Post-Meal Walks and Type 1 Diabetes: What the Science Actually Says with Lauren Turner, MSc

[00:00:00] Rob Howe: Hello, podcast listeners, got a very exciting episode for you today. I've been digging into the world of insulin sensitivity, because if there's one thing we all can agree on with type 1 diabetes, it's that when our blood glucose is high or out of range, we want to get it back down as quickly as possible. And one of the things that has garnered a lot of attention and headlines over the past few years is postprandial walking. So I emailed the foremost expert on diabetes and exercise that I know, Dr. Mike Riddell, who's a friend of the pod and has been on the pod in the past, and he recommended that I talk to Lauren Turner, who is a member of his lab at York University in Toronto. Lauren herself lives with type 1 diabetes and has for the past seven years, and she is a PhD student, and she has her name attached to 36 research publications around type 1 diabetes and exercise, and specifically around what we want to talk about today, which is postprandial walking. So Lauren and I really dig into what is behind the science of walking and glucose, and take away some really actionable steps for listeners. So I hope you guys enjoy this episode on something I'm very passionate about: exercise and type 1 diabetes with Lauren Turner.

[00:01:26] Rob Howe: Lauren Turner, welcome to the show. Thanks so much for being here.

[00:01:29] Lauren Turner: Thanks so much for having me.

[00:01:30] Rob Howe: I'm excited to have you because I got introduced to you by friend of the pod Dr. Mike Riddell, and I know that you work with him on a regular basis. So I want to shout out Dr. Mike for the introduction. But one of the things that I think is also so cool about the lab is that many of the researchers also live with type 1 diabetes. So I'd love to start this off with who you are, your diagnosis story and how you came to be where you are today.

[00:01:53] Lauren Turner: Yeah, absolutely. Honestly, I'm a big fan of Mike as well. He kind of got me into the research and type 1 world. I was 19 when I was diagnosed with type 1 diabetes. I was in kinesiology at McMaster, had learned about diabetes, and was learning about type 1, and I was kind of like, I think I'm having some of the symptoms. I was waking up in the middle of the night, hungry all the time, peeing all the time. I really think I might have type 1 diabetes. And then at the end of first year university I was diagnosed with type 1, and soon after I was like, well, I've always been really interested in exercise and now I have type 1 diabetes, so I may as well put the two things together. I started working at a type 1 diabetes research lab at McMaster, and I met Dr. Mike Riddell through that lab, and ever since then I have been in the type 1 exercise research space. So I've done my master's with Dr. Riddell and now I'm into the final year of my PhD.

[00:02:53] Rob Howe: What a journey. I think in a lot of ways, obviously, getting diagnosed with diabetes really sucks and is never really a good thing, but it's very cool that we have you on the research side to dig in and figure out things that can be helpful for people living with diabetes, especially around exercise, which I know we both know is so important and a big part of our lives. Also, you are not the only person on the pod who diagnosed themselves during either first year of med school or in the middle of med school. So it's always an interesting pipeline, learning about those symptoms and being like, well, maybe I'm not just overtired from studying and labs. Actually, something else is going on.

[00:03:24] Lauren Turner: Yeah, it wasn't just me eating food at the caf all the time. It's like, there's something else.

[00:03:31] Rob Howe: So let's talk a little bit about the topic of today's episode. I'll frame it up for our listeners a little bit. I am digging into as many ways as I can to help our listeners improve their insulin sensitivity. Because if there's one thing that I know is true in the diabetes community, or just out in the world in general, whenever we have those glucose excursions and our sugars are out of range, we want to find ways to get them back in range as quickly as possible. And while there is a lot of conversation online about movement being medicine, there often isn't as much research discussed alongside those topics. And so that's why you're here. We're going to talk about your thesis from 2023, which is The Timing of Walking and Post-Meal Blood Sugar Levels in Adults with Type 1 Diabetes. And there have also been some subsequent studies by you and your colleagues that we're going to reference as well. So are you ready to dig into it?

[00:04:18] Lauren Turner: So ready.

[00:04:19] Rob Howe: Okay. Well, first of all, getting into this study, how did you come up with this as a topic and a framework for spending time and doing your research?

