Ginger Vieira – Exercise with Type 1 Diabetes

[00:00:00] Scott K. Johnson: I’d like to introduce Ginger Vieira. She is one of my heroes and has helped me so much over the years. I just have so much gratitude and appreciation for her. Ginger has lived with type 1 diabetes and celiac disease since 1999 and fibromyalgia since 2014.

She’s the author of several books available on Amazon (affiliate links), including Pregnancy with Diabetes, Dealing with Diabetes Burnout, Emotional Eating with Diabetes, two more books for kids, When I Go Low, and Ain’t Going to Hide my T1D, and today we’re going to be talking about her newest book, Exercise with Type 1 Diabetes.

Ginger, welcome, and thank you so much for joining me today.

[00:00:46] Ginger Vieira: Hi Scott. Thank you for the intro,

[00:00:48] Scott K. Johnson: so this book is great. And I, I think people can tell by when I hold it up, but it is super concise, very digestible, very quick. But this is one of your skills. Ginger, you have this gift of being able to take a complicated topic, which is complicated for many reasons, right?

Exercise by itself is complicated. Diabetes by itself is complicated, but exercising with diabetes. It can be so challenging. Talk a little bit about why that is. It is a mess. You’re right.

[00:01:24] Ginger Vieira: It’s so crazy, right? Because we’re taking, we take constant injections of this hormone that drives blood sugar down, and we need it. Otherwise, we die, but a teensy bit too much, then you also die. And then, if you add a dog walk to it, it drives blood sugar down way too much. But if you’re lifting really heavy weights in a CrossFit workout, your blood sugar goes up, and that’s just a glimpse at the physiology of exercise that affects blood sugar.

And so because we don’t manage our own insulin production, like because it’s not automatic the way it’s supposed to be, we’re adding this huge, it’s like adding gasoline to a fire when you exercise, and you have insulin on board. And it’s really complicated and really scary. I can’t tell you how often I hear people just saying like, how are you doing this in response to an Instagram reel where I’m exercising?

How are you doing this? I’m so scared to even go on a walk with my kids. I don’t want people to feel that way because there are things you can learn so that you don’t feel so scared and that you have more ability to predict what’s going to happen and prevent and control what’s going to happen, right?

[00:02:38] Scott K. Johnson: I remember one of my endocrinologists many years back he said that exercise creates so many variables and challenges in diabetes management that it’s just really complicated and challenging. But there are the benefits of exercise for diabetes, but also just for overall health, they’re so great that they outweigh all of those challenges.

Although I’ve certainly gone through times where I’m just like, I can’t figure it out. I’m just going to stop and pull back from it. It’s a challenge. Big time.

[00:03:16] Ginger Vieira: And do you feel, so do you mean you like you pull back in general from the daily habit or you’re pulling back that day? Do you have gaps of time where you’re

[00:03:24] Scott K. Johnson: I think that I go through periods where I just would get overwhelmed by the complexity of exercise and just decide not to exercise. And then that can develop into this long-term rut of not moving enough, right? But then,

[00:03:40] Ginger Vieira: I think that’s really common.

[00:03:41] Scott K. Johnson: yeah, I think so too.

[00:03:42] Ginger Vieira: I hear that from people. Yeah. And, you said a big word, which is variables, there’s insulin, but there’s different types of insulin. There’s basal insulin, there’s insulin you took for a meal, insulin you took to correct a high, there’s the timing of when you work out, what you ate before, what you ate two hours before, insulin you took four hours before versus one hour before.

Like disconnecting from your pump or keeping it on and setting an extremely restricted basal rate, or maybe that’s not going to work because you’re doing strength training, and your blood sugar is going to spike, and you actually need more insulin during your workout. Like it is a mess. And when you explain even eight seconds of that to a non-diabetic, they’re like, what?

A non-diabetic woman once said to me like, you don’t know what it’s like to have to try to do this in your 60s or something. And I was like, believe me, I know the challenges of exercising at any age.

