Sheepishly I'm a huge fan... of walking.

I can be pretty stubborn.

Something that I've been stubbornly wrong about it that walking is legitimate "exercise". I've always thought it wasn't strenuous enough or cardio enough to make a real fitness difference. Even with all the recommendations from "authorities" to walk more, I had my own theories about it. I thought that encouraging walking was just a "baby-step" to help unfit people get closer to being active. Maybe the thinking was if you could get people to walk more, they might really exercise someday.

Well, through a circuitous route I've landed myself in the "walking is better than" running, or cycling, or jogging, or _____________ camp.  When I take a brisk walk, I find that my insulin kicks in and works better, faster. If it can be seen on a CGMS I'm guessing the same things are happening in everyone that walks. For me, seeing the numbers at work has been very eye-opening.

What does walking have that other forms of activity might not?

It's low-impact. You aren't likely to develop injuries from repetitive actions that your body isn't ready for. Since you walk your whole life, it's the most natural way for you to get moving. (One summer I injured my achilles tendon from doing lots of dog-walking in flip-flops, but that was unusually foolhardy.)

It's accessible. You can walk in any clothing you have on (caution with flip-flops recommended). You can walk wherever you are. You can walk with people who don't normally "exercise". The barriers to getting it done are very few.

It's easy, and the heart rate is spot on. How many times have you done a serious run or bike ride and found yourself exercising at a level that makes you feel lousy and sore, and not look forward to doing it again? For me, if I exercise at a heart rate of over 155 bpm, I'm officially working too hard. I find it very hard to dial myself back to that level when I run or cycle. When I walk at a fast pace I don't think it's possible to breech the threshold into unhealthy exercise. We never return from a walk and think "Wow, I'm super exhausted!" From talking to others, I have found that most people tend to exercise above their target heart rate zone, and often are reluctant to get out there for another workout, because, frankly, it was uncomfortable. For this reason many athletes use heart rate monitors to keep themselves in check and keep from working at a rate that is too high. For me walking is always in the low end of the target heart rate window, and I don't need a heart rate monitor to tell me how fast to walk.

It reduces stress instead of causing it.
Excessive or overly strenuous exercise can cause you negative stress that can oftentimes be worse for your body that better. Cortisol (stress hormone) release from strenuous exercise is conter-productive to most people's fitness goals. Walking has very little risk of working against you this way.

Conditioning. 
Contrary to what I had previously thought, walking regularly this season has improved my readiness for other activities. Last summer when I began stand up paddling I found that I could only go out for 15-20 minutes before my legs got too shaky to keep going. This year, on my first day out I was able to go out three different times for about an hour without feeling fatigue in my legs. I think it has a lot to do with the regular activity throughout the winter that prepared my legs for long periods of balance work. That was unexpected. 

I'm not saying that everyone should stop doing the exercise that they find stimulating and fun, but that for baseline activity walking is safe, easy, accessible and useful. I began exercising much more frequently since I moved walking onto my exercise menu. If I could cycle, rock climb, cross-country ski, stand up paddle, hike, and kayak everyday I would be ecstatic. Until I retire and live in such a paradise, going for one or two 20 minute walks a day has been incredibly helpful in increasing my insulin sensitivity and correcting BG that is headed out of range.

High intensity muscle work, a new tricky project...

I've been doing some sporadic strength training, but the frequency has been spotty because the effect on BG has been hard to predict and balance. The first time I did a 30 min. workout before dinner (a couple months ago) I ended up with my BG at 300 after dinner. Geesh, talk about counter-intuitive results...

Yesterday, I took a unit of insulin before working out and then had dinner, and saw it rise to 170 mg/dl before I took a walk and another correction and it began to descend.

I also threw in another variable which was that I had a glass of milk with dinner, which is usually "off my list". I understand that the carbs and other parts of the milk might be useful post-workout to help with recovery and muscle building. It's likely that I didn't bolus enough for the milk and the meal together. I was shy on the bolus because of the insulin sensitivity that often comes after exercise. I normally think of a glass of milk as 12 grams of carb, which is about what I usually eat for my whole meal. I only bolused for 15 grams.

