage and I jump rope for 40 minutes. And I would just make sure that I didn't eat after 3 p.m. So that when 7 p.m. came, I didn't have a bolus of rapid-acting insulin in my system. So it requires planning, right? And some experimenting and consistency. So the more consistency you can add to it, especially in your early experiments, as I would call it, the more you can learn, okay, this is how my body reacts. This is what my body needs. Let's, you know, or if it didn't go well, let's try that same experiment again with as many of the same variables as I can manage and recreate it and see what happens to this adjustment.

[00:25:19] Rob Howe: That's, that reminds me of when I was, you know, a competitive athlete playing basketball and trying to recreate and minimize as many variables as I could. So on a game day, I had a routine and would try to eat the same amount of carbs, same amount of calories at the same time for home games on the road to try to get up, you know, just and have the same routine so that I could show up and be my best self come game time. And like you said earlier, like no CGMs, you know, back at that time, a lot of testing, a lot of experimenting. And I think that curiosity that you talked about earlier and kind of like letting go of the judgment, the curiosity of, oh, well, if I tweak this or if I, if I minimize this variable, if I, if I can be curious about myself and my performance and what I want, can I, can I get there? And I think that's where using yourself as sort of a science experiment is really what we're doing on a day to day basis. And if you kind of take the judgment of yourself out of that, you can have a little bit of fun, even if you don't get it right every time.

[00:26:25] Ginger Vieira: Yeah. And learning how to not beat yourself up when it doesn't go right and say like, OK, whatever I just did didn't quite work out the way I was hoping. What can I try differently? And if you just do that switch in your head from beating yourself up to what can I do differently next time? and it really starts from coming from a place that does not have any self-pity in it because if you're like this sucks it's so hard it's not fair then you're not gonna ask what can I do differently next time because you're already certain that the world is against you and you

[00:26:55] Rob Howe: should just give up exactly let's talk really quickly because we've talked about hypos so when we're talking about exercise that brings your blood sugar down we're talking mostly you know steady state cardio is a great one. We're talking hiking, walking, a long extended run, aerobic exercise. On the other side, though, there can be some exercise and especially I'm sure in your powerlifting days, your blood sugars would respond to anaerobic exercise or like HIIT workouts or one rep max outputs in an opposite direction because of, you know, adrenaline and cortisol and other factors. So let's talk about, you know, your experience there.

[00:27:38] Ginger Vieira: Yeah. So anaerobic exercise, when you are doing something that's so intense that you can only do it for, you know, like, you know, even just a regular weightlifting workout, you're not doing a bench press for 10 minutes, right? It's like 60 seconds, maybe at most. And when your body can only do something for that short burst of intensity, you can't use oxygen and glucose as your primary source of fuel. So you have to actually, you can't get oxygen to the cells to use glucose as a primary fuel source. Sorry. So what your body has to do instead is a couple of things. And we often think that adrenaline is the main reason that raises our blood sugar during anaerobic exercise. But adrenaline doesn't kick in if you're just at Planet Fitness doing your own workout by yourself. It takes a lot to really trigger that adrenaline response. The soccer game? Sure. CrossFit competition? Maybe. CrossFit workout? out, it's probably more spiking because two things can happen. One, your liver is releasing stored glucose and your muscles are releasing stored glucose for fuel because your body can't get oxygen to the cells to use glucose for fuel, right? So your body is giving you some stored fuel. But in the type 1 diabetic body, we're missing the extra insulin to go along with it. So it just spikes our blood sugar. The other thing that can happen is gluconeogenesis with your body converting lactic acid into glucose to then again cycle to use for fuel. So it's kind of like creating its own fuel source again. And again, what we're not doing with that is producing insulin to go with it. So our blood sugar ends up spiking. And if you can create some consistency, I'll give you examples of my own powerlifting days, for example. I knew that I needed a small bolus, you know, And again, I'm five foot two. So for me, that was like one unit before a training session. I knew that, I know that today when I do weights, I do a very little amount of weights because I'm very sensitive to weightlifting. It can, I can trigger that extreme exhaustion in a heartbeat. So I only do like 15 minutes of probably half the weight that I could technically lift. You know what I mean? Because I cannot push that boundary. so that doesn't raise my blood sugar it's it's light enough i'm not doing anything and i always have cardio surrounding it so i don't need to prepare with extra insulin for that degree of weight lifting but if i were to go run sprints around the track yes sprinting looks like cardio but it's a short burst intensity of something you can only sustain for up to two minutes but that's even a lot, really more like 30 to 60 seconds for most anaerobic exercise, that's going to trigger a release of glucose. Sparring in karate, that definitely makes my blood sugar spike like crazy. And it's only been 10, 20 minutes and I'm breathing so hard, like I just ran for 30 minutes, but it's the intensity of what sparring actually looks like. It's triggering that release and that anaerobic spike. When I was competing in powerlifting, the morning of a competition, my blood sugar would just go up to the mid 200s and sit there no matter how much. Novolog I took trying to bring it down. And it sat there all day. Competitions are long and slow. And as soon as I won and was on my way home, my blood sugar just suddenly finally came down to 140. And this is before I'd have a CGM, so I'd just prick my finger constantly. but it just finally came down because the adrenaline finally calmed down right and what i learned for my next competition was the Novolog wasn't enough to boost it what i really needed was a lot more Lantus on board so i ended up learning how to increase my Lantus so that i had more insulin throughout the whole day ready to go so it's an experiment and soccer games kids doing soccer games will have to probably learn the same thing of how to get more insulin on board in the

