Exercise & T1D Livestream w/ Dr. Dessi Zaharieva & Chris Bright

[00:00:00] Rob Howe: What's going on, everybody? It's Rob from Diabetics Doing Things, and you're listening to the Diabetics Doing Things podcast. Today's episode is going to be a little bit different. We're trying some new things. And what you're going to hear is a live recording of a live stream on our YouTube channel from Wednesday, April 30th. I'm trying to bring in experts and people with lived experience to give you real actionable information and expertise on some of the most popular diabetes topics. And one that continually comes up for me and I get a lot of questions about is diabetes and exercise. So today what we talk about is the different types of exercise. And I have Dr. Dessi Zaharieva on and Chris Bright from the diabetes football community and Breakthrough T1D UK. We all three live with diabetes. So you have over 75 years of life with T1D on the podcast. And we dig into not only the topics that we outline, but some live Q&A as well. If you want to be part of these in the future, be sure you're subscribed to the DRIP email newsletter and keep an eye out on the Diabetics Doing Things social media. So uh, diabeticsdoingthings.com slash subscribe for more information. And this episode was brought to you by type zero and we get into some of the type zero calls to action in the interview. But if you want to save 20% on your order, use code Rob how at checkout for type zero health.com. Okay, let's get to the episode. What's going on, everybody? Welcome. Welcome in. I've got the, I've got the live pulled up here on YouTube next to me so I can make sure that everything's working. But thank you guys for joining. Sorry if there was confusion on the start time. We had our tech call time at 10 a.m. Eastern or 10 a.m. Central. And so we're starting the live here now at 1030. If you are listening, go ahead and fire off in the chat where you're listening from and where you're watching from and how long you've lived with diabetes or how long you've been taking care of somebody with diabetes for those of us who are caregivers of people with type 1. Very excited for this event today. It is our first event of this kind where we're doing the live stream here on YouTube. We're going to be doing Q&A. So I have two amazing experts with me who are going to join on this panel about T1D and exercise. I'm trying to bring in people to our content who not only live with diabetes and have great lived experience, but also people who are experts and who can provide a clinical perspective. As you guys know, if you've been listening for a long time or subscribing for a long time, I, Rob, don't provide medical advice because I'm not a doctor. So whenever I can bring in people who have that actual clinical knowledge and when we're talking about things that are really important, like exercise and the health benefits of it and how to prepare for it, I want to have a good mix of lived experience and of expertise. So today is our first step in that direction. And my guests are really amazing people who both live with type 1 diabetes and are amazing athletes as well as advocates and researchers in their own right. So I'm going to take you through just a couple of slides, a little bit of some updates. I'm Rob. I am the founder of Diabetics Doing Things. You guys know me if you listen to the podcast or watch the YouTube channel. and we've done over 340 podcasts since 2015 telling the amazing stories of people with diabetes from all over the world. I recently came back from the International Diabetes Federation Congress in Bangkok and it's been really amazing over the years to see how many places I've been able to go and the people I've been able to meet just from starting an online advocacy platform. A few years ago in 2023, we started doing events. We have done events for adults, pickleball tournaments, coffee shop meetups, as well as our signature youth and teen events, which is the Diabetes Legends Basketball Clinic. We've got three Diabetes Legends Basketball Clinics coming up this year in Dallas, in Denver, and our newest in Orlando, which will be at the Children with Diabetes Friends for Life conference. So more information on all of those coming very soon. And then we have content just like this. We've got social media content. We've got YouTube content. We've got podcast content to educate, empower, inform, and connect people with diabetes. I want to give a quick shout out. This is very relevant today for our exercise podcast or our exercise interview. We are sponsored by Type Zero Health. Type Zero makes clean exercise products, whether that's pre-workout, hydration, electrolytes, or creatine and some protein products. It's a T1D-owned business. John Jensen has come on the podcast a few times to talk about the business. You can use my code, RobHow, for 20% off all of your products. That code is always good, but they're also running good promotions throughout. I just used their Easter code last week to reorder some of my supplies. This is what I use when I work out, and they've been supporters of the podcast. And they're formulated to not spike your blood glucose, to keep things and keep the factors around your exercise as simple as possible. And we're going to talk about how we prepare individually for exercise. But I use this product, I stand by it, and they're big supporters of the podcast. So be sure to check them out. typezerohealth.com. Okay, well, I'm going to ask our panelists to come off of their mute and get live here so we can start this amazing panel. So I'd like to introduce you guys to Desi Zaharieva and Chris Bright, who are giving of themselves and giving their time to provide you guys with expert insight and lived experience around diabetes and exercise. So I'll kind of let them introduce themselves, starting with Desi.

[00:06:35] Dessi Zaharieva: Thanks, Rob. I am so excited to be here to talk about my favorite topic, exercise and type 1. So again, my name is Dessi Zaharieva. I am a senior research scientist and exercise physiologist. I work at Stanford University in pediatrics. And yeah, I've been living with type 1 diabetes for over 28 years myself. Looking forward to today.

