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Laura Greenfield has lived with type 1 diabetes for over 18 years. When told by health professionals that exercise would help her control BGs she tried it. Unfortunately, Laura discovered that exercise is a tricky balancing act and not simply a matter of physical exertion. At first, she found it made it even more difficult to maintain stable BG levels.
I caught up with Laura after a work out at her favorite spot - Club One in San Francisco. We started at the beginning.
When did you first learn you had diabetes?
When I was thirty. I had the classic symptoms for several months, but my doctors missed it. I began losing weight in spite of eating more than usual and was drinking and urinating quite a bit. I also complained to my internist of extreme fatigue after meals. He didn't think to test my BGs.
When were you actually diagnosed?
That summer I went to Washington, DC, on a business trip and collapsed in the street. A kindly woman picked me up and asked if I could make it to the emergency room a block away. The doctors tested my blood immediately - it was over 500 mg/dl! I was on my way to a coma.
A hospital nurse explained that I had diabetes and would have to learn how to give myself insulin injections. She demonstrated with an orange how to give a shot. I quickly learned that sticking a needle in an orange and sticking a needle into my body are two radically different experiences.
How did you learn to live with diabetes?
At first I didn't. I was in shock. When I returned from Washington, DC, my doctor tried to explain the disease to me. He used terminology I had never heard before and talked about a frightening array of possible complications including neuropathy, nephropathy and retinopathy. It was information overload. I couldn't understand it all and I confused words like hypoglycemia and hyperglycemia. So much of it sounded the same. It was impossible.
In an effort to cheer me up, my father told me his friend had diabetes and that it was "no big deal." No big deal? I couldn't believe it. My body was bent on a course of self-destruction and he thought it was no big deal?
It was a mad roller coaster ride between high blood sugar and low blood sugar. During hypoglycemic episodes, I'd eat the whole damn refrigerator, just open the door and start throwing food into my body. After three years I was an emotional wreck. I could not have gone on much longer feeling so out of control.
What helped you turn around?
Actually, I got lucky. I read in The San Francisco Chronicle about the University of San Francisco's Diabetes Teaching Center. They promised to teach me everything I needed to know to live successfully with the disease during a weekend intensive. Peggy Huang, the teaching nurse there, saved my life. Assisted by a team of specialists, she explained the biochemistry of diabetes and how to live practically with the condition.
It was during this training that I learned how important exercise is for controlling blood sugar. I had tried exercise before on my own but did not have much success with it because I didn't understand how to balance exercise, calories and insulin.
After my teaching center experience, I was inspired to join a gym and began a cardiovascular program. Aerobics class was scary because I didn't know how many carbohydrates to eat to get through the workout. People who do not have diabetes don't have to concern themselves with metabolic complications during physical activities. I, on the other hand, had to routinely leave during the aerobics class to measure my BGs and prevent hypoglycemia. Often during the workout I'd munch glucose tablets while I was hopping around.
During this time I developed a fitness philosophy, something of a mantra. I came to believe that if I had a strong body I could ward off the effects of this disease.
Was exercise your primary tool for controlling blood glucose?
Ultimately, exercise became the focal point of my day. No matter what I was doing at work. I exercised during the day or at the end of the day. I had a sedentary job. It got in the way of managing my diabetes, and I had to make up for it with exercise.
I exercised on a daily basis so I would not have to continually adjust my insulin dose or calorie load. Exercise has a 48-hour effect. If I go more than two days without exercise, my blood sugar goes up.
If I'm running high BGs because of stress, menstruation or overeating, I can use exercise to lower my blood sugar instead of taking additional insulin. Exercise does not cause the erratic shifts in blood sugar that insulin can.
Clinically, exercise improves HbA1c levels and is beneficial for blood lipids as well. Also, it burns calories so it's easier to maintain healthy body weight.
The psychological benefits of feeling strong and fit, and being able to train one's body in spite of living with a chronic disease, are invaluable. Exercise gives me a sense of well being. It liberates me. I can do what I want without feeling restricted by diabetes.
How did you choose your career?
I enjoyed my time in the gym more than my time at work so, naturally, I gravitated in that direction. I realized that if I could spend the day at the gym I could be more proactive in the control of my disease. In pursuit of that goal, I enrolled in an anatomy and physiology class. For a liberal arts major, the sciences can be a real struggle. But I survived and kept going, learning still more about exercise and physiology at UC Berkeley.
Despite discovering this new found love, I resisted leaving my established career in marketing to pursue my dream of becoming a personal fitness trainer. I had been raised to climb the corporate ladder and could not rationally justify abandoning the financial district, although my heart was pulling me in a new direction.
I wish I could tell you that I was courageous and took a leap of faith. Actually, fate gave me a kick in the pants. Just as I completed my studies at Berkeley, my company downsized. The decision was forced on me to find another job in marketing or follow where my life seemed to be leading. My friends rallied around and assured me that I could make it as a personal trainer. However, I wasn't so sure.
I decided to test the waters by seeking employment at Club One in San Francisco, the gym where I had been a member for two years. Coincidentally, they were starting an internship program for personal trainers. I was accepted. Through the internship program I received practical experience to compliment my studies. Also, during this time I completed the national certification exam for personal trainers from the American Council on Exercise.
Now, in addition to being a trainer, I am the fitness manager at Club One Health Club in downtown San Francisco. I also travel to the other four locations in the bay area to train people with diabetes.
Does working at a physically demanding job reduce your need for insulin?
Yes. Since I began my new life as a personal trainer, I have taken far less insulin. In the past, I required about 30 units a day. I now use around 20 spread over four shots a day. This clearly is a result of being more active as activity lowers BGs and increases insulin sensitivity. Of course, I am prone to episodes of hypoglycemia, so I measure my BGs frequently.
You seem so lively and happy. What's your secret?
I cannot emphasize enough how important a sense of control and a sense of purpose is to reducing stress. Regardless of a person's spiritual or philosophical beliefs, our lives are extraordinary. The fact that we exist is nothing less than a miracle. It's a gift that won't last forever. Too many of us go through life with blinders on, unaware of how truly magnificent we are. Only when I asked myself what task was worthy of my life did I begin to discover my purpose.
Have your feelings about diabetes changed?
Without discounting the serious negative aspects of diabetes, I have had positive changes in my life due to diabetes. I am stronger, both mentally and physically, for having wrestled with diabetes. It has given my life context and meaning that it lacked before.
I now have purpose. I teach diabetics how exercise can improve their lives. The satisfaction I feel as a client grows stronger and more independent is beyond words.
When a client shares his or her story with me, I am touched and thrilled that I can help. Often clients come to me soon after they first learn they are diabetic. I still remember how scary that time can be. They need assurance that they can still have a rewarding life. Many of my clients have told me they feel relieved and taken care of. It gladdens my heart to know this.
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.