April 27, 2007

Sports, Exercise and Blood Sugar Control

by



Thursday, April 27th 9pm est.
Gary Scheiner MS, CDE
Topic: Sports, Exercise and Blood Sugar Control

As both a Certified Diabetes Educator and diabetic for 20 years, Gary Scheiner knows the latest and best techniques for achieving optimal diabetes control. Gary earned a Bachelor of Arts in Psychology from Washington University in St. Louis, and a Master of Science in Exercise Physiology from Benedictine University. He received his diabetes training with the world renowned Joslin Diabetes Center. In addition to serving as a volunteer for the American Diabetes Association, Juvenile Diabetes Research Foundation, Diabetes Exercise & Sports Association and Setebaid Camping Services, Gary has authored two books (You Can Control Diabetes, 1997; and Think Like A Pancreas, 2004) and dozens of articles, and speaks at local and national meetings on diabetes, fitness and motivation. Gary received the 1997 William Martin Award for Outstanding Achievement in Patient Activities by the American Diabetes Association, the 1998 Allene Van Son Award for the development of effective diabetes teaching tools by the American Association of Diabetes Educators, and the 2003 Novo Nordisk Pharmaceuticals Research Grant Award for the study of basal insulin profiles in insulin pump users. Today, Gary owns and operates Integrated Diabetes Services, a private practice located in Wynnewood, PA (just outside of Philadelphia) specializing in intensive blood glucose control and lifestyle intervention for people with diabetes.

In addition to his office-based practice, he and his staff provide diabetes consultation throughout the country and abroad via phone, fax and the internet. He can be reached at 877-735-3648, or thought his web site: <a href=”http://www.integrateddiabetes.com”>www.integrateddiabetes.com</a>

[The DiabetesTalkFest Chat Room]: Gary Scheiner MS, CDE has entered at 6:05 pm [Jon] 6:05 pm: Hi Gary!

[sstrumello] 6:05 pm: Hey Gary

[Gary Scheiner MS, CDE] 6:05 pm: Hi! Sorry I’m late. Computers at my gym won’t let me log in to a “chat room”.

[Jon] 6:06 pm: I would like to introduce Gary Scheiner

[Jon] 6:06 pm: As both a Certified Diabetes Educator and diabetic for 20 years, Gary Scheiner knows the latest and best techniques for achieving optimal diabetes control. Gary earned a Bachelor of Arts in Psychology from Washington University in St. Louis, and a Master of Science in Exercise Physiology from Benedictine University. He received his diabetes training with the world renowned Joslin Diabetes Center.

[Jon] 6:06 pm: In addition to serving as a volunteer for the American Diabetes Association, Juvenile Diabetes Research Foundation, Diabetes Exercise &amp; Sports Association and Setebaid Camping Services, Gary has authored two books (You Can Control Diabetes, 1997; and Think Like A Pancreas, 2004) and dozens of articles, and speaks at local and national meetings on diabetes, fitness and motivation.

[Chris P] 6:06 pm: hey Gary how bout this….6.3

[Jon] 6:07 pm: Gary, are you ready to begin?

[Gary Scheiner MS, CDE] 6:07 pm: Fab – U – Luss, Chris. So long as you’re staying clear of a lot of lows!

[Gary Scheiner MS, CDE] 6:07 pm: Ready whenever you are, Jon.

[Chris P] 6:07 pm: you know how i am?

[Chris P] 6:08 pm: i meant who

[Gary Scheiner MS, CDE] 6:08 pm: Actually, I’ll be changing out my pump while I’m typing. And yes, I know who you are! I wasn’t going to say anything about that LOOOOOOVELY picture of you on the home page because I knew you!

[Chris P] 6:08 pm: hey what picture?

[Gary Scheiner MS, CDE] 6:08 pm: Jon, that is.

[Gary Scheiner MS, CDE] 6:10 pm: Anyone here into exercising? What do you do to stay in shape?

[Chris P] 6:11 pm: i walk my greyhound daily

[sstrumello] 6:11 pm: Gary, I understand you are currently trying a continuous glucose monitor made by one of the manufacturers at the present time, is that right?

[Jon] 6:11 pm: Gary, do you recommend cutting back on basil while pumping and exercising?