[00:07:01] Chris Bright: Hi, everyone. I'm Chris Bright. You might be able to tell by the accent, but I am from the United Kingdom. I've lived with Type 1 for just over 25 years. My current role is working for Breakthrough T1D in the UK, where I work in community engagement around partnerships and community events. I also founded the Diabetes Football Community, which again is a peer support based organization trying to support people through the power of sport. So like Desi, very, very excited about the conversation today and getting on to talking about exercise with type 1. And then for those of us, football, when Chris says it, and as football as we'll discuss today, is what we would call in the U.S. soccer. So we'll leave the American football to the pros, but it'll be mostly footy today. Okay, here's what we're going to talk about today. And we're going to be a good use of our time for you guys watching so that we can ask questions. If you have to leave the stream for any reason, go ahead and put your question in the chat and we may get to it later. And this will actually live as a podcast on diabetics doing things after, as well as on the YouTube channel. So you can come back and hear your question get answered. But I'm going to go over our agenda really quick. We're going to talk about the clinical benefits of exercise and why people with diabetes should have an exercise practice. And I'm really excited to kind of dig into that because even recently we were talking prior to turning on the live stream. Exercise is not just for elite athletes. It really does flow into all different parts of your life. and then i think a really popular question that i get regularly and i see a lot on social media is how to prepare for exercise and the different types of exercise and the factors that you need to consider uh when you're on your way to the gym or you're on your way to a practice then the factors that impact glucose during exercise it's not just insulin on board it's not just the type of exercise there's so many different things and i think something that i've been taught as I've been going on this podcast journey is that diabetes in many clinical circles is spoken of as the disease with too many inputs. So we're going to talk about some of those inputs and how they affect exercise. And then we'll finish our discussion on the mental health benefits of exercise and the brain body connection, body mind connection. And then we'll go to our audience Q&A. So really, really excited for that. And what I'm going to go ahead and do here is stop sharing the screen so that we have just the three of us up here on the stream. And I'm going to start, we're going to start with the clinical side. So Desi, this is really going to be for you. And I'm really excited to have you here as a resource to help explain some of the clinical health benefits of exercise related to diabetes. So why should people with diabetes have a consistent exercise practice? And I'd like to focus on as well, after you answer that sort of overarching question, the differences between anaerobic and aerobic exercise.

[00:10:18] Dessi Zaharieva: Yeah, these are often the questions I start with because no matter if you've had diabetes for a couple of months or many years, there's a lot we need to understand about how the body works when we exercise with type 1 diabetes. So it's kind of my go-to starting place. I would say that exercise is one of the most powerful tools for people with type 1 diabetes to improve long-term health benefits and health outcomes. There's so many things that can come from being regularly active. And Robby, you and I have talked about this, but it doesn't mean you need to be an elite athlete. I think one of the starting places is by practicing and doing exercise regularly, one of the main things that you can understand is some patterns and trends that might occur. If you are new to exercise, you don't know how your body's going to respond to something. Having diabetes myself for 28 years, I can tell you that's many exercise sessions where I've been able to repeat things over and over and over again and start to understand some similarities, but also understand probably some differences from practices to games, to competitions, to stress, and all these different things that can impact the body. But I would say by doing it regularly, a lot of different things, cardiovascular health benefits, you can see increases in insulin sensitivity. So I always try to say, I don't want people to think that more insulin is bad and less insulin is good. But the reality is, is just how that insulin gets used in the body can change. And sometimes that does mean a little less insulin as we are more active. So those are all of the things that can happen with regular practice of exercise. I love that. And I want to touch on something

[00:12:03] Rob Howe: that I think in the exercise community in general applies, but I think especially for people with diabetes and some of the resources that typically are given to the diabetes community through elite athletes. And I want to give you both props. You both are elite athletes in your own right, even though we're maybe past our prime. We were talking about this before we joined. but exercise I find is one of the interesting things that we expect as people we go in on our first day to to be really excellent at something not just the movement or the weight or the skill but then also managing the diabetes on top of that which can be really challenging so how do you you know even now as you're trying new exercise practices outside of sport how do you make sure to maintain that beginner mindset to to help you set yourself up for success

[00:12:54] Dessi Zaharieva: Yeah, I can kick it off. I just wanted to say that, again, having diabetes for over 28 years, every day is sort of a new day to get started. And I always start with the mindset that we're not striving for perfection, or we typically shouldn't be. I think it's really easy in diabetes if we are striving for perfection to feel like we're failing. And for me, it's how can we encourage everyone to be active, knowing that exercise itself causes disruptions to glucose levels. Like it could cause blood sugars to rise. It could cause blood sugars to drop. And I think if we're striving for being perfect and in range all the time, it's going to be difficult. So I always try to say that every day is a new day, but having that beginner mindset, even 28 years later is how I go into exercise. And it doesn't mean I want my blood sugars to be low all day long when I'm exercising, but I can start on a day and realize today's just going to be a little bit more difficult than it was yesterday. Or maybe today I'm going to try something a little different than what I did yesterday. And so I always have that beginner mindset, but I love that you mentioned that.