[00:04:39] Scott K. Johnson: Yes. so with that in mind, you’ve got all of this complicated material. How on earth did you approach breaking this down for your book? what was your game plan for putting the topics together, and how?

[00:04:56] Ginger Vieira: I love taking a pile of information, like a big old mess, and breaking it down so that I know my friends will be able to learn it in a way that isn’t stressful. And it starts with before you even head out the door for your dog walk, it starts with understanding these teeny details about insulin management that are so important.

So I like to always ensure I’m starting at like ground zero without going too far back, right? We can’t start at everything diabetes because then too many people wouldn’t get what they really need halfway through. But I write articles about this all the time, and I can’t fit it all in one article, and I can’t fit it all in an Instagram reel, right?

And people tell me what they’re frustrated with all the time. So I know what the challenges are. I live with it. I know what the challenges are there, too, right? And. So I’ve known for a while that I need to put this into one book, so I let the book idea simmer until I’m ready to pump it out, and I wrote most of this in about a week and a half.

[00:06:06] Scott K. Johnson: Wow.

[00:06:07] Ginger Vieira: And I wasn’t working at the time, I was between jobs, and so I was like, all right, every day I’m going to try to write a whole chapter, and I think about what’s in here all the time and I’ve written about it so much and I’ve explained it so much verbally and, presentations at events that it was all already in my head.

I didn’t have to do much research. I just needed to pump it out.

[00:06:29] Scott K. Johnson: Yeah. But you also managed to pump it out in a way that is very concise and digestible, and the path through the book feels very natural and just makes sense. This book is less than a hundred. it’s about what?

[00:06:47] Ginger Vieira: eighty pages. Yeah.

the reason I do that is because I actually am very impatient, and so I don’t want to read a 200-page book. And I know you don’t want to read a 200-page book. I want to give people exactly what they know without all the dramatic fluff that if I went to a publisher, they wouldn’t publish this.

It’s too short. They’d want some huge thing on the history of exercise and all this other stuff people don’t need. They need the nuts and bolts. And that’s what I want to give you: no nonsense.

[00:07:21] Scott K. Johnson: That’s what you’ve done. This is something you can sit down and read in a pleasurable afternoon, like not even an afternoon.

[00:07:30] Ginger Vieira: You might be really tired. I’d recommend a few afternoons, but not too many. It’s a lot of science.

[00:07:38] Scott K. Johnson: But not too much, right? It’s a really great balance of the science that you need, but not too much. and that, I think that’s one of the gifts that you bring to the diabetes space, and I would imagine any space you decide to teach in, but that balance of complicated information and the science behind it, but presented in a way that’s very digestible.

Bravo to you on that, for sure. It’s, you mentioned in your, in the back of the book, wrestling with fibromyalgia, too. And I remember when you went through that, and you had to change how you exercised a lot around that. Can you tell us a little more about that?

[00:08:25] Ginger Vieira: Everything. Yeah. Basically, while I was in the midst of setting records and powerlifting, I started getting pretty irrational pain in gradually every joint, and a doctor would say, you lift heavy weights. That’s what’s wrong with you. But it didn’t make sense. And I hadn’t been lifting weights for decades, right?

This is only a few years. It shouldn’t have been happening like that. And it was getting to the point where I actually stopped all weightlifting because I was in so much pain. And even after stopping, I could not lift the pot off the stove because the muscles in my hand were spasming so intensely.

I couldn’t turn my head more than this because my neck muscles were spasming. So intensely. So it was having like full-body muscle spasms. I finally, after firing a few doctors, got a diagnosis of fibromyalgia. I took muscle relaxants at a low dose for quite a while, and I stopped all intense exercise.

I really just walked my dog for, I’m not sure now exactly how, it was one year or two years, three dogs by the way, I was walking a lot of dogs. But, I just decided I’m going to let whatever’s going on calm down, and it did help. But then, I had to gradually rebuild my tolerance for exercise. So even if I can endure the physical part of it

without too much pain. I would be exhausted if I did anything that produced any type of fun exertion of exercise, even at a normal level. Like right now my body is very, so now we’re ten years later, right? I do not lift heavy weights because I know lactic acid, for some reason, is like a poison that gives me extreme exhaustion, and I can’t get it to go away.