[00:04:27] Lauren Turner: So, much like a lot of other people living with type 1, I think I was getting slightly annoyed with the rage bolusing every time my blood sugars were high. At the time when we came up with the idea, I was living at home, and I would eat a meal, my blood sugars would spike, and then I'd be sitting on the couch and it would just take forever for my glucose to come back into range. And we hear about all the long-term effects of chronic hyperglycemia and high blood sugar. So I was like, okay, what can I do to help bring my sugar back into range and help manage that? So my dad and I started going on walks after dinner, just 20-minute walks around the block with our dog, and it helped bring my blood sugar into range within that 20-minute period. So that's when I brought the idea to Dr. Riddell, and we came up with this idea around walking around dinner as a way to manage glycemia. And of course, walking after dinner is one way, but we also wanted to look at whether, if you walk before dinner, that can improve insulin sensitivity and actually have effects into the dinner period and beyond. So that's how we came up with the idea.

[00:05:36] Rob Howe: I love it, because I've been very plugged into this, and diabetes and exercise is obviously a huge passion of mine, both because of my background as an athlete and because of exactly what you're talking about. I notice a difference in my glucose excursions and those sugar spikes, and in my ability to stay in range better, when I'm exercising on a regular basis. I want to talk a little bit about how we see postprandial walks, pre-prandial walks, 10 to 20 minutes, and we see these big numbers. But I also want to talk a little bit about the study that you sent from you and your colleagues, because there were a couple of things in there that stood out to me as new information that I think is interesting for people, because we're also in the golden era of walking pads. I see a lot of people using walking pads in their office or at their home or wherever they are to find a way to get more steps in for this exact type of thing. So, one of the things I pulled out of the study that you sent, and we can link the study in the show notes. It actually has a really cool, useful tool on the side that you can search things with too, which was really fun. The first thing that I thought was really interesting was breaking these movement periods up. I think we often see a big number of minutes per week that people are supposed to exercise, and that can sometimes be daunting. But this was really interesting. It said three minutes of movement every 30 minutes to break up daily sitting improved time in range by 14%, which is a pretty significant number. So talk about breaking things up, or taking that large chunk of weekly or daily movement and breaking it up over a period of time.

[00:07:06] Lauren Turner: I think daunting is exactly the right word to use. We hear all the time that you need 60 minutes a day of activity, and sometimes it's hard to get 60 minutes of activity into your day. It's just not feasible. But getting up from your desk every 30 minutes or so, that's something that maybe people can do. Maybe you're using a walking pad, maybe it's some other form of movement. But with the three minutes of walking, really what's happening is your muscle is a huge glucose sink. You start activity, and even without giving yourself more insulin, you have what's called insulin-independent glucose uptake. So even without having to adjust your insulin or make big changes, which I guess for type 1 is often a part of exercise, you can just get up and do movement for three minutes. If that's walking, great. Maybe it's something else, like squats. And it helps bring insulin and glucose into the muscle and helps bring glucose back into range. And it's just so easy to do.

[00:08:09] Rob Howe: It is, and I love the idea of it being small. Three minutes almost sounds too good to be true, right? And we see sugar squats online as well. Shout out to my friend Lauren Bongiorno for making that really popular in some circles. But you said glucose sink. So is that like the way that we think of a sink with water, when we're washing our hands? Talk a little bit about the terminology just so that our listeners understand. But also, I'm sure everyone listening has heard about glucose uptake from your muscles. So when you're walking or when you're doing squats, what's happening? Like you said, it's insulin independent, so you don't necessarily have to, like you said earlier, rage bolus to get that same type of glucose uptake.