[00:14:01] Chris Bright: I love that we're talking about the consistency and like trying to manage expectations and trying to do maybe the same things to set ourselves up for success. But something that I've been made more aware of recently is that when we talk about elite athletes with diabetes, we sort of paint them in this superhero type of image where it seems like their A1Cs are always in range, their time and range is excellent, and they don't encounter the problems that the regular people encounter when they're going to exercise. I would like to dispel that. And also, Chris, talk to your perspective. I think when I was an elite athlete, the thing that I did really well, and maybe more elite than someone who's just getting started, is I knew what decisions to make if I was in a particular out-of-range moment, if my blood sugar was too low or my blood sugar was too high or I didn't get enough sleep or I was traveling and maybe my timing was different than a normal day. So my sugars were not always in range. And yet, I think as athletes, we try to encounter obstacles and work our way through them. and sport really taught me how to be resilient there. But for you, Chris, I'd love to hear how did you approach competition or even practice when you were an elite athlete? I think where we're going with mindset is a really good place to start, actually, because where you talk there about resilience, Rob, I think where people living with type 1 are inherently resilient. We're dealing with so much day in, day out, that we develop a resilience that maybe not everybody gets to in life but I think we get a great opportunity with the tests that we're put through to develop some I think the the thing that maybe I can feel that I've done well to try and put myself in a good position to take part in sport at various different levels is not getting too emotional about numbers and not getting too caught up with the challenges and the mistakes and I've used the phrase a few times seeing a mistake like a bad pass and even with it being a mistake or a wrong number it kind of isn't it's just an opportunity to learn so it's kind of softening all of the challenge and saying if the number is out of range it's just the number I've just got to deal with and I've just got to deal with it as part of a process rather than creating any emotional response to it and then as a result it puts me in a good mind frame then for how i then tackle the rest of the sport i'm just in that that space where i'm seeing it as a process and a problem to then work out and then go on to the next thing and that's then how i approach the sport and getting prepared for it is that i am then prepping with that same starting position it's kind of thinking about what is it that I need thinking about how I'm going to make small adjustments how I've got the right things around me whether that's my whether it was a insulin injection or a hypo treatment which allowed me to make small adjustments then it's that thinking that you know Desi and you've already touched on Rob about the kind of different types of intensity the duration maybe the time of the day just getting some of that planning into prior taking part in sport and thinking about testing and making sure I've got a good eye on my numbers. And then I always felt that if I'd done all of that little bit of prep work around it and I'd found something which worked, I was always in a place where if I find something that seemed to work and a pattern which seemed to work, and Desi's touching it as well about analysis of how things have been going, I was always quite good at retrospectively and reviewing what had happened and saying, right, well, it worked or it didn't, and then not getting too emotional about it working well or it not working well and then seeing okay small adjustment there no adjustment let's do that next week or the next time i do this sport and i'm really trying to yeah just just see it as a see it as part of a of a of whatever you would be doing in work a small problem yeah and i know it's your day today and i know it's the thing that we are feeling the pain from and sometimes the challenges from and sometimes feeling good about it, but actually just trying to work it out in a softer way, which doesn't hold so much weight. I really like that approach. And, you know, now we have so much data at our fingertips with CGM, those of us who wear CGM or maybe on automated insulin delivery, you know, insulin pumps. But when I was an elite athlete, and for many years for both of you as well, there weren't that many resources available. So I remember I had to go, I had a little journal, and I would just write down what worked and what didn't and what happened. And I'm not smart enough to just keep everything up in the top of my brain. So being able to go back and look at that and review that later in my career with an athletic trainer and somebody who was also invested in my success on the court really helped. But especially as a caregiver, I think that's something that you can do to help solve those problems and really understand that. And I think we've gotten some really cool comments about all of the different sports that people are participating in, sports and activities in the chat. Please continue to add those. But, you know, Desi, there's a difference between a lot of these exercises that are being listed here, aerobic versus anaerobic. So can you give us a little primer as the scientific expert here in the live stream on the differences between aerobic and anaerobic exercise and the impact that it has on diabetes?

[00:19:55] Dessi Zaharieva: Yeah, absolutely. I always try to simplify this because we get into these rabbit holes of trying to understand the physiology. But the reality is, is if even what I say today doesn't seem like it applies to you, just know that every person responds differently to exercise. And I just say that and preface this with there may be other factors that could also be contributing to why you may or may not be seeing the response. But when it comes to the actual way the body works with aerobic exercise, you know, and no one activity is purely anaerobic or purely anaerobic. I always try to say like it's kind of pulling from both sides and it may be more predominantly aerobic, which really just means activities like brisk walking, jogging, biking, you know, at a pretty, you know, steady intensity. We're not doing intervals or sprints, right? We use up oxygen to produce energy when we are doing aerobic based activities. We can typically sustain those activities for 30 minutes or longer. You use large muscle groups. And in the diabetes response, aerobic activities oftentimes tend to cause glucose levels to drop. The body's using up the energy in those muscles. And unfortunately, due to a lot of challenges with diabetes that we can't reduce the amount of insulin in the circulation in our body, our blood sugars often tend to drop the longer we do these aerobic-based activities, especially 30 minutes or longer. But when it comes to anaerobic activities, again, I always try to say even resistance exercise in many instances is more of a mixed type of activity. Unless you're absolutely doing like really the heaviest powerlifting one rep max or doing like, you know, the biggest sprint you've ever done that may be more anaerobic in nature, you know, under a minute of sprinting. anaerobic really relies on not using oxygen, using up very like short, intense efforts. And this type of intensity or exercise in some instances can actually cause glucose levels to rise. And we see this because of a number of different counter-regulatory hormones or basically hormones in the body that get released that can impact glucose levels. So you might have an increase in adrenaline or cortisol. And you might start to think about, oh, I see this maybe during competition or stress settings. But you also might see this because the liver itself in very intense activities may be causing glucose to be released at a faster rate than what the muscles can take up. And so where that glucose is going to end up is often in the bloodstream. So there are a lot of differences in these activities, but also remembering that one activity can fall into many different categories, just depending on the intensity you do it at.