I have been able to rebuild my tolerance for some weightlifting by lifting five-pound dumbbells for a year and then up to eight pounds. I have really been patient. So, I should give myself more credit when I say I’m not a very patient person. I make up for it by being extremely persistent, right?

And right now, for some reason, I still can’t figure out why I can’t tolerate even the lightest weightlifting workouts. So, every other night, I’m doing just three sets of one weightlifting exercise, and I’m doing it at night because then I am going to bed later. So, the exhaustion hits while I’m already asleep.

If I do it in the morning, I’m exhausted at two p.m. So it’s figuring out problem-solving, right? Which is what I love to do, and eventually, I’ll put it in a book, but I don’t think fibromyalgia is a messier. Not everyone’s experience is the same. So it’s hard to write resources for people on that.

[00:11:06] Scott K. Johnson: Yeah. I imagine that it was also, aside from figuring out all the how-to adapt your exercise and all that, as you mentioned, you were in a phase of like really intense exercise and then to have to stop, talk about the mental aspect of that a little bit.

[00:11:26] Ginger Vieira: I mean, what I really learned from that was how attached my ego was to succeeding or I’m accomplishing something every day in the gym, and it was actually like so freeing to not care anymore, like eventually, right? I went through a phase of really missing it, and eventually, I was like, Oh, I don’t need that to be awesome today.

And I still have friends from the lifting world, and I listened to them talk about their PRs, and they’re so obsessed. I’m like, you don’t need that. I don’t say that because that’s their world, but it’s interesting. And so today, instead, I get my kind of enthusiasm for exercise from being really gentle to myself.

So I can run three miles a day on a treadmill, but if I were to take that and go outside, then running outside is so much more work for your body, right? Cause you’re pushing yourself forward, then I’ll be exhausted. So I always have to, anytime I change what I’m doing, I got to start small and introduce my body to it and gradually increase the duration or the intensity.

So it’s this level of patience, but also this new mindset of not pushing myself. I’m finding a level that’s comfortable and kind to my body. It’s a whole different type of challenge in the gym.

[00:12:44] Scott K. Johnson: And I would say that demonstrates an immense amount of patience. Ginger, you

[00:12:51] Ginger Vieira: Yes.

[00:12:52] Scott K. Johnson: being a record-setting athlete who, at that time, was probably very intense.

[00:13:02] Ginger Vieira: push, push. Yeah. Yeah. And I am. I cannot push past even to a level of intensity, or I’ll pay for it later. And I do not like that exhaustion. I don’t have time to be tired. And right. So I can maintain a high level of energy throughout the day if I’m really kind to myself in the gym, which is just such a funny life lesson.

[00:13:27] Scott K. Johnson: Yeah, you’re right, it is.

But I think there are lessons in learning to be kind to yourself in the gym that also apply to diabetes. I think we often beat ourselves up over our diabetes way too often without recognizing the difficulty in the job we’ve been given and how well we actually do that most days.

[00:13:49] Ginger Vieira: it is crazy if I think most of us don’t stop and really look at what we’re juggling all day. And if you were to stop and look at that a little more, you wouldn’t beat yourself up for the blood sugar excursions that go beyond that little green range on your CGMs. Of course, it’s going beyond that.

I also really love talking lately about – I include this in the book, too – that we always talk about the fact that we don’t produce insulin properly, but there are actually five other hormones that we don’t produce properly.

[00:14:22] Scott K. Johnson: Yeah.

[00:14:23] Ginger Vieira: they’re not life-threatening, and we still produce enough, right? So that nobody is alarmed and terrified about it.