[00:08:47] Lauren Turner: When we think of a glucose sink, it's exactly like a sink when you're washing your hands, where all of a sudden you have this funnel of glucose entering into the muscle cells. Your muscles love using glucose. It's energy for your muscles. So it's really easy for glucose to go into the muscles as soon as activity starts. When we talk about insulin-independent glucose uptake, when you start moving you have things like increased blood flow, so your heart rate starts going faster, your blood vessels dilate, your blood flow increases, and you also have a translocation of something called GLUT4 transporters. GLUT4 transporters are there to help bring insulin to the cell and glucose into the cell. With exercise alone, you can have GLUT4 translocation to the cell membrane, and this helps bring glucose into the muscle cell. The reason it's so beneficial is that these effects also last for hours after exercise. It's not just the period where you're exercising, but also 24, even 48 hours later in some cases. So that's why exercise is such a powerful tool for bringing glucose back into range.

[00:10:02] Rob Howe: And for people who are maybe endurance athletes, like distance runners, for example, or, very popular now, a hybrid athlete, doing a really heavy workout one day, your insulin needs may differ the next day because of that GLUT4 transportation, right? And recovering those glycogen stores and things like that in your muscles. I'm not a scientist, so I want to make sure I'm explaining it correctly.

[00:10:24] Lauren Turner: No, you're absolutely right. And it's one of the reasons why we have to remind individuals to be so cognizant of hypoglycemia in the day following exercise. Of course you're really aware of your blood sugars as you're doing activity, but these effects actually last overnight and into the next day. So it's something to be cognizant of. If you have one of those days where you just keep going low and you can't figure out why, well, your muscles are trying to replenish those energy stores. So a lot of the time it is pulling glucose out and into the muscle as stores, even 24 or 48 hours later.

[00:11:03] Rob Howe: We're getting really into the nitty-gritty now, but automated insulin delivery systems learn on a 24-hour basis, right? So my insulin needs yesterday may be different from my insulin needs today. And that's why, you know, supplementing diet-wise or activity-wise is still not a cure, right? As you're managing your diabetes and doing your exercise and keeping yourself in range and doing the right strength exercises and doing the walking, you're still going to have to be active in that management, even on an automated system.

[00:11:37] Lauren Turner: Yeah, absolutely. And we've seen it. In one of our studies we looked at step counts. Using a wearable, it's so easy to see how many steps you're reaching in a day. On days where people were hitting over 7,000 steps per day, which is the goal that we set for people, their time in range improved, but their time below range, their time in hypoglycemia, also went up the same day and in the days around that more active period. And this was the same for individuals on hybrid closed loop or automated insulin delivery systems. It's not just MDI. Even when using those systems, we have to be cognizant.

[00:12:16] Rob Howe: I think that awareness is key, right? Okay, let's get to the big headline here, which is 30 minutes of walking. Like you and your dad, a 30-minute walk after a meal significantly reduced incremental glucose area under the curve under 140 milligrams per deciliter over four and a half hours, without causing hypoglycemia in adults. That's probably the headline that many people have seen. So can we talk a little bit about what's going on with all of the things we just talked about, specifically around mealtime, and then also talk about before and after and some of the differences?

[00:12:49] Lauren Turner: So we know around mealtime you have this double-edged sword, right? You have hyperglycemia following a meal, because the insulin we give ourselves as individuals with type 1 takes a little bit longer to hit peak action. So you have hyperglycemia, and then you start walking, you start being active, and all these things that we just talked about happen. You have increased glucose delivery to the muscle, you have increased translocation, and that causes glucose to fall, and you can get hypoglycemia. Our idea is that by doing pre-meal walks, you could help manage some of that, because now you increase insulin sensitivity. When you walk before your meal, you sit down, you eat, and even though your glucose maybe will go up a little bit, your insulin sensitivity is also increased, and it can help keep you in range. Of course, if you walk after a meal, there's perhaps a bigger risk for hypoglycemia, because you're now walking when insulin is at its peak action time.

[00:13:54] Rob Howe: Yeah, so I want to talk about this because I think it's really important. Research continues to improve and advance, and at the same time there's older, out-of-date research that continues to be repeated from person to person, or maybe even by a physician who just doesn't have the latest research available. One of those things is, I think, now-outdated research that talks about not exercising when you're in a period of hyperglycemia, so your glucose is elevated above, let's say, 250 milligrams per deciliter. But that was based on not having any other insulin activity on board. So can you talk a little bit about that? Because you mentioned that when you're walking with insulin on board, you are more likely to experience hypoglycemia, because you're going and doing all those good things for you, but you have insulin on board, and so you're going to see that number start to go down the longer that exercise goes. So talk a little bit about the old way of thinking and what wasn't included in that, compared to where we are today with what they call in the study bolus activities.

