CEimpact Podcast

Fitness to Control Blood Sugar

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The power of physical fitness in managing diabetes is transforming patient care. Join us this week as we discuss how pharmacists can significantly enhance patient outcomes by integrating exercise education into their practice, alongside traditional medication management.
 
The GameChanger
Incorporating brief but impactful conversations about the importance of physical fitness into patient consultations can significantly enhance diabetes management.
 
Guests
Mark Smith, Jr., PharmD, CDCES, AFAA-CGFI
Pharmacist
UAB Medicine

Ian Haywood, PharmD, BCPS, CDCES
Clinical Pharmacist
Baptist Memorial Hospital


 
Reference Materials
The Role of Exercise in Diabetes
Physical Activity and Diabetes Position from the ADA

Supplemental Continuing Education Courses
Glucose Whisperers: The Role of CGMs in Pharmacy Practice - 1hr
Guardians of the Glucose Galaxy: The Rise of CGMs - 1hr
Pharmacy and Continuous Glucose Monitoring: The Sweetest Pairing - 6.5hrs

Additional GameChangers Episodes
Continuous Glucose Monitors

Pharmacist Members, REDEEM YOUR CPE HERE!
 
Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)


CPE Information
 
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Discuss the impact of physical fitness on diabetes management.
2. Identify strategies for educating patients on exercise and diabetes.

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-224-H01-P
Initial release date: 08/05/2024
Expiration date: 08/05/2025
Additional CPE details can be found here.

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Speaker 1:

Hey friends, this is Jen Moulton, president and founder of CE Impact. I just wanted to pop on and say that today's podcast was so fun to record. I think you're going to love it. Our guests today were experts on our CGM course and they were so great to work with and gave such a fresh spin on how we talk with patients who have diabetes that we invited them to the podcast. And here's a piece of advice Be sure you listen all the way to the end, because there's some golden pearls that I don't want you to miss.

Speaker 1:

If you haven't seen our CGM course, there's a link to it in the show notes. The number of industry experts we partnered with on this course was unprecedented and, with the new over-the-counter CGM being released soon, I highly recommend you take it. If you care for patients with diabetes, it's a must-take, and if you're interested in learning about all the CGM rage in the health and wellness space, it's also a must take. So be sure to check it out. Thanks for listening. Each week, we love bringing this information to you, so let's get ready to learn.

Speaker 1:

Hey, ce plan members from CE Impact, this is Game Changers. Thanks for joining us today when we think about our patients with diabetes and what they can do to impact their blood glucose. We immediately go to diet and medications, but we overlook another powerful tool that we all have in our arsenal to regulate insulin, and that tool is physical fitness, and that's what we're talking about today. You, as a pharmacist, can have a big impact on this by talking to your patients about why this is important, and I don't think we often, as pharmacists, think about having that conversation, so I'm really excited to dig into that today. I also think you might learn a thing or two about the impact of fitness on your own general health, so that will be an added bonus. So let's get into it. Today. I am so excited to have with me two experts, mark Smith and Ian Haywood. And let's start with you, mark. Can you tell us just a little bit about your background and how it relates to this topic?

Speaker 2:

Absolutely so. I'm a pharmacist by trade. I've been practicing for over 12 years now practice in inpatient hospital setting, so we do see diabetes patients, obviously, and so in addition to that being a pharmacist as my background, I also am a certified group fitness instructor, and so I've been doing that for over three years, and so we come in and we see members that come into our club that are sort of on a journey to become more physically fit, and so my responsibility as an instructor is to make sure that they achieve those goals, and so I think that that's been the most rewarding part is to see those individuals make those positive changes.

Speaker 1:

Yeah, that's awesome, Ian. How about you? Can you tell us a little bit about your background as we get into this?

Speaker 3:

Yeah, absolutely. My name is Ian Haywood. I'm originally from Toronto, ontario, canada. I studied at Auburn University, so to all my Auburn family, war Eagle, and that's actually where I became a pharmacist there. Since then I live in Memphis, tennessee. I work at Baptist Memorial Hospital specializing in diabetes education. I work at Baptist Memorial Hospital specializing in diabetes education. I love it here. I love my team colleagues here at Baptist Pharmacy. A big thank you to my boss, dennis, for supporting me in my diabetes education journey. A little bit about me, and Mark too, is we actually met in pharmacy school and one of the things that kind of brought us together was working out all the time. I think that was kind of the way to kind of escape all the studying was just kind of, hey, we've got like you know, an hour here, let's go, let's go for a big jog, and that's kind of we, our friendship, kind of grew. And after pharmacy school we kind of split and so. But we're still connecting while we've been away. So it's been really good, really good.