You’re not in the ER because of it. But they manage all these things, including how much sugar your liver makes, how hungry you feel, all these things that help you manage your appetite, your weight, your insulin sensitivity, your blood sugar, and we’re not given the tools for that. And things like, that are making the news, things like Ozempic and, Mounjaro and, Trulicity and even metformin, they address those other things, but it’s still pushing the boundary for type 1 to be taking any of them.

[00:15:05] Scott K. Johnson: Yeah. It’s, it’s really interesting because, many years ago, I started using some of those additional tools. Even way back when Symlin was around, right? So,

[00:15:20] Ginger Vieira: I remember when you were on Symlin. Yeah.

[00:15:23] Scott K. Johnson: and it was very.

[00:15:23] Ginger Vieira: was new.

[00:15:24] Scott K. Johnson: It was new, but the thing I remember most about it is that I could clearly feel that, wow, this is something that I’ve been missing, right?

Like it, it just affected the way I felt in so many different ways and, that, and I’ve extended that as those families of additional medications have evolved, I’ve continued to hit my diabetes from every side I can. And I think it helps.

[00:15:55] Ginger Vieira: I take a tiny dose of Ozempic, and I take metformin as well, and Both are just so helpful for just trying to be a human being, frankly.

[00:16:06] Scott K. Johnson: Yeah. Yeah. And it’s interesting because, as you say, I think if I were to, if I were to miss a dose of any of those tools, I’m not gonna, I’m not going to land in the hospital, but I definitely see a difference in my blood sugars. I also feel a difference in the everyday kind of people without diabetes, how they feel versus how I might feel without some of those tools. So I think it’s really….

[00:16:34] Ginger Vieira: Yeah, I’d notice it for sure in a day, even just if I missed my metformin dose, and metformin is dismissed as this really old drug, but

[00:16:42] Scott K. Johnson: Mm hmm.

[00:16:43] Ginger Vieira: I find it so helpful.

[00:16:45] Scott K. Johnson: Yeah, I agree. And the good thing about that is it’s an old drug, which means it’s very safe. And it’s also very cheap. So there, there are some good things.

Ginger, if you were to talk to somebody who comes and says, Hey, gosh, I’m just so overwhelmed by exercise. I don’t know where to start. I’ve lived with diabetes for a while. I’m doing pretty good there. But anytime I mix in some exercise, it turns into this hot mess. Yeah.

[00:17:18] Ginger Vieira: The first thing I would talk to anybody about is their basal insulin, and it is the last thing most people think about because most of us have been put on a basal dose by our health care team, and it hasn’t changed in years, and depending on how much insulin you’re on so if someone’s on 35 units of long-acting insulin a day or 35 units of basal insulin a day, a change of one unit isn’t going to, they’re not going to notice that, right?

For me, I’m on about ten units of long-acting a day. So, a change of one unit is noticeable to me. So it’s that percentage, right? It’s about 10%. Most people are on too much basal insulin. If they, I was recently in this chat group of women with type one, and they’re talking about how just vacuuming the house makes their blood sugar crash like crazy.

[00:18:10] Scott K. Johnson: Yeah.

[00:18:11] Ginger Vieira: And nothing they did seem to be able to prevent it.

You’re on too much basal insulin. And so the goal, really, needs to be combined with being consistent about exercise. Suppose you’re only going to work out once a week. Then this is gonna be a mess, right? So, definitely exercise every day. But here’s another reason why. Suppose you can get your long-acting basal rates down to the amount that keeps you close to your target range. In that case, you’re adding mealtime insulin on top of that, so you don’t really want your basal insulin to keep you at a hundred because as soon as you add all the mealtime insulin on top of it or a walk, you’ll just crash like crazy.

Yeah. So I would start by looking at your basal insulin and I would guess that you’re on way too much.

[00:19:04] Scott K. Johnson: Talk a little bit about insulin on board and how you can leverage exercising in a fasted state to help with some of that.

[00:19:16] Ginger Vieira: How do you know? Of course, Scott and I have talked a lot about fasted exercise over the years. So, fasted exercise can be combined with intermittent fasting or not intermittent fasting. It’s just about the timing of exercising before you eat instead of that age-old advice. That really made sense 15 years ago, and it doesn’t make sense today to exercise after you eat.

