Staying Fit with Type 1 Diabetes

 Written by: Mikayla McTigue, SLU Dietetic Intern, MS of Nutrition Student, Type 1 Diabetic

Being in healthcare, it is astonishing to hear that diabetes has impacted the health of nearly every American. To put this into perspective, about 34 million Americans—just over 1 in 10–are living with diabetes in addition to 88 million having prediabetes.¹ But this data doesn’t account for the many individuals who go undiagnosed every year. The American Diabetes Association has predicted that 1.5 million people will be diagnosed by the end of 2022. While it’s unbelievable to hear, is it really all that surprising? For some, it can be prevented with healthy dietary habits and regular exercise; however, that cannot be the case for everyone suffering. This impacts individuals who have no say in what affects their health because of it being genetic, viral, autoimmune disorder, etc. Either type of diabetes can be affected; but, in type 1s, it is the only influence of diagnosis. In fact, researchers have not determined a specific cause but all their leads point to it being an immune system dysfunction.

Top Myths about Diabetes Fitness

Living with type 1 diabetes (T1DM) has brought me a whirlwind of hardships. One of my biggest challenges is managing my blood sugars while exercising. But don’t just take my word for it. In one of my *many* clinical rotations, I had educated a T1DM patient on making better eating choices and exercising regularly. They responded with, “I am afraid of exercising because of what it can do to my blood sugars.” Every diabetic is different when it comes to what works for them in keeping their blood sugars in a normal range while exercising. Personally, I am also trying to figure it out!

There are some popular misconceptions surrounding fitness for diabetes. Some of these myths, if not all, can discourage Type 1s from exercising and eating healthy. As a diabetic, I have heard quite a handful, but below are the top 3 common heard:

MYTH #1: Type 1 diabetics can only eat low-carb foods.

This is one of the most common myths heard in the diabetic world! What surprises me is that I have heard some nurses and doctors tell their patients this. While this is totally untrue, it is also frustrating. Wouldn’t you get mad if someone told you that you couldn’t eat cake anymore?!

It is common knowledge that carbs play a big role in diabetes, but the nutrient has been painted out to be the villain. This is due in part to early research. Their limited resources only gave them the conclusion of carbs raising blood sugars. While that is correct, that is not the whole truth. Carbs have one of the biggest roles in our bodies, meaning we are all wired to metabolize carbs as our main energy source (i.e., “the gas that fuels the car”). In type 1s, the individual is unable to transport it in the blood to provide energy; thus, it stays in the blood and raises “blood” sugar levels. Eating too many carbs is not necessarily the problem. Yes, more will have a greater impact on blood sugar levels, but insulin is what lowers them. No insulin, no maintenance of blood sugars.

What I’ve learned in higher education and being a diabetic, there is no real difference as to what a healthy diet should look like between a person with T1DM and a non-diabetic. As long as our insulin is calculated and given properly, we can eat the same food as a normal, healthy individual.

MYTH #2: When people with diabetes experience episodes of highs or lows, it means that they aren’t taking care of themselves.

Managing blood sugars in T1DM is a 24/7 job and we don’t get paid overtime. Everyone’s body reacts differently to various stimuli (e.g., food/drink, alcohol, stress, exercise, additional medications, etc.). Additionally, we must do math every time we want to eat something. The burn out can be real.

In my personal experience with diabetes, I have had bad days and I have had good days. None of that means that I am bad at taking care of myself. In fact, it feels strange to not have a bad day in a while. But all of this means I am human. A human that faces more challenges in my days than others. I’ve found it important to take it one day at a time, and to not criticize myself for something that isn’t and never will be my fault (which feels impossible to do sometimes).

MYTH #3: Diet and exercise will “cure” your diabetes.

If this were true, a lot more elite athletes would surface (including myself). T1DM is a lifelong condition that can be diagnosed at any age. Currently, there is no cure for it (no, having better lifestyle habits or using insulin does not cure T1DM, but instead it only manages your condition).

Managing the condition does come with a bit of skill, but eating a healthy, balanced diet of all foods and exercising regularly could help make it easier. Some say that their diagnosis was a blessing in disguise. Making them realize eating better and exercising more consistently, has lessened their highs and lows.

On the other hand, some people have found some challenges maintaining good blood sugar levels while trying to live healthier, especially during exercise. There are some common physiological reactions that occur to most, if not all, diabetics when they work out.² They may experience extreme lows when using the treadmill for 15 minutes, or even a steady incline when doing a resistance training workout (like CrossFit). Exercising is what causes insulin to become more sensitive (meaning it works better and transports more glucose), thus lowering blood sugar level faster. This could happen if you are new to exercising or have been off it for a while. It is best to talk with your doctor, to set up a lower/higher basal calculation when you exercise. Once you get into a routine of exercising regularly and eating healthier, it gets a little bit easier to maintain.

