Bill Klaproth (Host): This is The Healing Podcast, brought to you by MarinHealth. I'm Bill Klaproth, and today we talk with Kelly Stroup, a Clinical Nurse Manager for the Diabetes Care Program and Wound Care Program at MarinHealth as we talk about diabetes and exercise.

Kelly, welcome.

Kelly Stroup, MSN, CNL, CDE: Thank you, Bill. It's so nice to be with you today.

Host: Yeah, so great to talk with you. So let's start with this. Can you give us a brief introduction to your role and credentials at MarinHealth?

Kelly Stroup, MSN, CNL, CDE: Sure, absolutely. I am a Clinical Nurse Manager. I've been a Registered Nurse for about 24 years, and I've been here with MarinHealth for eight years. I've been the manager of the diabetes and wound care programs for a number of years, and diabetes is my passion.

Host: Well, let me ask you. You say diabetes is your passion. Can you share your personal journey and experiences with diabetes and exercise?

Kelly Stroup, MSN, CNL, CDE: Absolutely. I have lived with Type 1 diabetes for 40 years. It's part of my life. It's not who I am, but it's part of my journey. And I will be honest, I am not an avid exerciser, so, I joined that exercise group and tried to do some interesting things in my journey with diabetes and exercise over the last maybe five to 10 years, and it's been really phenomenal. So that's why I'm here to chat with you today.

Host: Yeah. So you weren't an exerciser, if you will, but because of this, you started to exercise or you're more into exercise. Would that be right?

Kelly Stroup, MSN, CNL, CDE: Yeah, it actually, family members, my husband started pursuing marathons and so I thought, well, there's no way I can run a marathon, but maybe I'll try a half marathon. And I did.

Host: I love it. So you've completed a half marathon. And are you training for another?

Kelly Stroup, MSN, CNL, CDE: I am, I currently am navigating an injury, so my training currently is a little slow. I hope to resume some training in the next coming two to three months. But yeah, I would love to do another half marathon later this year in November of 25.

Host: I love it. And exercise is so good for people with diabetes. So can you explain that to us, why exercise is so important for individuals with diabetes?

Kelly Stroup, MSN, CNL, CDE: Absolutely. I think it's important for anybody listening to the podcast to understand exercise is important and valuable to everyone, but primarily when you're talking about Type 1 and Type 2 diabetes. Exercise can be an avenue where metabolism is improved. Insulin resistance is a language that we use in the diabetes world that talks about your body is creating insulin, but maybe in a Type 2 patient it doesn't get utilized really well and exercise improves insulin resistance and decreases it so your body is more able to use that insulin that it is already producing, which makes your diabetes journey improved. For Type 1 diabetes, same. It can improve metabolism, your insulin resistance. Also we know exercise affects one's mental health and cardiovascular health.

So it's really a whole body benefit for many reasons, not just if you're living with diabetes, but in healthcare in general.

Host: Yeah, so some really important benefits, improved metabolism. Better insulin resistance, and as you said, mental health, people that regularly exercise just feel better, may have a better outlook on life generally, but are there any risks then Kelly, associated with exercising for people with diabetes that they would need to consider?

Kelly Stroup, MSN, CNL, CDE: Oh man. That's a great question. And I think a lot of times, having diabetes, patients can feel, oh, I can't do that. That's what I started out as. I'll never be able to do that. I can't do that. And some of the risks are obviously diabetes affects your blood sugars, your glycemic control, and trending.

So high blood sugars and low blood sugars can be a risk for people who are starting out with exercise and understanding what happens when you begin an exercise program that you can run into sometimes high blood sugars when you start, as well as low blood sugars because you are using up a lot of energy when you are exercising.

Host: So I have a niece, her name is Evie. I think she's 10 now. She's Type 1 diabetic. She is amazing. She is a cheerleader. She plays hockey, she plays sports. It's amazing to see this kid play hockey. So I know about exercise and how you've gotta monitor the blood sugar and things like that. My niece and nephew are always on that.

So how can individuals with diabetes recognize exercise induced hypoglycemia, and what steps should they follow in response?

Kelly Stroup, MSN, CNL, CDE: Absolutely. You know, the exercise induced hypoglycemia, you never want a patient to have a low blood sugar. That's what hypoglycemia is. Low blood sugar. It can cause a variety of symptoms in each individual, but when it's exercise induced, really understanding, and watching a continuous glucose monitor. I would never recommend exercise for a patient without wearing a continuous glucose monitor or something we call a CGM, in the diabetes world. It's important because it'll give you real time alerts. You can watch the number as well as the arrow and actually prevent hypoglycemia before it occurs because you're able to watch it in real time. Treating a low blood sugar is obviously you gotta have snacks with you.

Primarily what I used for myself was gummy bears, because I could run with it, I could keep it, and it wouldn't melt in my pocket. If you're doing hockey like your niece, Evie, drinking juice or having juice on the sidelines or in the ice rink is really helpful. But wearing a CGM and treating it early on before you're actually running low is something that is really, really important for patients to understand as they begin a program.