[00:22:42] Rob Howe: Desi, you reminded me of a great story, and I'm going to brag on you for a little bit here, if you don't mind. But those who are listening and watching on the chat, this is not hyperbole to say that Desi is one of the foremost authorities on diabetes and exercise in the world. And one of her colleagues, Dr. Mike Riddell, who I've had the pleasure of meeting over over the years, and I'm a huge fan of, has also been on the podcast before. I saw a presentation of his in Denver in 2019, where he intentionally gave himself hypoglycemia, like he intentionally gave himself low blood sugar. And then in the middle of his presentation, he started sprinting back and forth in this little room to show the impact of short-term intervals and adrenaline and anaerobic exercise on blood glucose to show how to spike his sugars up. which blew everybody's mind in the presentation. And I was like, wow, this is a committed guy in a presentation. And if you know Mike at all, you know that that's just very much his personality. But I think it's really important to hear that because I promise I'll land the plane on this point I'm making here. But earlier you talked about there are things going on in our bodies relative to insulin needs, whether to reduce insulin needs or increase insulin needs around exercise, that have nothing to do with food, and they are associated to those other factors, which we're going to dig into a little bit more later in the chat. But I really do want to highlight that there's a lot more going on during exercise than maybe you realize, and the likelihood that your exercise is either exclusively anaerobic or aerobic is unlikely. for me, basketball is, is both. Uh, and, and I also am kind of intense and I love to play. So my heartbreak gets up and my, my body starts to respond, uh, in a competitive way in an adrenalized way. And that causes some insulin resistance. So we'll talk a little bit more about that. Um, did you have something else to add? Yeah, I just kind of wanted to say exactly on

[00:24:49] Dessi Zaharieva: this point, but, um, it can be confusing because when you're doing even something like basketball, Like Rob, you were saying one day might be more of like a scrimmage day or like a game or practice kind of day where you're running up and down the court a lot. But another practice might be a lot more like drills and a lot more lower intensity overall. You're still probably doing it for over an hour, but the intensity just changes. So this is where I like to hone in on just this idea that it's the same activity. You're still playing basketball. It's just a different intensity. And that in itself makes it difficult because sometimes people say, oh, I did see my blood sugars do X when I did a game. But then it could also be the foods that they ate, all these other factors, which we'll get into. But I always like to just kind of remind people that there's a lot going on when it comes to managing our diabetes. And going back to the first point of why we don't strive for perfection, because it's often difficult to figure out what is causing those ups and downs.

[00:25:46] Chris Bright: I'm really excited to dig into that because I think, you know, stress for me was something I had to learn about when I was an athlete of that impacted my blood sugars. OK, so so, Chris, I want to get into a little bit of this around the community aspect, because you are one of the founders of the diabetes football community. And that is a group of at least right now of a futsal team where everybody on the team has type 1 diabetes. So I want to ask two questions. The first is, how do you prepare for whether it's an indoor football or football match now, later in your career? And then what's it like to play on a team full of T1Ds? Yeah, I mean, just to preface it, it's amazing to see it. It's amazing to be a part of. and actually the preparation that I go through, I get to then see what I might do in others and in terms of how they would approach it, I would see the differences in what we do to approach what is a very similar situation, which I think is fascinating and which Desi's just touched on and all of the different ways that our bodies, because of the individual element of them, react to what is essentially a very similar-ish kind of thing that we're all going through. But from my perspective, I think I always look at routine. I always go into things thinking about the foundations of what it is that I'm going to be doing. And I think we'll get into some of where the variances can fall. And I think for me, starting with routine, I'm looking at then how I carry the right equipment with me, the right things to make adjustments. I'm always thinking about the previous meal bolus as well. trying to make sure that there's plenty of space between the last meal and then the exercise that I'm going to take part in. We're talking about variables. That hopefully reduces one variable, which is having lots of insulin on board, which can react and create challenges. So trying to reduce that insulin on board by having meals spaced well apart and then thinking about how hot it's going to be, whether it's indoor or outdoor. the type of game the amount of time I might be thinking I'm going to be playing I think is really interesting and it was also when you were talking there Rob about the competition element so one, are we playing a team at the bottom of the league or are we playing a team at the top of the league because that's going to make a difference as well if I'm playing in defence and we're playing a team we're going to beat 5 or 6-0 or we think we're likely to beat I'm probably going to have an easier afternoon than I would have if we were playing a team at the top. So you start to think about all those different variables, I think, before the game, which does come into my mind about then the preparation. But I think about that routine. I think about spacing insulin away from the game. I think about the same sort of food as well, because the food then is a bit more predictable for me coming into the game and what my levels are likely to do. So again, really trying to keep things as same or as routinely as I can. Because again, variables, I'm thinking about that all the time. And then testing. And we've already spoken about it. But being okay at being reactive and being okay with the fact that I might have done all of those things. And it comes to half past two. And I think this is going to be fine for the three o'clock kickoff. And I come in and I am on the verge of a hypo. but just being okay with that that i have got to this is my life this is the way that i've got to do it to be out on that field or on that court and right it's just an adjustment i've just got making an adjustment i've just got to take this on and just not feeling any way about that other than i've got to do it this is what it takes this is what i'm going to do and then thinking about right next time i test hopefully my levels are good and then honestly when it comes to the game forget about it that that's how i have that's how i've always been and always how i always think i have to be to do sport at that kind of level and i've always thought about um and i don't know whether either of you feel this as well about nerves and anxiety but i was always a player that kind of i had a bit of that i always had a bit of nerves and anxiety and the stress which came in so i always had to try and diminish my sport to like make me feel okay like because i didn't want that stress spike in my level so I always used to like do self-talk with myself to reduce the power of what I'm doing even if it was a huge game even if it was a game on the television or a national team game in Europe I'm saying to myself it's just a bag of air in leather that I'm kicking around and I just do this to myself I would self-talk myself into that space that then when I went out there I was like I'm so relaxed because I'm I do the best I can do anyway but I'm just I've chilled myself out and you can and i could see it in my glucose levels and and again just trying to you know make it less weighty what i'm doing and try and take some of the stress out of it because we know the physiological response is not you know it's not helpful if my levels are 17 and i'm looking for performance because that's not going to allow me to perform at my best so i think that's my kind of prep thing and then in terms of the community side of it i think it's just an amazing place to to see um the individual element and and how everybody's dealing with type 1 differently whether that's they're using injections or pumps or which type of sensor the individual way of looking at the same thing i think is really fascinating for me when i go into that environment but also just going into there's something special about playing in a team of men that where there's a lot of challenges about how men speak in sporting environments and how they feel where you go into this space and people are talking about something which is quite personal to them a medical condition and it just encourages a different atmosphere and an environment and as a result i just i always go in and i feel lighter coming out and and that's probably the there's some sort of magic in the air where playing on a team with everyone's type 1 and you're all you're all doing the thing that you love doing but you've got this this bond that you can't really measure or write down or really quantify it. It's difficult, but yeah, very, very special. And I'm very privileged to be able to help do that with the diabetes football community. I think you hit the nail on the head with that, that vulnerability really is magic. And I think that's something that I hadn't really seen at a level of sport until we started to do our Diabetes Legends basketball clinics and to see how the kids, no matter the age or where they're from or how skilled they are, they bond over something that's deeper than the sport. And they can still have fun and kind of, like you said, forget about managing the diabetes in that moment. But they're sharing something and they're sharing that burden along the way. We're going to talk a little bit about mental health as we get to the close. Something I wanted to say is like having curiosity around the numbers is something that I've gotten better at as I've gotten older. I think about my 22-year-old self playing at the highest level. I probably wouldn't have as much patience with myself. I was very, like, hardcore at that time. But, you know, I think when I'm trying to go into an exercise, you know, Chris, I really like the idea of, like, what kind of match or what kind of game or practice am I preparing for? Because the four factors that I kind of look at as I was preparing for today, starting blood glucose? Do I need to put the activity mode or the temp target on my insulin pump based on the activity I'm doing? Do I have insulin on board? My preference is to exercise fasted just so I don't have to worry about that. But sometimes my glucose is higher than I like, and I will put a little bit of insulin on board for a basketball game, for example. And then what am I doing? What type of exercise? Desi, you had mentioned, you know, strength training is a lot of times, uh, aerobic at some, it's, you know, a zone two cardio for those who are really locked in on the, on the trends right now, um, where it's kind of steady state for a longer period of time increases your insulin sensitivity. So I can kind of guess if I, if I keep those factors, uh, you know, what my starting blood sugar is going to be and then where I'm going to end up and what's going to happen after the exercise. Uh, for example, after a basketball game that's an hour and pretty intense, I will probably have a glucose crash afterwards. I'll probably, you know, head with an arrow down once I leave the game. So I try to come prepared or, you know, with a little snack or a protein bar or something in my gym bag. And it's weird to think of that as diabetes management, but that is part of managing diabetes around sport. So I want to get into the factors which impact glucose levels outside of just insulin and, you know, testing your glucose. It can make it really hard to live well with diabetes. You know, Desi, we've talked about and Chris, both of you really have mentioned the consistency aspect and trying to minimize the variables. But sometimes the variables that are at play, we're not even aware of in terms of the impact that they're having on our blood glucose. So, for example, somebody who goes to a Pilates class every Monday at 5 p.m., we all know that Mondays can kind of get crazy sometimes in the working world, and they're not always the same. Maybe you had a difficult night of sleep or a stressful day, and that causes your exercise practice to be a little different. So, Desi, what are those factors, and what can we do, and what can we learn about those factors that help us manage our glucose as we prepare for exercise?