Tip: Try to keep a journal of what foods you eat and exercises you did that played a significant impact on your blood sugar levels.

Stay on top of your blood sugars while exercising

Physical activity is important to health and wellness regardless of whether you have diabetes or not. But if you have T1DM it is crucial to balance insulin doses with the type of activity you are doing. This chart describes how exercise can affect your blood glucose levels during various activities:

Figure 1. Different types of exercise and how they affect T1DM.

https://www.jdrf.org/t1d-resources/living-with-t1d/exercise/exercise-impact/

OK, so what do I need to do?

If you are new to exercise, or just getting back into a routine, you might want to engage in some trial and error. Keep in contact with your doctor about exercising, so they know how to change your insulin to match what you are doing.

Preventing LOWs

If you are below 100 mg/dl or your sugars seem to be trending down, eat something before you start.³ Keep a fast-acting carb with you at the gym or somewhere else (I like regular Gatorade or Skittles). Personally, I eat about 20-30 carbs worth and wait until my sugars are around 130-150 mg/dL before I continue. Additionally, I cut back on my basal rate during a cardio exercise by about half my normal rate. Everyone is different, so this may be another question for your doctor to help you sort through. Don’t be afraid to annoy them with questions. It’s their job to help you!

Preventing HIGHs

If you are wanting to start resistance training, it would be helpful in keeping your insulin pens/PDM and glucose monitor nearby. If your sugars are sunning high before you start, it may be better to start with a little warm-up cardio, then go into weightlifting. Be cautious if you decide to do cardio after. In this scenario, your doctor might increase your basal rate to match your rising levels.

It may seem intimidating to exercise, while risking the maintenance of good blood sugars. But, there will come a time when you understand what affects you during it and after. It is different from person-to-person, so take my personal experiences with a “grain of salt”. I believe the best thing you can do is talking with your doctor and researching on your own (from reputable sources!). I like to refer to the American Diabetes Association, JDRF, Beyond Type 1, and the CDC for when I do my own research.

I hope that you got a lot out of this information but if not, please remember this: Accept that you aren’t going to get it right every time. There is no such thing as “perfect” health, so why would there ever be such a thing as “perfect” diabetes management.

References:

1. National Diabetes Statistics Report. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html. Published January 7, 2022. Accessed February 22, 2022.
2. Oerum C. 3 diabetes fitness myths you shouldn't believe. Beyond Type 1. https://beyondtype1.org/3-diabetes-fitness-myths-you-shouldnt-believe/. Published September 7, 2021. Accessed February 27, 2022.
3. Exercise and type 1. American Diabetes Association. https://www.diabetes.org/healthy-living/fitness/exercise-and-type-1. Accessed February 27, 2022.

The Life of a Culinary Entrepreneurship Dietetic Intern

written by: Libby McCaslin

Hi everyone, SLU dietetic intern Libby here!

Often when mentioning to new people that I am currently completing a dietetic internship and studying to become a registered dietitian, most assume that I am going to work clinically or start a private practice. It is no secret that there are many different directions one may go within the profession of dietetics, but I feel like the culinary entrepreneurship realm deserves a bit more of a spotlight and I am here to do just that by answering a few questions I often get! 

Why did you decide to apply to the culinary entrepreneurship concentration of the dietetic internship?

When doing research on different dietetic internships to apply for in undergrad, SLU’s program pulled me in for many reasons, but the fact that they have a culinary entrepreneurship track was at the core of it all. This concentration provides interns the opportunity to not only practice medical nutrition therapy, but also develop strong business skills and learn how we can become entrepreneurs as dietitians. It is a long-term goal of mine to open a restaurant someday with a focus on sustainability and highlighting local, in-season foods. I strongly believe that it is important to have a nutritional lens when one is cooking, and I want to share with my community how that can be produced and consumed in fun ways in a location where all are welcome. This concentration and internship has truly been a dream come true and I am very thankful to be a part of it!

Typical Day Schedule:

Every Monday all of the interns gather to have have sessions dedicated to different important topics where local dietitians come to talk to each SLU intern about what they do and how we can improve our own patient/client care. On some Mondays we also have garden sessions at local schools, nutrition educations and post clinicals. Tuesday through Friday we are all at our different sites seeing patients/customers/clients or completing rotation checklists. Depending on the semester, concentration-specific Master’s classes are in full swing as well!

How does the culinary entrepreneurship concentration compare and differ from the other concentrations (MNT, Pediatrics, Sports Nutrition)?