[Chris P] 6:11 pm: Gary i got kicked out which homepage are you talking about

[Gary Scheiner MS, CDE] 6:12 pm: Dat is correct, sst. I’ve used the Dexcom for the past few weeks, and I had a chance to sample the Medtronic sensor recently as well.

[JoeC] 6:12 pm: Hi Gary. Has the DexCom coming along?

[Gary Scheiner MS, CDE] 6:12 pm: Jon – I only recommend cutting back on the basal for prolonged exercise (over 2 hours). It is not usually effective to lower the basal for shorter periods of time.

[Chris P] 6:13 pm: I cant wait til the new pump comes out but the sensors aren’t covered

[Gary Scheiner MS, CDE] 6:13 pm: The DexCom takes a bit of getting used to. It is much simpler to use than the Medtronic system, but you have to accept some snafus the first 8-12 hours after starting each sensor.

[sstrumello] 6:14 pm: how much would you cut basals in the case of 2+ hours of exercise … I hear different amounts from everyone, and its always been a guess for me

[Gary Scheiner MS, CDE] 6:14 pm: SST – I’d start out with a 50% basal reduction, but it is important to start the reduction about an hour prior to the activity. Starting it too late will cause a major drop during the first 90 minutes of exercise.

[Jon] 6:15 pm: what do you recommend for somebody who does an hour of heavy exercise?

[JoeC] 6:16 pm: Gary, what are some of those snafus you have experienced?

[Gary Scheiner MS, CDE] 6:16 pm: FYI, the DexCom and Medtronic sensors are very similar in terms of their accuracy. Both are good for following up &amp; down trends and alerting you when you are veering towards high or low levels, but you can’t take the specific numbers they show at face value.

[sstrumello] 6:17 pm: was that right, starting too late will cause a drop during the first 90 minutes? how is that possible?

[Chris P.] 6:17 pm: Gary where do we stand as far as insurance coverage for these sensors?

[Gary Scheiner MS, CDE] 6:17 pm: Jon – for an hour of heavy exercise, I’d recommend a sharp bolus reduction (if the activity is after a meal), or a substantial snack (if the activity is prior to a meal).

[Chris P.] 6:18 pm: I cant believe that Minimed would bring the pump to market without the fact of the sensors being covered!:(

[Gary Scheiner MS, CDE] 6:18 pm: SST – consider how insulin works. Each pulse of basal insulin every couple of minutes is like a miniature bolus. And each of those boluses takes about an hour to peak and 3-4 hours to dissipate. The basal you received 1-2 hours ago is what is working in your bloodstream right now.

[sstrumello] 6:20 pm: But I find that my lows occur like 5 hours after exercise, never immediately after

[Gary Scheiner MS, CDE] 6:20 pm: Currently there is no insurance coverage that I’m aware of for the sensors or the equipment that goes with it, and the sensors are not cheap. Medtronic’s are $40 each, and
Dexcom’s are $35 each. Even though they are supposed to be used for 3 days, many people have found ways to “stretch” them out for as long as 6 days. And Dexcom is reportedly close to having a 7-day sensor available.

[Gary Scheiner MS, CDE] 6:21 pm: Is it just me, or is the program having a hard time keeping up with my typing speed?

[Chris P.] 6:21 pm: How should we go about getting insurance to cover them?

[JoeC] 6:22 pm: DexCom is trying to get fingerstick replacement status too. Do you see that happening?

[Jon] 6:22 pm: the server may be slow tonight

[Gary Scheiner MS, CDE] 6:23 pm: Medtronic is doing extensive research right now to prove the clinical, therapeutic and financial value of CGM. They will use that data to try to convince insurance companies to pay for them.

[lag3g] 6:23 pm: Chris – Insurance coverage is the definite goal of the manufacturers of continuous glucose monitors BUT there has not been enough research to show that these devices provide benefits above and beyond standard glucose meters, and therefore worth the extra cost. They also have to show that they are as accurate as glucose meters. All of this research takes time but the research is being done.