[00:35:43] Dessi Zaharieva: Do we have another hour to talk about these?

[00:35:45] Rob Howe: I know. I wish we did.

[00:35:48] Dessi Zaharieva: That's how it feels, right? I really just like to kind of mention that the reason I joke about this is because there are just so many factors that can impact glucose levels. And to not get discouraged by this, but realize that there's still a lot worth studying and actually trying to understand. One of the ones that, you know, we've already touched on a number of them. So just firing off some of the common things that you think about, but the timing of exercises. And in the morning or in the afternoon, we might see differences and different ways that the body uses energy. Are we in the fed or in the fasted state? Like Rob, you just said, if you remove the idea of food or food in your system, that's one less variable. But in the fasted state, we might see different responses than we do in the fed state. So fed, fasted, looking at the time of day, looking at stress hormones. Is it like a competition day? I always think about it. Even are you sitting to write an exam? Even if you remove the exercise element, that stress component is really important. We can think about how we're feeling that day. Are we feeling really tired? Did we, like you said, not have a great sleep? I always try to say, when did you last have a hypoglycemia episode? We often forget that the fact that maybe earlier today, like I had a really big bike ride on the weekend. That day, I had a few more lows with that bike ride than I do on a normal day. That means the next day, I need to be a little bit more cautious because I'm probably more at risk of having a hypoglycemia episode. So that can also matter. We also are now starting to understand a little bit more about menstrual cycles and the phase of a menstrual cycle, that there may be differences in glucose responses in the luteal versus this follicular phase. So there's just so much to think about when it comes to diabetes. And oftentimes it's not just the idea of meals or insulin, but those are two of the biggest

[00:37:39] Rob Howe: factors I always like to think about. As I was learning more about this in the past few years, I came across this research that was talking about sleep and they were studying people who were in medical school, which is often a very stressful and like low sleep time for students who are in a particular part of that. And the study was on insulin sensitivity and lack of sleep. And so these people didn't even have diabetes and their insulin sensitivity was decreased almost up to 50% in some cases from irregular sleep. Only after a few nights of irregular sleep and like getting less than you need, your insulin sensitivity becomes challenging. And so sometimes it's not the diabetes at all. We just know because we're measuring the glucose and we're acting as the pancreas, we know that there is like some of that fallout. So, and I think you touched on something else that's interesting. And Chris and I have the benefit of living as men with diabetes because there's so many factors that women with diabetes have to deal with that we don't have to think about. But the research that's now being done for women with diabetes around, you know, their menstrual cycles and different phases and how that affects diabetes and insulin sensitivity, really interesting. And I'm glad that that's now sort of being discussed more broadly.