And the reason you wanna do this is because if you exercise before you eat, you didn’t just take a big bolus of insulin for the carbs and the protein and the fat in your meal. And so you don’t have all that insulin on board to tank you if you try to exercise within the four to five-hour window after eating.

So for example, I like to exercise at the, moment, I exercise first thing in the morning. I walk about 45 minutes with my dog and my husband and then get my kids to school. Then I go to the gym or run outside. I live in Vermont. It all depends on the time of year. And then I get my cardio, and I do all of that without having eaten.

I also save my coffee for afterward, but that’s mostly because it would make me have to pee every 20 minutes. But that’s a different problem. But without having all that mealtime insulin on board. I don’t have to worry about crashing. Instead, I have to keep an eye on my blood sugar rising because I didn’t eat.

My liver will eventually give me some glucose because I didn’t eat. And that’s just the body doing what it does, whether you have diabetes or not. So I do around eight a.m. keep an eye on that rising level, and I don’t, I always wait to see it starting to rise because some days it just

[00:21:05] Scott K. Johnson: Yeah.

[00:21:06] Ginger Vieira: especially if like maybe the day before I got a lot of exercise and I didn’t eat and as much as I might, like whatever might have made me extra sensitive.

So then I take a half unit of Novolog to cover that glucose from my liver, and then I continue with my exercise. So I have my long-acting dose boiled down as much as I can, too, if I know that if I start going low during fasted exercise, I have too much Lantus on board. But all right, let’s say you don’t like exercising first thing in the morning. When my children were really young, my exercise window, I walked my dogs obviously earlier, but my intense exercise window was seven p.m. after they went to bed, so I would make sure not to eat after 4 p.m. –  that’d be my last snack. I’d exercise. I was jumping rope a lot back then, so I would jump rope for 30 to 40 minutes in the garage, and then I’d eat dinner after that. Those are just two examples. You gotta, everybody’s life is different, you gotta figure out that, but. It’s really valuable to me to micromanage the scheduling of that to be able to exercise as much as I want and enjoy it and not have to eat lots of jelly beans to get through it, which is not fun and ruins everything about it.

[00:22:25] Scott K. Johnson: Yeah. Not, jelly beans are pretty delicious, you want to have them when you want to have them.

[00:22:29] Ginger Vieira: Not when you’re dying? Yeah, I’d rather eat them, yeah, after dinner.

[00:22:34] Scott K. Johnson: I’ve leveraged, exercising in a fasted state as well. And for me, it just reduces that problem of dropping too low because of insulin on board. There’s the insulin we take; it’s hanging around for a long time. And even having just a little bit, when you exercise it, it can, it feels to me like it really supercharges that insulin. And, if I have eaten and eaten with insulin prior, it just, makes too many variables,

[00:23:14] Ginger Vieira: Yeah, it also actually, you’re, so what are you using for fuel if you’re not burning up all the glucose? You’re burning more body fat for fuel. So it also can help accelerate weight loss, too. I also use inhaled insulin, which has a much shorter action time. It sticks around in your body significantly less.

So the smaller dose is out of my system after about an hour, and the larger dose is like the bigger window of it, which is two hours. So I stop worrying about it after two hours. So that gives me even more flexibility on top of fasting because I know I can eat lunch at 12 o’clock and walk my dog at one. Depending on what I had for lunch if it was really low carb, and I only took a small dose of Affreza, I just let the walk burn off anything else that might be digesting from that salad.

[00:24:04] Scott K. Johnson: Yeah. That’s a great tool. When I think about exercise, I often fall into the mistake of picturing like, Oh, you know, I’ve got to drive to the gym. I need to change clothes. I need to have this intense workout. Can you talk about the value of some of that everyday activity?

You mentioned vacuuming, vacuuming the house, or things like that. But there are

[00:24:29] Ginger Vieira: Dancing in the kitchen.