Host: Yeah, that is really good advice as you talk about snacks, gummy bears for you, juice of course. So as you said, you've become, a runner and you've competed in a half marathon, training for another, although injury is slowing you down a little bit. So let's talk a little bit more about that. What are your recommendations then for meals before, during, and after long runs for any runner that might be listening to the podcast. What should they do to maintain optimal energy and blood sugar levels for people that would go on a long run?

Kelly Stroup, MSN, CNL, CDE: Yep. I started out doing very short runs Bill because I just was, I was not a runner. I didn't exercise regularly in the past, so I really had to learn doing half mile to one mile stints and I was able to track and see, okay, if I had toast with peanut butter, you know, protein with a carbohydrate, what did that do to my blood sugars in the morning? If I was running in the evening, what had I eaten all day long? Was I going to eat dinner before I went on a run? And if I was having dinner, I would need to really pay attention to what carbohydrate I was eating. If it wasn't enough of a carbohydrate, I would actually end up with a low blood sugar unexpectedly. So I really had to actually increase some quick carbohydrates. I know some exercisers do pasta, right? They load up on pasta because that's a carbohydrate that will quickly affect your blood sugar. So I would have to play around as I trained over months and months to really learn what I needed individually, but always carbohydrates and a protein to keep your blood sugars from dropping off.

Host: You know, as I'm hearing you talk and my niece Evie, and my niece and nephew, they've learned so much about food and how food affects the body. And hearing you talk about, I know if I do this, I get this and I have to combine a carbohydrate with a protein. I don't want to say benefit, but it is the only word I can think of.

Is there a benefit to knowing food so well now that you've got diabetes, that you understand food and exactly what it can do to your body, where most people have no idea?

Kelly Stroup, MSN, CNL, CDE: Absolutely. Different foods will affect each individual person differently. And really if you have diabetes and if you don't, wearing a continuous glucose monitor and eating your typical meal, your normal, what we would have for breakfast, lunch, or dinner, and go on a walk after dinner and see what happens.

Because Bill, you and I could sit down at dinner, or have brunch together and eat the exact same thing and our blood sugars would do something totally different whether you have diabetes or not. So it's really, it's important to understand and exercise is going to affect how the food that you eat affects your blood sugars, right?

If you're going to go out for a run, one of my longest training runs, I think was 12 miles. You never do the full 13.1 before your race, but one of those longest, 12, 10, 12 mile runs. I really had to, I knew I needed a half of peanut butter and jelly sandwich with regular jelly and sugar in it.

 I knew I needed that to sustain for those long runs, but I didn't before running, it would've affected my blood sugars differently. So understanding food is maybe one of the number ones with continuous glucose monitoring before you start an exercise program.

Host: Yeah, that's really interesting. So on the 13.1, the half marathon, and you said you've really have learned what you need to do. Can you share with us how do you manage your blood sugar levels throughout your endurance training or long runs? What is that process like for you?

Kelly Stroup, MSN, CNL, CDE: Yeah, you know what? We've already talked about the food before and after what I needed to eat ahead of time. But I found for myself, runners or endurance training, whether it's running or long distance biking or swimming, whatever that might look like, there are a lot of opportunities out there for various, you know, food on the go.

And so some people use something called GU packets, G-U packets. It's kinda like a gel and it's flavored. It has lots of carbohydrates, electrolytes, and some protein. What I found for me was there were GU gummies, and I knew exactly, usually they come in a pack of, I don't know, 10 gummies or something like that.

And I would have, and I knew at mile three I needed five. At mile six, I needed five more, but that took time Bill to figure out what I needed during those long runs, and that's what I ate before I used those GU gummies. And I always run with a jacket, like a vest. So I had each pocket was. I was stocked with things for low blood sugars.

I had those gummy bears with sugar in them for a low, I had the GU gummies or chew, I, maybe they called chews. And I knew how many miles I would track my miles and knew, okay, mile three, I needed these, mile six, I needed these, nine and 12. And then you finally finish the finish line. So it was time, it took time to figure those out.

Host: I bet. So this pocket at mile three, this pocket at mile six, that kind of a thing?

Kelly Stroup, MSN, CNL, CDE: Exactly. Yeah, it was kind of funny, but it worked. It worked really well, but again, it took months to figure that out, so I knew what worked for me.

Host: So what surprising thing did you learn about yourself or your body that you didn't know before you started all this training?

Kelly Stroup, MSN, CNL, CDE: I am kind of a badass. I'm kidding. You're going to have to block that out, Bill.

Host: No, I like it. We're leaving it in. We're leaving it in.

Kelly Stroup, MSN, CNL, CDE: Okay. Honestly, though, I didn't ever even imagine that I could do that. Not because I had diabetes, not because, you know, I wasn't an exerciser, but in my mind it was, man, that's for those people, or I'm not, I'm not an exerciser.

It would, that's not me. And I putting your mind to something like, okay, I'm going to just try it and see, and Bill, it was hard. There were days where I would go out for a run and, oh, shoot, my blood sugar's low. I've run out of gummies. I'm calling my husband, please come and bring me some apple juice because I didn't plan well, and, I think those mental maybe attacks can be so devastating.