[00:38:59] Dessi Zaharieva: Yeah. And we're learning so much more every day. So, you know, that that's one area that's like a lot of my colleagues are focusing on, but another area we're doing some research in with some of my colleagues in Australia is even just like supplementation around exercise. So protein intake, some of my master's research was the impacts of caffeine on performance. You know, there's just so many things that we overlook as if you don't have diabetes, you can take caffeine and not really think about how it's going to impact your glucose levels or performance. Same thing like protein. Well, we kind of take it and don't really think about it, but now we're starting to see that maybe it is actually something we need to think about that can impact our glucose responses to exercise. So yeah, just a shout out to all of the colleagues and researchers around that are trying to understand some of the challenges or benefits that these things can

[00:39:45] Rob Howe: do for exercise and type 1. Well said. I think I'd love to, um, before we get to Q and a, I kind of like to finish with something that's really important to me. And I think really critical to discuss, uh, just around diabetes in general, but has really helped me as I've moved into this next phase of my life around exercise where I'm no longer an elite athlete. I still enjoy playing competitive sports, but, uh, I'm training for different reasons now. And, uh, and that's around mental health because people with diabetes are, you know, research shows they're three times as likely to suffer from anxiety, uh, and depression, which is, uh, it makes sense because we're always thinking ahead. We're always thinking about numbers in the past and the future. Uh, and that can be really overwhelming. And, you know, sometimes diabetes distress comes into that play as well. So I'd love to talk a little bit about like exercise as it it's not just a physical health benefit. There's also the mental activity, not only what's happening in the brain and body and the mind body connection. But, Chris, as you mentioned, connecting with other people, whether they have diabetes or not. You know, for me, getting outside and taking a walk in the sunshine does so much for my mood and for my blood glucose as well. That's kind of my go-to if I'm having a hyperglycemia incident is I'm going to go outside, grab a bottle of water, and go for a walk. And it's amazing how different I can feel after something like that. So, Desi, I guess talk a little bit for you first about the mental health benefits and you also in your next phase as an elite athlete and now as more of a typical person who your exercise is not your number one priority now.

[00:41:33] Dessi Zaharieva: Um, how has your approach changed? Yeah, I think it's challenging to shift over to not being kind of an elite level athlete anymore. I wish I had not only just the energy, but the time to make sure that I can be as active as I was. But I think one, the mental health component of understanding that things change, you go through different stages of life. And so for me, I know I'm not going to be as active and what comes along with that. Maybe my insulin needs are going to change And that's okay. I always used to say, well, I was just exercising every single day. My insulin sensitivity was sky high all the time. But the reality is, is we go through different phases in life right now. My career is, you know, is what I'm focusing on a lot more of my efforts, but that doesn't mean it needs to be the only thing I do. So I try to shift on, even if I'm not going to Brazilian jujitsu and doing that every single day, what else can I do on days that I can't make it to training? You know, can I go lift in the gym and make it like a 30 minute workout? I know that if I even get that little bit of activity, not only the rest of that day, but the next day I'll feel a little bit better. And not only insulin needs wise, the way that my blood sugars are, you know, navigated, but I just feel like doing little things, even if it's just a walk outside is a great place to start. All of this can have a positive impact on our mental health. and I realize that when I get into the focus of all I've been doing is work or not really getting to be active, right when I get back to being active, it's like a sigh of relief and you kind of remember, oh, this is why we need to be doing this every single day and make sure that we keep moving. So, you know, I think it's important to kind of remember that too. We don't need to be the elite athlete, but just get moving a little bit. I love that. And I think stacking a day is