Speaker 1:

Yeah, I love that and it's come full circle.

Speaker 4:

You started out working out together and you're talking about working out, so it's perfect.

Speaker 1:

You know it's so interesting. Whenever, you know, I talk to students in pharmacy school, it's like how do you cope with you know all the stress and all that it's always related to working out. So I think I, you know, that's where I develop friendships, to going on runs going to the gym.

Speaker 1:

Yeah, that's super fun. I think a lot of us can relate to that. So can you talk to me about why is this education important right now? Like I know, you know, we're hearing so much about diabetes and CGMs, which we'll talk about a little bit as well. That relates to that, but why is this particular education so critical to know right now?

Speaker 2:

I think one of the things to know is there's been a recent surge, obviously, and since we are pharmacists, there's been a recent surge in the use of weight loss medications.

Speaker 2:

There's been a recent surge in the use of weight loss medications, and so I feel like that sort of wave is so strong that patients and sometimes even healthcare providers you know, whatever it may be, the GOPs you know the host of GOPs that we have that that's the all in be all answer.

Speaker 2:

And while they do serve a purpose, getting back to the basis and really honing in on the on the basis of lifestyle modification and, specifically, physical fitness, it becomes even, in my opinion, even more important to provide that level of education, because if a patient starts to see results solely from a weight loss medication, then more than likely they'll be less inclined to possibly want to explore physical fitness, because it's like, hey, this weight loss medication is working, there's no need for me to exercise, or there's no need for me to like, want to eat, right, you know, sometimes that motivation comes in, but when something is working, there's a tendency to not want to engage in that physical activity.

Speaker 2:

So I think that's where it's important for us, as pharmacists, to provide that level of education, even if it's just one or two sentences. You know, when you dispense a GLP-1 to say, hey, while this medication is going to provide weight loss, it's also super important that you incorporate regular physical fitness into your regimen. So I think that there's a unique pocket for that role, especially with the rise of the use of weight loss medications, especially in today's age.

Speaker 1:

Yeah, I think that's a really good point. Oh yeah, go ahead, ian.

Speaker 3:

Yeah, just to kind of piggyback on what Mark was saying, especially in the South, like in this region, there's one of the biggest things that I've noticed working in the hospital is that there's just a very lack of education about the disease itself. There's so many people that I've spoke with that, you know, they don't know what the long-term complications are with diabetes. They don't know that there is even a CGM, what that is. They don't know. You know kind of how to manage it the best way and I feel like if they knew how to limit more education with those things, that their A1C would be a little bit better than what it is and what we see every day. So just to, I think all of it is kind of it encompasses everything, but I think a lot of that is has to do with the education.

Speaker 1:

Yeah, yeah, that's a really good point and I think so much you know of what we do is health coaching and you know where you know, how much do you know about this, what you know and then offering that. So I think that's those are both really great points. I think you know we've always looked for that magic bullet, which is a GLP-1. We did a podcast a couple of weeks ago and we were talking about there's two kinds of people.

Speaker 1:

There are people that are on GLP-1s and there are people who want to be on GLP-1s. I think that's all that's out there right now. So it's like we finally found that magic bullet and you know that's what people are going to, but we don't have long-term data about what does that do to muscle mass, what does that, you know, and then what are the implications of that? So I think that is a really good point, that we can even just say it out loud, just to create the awareness, even if we're not fully coaching them through that conversation. So I think that's a really good point. So you know, you both talked about the role of exercise, and in particularly in diabetes. So you know where, where does the pharmacist fit into this? And particularly, both of you are in a hospital setting. So how is it playing out in your particular practice?

Speaker 3:

Well, I think pharmacists play a vital role not only in dispensing medication, but also in preventative care measures, medication reviews, also with chronic disease management, disease and medication education. When it comes to exercise and diabetes, there's already a shortage in primary care providers and endocrinologists in the community, so it can be very difficult to get all the necessary information on how to manage physical activity with their blood sugars each visit, each visit. So, especially when it comes to managing it with diabetes medications such as insulin and sulfonylureas, as both can have a huge impact on one's blood glucose if not properly educated. So, and this is where pharmacists can play a massive role with the exercise and the diabetes management part.