[00:14:58] Lauren Turner: I think the biggest thing to think about is, of course, safety, and I think that's where these old recommendations came in. And the recommendations still stand: if you are over 250, test ketones and see if your ketones are elevated. If you have symptoms of ketosis, you're getting nauseous, you feel unwell, then yeah, it's probably a good idea to think about other things that are going on. Maybe there's illness, maybe there's stress, maybe it's a bad infusion site if you're using a pump. So I think it's always really important not to completely disregard it, and to still keep it in mind and be cognizant. But one of the things that we've begun to learn a lot about is this idea of insulin on board. Some connected pens show this for those on MDI, and I know most insulin pumps show an estimate of how much insulin is on board. Essentially, what this is talking about is bolus insulin. So it's insulin that you give for meals, and sometimes it's insulin that's given as a correction for hyperglycemia. But the pumps are all using their own estimate to get an idea of how much bolus insulin is on board. And it's exactly that. It's an estimate. They're not always 100% right. What we do know now, from research using some really good insulin assays, where you can look at insulin concentrations actually in circulation in someone's blood, is that when you start exercising, insulin concentration in circulation, and this is insulin from a meal bolus, actually goes up. So if your pump is saying zero units of insulin on board when you start exercising, it may actually not be zero units on board. You could still have some insulin action. Because of that, we always like to think, well, when was the last time I took a bolus for a meal? Maybe my pump gave me some insulin to help correct hyperglycemia. That's also why, if you go for a walk, even if it says zero units of insulin on board, you may find yourself going low. I've certainly been in those situations where I'm like, well, I have no insulin on board, and I'm stopping and eating sugar along the way.

[00:17:15] Rob Howe: Yeah, it is interesting, right? And even if you're on MDI and have a smart pen, you still have your basal insulin on board. And oftentimes, at least on previous pumps that I was on (I think my current one actually does show this), basal insulin wasn't included in the insulin on board tracker. It was really only tracking bolus insulin. And then, like you said, the insulin timing that's put into the pump technology isn't exact. It's using an equation based on the last time you bolused. So you're likely to have some residual effects of the insulin there, which I'm sure we've all felt, right? So yeah, it's important to keep safety paramount. So for you, let's apply our own lens to this line. When do you start feeling your glucose is high enough for you to take more action? Because for me it's 185, maybe for like 30 minutes, and I'm like, okay, I kind of want to get this down.

[00:18:07] Lauren Turner: I think anywhere around 180, 185 is where I start to get a little antsy. Just for me personally, that's my set point, where I'm like, well, I know if I hit it at 185 and I start going for a walk or start doing some squats, I can bring it back down into range. I won't have to exercise that long, so my risk for hypoglycemia likely isn't as high. So that's kind of the sweet spot. I will say we haven't looked in studies yet at starting at a lower set point, but it is a study that we're actually recruiting for soon and starting. We want to use more of a 125 threshold. If someone's at 125, how much movement is needed to bring their blood glucose back down into a slightly lower range, and try to really hit that spike before it even happens? Anecdotally, that's what I do when I'm sitting at my desk at work, but we haven't seen it, to my knowledge, in broader populations yet.

[00:19:10] Rob Howe: Yeah, I'm really interested in that. Obviously, the industry standard, time in tight range, is becoming more of a measure that's being studied, which is really interesting. I know there are people who are like, my gosh, you guys are worried about 120, I'm more worried about 250, how do I address that? So that's kind of where I want to go next, because in the study there was a stat that said there's an 83% chance of returning to target glucose range in less than an hour if you just do 10 to 30 minutes of activity when the starting glucose is between 181 and 249. I'm just going to name this anecdotally: I'm having a high blood sugar, but it's not severe hyperglycemia. For me, it'd be like, I'm annoyed, maybe I'm in a bad mood. I'm sitting in my office, I had a sandwich, like a bready sandwich, a high-carb lunch, and I'm sitting down afterwards and starting to get a little antsy. And in the study, that was with limited risk for hypoglycemia. That's obviously when we rage bolus and things like that, we leave ourselves more open to riding that roller coaster.