[Chris P.] 6:23 pm: thats good as i dont see many people using them if they must pay out of pocket

[Gary Scheiner MS, CDE] 6:24 pm: I do not know about DexCom trying to do that. I don’t see that ever happening. The specific BG data generated by the sensors are off by an average of 15-20%; you can’t base insulin-dosing decisions on that kind or information.

[Chris P.] 6:25 pm: lag yeah that appears to be the truth at the time i guess the accuracy of these devices is slowing things down

[Gary Scheiner MS, CDE] 6:25 pm: SST – you might benefit from a more modest temp basal reduction for several hours after exercise. You’re experiencing something commonly known as “delayed onset hypoglycemia”, and the temp basals of 70-80% after the workout can be effective in countering it.

[sstrumello] 6:26 pm: Thanks, I’ll try that and see if it works better!

[sstrumello] 6:27 pm: Do you get the sense that the manufacturers are rushing products onto the market before getting them right? I am thinking that these are not really accurate, and expensive as well, just like the ill-fated glucowatch.

[Chris P.] 6:28 pm: I was part of the glucowatch study and what a piece of junk it was!

[Chris P.] 6:29 pm: When I took it off my arm was completely raw and for days afterward

[johnny johnboyboy] 6:29 pm: yuck

[Ellen] 6:29 pm: The MM RT system is too #$%^&amp;* ersome – my son’s not going to wear it.

[Ellen] 6:29 pm: wow that was weird

[Gary Scheiner MS, CDE] 6:29 pm: SST – Yes, there is work to be done on the sensors, but these companies are investing a fortune and have to start recouping some of that money to continue with the R &amp; D. As they are right now, both the DexCom and Medtronic (and soon the Navigator)(sensors will have their rightful place helping people with hypoglycemic unawareness issues. I also seem them being very useful to women during pregnancy.

[Ellen] 6:30 pm: bulky a better word – will the room accept that? LOL

[Chris P.] 6:30 pm: i dont mind using my meter for my tests i do 10 per day anyway\

[julie] 6:30 pm: hi

[johnny johnboyboy] 6:30 pm: hi julie

[Gary Scheiner MS, CDE] 6:30 pm: Eresome? I never heard it described quite that way!

[Ellen] 6:31 pm: #$%^&amp;* ersome

[Jon] 6:31 pm: Ellen, busted by the filter

[Gary Scheiner MS, CDE] 6:31 pm: This typing thing is frustrating. My brain is processing a lot faster than the server is posting.

[Ellen] 6:31 pm: oy c u m b e r s o m e

[Chris P.] 6:31 pm: Gary…other than the CGMS to u see any benefit in upgrading from the 715 to the 722?

[Gary Scheiner MS, CDE] 6:32 pm: I apologize for all my typos; I gave up on waiting for my messages to appear so I could edit them before posting.

[sstrumello] 6:32 pm: sorry about that … it must be server issues tonight, I’m having the same issue

[johnny johnboyboy] 6:32 pm: Gary, do you think that with CGMS some of the hypo awareness returns as hypos eventually are avoided?

[Gary Scheiner MS, CDE] 6:32 pm: Ha Ha! I get it. Ellen, that’s going to live in infamy.

[Ellen] 6:33 pm: It’s good to have humor

[Jon] 6:33 pm: don’t worry, Gary, I will fix your typos when we post the transcript

[Gary Scheiner MS, CDE] 6:34 pm: JJ – Absolutely. You can probably circumvent 90% of your usual hypos if you use a CGM correctly and persistently. That kind of change will surely restore some of the early signs of hypoglycemia.

[julie] 6:34 pm: am i allowed to ask a sports/bg question?

[Gary Scheiner MS, CDE] 6:35 pm: Jon, I just hope I don’t accidentally post anything peVferted…. LIKE ELLEN!

[johnny johnboyboy] 6:35 pm: i exercise in the mornings…fortunately my bgs are most stable then…but i have been going low in the evenings…i can’t figure it out

[Jon] 6:35 pm: if you do, the sensor will bust you just like it did her. (Can I say bust?)

[Gary Scheiner MS, CDE] 6:35 pm: Absolutely not, Julie! Just kidding, go ahead.

[julie] 6:35 pm: okay

[Gary Scheiner MS, CDE] 6:36 pm: You can, Jon, if I can say “can”.