Speaker 2:

I agree with Dr Haywood 1000% For me. On the inpatient side, in the hospital, more than likely I'm seeing patients that get admitted that have, you know, super high blood sugar coming in like over 500, sometimes even six or 700. And that's the, that's sort of the consequence of the lack of adher adherence most of the time, and so it's you know. So it's our, it's our role as pharmacists to make sure, like along with the glycemic team, to sort of manage that on the inpatient side acutely. So, um, it's, it's important to provide them with that level of education upon discharge to say, hey, you know, this is why you need to be consistent with your insulin injections, the mealtime and the basal insulin.

Speaker 2:

From the group fitness instructor standpoint, it's also important to provide members with that level of education when it comes to making sure that they're checking their blood sugar before they begin an exercise program or before they get ready to take my class, so to speak, to make sure that they're not too low so that it doesn't drop during class, and so little small things like that. I don't think it takes a huge message and I think that's kind of what Dr Haywood and I have been really consistent about is there's no one huge message, but it's all like little pockets of information that patients can continue to gather, whether they're attending Dr Haywood's diabetes class in the evening time. If they take one piece of information from that, then it's golden If they come in. If I'm counseling a patient upon discharge about a bolus or basal insulin, just one little, small piece of information, that kind of thing can go a long way, and so that's what we found out so far.

Speaker 3:

And I think also pharmacists play like a vital role in diabetes management teams within a variety of ambulatory settings and also in collaborative drug therapy management, where they even have the authority to prescribe in some states. So this can be extremely helpful in patients wanting to exercise, as doses may need to be adjusted and that's where they can actually play a role in that and also on the education on timing of administration of these medications prior to exercise. That's another way what pharmacists can play a role in managing these patients too.

Speaker 1:

Can you talk a little bit more about that, like talking specifically to pharmacists, about you know having those conversations, that like talking specifically to pharmacists, about you know having those conversations, what you know, I think often we don't understand. You know we, we don't know enough and so we think, oh, we'll leave that to the dietician, or you know somebody else can talk to them about. You know what the timing of that is, as it relates to exercise. So can you like what are, what are some things that we can say to the patient that talks about that piece?

Speaker 3:

So, for example, when you exercise, depending on when you give that bolus prior to eating, your body's going to have an excess amount of insulin in circulating, so at that point it's important for them to know what time they're about to eat. What time did they give their last bowls of insulin? Do I need to delay the exercise, maybe an extra hour, so that way there's less insulin, so that way that can reduce the risk of hypoglycemia? These are all things that people need to. You know, patients with diabetes need to be thinking about and also, as pharmacists, we need to let them know to be thinking about these things as well. So I think timing is such a crucial, a crucial part of diabetes management.

Speaker 1:

When it comes to exercise, yeah, Do you think that patients you know I know you talked a little bit about just some lack of education and you know we talk a lot about health equity and you know community health workers in some of this space, and you know just there is such misinformation or a lack of education? Do you think that some patients don't work out because they're like I don't know what it's going to do and so I'm just not going to do it, like? Do you think that's actually a barrier to it?

Speaker 2:

I personally think and I can speak for Dr Haywood as well it's. It's a huge barrier. You know the the presentation that we did on on CGM and physical fitness included a health equity component and that equity component was based around the sort of current idea that they have about exercising itself, and from talking to patients in the rural area here in the South, it comes off as if exercise is this huge mountain that they have to climb and it's such a huge mountain that they don't even want to be bothered going down that road. I'll just stick with just taking the medication and just hope that everything works out okay and sort of going back to that basis of it only takes 30 minutes of moderate physical activity to get the job done. I mean, ada lays it out really really good. Ada lays it out really really good.