[00:31:44] Rob Howe: first place, which is scary to do. It is. And, you know, I think this actually transitions really well into one of our next challenges. You know, there's so many things around diet culture. Your book does a great job of kind of like saying, you know, you want to lose weight with diabetes, ditch the diet and approach it with a different mindset. But, you know, insulin, and I think there's a lot of stigma around taking more insulin because it can cause weight gain. And, you know, for many people when they're exercising, one of their goals is to lose weight. And so, you know, we also talk in your book, you also talk about treating low blood sugar after a workout, like you're, you're trying to there, you're there to burn calories. And then immediately after you work out, your blood sugar goes low and you have to treat that low blood sugar with carbs, but also calories. And a lot of times calories that you wouldn't want to choose otherwise. Like for me, I treat most of my lows with gummy bears, which are not part of my, you

[00:32:37] Ginger Vieira: nutrition, but I take them medicinally, you know, so. Right. Hey, I use Mike and Ike medicinally and they are medicine. I take exactly the amount I need. And yeah, but yeah, that's if you're trying to lose weight. One thing to know for sure is that if you are going from not exercising much to not exercising every day, people get really frustrated because they start going low all the time, eating all the time, exhausted, and then they give up. If you start exercising regularly, suddenly, you need to immediately, and then again, probably a week later and a few weeks after that, talk to your healthcare team about lowering all your basal rate and potentially your meal boluses immediately. Otherwise, if you're having lows every day, you'll have too much insulin on board. I've gone to a little chat with a bunch of type ones to talk about exercise, and they all say, well, I try, but I'm just going low all the time. And I say, you need to lower your basal rate. They're like, no, no, I don't think so. I'm like, yes, yes, Yes. And they're afraid they're going to be high all the time. But the more consistent you are with your exercise routine, the more those lowered basal rates become your new normal. Instead of thinking of them as the abnormal basal rate, make this part of every day. My friend always says to me, how do you make sure you do it every day? Because it's so much easier to exercise every day as a person with type 1 than to exercise sporadically. so if you just i know that if i get that 30 minutes of cardio my insulin sensitivity is going to be roughly the same as it was the day before right so that's one thing to keep in mind and then your habit with treating lows if you are regularly binge eating to treat lows you got to take a microscope to that because we tend there's this kind of toxic belief like you mentioned earlier that this is normal to eat 500 calories for every low and it's normal to just let yourself binge eat and it's something that you don't have control over. That's a belief. It's false. You do have control over how much food you put in your mouth. I used to overeat during loads and I was finally just like, this sucks that I keep doing this to myself. And I came up with some rules that just helped me get into a habit of not doing that. One is that I only use foods that I see as medicine. That doesn't mean they're gross food. That just means I don't think of these Mike and Ikes as a snack, right? I'm going to use three because I know I only need three to bring this blood sugar up. The second is if I'm feeling that urge to binge, like my brain is just desperate for more, I will reach for a tall glass of ice water that can really calm down that feeling in my brain. I'll eat carrots if I need to, because that gnoshing feeling, my jaw feels like, oh, I am getting more calories, but it's really just carrots, you know? You're going to take a lot of extra bites. They do. And there's just no way I'm going to binge on baggy carrots because they're not that good. And then gum, stick a piece of bazooka gum in there and just chew, just and then sit on your hands and use self-control. Tell yourself, make it your mantra. I am in control of how much food I eat during this low. That's it. You are in control of it. It is not in control of you. Just because your brain is begging for more doesn't mean that you don't rationally know you don't need more food right now. And then reminding yourself what happens if you do just keep binging. It sucks if you do that, right? It affects the rest of your day.