Here at SLU, day-to-day culinary entrepreneurship internship life in terms of rotation experience really doesn’t differ much from the other concentrations. We each are set up to complete around 1200 hours of rotations divided among clinical, community and foodservice sites within a 15-month period. And just because I’m a culinary intern doesn’t mean I get more time in foodservice rotations than the others. This is one of my favorite aspects to this program because we are all provided equal opportunities to learn in each of the different parts of the dietetics world, but there also is a strong culinary focus for community rotations and the master’s portion of the program.

Where concentrations do differ comes down to our master classes and capstone/thesis topics. The culinary entrepreneurship program includes nutrition-based classes, new venture entrepreneurship classes where you get to practice creating your own start-up company, sustainable food systems, finance, marketing and organizational management. Our capstone/thesis is to be culinary or foodservice based as well.

I have teamed up with 2 other culinary interns, Samantha and Mikayla, and we are creating a book for our capstone project called “Everyone Has to Eat”. It is a 2-in-1 cookbook and guide with over 60 delicious, plant-forward recipes, as well as guide to making intuitively healthful decisions when dinging out. We hope to provide the tools to making better, budget and time friendly food choices to the busy young adult. We are still in the development process but plan to be selling it come mid-April, so keep your eyes peeled for a post about it on the SLU Nutrition and Dietetics Instagram page - @slunutrition1818.

What has been your favorite rotation this far and why?

I was lucky enough to get to spend 6 weeks of my foodservice rotations working at Fresh Gatherings, the café located in our departments Allied Health building. This has been my favorite rotation because it was really my first experience working in a fast-paced foodservice environment where I got to do the all of prepping and cooking. I was able to work with a team to develop several lunch special menu items, as well as a few salads for the grab n’ go refrigerator. This was the first time I really got the opportunity to menu plan, develop and serve menu items for the masses and it was a very exciting experience. Two really fun items I got to help create were a Birria Crunchwrap and a Thanksgiving burrito with all of the classic fixings – which may sound interesting but sure was delicious. My experience at Fresh is something I know I will carry with myself throughout my future career as a dietitian to come!

My Experience with the Integrative and Functional Nutrition Academy

 written by: Samantha Larkin, dietetic intern

During my undergraduate experience, I was struggling to find my niche within nutrition. Most of my professors taught about in-patient, clinical experience, and I knew that was not for me. I learned of the Integrative and Functional Nutrition Academy (IFNA) through one of my mentors during the summer of 2020. After researching the organization and their values, it seemed like a perfect fit.

To better understand IFNA, it is an evidence-based, whole systems approach to patient and client care. They combine modern science, clinical wisdom and thinking, while focusing on six key clinical areas: whole body systems approach; root cause analysis; therapeutic elimination diets and food plans; conventional and functional diagnostic labs; the art and science of dietary supplements; and mind-body modalities. 

If this sounds interesting to you, here are the basics of the program:

●       A 2 year online program plus an exam.

●       5 tracks with 33 modules.

●       Available to RDNs and RD to be students.

●       A new guest lecturer for every module.

●       Estimated cost of the credential program: $5,660.

Initially, the expenses were a concern for me, but as I go into detail below, there were aspects that allowed me to justify the price. The first track has a student discount, the subsequent four do not. However, you pay for one track at a time, so the total price is spread out over two years.

The greatest appeal was that I could complete this program prior to becoming a registered dietitian. The functional and integrative nutrition field is a competitive area to break into; I knew it would set me up for success in finding a related job.

You might be wondering how it is possible to complete a 2 year program while in school. Personally, setting aside a couple hours each weekend for IFNA was the best way to balance schoolwork and the lectures. I had to switch up my tactic during the internship due to my weekends being chalk full of rotation and class assignments. I made the most of my winter break to finish the final track. I found the information from IFNA deviated enough from the school curriculum that it did not resemble homework. And the cost was a significant motivator!

If you are currently in the SLU dietetic internship, or are about to start, you might wonder which concentrations IFNA applies to. The foundations of integrative and functional nutrition can be applied to many different areas of dietetics including all four concentrations offered at SLU. I am in the culinary concentration, and through IFNA, I learned of the synergistic qualities of certain foods when combined. I have seen an improvement in my understanding of how to enhance flavors and create a deliciously healthy meal. Many of the underlying themes in the IFNA program is food as medicine, so having a culinary background can lay the groundwork for a functional dietitian.

Regardless of your concentration, if you are interested in learning more about different labs, nutrigenetics, and the latest science regarding human nutrition, this program will beneficially serve you.

My greatest takeaways from this program include being able to interpret different laboratory results, learning about genetic variations and their impacts on nutrition status, and understanding the pathophysiology of different disease states using a functional lens.

If you are still on the fence about whether this is a realm you want to pursue, the Academy of Nutrition and Dietetics has a dietetic practice group tailored to integrative and functional medicine. Their website has great resources and more information on what it means to be a functional and integrative dietitian.