[00:20:07] Lauren Turner: And that's exactly it. I think it all sounds great when you see it in a big study, but as we all know, individual factors play such a big role, and 180 one day may not be the same as 180 another. One day I may be 180 with double arrows going up because I really miscalculated my bolus for a meal, and another day it may be 180 with arrows going down and lots of insulin on board. So I think that's where it becomes important to use the technology to your advantage. Use CGM alarms, and recognize that as you're coming back down into range and you want to prevent hypoglycemia, you don't have to wait until you're at that lower limit. Maybe stop a little bit earlier. Again, it's glucose and individual threshold dependent.

[00:20:54] Rob Howe: I want to talk a little bit about the factors and individuality, because wherever you are listening to this podcast, we are all at differing levels of fitness, right? I try not to use myself as a general example, because most of my life has been built around vigorous exercise and my identity as an athlete. So I have a really great muscle base. I have more muscle in my body than a lot of people. So my insulin absorption when I get moving, my glucose uptake, there's a lot of muscle there. I have a large sink, so to speak, to call it back to earlier. So how do different levels of fitness factor into this, as well as walking intensity? And what do you look at in the data to increase the effectiveness? Whether that's walking faster, or maybe carrying a weight. I know rucking is very popular right now, where you wear a weighted vest. What are you seeing there, and how can you tell someone to find a different type of personalization for this?

[00:21:46] Lauren Turner: It's a great question, and typically the way we go about it is thinking about RPE. So individualizing it to the person: how hard does this feel for you? So it's perceived...

[00:21:56] Rob Howe: And RPE, that's perceived effort, right? Rate of perceived effort? Okay.

[00:22:00] Lauren Turner: Yeah, it's perceived effort, and you can think of it on a scale of 1 to 10. One is you're sitting on your couch doing nothing. Ten is an all-out sprint. You're out of breath, you cannot go for longer than 10 to 20 seconds. I never do that, I hate sprinting. But then you have that happy in-between part, which we like to say is an RPE of 3 to 4, where you could still carry on a conversation. You may be a little bit out of breath, but you can hold full sentences. And holding full sentences for one person may not be the same intensity as, like you said, for someone else. So if you do have a higher cardiorespiratory fitness base, maybe that means going somewhere where there are hills, or adding incline to a treadmill to increase that intensity. Whereas for someone else, maybe it is a slightly slower walk, and maybe it's taking breaks if needed. So it's really about finding that individuality. I will say, too, walking is so accessible for a lot of people, but there are instances where individuals may have mobility issues and maybe aren't able to walk. I haven't seen it in the type 1 space, but I know it's common in other spaces: using an arm ergometer, so cycling with your arms, is another way to go about it.

[00:23:23] Rob Howe: And you want to talk about getting really tired really fast? That arm treadmill. It's often in physical therapy, where you have mobility challenges in your legs or your feet, or you're recovering from a foot injury or something, and they put you on this arm treadmill. Nothing will get me breathing hard faster, max heart rate, than that arm treadmill. That thing is crazy.

[00:23:43] Lauren Turner: It's so hard. Talk about individuality. My goodness. There are women who are three times my age doing that and kicking my butt on the arm cycle ergometer. It's impressive.

[00:23:55] Rob Howe: I guess for people in wheelchairs, for example, I've seen some more accessible workouts where you're really just focusing on your upper body while you're sitting in a seated position, maybe picking up a book or a computer or something that gives you a little bit of strain and can get your blood flowing.

[00:24:10] Lauren Turner: And also, if you don't like walking, if you have a spin bike in your house, maybe you can try that. Stair climbing is another great exercise. Stairs are typically accessible for everyone, often in office buildings. You can climb up and down the stairs. So there are lots of different ways to go about it.