[00:36:03] Rob Howe: I also think just it's hard. It is hard. And your brain is sending you weird signals. We did a podcast earlier this year with my buddy Ben Zeal. And we talked about, you know, diabetes causes disordered eating, even if you're doing everything you're supposed to be doing. because not everybody's supposed to count every single carb that they eat. Not everybody's supposed to, we're not wired to eat Mike and Ike's medicinally. It's cool that we can, but that's different and it's weird. And so give yourself a little bit of grace too if you don't get it right every single time because yeah, your brain, when you're low, your brain is sending you dopamine after you eat saying, yes, more of this. We need to live. We need that sugar in our system. But like you said, you can change that self-talk. you can adjust those toxic beliefs to say, you know, I am in control. I am consciously treating this low blood sugar, not just giving in to the binge fridge raid. Although sometimes you got to do that.

[00:36:59] Ginger Vieira: I mean, if it happens time to time, and also there are lows where a bowl of cereal is a valid thing that you just, I've had a low where it's like, I know that in order to feel like I'm going to be okay, I need two bowl of cereal. And it, you know, to me, that wasn't a binge. It was very methodical of, I'm going to eat two bowls of cereal because I'm really worried right now about the amount of insulin I have on board. I was so low. And, you know, I made that decision consciously and then watched carefully to try to prevent an overdue, you know, on the other end.

[00:37:32] Rob Howe: Of course. I think, you know, again, a little bit more thought. And, you know, thought determines action. And I think, you know, we talked about curiosity. you know those are really foundational elements to whether it's exercise or anything else like living well and thriving like you said earlier with diabetes and it's like taking ownership

[00:37:51] Ginger Vieira: really it starts with just being honest with yourself but like i do have control over how much i eat or if i choose to get up and go out the door and exercise you know it's just being honest with yourself about that you're the one making the decisions and they're not always easy decisions and you don't always make the perfect decision. But even if you make the imperfect decision, just own it. Like, yeah, I chose to binge during that low and I'm going to have to manage the mess that follows. And then I'm going to brush off and move on. And tomorrow I'm going

[00:38:21] Rob Howe: to maybe try to do it differently. Totally agree. Something I haven't really talked about in a while on the podcast is intermittent fasting. And there is a chapter in your book about, about IF, about intermittent fasting. I'll share that until I got on my first hybrid closed loop system, so this was 2018, I started on the MiniMed 670G, I never missed a meal basically. That was part of my routine. And my blood sugars, I'd wake up in the morning, I might get a little bit of feet on phenomenon, feet on the floor, then I'd come down a little bit and then I would eat breakfast and I'd come down and lunch and lunch would carry through. And I would do my best to stay in range by timing my meals and, you know, keeping those consistent. That changed. And when I started reading more about intermittent fasting and I wanted to try that, but before I got on my, you know, closed loop system, automated instant delivery, I, I couldn't do it successfully in the morning because I, you know, I hadn't adjusted my basal rates appropriately. So, but now anyway, I haven't eaten breakfast, basically, you know, 99 out of a hundred meals or days I don't eat breakfast and I do the 16-8 intermittent fasting. And so, you know, for you, what benefits would you tell someone living with diabetes, like trying that and then also approaching that if you're

[00:39:44] Ginger Vieira: not on a automated insulin delivery system? Sure. I started the 16-8 back after my first child was born, I think. And it absolutely helped me ruse the eight pounds of postpartum chub that I was still carrying. And I didn't go nuts with it. It wasn't like religion. It was like I just really tried to not eat till 1 p.m. every day. And I felt so good doing that. It just simplified an entire first half of the day. And I did it again with my second after my second was born to lose those same eight pounds postpartum chub. And then when I had two little kids running ground. IF was also really helpful for just eliminating the need to worry about load for the first half of the day. I can go to the playground and chase this one and chase that one and not worry about insulin on board. And this was, you know, my kids are eight and six and I was kind of intermittently using it at CGM because I was real burnt out on CGM after the two pregnancies and breaking my finger a lot. So it was just really nice to eliminate, you know, not eliminate completely, but hugely reduce the need to worry about insulin on board.