[Gary Scheiner MS, CDE] 6:37 pm: Oh, poor Ellen. This must be so mortifying for her.

[Ellen] 6:37 pm: I was wondering which prick of the sensor is the worst? LOL

[johnny johnboyboy] 6:37 pm: :s

[julie] 6:38 pm: well i play hockey ,dance and swim, and my blood sugars react differently for each of them– with hockey sometimes my blood sugar will be fine and then a 1/2 hour in it will spike up and i will have dose and sit out—some people would expect me to come down after i get off the ice but i dont.– any suggestions? dance is the activity i mostly go low in and swimming it depends

[sstrumello] 6:38 pm: OK, Ellen … now you’re just being crude πŸ™„

[julie] 6:38 pm: sometimes it goes high, sometimes it goes low and sometimes its perfect

[Chris P.] 6:38 pm: Gary other than CGMS any differences between MM 715 and 722?

[Jon] 6:38 pm: I am just glad none of you were here when Gina and I were testing the sensor to see what we could get away with in here.

[Gary Scheiner MS, CDE] 6:39 pm: I’d have to say that size matters, and the Medtronic’s penetration is a bit more substantial.

[julie] 6:39 pm: and i was just wondering if you had any suggestions to what i could do

[Ellen] 6:39 pm: Gary have you worn all the sensors? Which was most comfortable?

[julie] 6:39 pm: man this thing i slow

[Gary Scheiner MS, CDE] 6:41 pm: Julie – What you’re seeing is perfectly natural. With hockey comes a lot of adrenaline production, and that will make your sugars go up. You will probably need to bolus some insulin before you take the ice just to prevent the rise. Dance is more aerobic and less stressful, thus less adrenaline and a greater BG drop. I imagine that swim practice will make you drop a lot, but meets will shot your BG up.

[julie] 6:41 pm: the thing is my bg shoots up more during practices though

[Gary Scheiner MS, CDE] 6:42 pm: 715 and 722 are virtually identical. There are some slight memory differences that have no bearing on how the pump is really used. Just 722 will have the software and receiver for working with the sensor.

[johnny johnboyboy] 6:42 pm: gary, have you read anything about the research on the benefits of sprinting at the end of sustained moderate exercise?

[julie] 6:42 pm: (are we talking about the minimed upgrade?)

[Gary Scheiner MS, CDE] 6:43 pm: Ellen – I haven’t worn the Navigator yet. Between DexCom and MM, the
DexCom was more comfortable. It is a really small, thin filament, and the adhesive is built right into the sensor housing.

[JoeC] 6:44 pm: Gary, would you recommend to anyone to buy the DexCom at this time?

[Gary Scheiner MS, CDE] 6:45 pm: Julie – you mean during swim practices? Perhaps you’re disconnected from your pump for too long, or maybe there is still food digesting from earlier. There are a lot of factors involved; IF YOU’D LIKE TO E-MAIL ME WE CAN DISCUSS THE DETAILS A BIT MORE. (I’m [email protected])

[Ellen] 6:46 pm: For those who may not know, there is one blog on the DexCom <a href=”http://www.insulinfactor.com/article_dexcom.html”>http://www.insulinfactor.com/article_dexcom.html</a>

[Gary Scheiner MS, CDE] 6:46 pm: JJ – Yep, I read that. I’d save that as a last resort, like if you’re on a desert island with no glucose tablets and nothing but your meter.

[julie] 6:47 pm: yeah , during swim practices

[julie] 6:47 pm: thanks

[johnny johnboyboy] 6:48 pm: πŸ˜›

[johnny johnboyboy] 6:48 pm: ok thanks

[Gary Scheiner MS, CDE] 6:48 pm: Joe – I would recommend DexCom to those who are having serious issues with hypoglycemia — either too often or too severe. Also for those whose BG can spike suddenly due to a pump malfunction, and may go into DKA easily. The high/low alarms on the DexCom are worth their weight in gold to those folks. Women w/Type-1 entering pregnancy could also benefit greatly from it.

[Ellen] 6:49 pm: I’m about to send my kid off to college and would love to have a Navigator for him…but it’s not available yet – I’m still hoping it’ll be the best of the three choices.