And so, you know what, I'm going to try again tomorrow. And I think that understanding that dynamic of mental health, physical health, you're dealing with a chronic illness and you just want to run and see if you can do it. That's really what I found out, that those were surprising lessons for me. That, you know what? I'm going to try it again tomorrow and maybe take extra pack of gummies for low blood sugars and you just learn that, but not let it defeat me.

Host: See, you're a badass.

Kelly Stroup, MSN, CNL, CDE: I guess so, yes I am.

Host: Say Yes. Say

Kelly Stroup, MSN, CNL, CDE: Yes.

Host: Proud. It's, sounds, it's, you are a badass. It sounds like you got a confidence boost from this as well.

Kelly Stroup, MSN, CNL, CDE: Absolutely. Absolutely. I think I can do this. Other people run more, but I can run 13.1 miles and you know what, I have to add this. Bill, I didn't stop. That was in my head. I was going to start that run and I was just going to run the whole time. And so even the aid stations, you know, because marathons are set up with aid stations for water or snacks or Gatorade, and I would just wave and of course I had my own water packs. I didn't just not drink water, but I knew I didn't want to stop because I think it would be hard for me to get restarted. But in my forties, Bill, my first marathon, I think it was like 42 years old. It's not like I'm a young whipper snapper anymore, but, yeah, I can do it.

Host: I love it. Love it. Alright, so Kelly for people that say, I can't run, I just can't do it. Are there specific types of exercises you generally recommend to your patients with diabetes?

Kelly Stroup, MSN, CNL, CDE: You know what? Just take a walk. Just walk. You don't have to run a marathon. You don't even have to walk up hills and hard hikes. Just go out in the neighborhood and take a walk. And because I am dealing with an injury right now, Bill, I'm just walking and it's good for my heart. It's good for my mind, it's good for my soul and my thinking. So just start by taking a walk.

Host: I think that's great advice, Kelly. Good for the heart. Good for the mind. Good for the soul. Easy to take a walk. So what guidance do you provide to patients who are new to exercising and want to start safely while managing diabetes?

Kelly Stroup, MSN, CNL, CDE: Great question. Number one, continuous glucose monitoring. Wear a monitor. Understand what that monitor is showing you, the number and the arrow, the guidance of understanding how that trend is running in your body. And then always start slow. Again, I started with

half mile jogs and my daughter would go with me. My, my 12-year-old at the time would go with me, just to jog with me. Patients have to understand that, yes, set a goal, but you have to start somewhere slow. And I think that's setting a goal of, Hey, you know what? I did half a mile today. That was wonderful. It worked and my blood sugar was fine. I didn't have a high or a low. So that's what I recommend to anyone who wants to start. Just start small and always wear a continuous glucose monitor. I can't stress that importance enough.

Host: And that's how you learn by wearing that monitor. Right?

Kelly Stroup, MSN, CNL, CDE: Absolutely. Yeah. That's how you see what's happening. If you didn't see what was happening, you wouldn't know on the inside, and blood sugars could be running a rollercoaster and that would make you feel terrible and probably in your mind, say, I'm never going to exercise again.

Host: Right, right. Alright, well that's good advice. Wear a monitor and start slow. So for people that do that, and we know that we've heard the stories countless times over and over. People are, have great intentions and they start exercising and they want to stick with it, and then they get into it and life happens and things happen, and the exercise falls by the wayside. Before you know it, they're not exercising. Any tips for making exercise a sustainable part of diabetes management?

Kelly Stroup, MSN, CNL, CDE: Yeah. You know, go with a friend. I took my daughter with me, or my husband would run with me. If you have a friend, someone that you can take a walk with, because I think that that mental capacity of the joy that you have with being with another human being and having a relationship and conversation.

Start there. Having someone go with you and maybe, they won't run a marathon with you. I don't want to run a race with a friend, but man, going with a walk, with a, going on a walk with a friend or exercising with someone is mentally will sustain you, I think more than trying to tackle something alone.

Host: Mm-hmm. Great advice. Bring a friend. Kelly, this has been awesome. Before we wrap up, one last question. Anything we missed? Anything you want to say to anyone listening right now who has diabetes and listening to this and is like, oh man, I'm going to have to exercise. Any final thoughts?

Kelly Stroup, MSN, CNL, CDE: I think with the fun of recording a podcast about exercise and the laughs that we've had Bill like, patient, whoever you are that's listening, you could be a badass too in your own way and exercise. And friends and I think that mental break is, you know, don't allow that I can't do this because. Say I can and I will do X. And I think speaking it with friends, knowing it, deep inside, you'll be successful in your own way.

Host: For sure, and you had those doubts too. You said you weren't a big exerciser. And look at you now. Kelly, thank you so much for your time. This has really been awesome.

Kelly Stroup, MSN, CNL, CDE: You're welcome, Bill, and thank you for having me on today. I appreciate it.

Host: Once again, that is Kelly Stroup. To learn more, visit mymarinhealth.org/bdc. And if you found this podcast helpful, and I'm sure you did, please share it on your social channels and check out the full podcast library for topics of interest to you. This is The Healing Podcast, brought to you by MarinHealth. Thanks for listening.