[00:24:30] Scott K. Johnson: Yeah,

there are many things we can do in our normal day that, for, and for a lot of people, just walking to their mailbox and back might be a workout, right?

[00:24:40] Ginger Vieira: Yeah.

I mean, if you’re really starting from ground zero in terms of daily exercise, choose three or four of your favorite Taylor Swift songs, put them on a playlist, and dance in the kitchen with your kids, especially if you’re just cramped for time, and you haven’t figured out how to make exercise fit in the chaos of your schedule. Just do it right there in the living room. It doesn’t have to be crazy, and we also underestimate the value of walking.

I walk my dog twice a day for 30 to 40 minutes. And even I still underestimate the value of walking. When I get back from those dog walks, sometimes, like I’m out of breath, and I’ll say to my husband, Oh, that was a workout. And it was just the walk we do every day. And I just can’t imagine, man, what if I didn’t do those walks every day?

Like my insulin needs will go up. The amount of calories I burn in a day would go down. I just have that much heart. My energy would go down. You know what I mean? It’s just a mental boost. So even if you can just carve out 20 minutes for a walk, try that. Start small. It does not have to be CrossFit,

[00:25:49] Scott K. Johnson: Yeah. I love

[00:25:50] Ginger Vieira: In some cases, perhaps it shouldn’t be.

[00:25:52] Scott K. Johnson: Yeah, that’s it. That’s funny. I love the approach of just being kind to yourself, being gentle to yourself, and starting small – you don’t need to jump two feet into the deep end with exercise.

[00:26:10] Ginger Vieira: you never have to build your way up to a CrossFit workout. It’s not necessary, and a lot of those people end up injured anyway, and so they’re in physical therapy, and they’re not exercising right now. Just be kind to yourself and go for that walk.

[00:26:25] Scott K. Johnson: Yeah, I love that. So, you also shared that you just launched a new YouTube channel. Tell us a little bit about that. That’s very exciting!

[00:26:36] Ginger Vieira: My new YouTube channel is called Diabetes Nerd. If you go to YouTube.com/@DiabetesNerd, you’ll find me. I am just gonna try to explain as much as I can about every type of diabetes every week. And you’ll find five videos there so far. I don’t know when Scott publishes this. Maybe there’ll be ten by the time this is published, which would be awesome, right?

And I really want to continue explaining diabetes in a resource everybody can access. And keeping it light, fun, and supportive with 100 percent compassion for how hard any type of diabetes is. And it doesn’t have to come from some stiff old doctor in a white coat.

[00:27:20] Scott K. Johnson: Yeah, I love that. I think it’s, as I mentioned earlier, you have a gift for teaching complicated things in a very easy-to-understand and digestible way. So, please keep writing your books and keep making videos. I love that you created your YouTube channel. I think that’s really great.

Is there anything that I haven’t asked about that you wanted to be sure to bring up today?

[00:27:48] Ginger Vieira: Give yourself a pat on the back for making it through another day. You’re doing awesome. I don’t care what your A1C is. You’re killing it.

[00:27:56] Scott K. Johnson: I love that. Yeah. Well done. Well done. I will link your website where you can find all of Ginger’s books. She has a lot of them, and they’re all great. So buy them all. Read them all. Although I probably, I’ll skip the pregnancy one, that one, there’s certain things that just, although, hey, if

[00:28:18] Ginger Vieira: You’re so close-minded, Scott.

[00:28:20] Scott K. Johnson: I know, but it’s good to, it’s good to learn about, and then I’ll also link your YouTube channel, go subscribe, and, check out the great videos, it’s just, great, and Ginger, congratulations on the success, and thank you so much for sharing yourself with us and helping us live diabetes in a better way.

[00:28:43] Ginger Vieira: Thank you, Scott. I look forward to getting your blog emails when they come out because that is genuine real-life diabetes, so thank you for being so genuine.

[00:28:51] Scott K. Johnson: My pleasure. My pleasure. All right. Thank you, everyone, for watching, and we’ll be back again soon with another wonderful guest.