[00:24:30] Rob Howe: Yeah, when I used to work in a tall office building, if my sugars were a certain number, I would definitely take the stairs versus the elevator, and that would help me out. We talked earlier about the importance of muscles in glucose uptake. Obviously we've talked about walking. We talked about the cardiovascular side, that 3 to 4 RPE, what's commonly talked about as the zone 2 cardio range when we're talking about heart rate zones. But strength training is also a big part of building muscle, so that you can use those muscles to help pull that glucose out of your bloodstream. How do you think about this from a research perspective, the importance of muscle growth and glucose uptake?

[00:25:07] Lauren Turner: As we talked about, muscle is typically the biggest insulin and glucose user in the body. You have a huge amount of glucose that's brought into the muscles, and a lot of the time muscle mass, so how much muscle you have, is correlated to glucose uptake. It's also slightly independent of muscle mass, though. There are different pathways, and just by doing resistance training frequently you can increase your insulin sensitivity. For me, the biggest thing with strength training is that there are the acute glycemic effects of strength training, and then there are the long-term effects. Acutely, a lot of the time what happens with strength training is you actually see an increase in glucose levels, because you have those adrenaline responses. But then a little bit later in the day, because of all the things we already talked about, you're at risk for hypoglycemia, or at least increased insulin sensitivity. But I think when thinking about strength training, the biggest thing is long-term functionality. It's of course good for glucose metabolism, but it's also your ability to carry groceries into your house and live out your activities of daily living, and maybe carry your kids or grandkids. So for me, resistance training touches on a lot more than just the glycemic effects.

[00:26:29] Rob Howe: A hundred percent. Just being able to carry something heavy, or stay balanced in a situation where you need it, or pick up something high on a shelf, is obviously really important. And I think too, like you said, it can be challenging. It can be frustrating when you're doing something good for yourself, and you know that strength training is good, but you're seeing that number go up for a short time and come down. If you're listening and you're frustrated by this, we did a great episode about a year and a half ago with Dessi Zaharieva from Stanford about the differences in glucose from aerobic and anaerobic exercise, and what to think about when you're approaching some of those, that's also research-backed. So, another great introduction from Mike. Thank you, Dr. Mike, for that. Let's go back to something we talked about a little bit earlier, when we used the word daunting. Someone reads something like the WHO recommendation of 150 minutes of exercise per week, which, even if you divide it over five days, is quite a bit of exercise for somebody who's just starting out. So for someone with type 1 diabetes who maybe has tried exercise and found that it caused a lot of glucose variability, and caused them to go low in a workout or just struggle to be consistent, what is the recommended time, or how would you structure the week for someone who is just getting started?

[00:27:45] Lauren Turner: For me at least, it goes back to this whole idea of smaller bouts of activity. A hundred and fifty minutes is a lot to ask of someone. It's a lot to ask of young professionals who are busy. It's a lot for anyone to do. I think the 150 minutes of aerobic activity also encompasses activities of daily living. So it's daunting when you think, well, maybe this is a 60-minute run, but it also includes things like vacuuming, or walking to work, or walking to the subway to get to work. So when you start to break it down like that, it can make it a little bit less daunting. The other thing that I really love right now that's coming out in the literature is this idea of exercise snacks. These are higher-intensity exercise bouts done for a short amount of time that can increase things like cardiovascular fitness. For these you have to hit a higher intensity, but again it's just three minutes, or sometimes even less than a minute, of really high-intensity exercise, like intense stair climbing or squat jumps or something along those lines.

[00:28:55] Rob Howe: What do exercise snacks look like at a research lab? What do you see pretty regularly?

[00:29:04] Lauren Turner: Typically stair climbing is the go-to. Stair climbing, squat jumps, anything where you're like, wow, I would hate to do this for over a minute, that's your exercise snack right there. But they are a great way to increase cardiorespiratory fitness and improve your overall health, and any sort of movement is better than none. You do five minutes more a day and you're already doing better than the day before. And I think that's important to keep in mind.

