1. Winter Fatigue:
Staying Positive and Active
While Waiting for Spring
Jacqueline Shahar, M.Ed., RCEP, CDE
Joslin Diabetes Center
Boston, MA
© Joslin Diabetes Center

2. Objectives
• Exercise options in the spring
• Fuel metabolism with exercise
• Blood glucose management
with exercise

3. Exercise Options
• Walking
• Running
• Cycling
• Hiking
• Yoga
• Physical activities:
– Raking leaves
– Painting

4. Additional Exercise Options
• Outdoor TRX training
• Resistance band training in the park
• Combine aerobic
and resistance training
outdoors
• Sign up for an event/activity
– ADA: Tour De Cure, Walk to Stop Diabetes
– JDRF: Walk to Cure Diabetes
– Insulindependance: regional chapters and events

5. Fuel Metabolism and Exercise
Chu et al., The Physician and Sportsmedicine, Volume 39, 2011

6. Blood Glucose Control & Exercise
• What is best BG range to perform your
exercise and prevent lows and highs?
• Target BG: 140-230mg/dl
• Low-moderate vs. vigorous exercise
• BG may be different
• Check BG before, half way and after exercise
• Check amount of “Insulin on Board” in your
pump

7. Insulin Adjustments on Exercise Days
• Reduced bolus (meal/snack insulin) by 30% to
50% with the meal close to activity time
• Reduced long acting by 10-30% for
activity/sports performed over a long period of
time
• Basal, temp basal or disconnect
• If BG high, small correction dose maybe required
• Be aware of “lag effect”
• Principle method - trial and error

8. Snacking Choices with Exercise
Before exercise:
• A mix of carbs and healthy fats to help sustain BG with
exercise
During exercise - choose snacks that are:
• Convenient to carry
• Do not cause stomach upset
• Absorb quickly
• Sports drinks – Gatorade, Powerade
• Gels, GU
• Fruit: dried fruits, banana
• Juice
• Avoid protein shakes

9. Snacks Post Exercise/Recovery
• To replenish muscle glycogen stores and repair
muscle damage eat:
• Carbs
• Proteins - ~20g protein within 1 hour after
exercise. Essential for muscle growth and
recovery.
• Whey protein shakes
• Meal
Ivy, Journal of Sports Science and Medicine, 2004

10. Hydration
• Hydration
• 250mL of fluid intake every 20mins of exercise
• Water or sports drinks
• Replace electrolytes
• Dehydration causes cramps, hyperglycemia, heat stroke

11. How to Achieve Your Goals?
• Use SMART goals to start your spring
exercise routine
– Specific; Measurable; Adjustable;
Realistic; Time frame
• Manage your time
• Exercise with your family and friends
• Develop alternative activity plans

12. Summary
• Find the right activity for you: outdoor vs. indoor; group
vs. individualized.
• Check BG with exercise to adjust meds as needed.
• Use SMART goals to move in the right direction and
achieve your goals.
• Find the right snack that helps manage your BG with exercise.

13. Thank You!