[00:41:01] Rob Howe: And you take out those variables, right? And if all of a sudden you're running around the house, chasing the kids a little bit more than normal, you don't have to worry about, oh, I've got two units of insulin on board and I need to find those medicinal Mike and Ikes.

[00:41:14] Ginger Vieira: And we were living pretty out in the woods. So we could just spontaneously be like, let's go walk down the half mile long driveway. And, you know, if you have, it doesn't matter if it's only a half mile with two little kids. And if you have insulin on board, it's potentially going to suck, you know? Yeah. So, and I would put my kids in the backpack and take them on long walks through the woods. You know, like I was still very active. And the last thing you want to do is go low when you have a baby on your back and you're in the middle of the woods. For sure. Right? And so something to also keep in mind with IF, but also weight loss that comes with it. If you lose two, three pounds, your basal rates need to go down and your basal inflowin dose needs to go down quickly or you're going to be going low all the time. For me with long acting, I mean, I love tweaking my long acting dose. If I know I'm just going to be eating really diligently, even just for a week, I know I need to reduce my long acting dose by 10%. So if you haven't already learned how to make little adjustments in your bagel rates, IF is a great way to learn that because you'll need to if you suddenly clean up or reduce the amount of food you're eating, you're going to need less background inform. And it doesn't have to be crazy complicated. It could be a reduction that applies across the board if you don't want to get more into it than that. and give yourself some grace when you're experimenting with something like IF. Let yourself run a smidge higher perhaps. If you're always down here, it'll be perfect. You're learning, so you're studying something new. Let yourself run a little higher so that you can experiment safely without lots of load. And something to keep in mind with IF if you do have Down phenomenon is you're going to have to potentially take a small bolus for that morning spike. like so before I was on that form and I absolutely needed nearly a unit sometimes and that was a little nerve-wracking to do because I didn't want rapid IP inform on board but I would just keep checking looking at the data and yeah this is how much I need and even when I need it so that's a variable to throw in there and people will ask me well if I take that does that cancel out the fasting benefits you're like well no the first priority is blood sugar management right the

[00:43:43] Rob Howe: second priority is fasting i think that too there's always something that will you know we can mess up a fast you know we're not all going to be dialed into you know the the kind of extreme ends of things like trying to get into like a ketosis state or whatever the case may be yeah and you

[00:44:00] Ginger Vieira: don't need to to benefit from it it doesn't matter yeah and that's that's kind of the thing is like

[00:44:05] Rob Howe: even so I cold plunge most days and, you know, in the, in the bodybuilding community or like, you know, extreme levels of like athleticism, you shouldn't cold plunge after a weightlifting session because it can diminish some of the hypertrophy that you're trying to gain from that. But for me, I'm not competing that. So the, whatever, the most important thing for me is that I exercise and that I cold plunge. And so that's the thing I think that you're saying as well. It's like, hey, let's minimize some of the variables. If you have to take a little bit of insulin and that, you know, and you have to eat a couple of Mike and Ikes. Or treat a low. Yeah,

[00:44:39] Ginger Vieira: that's another question I get a lot is, well, if I have to treat a low, I ruined it. No, you didn't ruin it. You kept yourself alive. You learned something for next time. And if you don't over-treat the low, you can continue your fat, right? That's a great way to learn. IF is a great motivation, I think, for two things. Doing what it takes before bed to wake up in range so you You don't have to take a correction of insulin when you wake up and learning how to not over treat lows. Because if you just have the three Mike and Ikes for the mild low, then you're still in range. You don't have to take more insulin to compensate for over treating. And you can still continue your fast. Is it perfect? No, but who cares? It still has awesome benefits. So I find too that it helps naturally reduce calorie intake by, you know, it's different for my body for yours because our meal sizes are different, right? But it's eliminating my entire meal from my day practically. So it's immediately cutting, let's say 400 calories at least from my day. And I'm not like having to eat teeny meals the rest of the day to get that 400 calorie reduction. I'm just eating my normal meals once I start eating. And so that can lead to that nice steady gradual weight loss if that's your goal or weight management.

[00:45:55] Rob Howe: Yeah. And I think even for me, it's not as much about weight management as it is like just creating a routine that simplifies some of my diabetes management. Just also learning about yourself. I'm not a person, I never really liked eating breakfast that much. And, you know, now having that option, you know, it really kind of resonates. And so finding, you know, that balance to live the life with diabetes that you want is super important. But I also think, you know, earlier you alluded to this, the consistency is what brings the change and the habit forming. And so, you know, show me your habits and I'll show you, you know, your success is an idiom, I guess.