[00:29:31] Rob Howe: I also think, just to be encouraging again, if you make it three days in a row and then you forget, or you don't have as good of a day, you can always recommit. I think a lot of times the magic is in the recommitment, and being willing to accept yourself again, to come back and return to those habits that we're trying to build. Because Rome wasn't built in a day, or whatever other cliche you love to use. As long as you're going back and remembering why you're doing something, and you can give yourself a little bit of grace. I think that's something that's really important and often gets overlooked when we're talking about competitive exercise or hustle and gym culture and things of that nature.

[00:30:04] Lauren Turner: Absolutely. I think also, living with type 1, it can be really discouraging sometimes if you go to the gym and you have a low. It's like, well, why am I even working out to begin with? But...

[00:30:16] Rob Howe: Just pounding gummy bears in a Pilates class, you know.

[00:30:18] Lauren Turner: Yeah. I mean, as much as I love a gummy bear, that wasn't the purpose of the workout. So I think it's also giving yourself grace in the sense that not everyone around you is having to deal with that, and just getting to the gym and doing any sort of movement in the day is really a win for your health on all fronts.

[00:30:37] Rob Howe: Totally agree. Instant retweet from me on that one. Okay, I want to talk about you. You've been living with diabetes and you're in the exercise and diabetes research space. As someone who has seen the latest data on T1D and exercise, regardless of which insulin therapy you're on, what's something that you, Lauren, are thinking differently about now than maybe prior to seeing that? What's something you've changed your mind on?

[00:31:04] Lauren Turner: Recently, the biggest thing that I've had a mind shift on is the idea of using carbohydrates during exercise. I was always of the mindset, well, what's the purpose of working out if I'm just going to have to eat gummy bears as I go? But it was the mindset of, well, if I go into exercise and I have a little bit of carb at the beginning, whether that's 10 grams or 20 grams, just to help boost that glucose up a little bit, maybe if I have some insulin on board, to counteract that. Then rather than having hypoglycemia 20 minutes into my workout, I can actually get through the whole 60-minute workout bout without having to stop to treat a low, and also without over-treating. So for me that's a really exciting area that's coming out, and it's different types of carbs too, longer-acting carbs. So I think it's again that idea of how we can encourage activity in a way that's achievable for individuals living with type 1 diabetes.

[00:32:04] Rob Howe: A hundred percent. And I think being willing to test and learn, and try things that maybe don't work, and not let that be a reason that you don't do something again, is also really important. Obviously you guys are researchers and you're evaluating these things with a different lens, but be willing to test different types of carbs. One type of carb that works well for one person may not work for another, and that's just because we're all different physiologically. I just want to encourage people who maybe haven't quite gotten it right, or feel like they have tried and it didn't work and are feeling discouraged about that. You can find a way to get back up and continue to try.

[00:32:42] Lauren Turner: And no day's the same, and sometimes you really just have to do what works for...

[00:32:47] Rob Howe: Is that something that you guys, because there are so many people in the lab who live with type 1 diabetes, how does that show up? No day is the same. How does that show up for you guys in your research?

[00:32:56] Lauren Turner: For us, it's Dr. Riddell and myself in the lab who have type 1, and we joke with each other, like, yeah, we may sit on the guidelines and we may write these studies, but we actually follow none of our own advice. It's all based on vibes as you go. But I think it's listening to other individuals who have type 1 and what they find out. For instance, we were talking earlier about insulin on board, and how it may seem like you have almost no insulin on board, but then you start working out and you're still dropping low. So we think about those things that we see happening with each other and say, well, maybe there is something bigger going on here, and maybe there's a strategy we can use to help mitigate that. It's nice to be able to commiserate and talk and think through these things as a team.

[00:33:45] Rob Howe: Yeah, and I'm sure having that lens too, when you're evaluating the data or talking to study participants, is super important, and important for being relatable. I'm glad that even the researchers are going off of vibes in their own lives, because that's so much a part of it. Well, cool. Lauren, thank you so much for your time and for being so willing to contribute. I'm really excited about the research that you and your colleagues are doing. As somebody with diabetes who loves to exercise, it's really cool to see all of the compounding effects. I just really lucked out that I love exercise, and being an athlete is important to my identity, and seeing how good it is for my diabetes is always exciting. So thank you.

[00:34:23] Lauren Turner: Thanks so much for having me.