[julie] 6:50 pm: thank you for the advice πŸ˜€

[Gary Scheiner MS, CDE] 6:50 pm: From what I’ve seen &amp; heard, Navigator shows a lot of promise, Ellen. I still don’t think it’s going to replace traditional fingerstick testing, but it can serve as a nice security blanket.

[Gary Scheiner MS, CDE] 6:51 pm: Hey, Jon – mind if I plug my schtick?

[Jon] 6:51 pm: of course you can plug whatever you want here Gary

[Jon] 6:51 pm: as long as you don’t offend the filter like Ellen

[Jon] 6:52 pm: We only have a few minutes left. Time to get those last minute questions in everybody

[Gary Scheiner MS, CDE] 6:53 pm: For anyone here who is interested in some expert diabetes “coaching”, my practice offers such a service to people all over the USA &amp; overseas. We work with individuals and families by way of phone, fax and the internet. You can call my office toll-free at 877-735-3648 for information, or visit my web site: <a href=”http://www.integrateddiabetes.com”>www.integrateddiabetes.com</a>; click on the “remote consulting” icon.

[Jon] 6:54 pm: I personally can recommend Gary. He has been a big help with my son, Chris.

[Jon] 6:54 pm: Are there any more questions for Gary?

[JoeC] 6:54 pm: Gary, is your office DexCom “trained”. I’d hop on the turnpike in an instant if you’d be willing to train us.

[Gary Scheiner MS, CDE] 6:54 pm: Oh, don’t forget about the DESA (Diabetes Exercise &amp; Sports Association) annual conference… it’s going to be at the University of North Carolina in Chapel Hill, NC, May 18-21. Info is at <a href=”http://www.diabetes-exercise.com”>www.diabetes-exercise.com</a>

[sstrumello] 6:56 pm: Gary, I hope you can join us again before the summer!

[Gary Scheiner MS, CDE] 6:56 pm: Yep, not a problem. However, it is not FDA approved for children, although it can be prescribed “off-label” if your doctor has the gumption.

[Jon] 6:57 pm: Thanks for coming Gary

[Jon] 6:57 pm: Thanks everybody for being here

[JoeC] 6:57 pm: I got a prescription in my wallet.

[sstrumello] 6:57 pm: Thanks for joining us tonite Gary

[Ellen] 6:57 pm: Good luck with it Joe..I hope you’ll blog your experience

[Jon] 6:57 pm: Read the latest review of Gary’s book at <a href=”http://www.diabeteshealth.com/read,1004,4536.html”>http://www.diabeteshealth.com/read,1004,4536.html</a>

[Ellen] 6:58 pm: What’s the return policy and will they replace faulty sensors?

[Gary Scheiner MS, CDE] 6:58 pm: Jon, thanks for inviting me to join you &amp; the rest of the group. You always have some very sharp participants! And then, of course, there’s Ellen. (just kidding!)

[Jon] 6:58 pm: I hope we can get you back in here again soon

[Gary Scheiner MS, CDE] 6:59 pm: Just let me know when, Jon. I’d love to.

[Jon] 6:59 pm: Thanks again everybody

[Jon] 6:59 pm: There will be a transcript of this chat posted up soon on the homepage

[JoeC] 6:59 pm: Thanks Gary.

[Gary Scheiner MS, CDE] 6:59 pm: Joe, give me a call!

[JoeC] 6:59 pm: Will do. Go Flyers.

[Gary Scheiner MS, CDE] 7:00 pm: Hasta La Vista Babies.

[Jon] 7:00 pm: Chat closed, you are all welcome to stay as long as you want!

[betty] 7:01 pm: sorry I’m late. Hi everyone

[Gary Scheiner MS, CDE] 7:01 pm: Ellen, I know that DexCom will replace any defective sensors; I’ve already had two of them go bad. I don’t know about their return policy.

[Ellen] 7:02 pm: Thanks Gary. The head of sales couldn’t answer that question either

[Ellen] 7:02 pm: Nor the warranty info

[Gary Scheiner MS, CDE] 7:02 pm: That’s not a good sign.

[Gary Scheiner MS, CDE] 7:03 pm: Gotta run. Shoot me an e-mail if you want to discuss anything further!