Speaker 2:

So even though the ADA does a great job of explaining what the recommendation is, I think our job as pharmacists is to paint that picture so that they can see it as clear as we do. You know, 30 minutes a day of just, you know, light to moderate physical activity, I mean that's such a, that's such a general term. You can get so creative with that and we have gotten creative with that, but and but. I think all that is centered around getting them to understand that what they envision as a huge, impossible task is very, quite manageable, and and and it's, and it's very, quite reasonable, and so, um, I personally think that that's the, that's the trick is getting them to understand that this isn't, this isn't a huge ask or a huge obligation that we're, you know, charging you to do, but really just about those small little steps of progress and starting to see those results as a consequence.

Speaker 1:

Yeah, not letting perfect be the enemy of good.

Speaker 2:

You don't have to join your gym.

Speaker 1:

You can go for a walk.

Speaker 2:

You don't have to join your gym, you can go for a walk. You don't have to join Lifetime Fitness, you can just really go outside, you know, and there's a lot that can be done out there for sure.

Speaker 3:

Yeah, For type ones, what I've found is one of the biggest barrier to exercise is the risk of hypoglycemia. I think that may be probably the biggest barrier for them is that, you know, a lot of the type ones are not overweight. They are actually in, you know, you know fairly decent shape and want to exercise, but they're scared to because of that fear of their blood sugar getting too low and not knowing what to do, especially when it comes to young adolescents, and so it's very that's where a huge part of that education and, you know, contacting a CDCS and getting that extra information and handouts to kind of manage those situations could be beneficial for them.

Speaker 1:

So yeah, yeah, it's not an easy thing and you really do have to pay attention. It's we've I've known a couple of, you know, kiddos around age 12 and you know you think about how active some of those kids can be. So it's, it's tough, it's it's not not easy in the beginning to try and figure that out. So that's a great segue into you both. Actually, we're part of our CGM course that we developed and that's how we got to know you and work with you. Can you talk a little bit about CGMs and how they serve the patient and the provider, I think, in this space and how helpful they can be as it relates to exercise?

Speaker 2:

Sure, sure.

Speaker 2:

I think, from a general standpoint, starting out as it is, continuous glucose monitoring is a very valuable tool alongside you know education, medication and, you know, lifestyle modifications as well.

Speaker 2:

It's another tool that's used to combat this manageable disease.

Speaker 2:

And so and that's the way it should be used it's a reliable piece of information that has become so far advanced and is continuing to become more advanced, with real-time information that's available to not only the patient but to the providers as well, so that if a set of numbers or a time and range is sort of undesirable, then changes can be made almost instantaneously or on the spot. It serves as a clear indication as to where the blood sugars are trending at that particular moment, and it just serves as a great tool for the management, or the better management, of diabetes, whether it be type 1 or type 2. And as it becomes more and more sophisticated, I think it's our job as providers to stay sort of in the loop, if you will, about these CGMs as they continue to become more and more advanced, because the patients are going to be appreciative of that. You know we all love new technology when it comes out, and so I think it's our job to kind of stay up to date on those changes.

Speaker 1:

Yeah, I think too. When I think about CGMs, I think they can be all so motivating because you see the data. I mean, as the patient, you know you can see the data, and so then you can say, okay, when I work out, this is what happens to my blood sugar and maybe I don't need to be on all these medications. It can be sort of a cycle in a positive way. So I don't know if you've seen that in either one of your practices.

Speaker 3:

Yeah, I have actually. Especially, they get excited about it. They're seeing it real time. Yeah, they get to it. It's a little bit more easier for them to, you know, manage the lows when they can see it, the arrows trending down. You know they may have a fast acting carbohydrate nearby. They know it's time to maybe go ahead and, you know, nibble on something, especially also with the physicians. Going back to what Dr Smith was saying, it's super helpful for them when they can look at the diagram and see where the lows are. If they're having nocturnal hypoglycemia, they can start to make adjustments. That's where a lot of interventions can be made, especially when they're starting to see the lows overnight. So I think it's super helpful.

Speaker 3:

But not everybody wants to use one. You know there's in some, a lot of people don't. They can't afford it. You know type ones or type twos. It's not it's new. This is a very new tool, like Mark Dr Smith was saying, but not everybody's able to use them, like Mark Dr Smith was saying, but not everybody's able to use them. And that's when we have to still help them manage. You know, give them that education in terms of ensuring they're monitoring, like you know, those finger sticks throughout their exercise. Post-recovery. It's super important that they keep monitoring, especially if they're going to exercise that day. So, um, it's kind of one of those things that if you have, if you're able to get it, that's great, but if you're not, we still have to give them the education of how to manage it without without.