[00:43:19] Rob Howe: like celebrating the small wins is something that I really believe in, especially if you're getting started exercise is not punishment you don't have to you know cause yourself pain to to be doing something good for yourself absolutely yeah even even being able to meet those small days like adding a little more like doing this today is going to make me better tomorrow and that's all we can control uh chris how about you as we finish up uh here quickly so we can get time for q a yeah i think similar to desi about the challenge and and where this is now for me in my playing days is kind of the twilight years of of what I was capable of and coming to terms with that is not easy I think um trying to recognize the what you could do versus what you can do now and just sort of embracing that and thinking about the opportunities to do other things as well and give back I think my role I sort of have changed the way I play to continue to play and And I've also changed the role that I probably have in the team where I'm, well, I am the oldest player in the squad that I am a part of. I am too. Yeah, it presents a different challenge for you in the dressing room then. And I try and see myself more as a mentor type and try to support some of the younger players coming through and give them useful snippets of insight. Even if they don't see me running around them anymore, they can just hopefully remember that I might have been able to do that a few years ago and the information is still useful. I see that as where I'm at in terms of playing. Coming to terms with that has not been too easy, but I think at the same time, recognising that this is part of life and that this is the changes that happen. and I think exactly again the same as Desi trying to fit exercise in and just I always feel more positive whatever it is whatever I've done during the day if I've got outside even if it was for a 15 minute jog a light jog even if it's not a training run you know like before where I might have been caning myself to run a decent time even now if it's just a gentle run I will feel a lot better for it and it's the small wins in the day there's something in that where you feel a bit more like it's how you know it's had a good impact on your body it almost then knocks off into your mind you feel like you've you've ticked another thing off that day which is good for you and it does it just it's it rolls into other things it rolls into the next day it rolls into into your work how you might feel that evening or that day depending on the time you do it and yeah i just feel it's it also provides a management thing for me around insulin sensitivity and making sure i don't all of a sudden my insulin sensitivity drops off a cliff and then my i'm needing you know twice three times the amount of insulin that i was doing before it becomes part of the routine and the way that you you manage but it's it's much more than it being about glucose levels and and how they're managed it is huge about mental health and it's always been a place for me to forget and release and enjoy and really take take in the moment i agree and i want to touch on something you said and we're going right to q a because i know we have some caregivers who are asking great questions here in the chat um it's interesting how your mindset can change as you age as an athlete you were talking about uh you know really being hard on yourself to hit a certain time or a certain intensity in the past and how that was so critical or you thought that was so critical to your training at that time. Um, and I, and I saw myself a lot in that, my younger self for sure. And I think, um, you know, athletic careers are short, especially on the elite side. Um, but something that I've made a lot of peace with lately is I've played so much more sport after my elite days were over than I ever thought I would. And that's been not only central to my identity as a person and my happiness, but also my overall health and well-being, which flows into my diabetes management. And so, you know, if you change that mindset a little bit and you say, okay, well, maybe I can't be my best today, but I can still show up. I can still give an effort and, you know, that'll set me up for long-term success. I think the longevity aspect of a career, you know, it can change. I'm definitely not the same guy I was four years ago, 10 years ago. But I think about all of my friends who wish they, you know, could come back and play or wish they could still compete at that level or, you know, are trying to get back started. And I'm glad that I've been able to be consistent. And so I think if you can be consistent for a long period of time, you can certainly have a ton of fun and, you know, get a lot of that, like you said, ability to disconnect, get off the phone, get outside, meet, hang out with other people, have a good time doing something you love. So, okay, we're going to go to the Q&A. So I'm going to put up this Q&A slide here because I made the slide, so we're going to put it up. And thank you guys already for the questions that you've submitted. We've got a couple of good ones. So I'm going to go ahead and show this one on the stream. Um, so this one's from Ryan, uh, and you guys feel free to, to, uh, add your response to this. So if you're competing or you're playing a game, uh, what is your ideal blood glucose level that you like to be around? Uh, and what level do you feel like you perform the best at? And we'll keep these quick. Cause we want to make sure we get everybody out of here on time. Yeah, I can

[00:49:01] Dessi Zaharieva: take a quick start on this one. You know, the guidelines recommend, and I always start with this, this is why we research in this area, anywhere between kind of 120 and 180 is considered in milligrams per deciliter, a safe starting place to exercise. But I think it's really important that people understand there's going to be some differences. For example, I do Brazilian jujitsu, my blood sugar actually often spikes with the intensity that I exercise at. So I may be in terms of the black sheep that I want to start a little bit lower than even what the guidelines recommend. So it's very individualized. So that'll be my quick wrap up that I actually generally like to start even a little bit lower. If I was at 100, if it was the average person going for a basketball game or practice, I'd be a little nervous, but I would feel much more comfortable with that. But it also depends on a number of factors. I agree. And I'm going to put Robert's

[00:49:52] Rob Howe: question up here because my, my answer to this is no, I, I, you know, outside of that 180 range, that's about as high as I feel comfortable. Something happens to my hands. I can't catch or like shoot as well. Uh, when my blood sugar is over one 80. Uh, so yeah, I like to start, uh, around one 31, one 40, because that, that gives me a nice variance. I can be 40 milligrams per deciliter up or down, and I'm not going to be, uh, too in danger. And unfortunately I have a CGM now that does a lot of that work for me, uh, so I can measure it after the fact as well.

[00:50:24] Dessi Zaharieva: Yeah. It also depends how you feel, right? So some people at a higher blood sugar may feel okay. And I think that's often what I try to tell people that it's, uh, as long as you feel okay and don't have ketones, you know, um, if you start a little higher, you've got a little more room to drop. So it may not be our goal to start, you know, really high, but it's, it's usually safe to start doing something a little more aerobic to bring our glucose levels down. Yeah. Um, I'd like to talk

[00:50:48] Chris Bright: a little bit about something as we are just talking about sport in general we have some parents who are here in the chat is like talking to your coaches and teammates about your diabetes or even trainers so how did you guys approach that you know during your playing careers and and how do you think about that today you want me i'll go with that first then um i would say i didn't approach it in the way that I would approach that I would approach it now how I did when I was playing at my you know when it was my highest levels that I achieved because I wasn't very open and I wasn't very um honest sometimes about what the impact of living with type 1 diabetes was and truthfully it's because I feared what that would mean for being picked in a team I play in a team sport it's very subjective and if the my position is very nip and tuck with another individual i always feared that the the lack of knowledge and awareness that i saw out there that somebody if i gave away a little bit of ground if you like by saying i live with a hidden disability i live with type 1 diabetes that actually that would i would that would be a challenge to my my playing in a team and actually the national team manager didn't know i had type 1 diabetes when he picked me and it's sad that that's how I felt I had to be but I wouldn't change how I did it and why I did it I think what I would do now is and what I am challenging to do now is to change that and really raise awareness and a lot of my advocacy efforts with the diabetes football community or Breakthrough T1D we do an awful lot of work now in trying to influence the policies which are out there and the support which is provided by sporting organizations here in the the United Kingdom because by getting this spoken about in the mainstream is the only way to create an environment which is where people feel that they can talk about their levels and talk to their coaches more openly because I didn't feel I could. Yeah I just wanted to add to that I think

[00:52:53] Dessi Zaharieva: when I was at my highest level of sport I was very defensive about it like it wasn't I would always kind of say this you know it's I'm fine and even if I wasn't fine or I was you know it was always, I felt like I had to defend the diabetes and I really think it came from a place of my coaches didn't understand it. Right. I think, and maybe because I didn't do a great job educating and we have so many more resources now. Like I was still trying to figure out diabetes. How do you want me to teach my coach about it when I don't really get it? Like that was where I was as, you know, my teenage years and into my twenties when I was competing at the highest level. So I think it's offering that support to coaches now so they can have that guidance.