In the end, I spent the 7pm-midnight window out of range, and a correction at about 9:30pm brought things back to normal overnight. I looks like I needed about 1.5 more units somewhere in the mix. The caveat... I'm not sure I would want to bolus much more in this situation because my wake-up BG was 50-60 mg/dl. I think the exercise impacted my overnight basal. There are surely a few moving parts here.

I may try working out earlier in the day so that I can isolate the impact and get it straightened out before it gets tangled in meal and bedtime factors. It's a bit tricky because the AM isn't probably the best time to do strength training because of the dawn phenomenon, but the pre-dinner window is also less than perfect. Well, just until I get it sorted out... and I will.

Getting Outside!

 School's not quite out yet, but we've been pretending. We got out for a weeknight bike ride on Tuesday. I like getting in some activity and having it not be so clinical. I haven't been on the elliptical machine in weeks, and the fresh air is really welcome. Hopefully, I'll be able to keep the kids interested all summer, skinned knees and all! Luckily, Penny is the toughest and the most resilient.

May Numbers and Whatnot

Our strawberry patch really kicked out some fruit this year.

Another 30 Days
I think according to my sensor data this past month was one of my best for glucose control. I think getting confident with using Symilin and using regular exercise to become more insulin sensitive has helped a lot.

Numbers
My 30 Day Average BG is 120 with a standard deviation of 39. This means I'm staying mostly between 100 and 140 mg/dl. I would say this is accurate, based on my (somewhat obsessive) CGMS watching.

The at-home-A1C showed 6.3 which comes out to an average glucose value of 134 mg/dl.

I expected a lower A1C value, but I'm coming to the conclusion that I might be at that point where running the numbers any lower would have me in hypo territory much more often. As it is, I'm using a glucose tablets about every other day to keep myself in range.
  
Insulin
I have adjusted my basal so that my total daily dose is at it's lowest at 23-26 units a day, and sometimes it still seems to be a bit too high. I have lost a few pounds since starting Symilin, so I think insulin sensitivity and less body weight play into that equation.


Exercise
I've found that taking 1-2 brisk walks a day has given me the best return on investment with exercise. I usually take one in the beginning of my work day and then another after dinner. When this has been regular, I see the most consistent BG levels and lowest need for insulin.

Also, in the past, the arrival of warm weather has also tended to lower my insulin demands, so that's probably going on too.

The End of the Yerba Mate Experiment
I was excited about the possibilities that Yerba Mate might offer for metabolism, etc. After drinking it throughout the day for about 6-8 weeks, I decided to stop using it. Why? Well, it started with vanity. It was staining my teeth. But, one of the things that improved when I stopped using it was that my episodes with rapid heart rate reduced in frequency, by a lot. I guess it doesn't take a genius to hypothesize that consuming a stimulant might impact heart rate/rhythm, but I've never claimed to be a genius. So, I went to the dentist and had my teeth buffed back to their normal hue and I'm rarely noticing my pulse being out of whack. It's a win-win. My morning coffee and moderate exercise don't seem to have any impact on my heart rhythms.

Thyroid Questions
Last month I was a bit peeved that my doctor wasn't more aggressive about finding out why my TSH levels were high. I began taking a supplement (Thyroid Energy) and during that time I was also having more noticeable rapid heart rate. I decided to take way less, way less often. So, now if I have a day where I'm feeling really sluggish, despondent, or low energy, I take the supplement the next AM. It seems to help. I've only taken a low dose of it about 3 times in the last month. My energy has been good and I've been feeling good overall. I think it's right that we didn't mess with anything major, and I feel it's wise to use the supplement at the lowest possible dose. 

I'm finding it really useful to have these monthly  notes so that I can go back and review where I have been. I have already looked back at the previous 4 months a few times when I want to verify my progress. I recommend keeping health summary notes for yourself if you haven't done it.