Speaker 2:

Yeah, I've seen, uh, we've seen, like in our fourth year this is kind of going back to pharmacy school days in our fourth year, like sort of putting our putting ourselves in the shoe of the patient we for one particular rotation and we were, we were patients that had diabetes and so we were required to tell the story. Are you not about to tell that?

Speaker 1:

story. Tell the story. There's a story you got to tell the story. Do we have time? I hope we that story. Oh, tell the story. There's a story you got to tell the story. Well, do we have time? I hope we have time. We have plenty of time.

Speaker 2:

So this goes back to our maybe second year in pharmacy school. This was in one of our labs, and this particular lab was dedicated to diabetes management, and so this particular section. We were charged with the same thing of self self monitoring blood glucose management, and each one of us had to give ourself a stick to determine what our blood sugar was at that particular time. Well, coincidentally enough, dr Haywood and I were paired together, and he had to check his blood sugar and I also had to check mine, and in addition to that, we had to inject ourselves with what was called insulin, which was basically just like a, like a, like a water, water basically. But we had to, you know, perform as we would injecting ourselves with insulin. So this is where it becomes really good. So I, I go first, I go first and I inject myself with insulin. Easy peasy, 100, fine.

Speaker 2:

Dr haywood is looking like oh my god, you did a really good job. That's amazing. And so now it's his turn. Right, he gets ready to inject himself and he, you know, untwist the cap, he puts the, he puts the needle on and keep in mind, you're, you know, you're also counseling how you're, you know how you're supposed to do it. You know, you know you sanitize the area, make sure it's everything is fine right here.

Speaker 2:

And I noticed that he's taken an awfully long time to not only screw the needle on, but now he's getting ready to inject and he's just sort of there's like a barrier that's preventing him from injecting himself. And it's like are you OK? Like do you, do you need me to do it? And so that was this huge, that was this huge moment of oh my God, god, he's. He's not really going to inject himself, he's just going to stand there in this moment and I'm looking at him very awkward and like, like are you going to do it or are we going to skip to the next step or what you know? Like, like, what should we do? And he just became silent. And so that was, that was a moment, that was a moment. But uh, but to get back, to get back to that um, but those are real things, right.

Speaker 2:

That's a whole separate conversation when it comes to it 1,000%, and it's one of the barriers of having to do that consistently and routinely, to make it a part of everyday life. And I think one thing that I like about CGMs is that it's something that's constantly testing you all the time. You know it lives in that interstitial fluid and you're able to get those numbers in real time to sort of alleviate that burden of having to carry around. You know these, these devices that that randomly check your blood glucose, and so we, we got to experience that. And this is kind of feeding back on Dr Haywood's and your method about how you know patients can become, can become competitive with it and like oh, I see my numbers are looking good, Let me try to do better.

Speaker 2:

The closest thing that resonates with me with that is like I have an Apple watch and so I um, I track my workouts with Apple watch and so, like, if I noticed that I'm not at my move goal or my calorie goal, I'm going to try hard. You know, when I get into the gym to try to achieve that goal, and I think, like when I'm talking to patients that have diabetes, that are on a CGM, it's sort of that same motivating factor of okay, I know that my level is this number here, and I want to make sure that you know, with this, with with consistent exercise, that I can keep my A1C at a certain level without it having to go up. As long as I'm, you know, physically active and taking my medications as as prescribed, it becomes a healthy competition within yourself. Yeah, you know, and so I think that, for for those individuals that qualify, it's a beautiful thing. You know, it's not for everybody, obviously, but it could be a healthy competition within yourself.

Speaker 1:

Yeah, I love it. I love it. Make it a game.

Speaker 2:

Exactly.

Speaker 1:

Game changers.

Speaker 2:

Game changers.

Speaker 1:

Do you see any? You know having I mean being in you know, group fitness environment. Do you see people who are hesitant to wear them because of a stigma?

Speaker 2:

No, it's actually. It's actually quite the opposite. And I don't know if it's and I don't know if it's because we've been doing this, this project, for the past couple of months, on and off with you guys, this project for the past couple of months, on and off with you guys. But I promise, and I kid you not, I've seen more and more individuals that have CGMs, that are walking around in the gym. I don't know if because I'm, because we've been working on these projects lately, but I've seen trainers in the gym that that I never knew they had diabetes and they're walking around with their CGM on. It's like, oh, didn't even know, you know.