[00:46:36] Ginger Vieira: Yes. The version I like of that is Bruce Lee saying we are what we repeatedly do. that's right that's right you got to put in that repetition and consistency 100 and i think

[00:46:47] Rob Howe: going back to exercise a concept that i have totally adopted from one of my friends who is just recently now is the assistant coach for the university of texas basketball team what was the phoenix sun strength coach for many years the idea of micro dosing your workouts and just showing up for the same 15 to 30 minutes, maybe twice a day for his pro athletes, but for us normies, 30 minutes a day at the same time, addressing and just being in the gym. We don't have to run a marathon every day. We don't have to hit our one rep max every time. And in fact, if we just exercise enough that we want to come back tomorrow, kind of like Hemingway talks about writing, just leave a little bit for tomorrow. And if you adapt that into your workout routine or your exercise routine, even if it's just going for a walk in the morning, leaving a little bit for tomorrow and being able to show up for yourself. It's amazing how much progress you can make over a long period of time from just being consistent.

[00:47:46] Ginger Vieira: I mean, as someone with fibromyalgia, that's something I've really had to embrace because I can't push myself to a max capacity because I'll pay for it for days. And so, you know, I walk my dog twice a day and I do cardio up to 30, maybe 40 minutes if I'm really in the mood with a jump rope. But right now I'm 30, feels like plenty. And then if I want to do weights and it's 15, you know, it's later in the day, it's not usually connected to the cardio. It's just dabbled or through the day, right? And I'm never killing myself. I've had people say, oh, I go to the gym, I just kill myself. I'm just so, I'm like, why are you doing that? You don't need to do that. You don't need to do that. And it's a culture that we've gotten from different things that make us think we need to go brutal for an hour at a CrossFit gym in order to get benefits, but you don't. Just show up, as you said, for a little bit and make you happy.

[00:48:42] Rob Howe: Great advice. And I think too, some of that is you can't make up for a month, a year of missed workouts in one day. You just got to keep consistent. And I think that whatever you've got to do to make sure that you're able to show up for yourself tomorrow is where you should start to start to work at it.

[00:48:59] Ginger Vieira: And I will say, if we have a minute left, that there are lots of days where I wake up and I'm like, girl, I don't think I have the energy to exercise today. And by the time I get the dogs out and finish that morning dog walk, I'm like, well, I'm ready for my run. So regardless, what helps me is I put on, before I even go down the stairs, I put on my exercise clothes. So whether I think I have the energy for it or not, I'm ready. And that is one more hurdle. So and then what I also remind myself is, you know, if you just get this 30 minutes and you're going to have that insulin sensitivity that you're used to and it can be that much easier to dose insulin for lunch when you do eat, you know, and it feels so good once you start. So even if you don't think, I just want people who haven't gotten in that rhythm and that ground of exercising every day, don't think that the people who do exercise every day, that it's always easy to show up. They're still convincing themselves to go sometimes. They're still talking themselves through it and saying, oh, you've got to do this because it's part of that habit and it's part of their routine. And it's very, it's, there's no excuses that get in the way. I don't care if it's school starting next week or now it's summer or, well, I'm going to be on vacation. I bring my sneakers with me on vacation because part of what's going to help me feel good on vacation is exercising.

[00:50:24] Rob Howe: I love those little atomic habits. Shout out to James, James Clear's book, Atomic Habits of, you know, if you've got your, you want to go for a run, just put your shoes on. You want to go to the gym, put your exercise clothes on. You're already there. For me, my atomic habit is I put my journal on my keyboard. So in order for me to get on my computer, I have to physically pick up the journal and move it. So I've already got it in my hand. I might as well write in it. So, you know, I think you can use those little tricks. You can use learning yourself, being curious, setting yourself up for success and reminding you, yeah, I don't wake up every day with the lightning bolt to the heart ready to take on the world. Most days I just have to get into the rhythm and get that momentum building. So great advice. Thanks. Okay. Well, Ginger, thank you so much for your time today. The newest book, the latest book is Exercise with Type 1 Diabetes, How to Exercise Without Scary Lows or Frustrating Highs. It's available on Amazon. We'll have the link in the show notes. And Ginger, thank you for being such a great voice for people with diabetes on the internet publicly. And also, I know you're a great resource one-on-one as well for so many. So thank you very much. Thanks for having me.

[00:51:31] Ginger Vieira: Great. Bye. Got you, Rob.