[00:53:34] Rob Howe: Yeah, I'll tack on one last thing and then we'll get to Robert has another question that's really good. But I my parents and I were because I was diagnosed kind of in the middle of pursuing an elite career. So my first two years of high school, I didn't have diabetes. My second two years I did. And I was had the benefit, so to speak, of honeymooning during those two years and being on injections. And so that that was helpful. But when I got to college, the stress level, the stakes were much higher. Um, and I changed from injections to an insulin pump. So there were learnings that went along with that. Um, but my parents and I made the decision to be very upfront about my diabetes in the recruiting process because I was going to go live somewhere and spend four years somewhere. So I felt the need to be upfront and honest. And I'm really glad for that because I found a really great support with the athletic training staff, not always with my coach, but a really great with my athletic trainers. but then I changed that decision completely when I was at the pro level very similar to what Chris was saying like I didn't want any reason to you know I didn't want diabetes to be the reason that someone didn't take a flyer out on me there were plenty of other reasons to not sign me at that point the diabetes was not the reason that my career didn't work out and so you know I think at that time I also wouldn't change it but it's just the facts of where you are and you kind of have to ask yourself and your family or your care team, like, how comfortable are we managing this on my own? And, you know, how, how important is it that we accomplish this, whether or not the people have diabetes. And I think, you know, what Desi said, I really love to also continue this, to raise awareness around the amazing things that athletes with diabetes do, you know, at the highest level. And so, you know, I also was very defensive in those years. And because you're young and diabetes is very personal and can feel very encroached upon if you get doubted. Plus, when you're an elite athlete or you're trying to be an elite athlete, you kind of have a hardcore alpha mentality, which is always funny to deal with. Okay, so Robert has a good question. I'd like to make a recommendation on this. He says my son's coach has asked him to bulk up in the offseason. I was also a lean kind of guy, and my coaches wanted me to gain a bunch of weight and muscle. A virtual trainer, there's a great guy that I recommend, Ben Zeal. His name is Man of Zeal on Instagram. I'll put his name or his handle in the chat. He's a strength coach and registered dietitian who lives with type 1 and was also an athlete, so he could help you maybe with answering questions about a meal plan. And to me, being strong is in whatever sport you're playing, like you're never going to regret being stronger. And being consistent, I think, is the most important thing, especially when you're younger. So make sure you've got oversight and sign up for the sign off from the coaching staff and that you're doing things reasonably. But, man, I remember how many calories I used to eat. And my brother and sister were also like athletes and very large individuals. We're a big family. I cringe when I think of what my parents' grocery bill was on a weekly basis, all the calories that we were taking in. So, okay. Well, I'm going to kind of stop sharing as we come to the end. I want to thank you, Desi and Chris, for being here, for all these amazing resources that you provided to the Diabetics Doing Things community. We've had a really great and very consistent group of folks watching today. So thank you guys also for attending this morning, this afternoon, wherever in the world you are coming in from. We had some folks from India. We had some folks from the U.S. So thank you guys all for your time. And, yeah, DiabeticsDoingThings.com slash subscribe if you want to get our e-mails, if you want to listen to our podcasts on every major podcast platform. And thanks again to Type Zero for making this possible and for sponsoring the podcast. you can check out the Rob house stack, which is the supplements that I take on type zero health.com. And Desi, Chris, anything that you guys want to plug while that you're here on the show?

[00:57:49] Dessi Zaharieva: I just wanted to say, thanks for having us. I really appreciate it and try and get started. Reach out to us. We're here. I'm always happy. I'm on social media. You can find me look up. I'm the only one. So happy to get connected.

[00:58:05] Chris Bright: Yes. and similar just to say massive thank you for everyone that joined us today and thank you Rob for having us on the podcast and um and on this live so yeah and if you want to check out anything that I'm up to I think the diabetes football community easy to search for in google you'll find me through that and um yeah some exciting work that we're doing I think inspire t1d which me and desi are a championing at the moment I know Rob you're involved with in trying to get a global collaborative work going forward for physical activity and exercise so we're really excited about that as well so yeah lots to come lots of exciting development so i guess everyone who's here today keep your eyes peeled yeah i actually wanted to make sure we closed with that is the you know the reason of the the origin of this interview and this conversation came from the work that you guys are doing with inspire t1d which is connecting people globally whether they're researchers or patients or athletes or advocates to, you know, build a global cohort of people who are focused on exercise and T1D and the benefits of it. So thank you guys for the work that you're doing there. Like, and again, like the longer the advocacy journey, like the more I see, like the most amazing things that people are doing in the community are all side projects. And it reminds me of one of the greatest side projects in the history of the world, which was Dr. Frederick Banting and Dr. Charles Best doing a summer project that resulted in the discovery of insulin. So I'm not holding you guys to that standard. You don't have to hit that mark. But I do love when people put aside project. You never know where it will lead. So thank you guys so much for your time today. And thank you, everyone, for engaging and asking questions. We'll see you again next time.