Speaker 2:

And so, um, I would say at at at my club, um, I don't think there's any, any um, any hesitancy, because I also feel like those individuals, um, are kind of, are kind of hip to it, if you will. You know, they understand, they understand the importance and they understand the value of it. And, going back to dr haywood's point, that's not always the case, like when they're at that point to where they're wearing it comfortably. I think the education part has been done. I think there's a huge gap between getting them to understand the importance of it. There's a gap in there and that's a potential pocket for us as pharmacists, to get them to understand hey, this device is actually really good. Let me take the time to break it down to you, to show you how good it is and so. But but the individuals that I see walking around at my club, it's to the point where they understand or they have a, they have a solid understanding of how important it is to have this device on to continue to track my blood sugar. That's been my experience.

Speaker 1:

And I think it's becoming popular for people not with diabetes to wear that part which.

Speaker 1:

I know has been a little bit of. You know, like Sue Cornell and I talked a little bit about that, you know, six months ago and she was like I don't know. I feel like people with diabetes don't always get them. So it's kind of an equity thing. We want to make sure that people who need them get them. But now there's an OTC coming out and it may be out soon.

Speaker 1:

It may be out when this podcast is out, I think it's sometime in late July or early August where there's an over-the-counter coming out and I think it's exactly for lifestyle. I think it's wanting to see what when you eat, what happens and when you work out what happens, and so that could really be, I think, a good thing for patients with diabetes, because it's not necessarily a stigma like I have diabetes, it's. People are just wearing them because they want to be in the know and they want to be healthy. So I think that's pretty cool and I'm really anxious to see what happens with that Cause. I think there's been, you know, kind of a lot in that in that healthy space. Can you talk a little bit about the? What exercise is recommended? So you know, is it anaerobic, is it? You know what. What do you talk to patients about? If they're going to do anything, what's the lowest hanging fruit that has the most impact? Do?

Speaker 3:

anything. What's the lowest hanging fruit that has the most impact? Well, honestly, honestly, I actually I think any type of physical activity is better than nothing at all. So I think that's just, you know, one of the things that I want everybody to be clear on. If you don't do any type of physical activity, anything is better than nothing at all. That's number one.

Speaker 3:

But at least trying to implement 150, or try to get to 150 minutes a week can be so important, whether you have diabetes or you don't have diabetes, in improving your health. That's important, and I know we're about to talk about, you know, young adults and pediatrics, but for the elderly population that might be listening to this, flexibility and balance training is super important. There is still stuff that they can do that we don't really focus on them too much, but I just don't want them to be left out in terms of there are a lot of things that they can even do Yoga, tai Chi. Those are great exercises that they can use. Like my grandmother, I got her into yoga right now. So I mean, she's in California, in Sacramento, and she goes, she calls me, I'm headed to my yoga class. I'm like this is great, it's before. She was just kind of, you know, doing a lot of sitting around the house and doing a lot of that stuff, and now she's out once or twice a week doing yoga. She loves it, so yeah yoga Apparently.

Speaker 1:

that's the new thing.

Speaker 3:

Chair yoga.

Speaker 1:

Yeah, that's great. Sometimes I think people get stuck because they think, oh, I just don't know what to do. I think having that objective number again, making it a game, 150 minutes a week, yeah, that's great.

Speaker 3:

I think resistance, I think in our, in our CE that we included as well, that if you can do some, you know, two to three times, or some resistance training a week, you know, or even some anaerobic exercise, maybe up to 60 minutes a week, or that's really good, that can be very helpful too. But you got to be very careful when you want to, you want to be careful on the intensity of your exercises, the duration, especially because those things can start to affect your blood sugar post -recovery. So you just got to be very mindful of that.

Speaker 1:

Yeah, yeah, and you mentioned um, the course that we did with um. Both of you were faculty for our CGM course. Can you talk a little bit about what's in that module? Like what? What do you go through in that module, because I think it's definitely more than what we're talking about today for sure, for sure.

Speaker 2:

We um, we start out by um, talking, talking about physical fitness in and of itself, like before we get into diabetes management, before we get into CGMs. Even we talk about physical fitness as a whole. We get into the benefits of physical fitness. You know, irrespective of diabetes management, talk about the benefits of physical fitness. We talk about some of the barriers of physical fitness, which is also important, things like lack of motivation, lack of time, those things that are common, the things that are responsible for that imaginary mountain that patients tend to think exist as a reason why they can't work out. And so, after we discuss physical fitness as a whole, then we get into the types of exercise. So we got aerobic versus anaerobic, with the presence of oxygen versus without the presence of oxygen, and those types of exercises that are included with that. And then we get into sort of transition into the diabetes specific component. That's when Dr Haywood mentions the ADA recommendations when it comes to exercise. So then we talk about the benefits specifically for patients that have diabetes, the benefits that they can achieve with lifestyle modification, specifically exercise.

Speaker 2:

And then we roll into CGM use and the helpful strategies, if you will, for patients that have diabetes, sort of like when to you know when to check their blood sugar? Uh, before exercise, you know how to you know keep a fast acting sugar source around in the event of hypoglycemia, which is our biggest, one of our biggest concerns when it comes to diabetes and exercise, you know, trying to avoid hypoglycemia. Um, how to, how to interpret a, a chart for your, for your CGM? Like how to, how to interpret that data that gets generated from the, from the CGM use and and so that's, that's kind of. That's kind of how we, that's kind of how we approach that. Did I leave anything?

Speaker 3:

out, dr Haywood, no, I think. One last thing we do talk about some social economic barriers that can prevent a lot of people from exercising in their communities, and I think that's very important to highlight. Other than that, I think you've covered everything. Those social economic barriers are something that, as a nation, we need to kind of work on, to kind of get these things handled in a way that can promote more facilities in these areas that lack them, or make them more closer to the facilities that are, make them more closer to the, you know, the areas of the city that are not as well educated, you know. So I think it's just really important that we try, as like a whole nation, try to start to fix some of these problems, because obesity and diabetes is not just in one part of the community, it's everywhere. So we don't want to leave those people out.

Speaker 1:

Yeah, yeah, I think you both make great points and your CE that you did as part of that CGM is so good.

Speaker 1:

So I would highly recommend that because I think you do provide some really, really valuable information and I think so often as pharmacists we're just focused on the medication. But you know, I think adding this question to the patient interaction that we have with people with diabetes, as well as any chronic disease, really I mean, I think there's, you know, we don't really have time to go into all that today, but I think exercise, you know, from a mental capacity and heart disease, and I mean it influences everything. So I think it is so important for us to just maybe ask that question of patients. You know, do you have an exercise regimen? Do you exercise on a regular basis? Do you get 150 minutes of active? You know, activity every week. So maybe that's the question that we had 150 minutes. If we can just all say 150 minutes, um, you know, I think that then you can gamify it or whatever it is that you do to get into those habits, um, every patient 150 minutes sounds.

Speaker 2:

It's 150 minutes sound sounds like a lot.

Speaker 1:

I I think um we want to try to tell you know, I don't know. I feel like over two hours sounds worse than 150 minutes.

Speaker 2:

Well, I mean no, just say 30 minutes for at least five days a week 30 minutes five days a week.

Speaker 1:

OK, that's good.

Speaker 2:

That kind of stings a little less.

Speaker 3:

It doesn't really. I don't even go that high with my patient population. I start off with about 10 minutes and then we work our way up to 30, but we're going to start at 10. And that's that's how I start with. You know, a class. I'm just like hey, if you can just walk to that stop sign, you know if you live in a safe neighborhood, if you can just start off doing that. You know we can get to 30, but we're going to start off about 10. And then I you know, that's me though, but you know.

Speaker 1:

I live. Well, that's a really good point. You know meeting patients where they are, so you know if you're not doing anything at all. That's a great place to start. You know if you're an active person, maybe it's. You know, 150 minutes Okay, 30 minutes, five times a week.

Speaker 2:

Thank you, thank you, it's all the same math. Yeah.

Speaker 1:

How you catch it. I love it. I love it. Well, as we wrap up um what. So, if you want pharmacists and technicians to take anything away from this conversation today, what? What's each of you like? What's your main point?

Speaker 2:

Um, I can go first. Uh, like for me, for me, um, my whole message, uh, in my practice and and practicing for over 12 years now, and this is something that I still try to remember on a day-to-day basis is, uh, it's, it's small pieces. It's it's small pieces of information. It doesn't take a 60-minute lecture to have an impact on the patient. If I'm working in a retail setting and a patient gets prescribed a weight loss medication and I know the advantages and benefits of physical activity, and I know the advantages and benefits of physical activity, it's a huge responsibility on me to get that message across, to say, hey, you know you're going to be taking this weight loss medication and further manage your diabetes and your overall health. That takes 30 seconds, small pieces of information, and what I've noticed is that individuals are appreciative of that. And the next thing you know you'll be getting phone calls and emails about additional questions that they might have, because you've provided them with just a little bit of piece of information that they might not have known, leading into this to answer more questions, and then that, in turn, provides you with the opportunity to provide more relevant information, and so bringing it back. Bringing it back is, uh, not looking at it as a mountain, but just small pieces of of that puzzle to help build that mountain. Um, it's kind of, it's kind of my take home message when it comes to physical fitness and managing expectations.

Speaker 2:

Um, I think Dr Haywood mentioned it a little bit when he was talking about, uh, physical fitness and the different types of exercise.

Speaker 2:

You know, not everyone is going to come out and be able to, you know, take a hit class, like the classes that I teach. You know, meeting the patients where they are, as you mentioned, is all a part of managing those expectations. So, if they're in the business of, you know, uh, wanting to do, uh, an extreme type exercise, then you, you know, familiarize yourself enough to know that their heart rate should be, at this point, you know, to be considered, you know, high intensity, um, or if they're, if they're not in that business, uh, if they want to start low impact, which is completely fine, um, making sure that their heart rate doesn't get higher than this particular number based on their age and their weight. So, managing expectations, it's not a one fix for anything when it comes to not just diabetes but more specifically, physical fitness. There's an art to it and part of that art is making sure that you manage those expectations and meet the patients where they are. So I think those would be my two key points that I would probably nail home to the patient.

Speaker 1:

Yeah, such a great point and I think if we view ourselves, pharmacists, as primary care providers, which we are, we're a primary care pharmacist provider. Just to have those conversations, I think we just don't often, like you said, 30 seconds might not even be that long to ask a question and just, you know, to try to raise that awareness. So I think you know we view ourselves as the holistic provider and not, you know, we're not just focused on medications, but it's all a piece of that. So I think that's a really good point. How about you, ian?

Speaker 3:

My three probably be number one resistance training before aerobic exercise to prevent and minimize the chances of hypoglycemia, that's very important. Working out in the afternoon if they just know that working out in the afternoon will increase the risk of nocturnal hypoglycemia, so that's something that they need to be educated about. Okay, monitor, monitor and monitor. Okay, check before your blood sugar before you work out. Check it during your workout multiple, multiple times. Okay, keep looking at your CGM.

Speaker 3:

If you don't have a CGM, keep poking yourself to know what your blood sugar readings are, watch the arrows, and especially even in the recovery phase. More importantly, those blood sugars can drop up to 48 to 72 hours and continually work on your blood sugar. So it's very important. Another little treat is that, remember some anaerobic exercises can actually increase your blood sugar. So those things need to be addressed and be very careful because when you're treating those things those things you know your blood sugar can still drop later in the evening and so you don't want to treat yourself too aggressively for that to prevent the nocturnal hypoglycemia. And then one last thing is remember the accuracy of the CGMs can be a little bit different when you're exercising. It's not going to be is accurate, so it's very important to pay attention to the trend arrows when you're working out with CGMs and get set alerts so that way you can prevent any low blood sugars. Okay, that's. Those are my hidden gems for y'all, for everybody.

Speaker 1:

And those were gems that we didn't even talk about the whole podcast, I think. Now you're you're leaving people with a taste for more, which is the CGM course. So that was perfectly said and not planned, but I appreciate you doing that. Those, I mean those are things that are really important that we didn't talk about. So if you do, you know, if you are interested in this topic, I really just highly recommend that you do that course. Not that this is a commercial for our course, but you know, I think you really go into all of those really key points.

Speaker 1:

So if you work with diabetes patients, particularly on a regular basis, I think it's really critical to have some of that information and be sure that we're incorporating that into the medication management discussions as well. So, yeah, that was great. Well, it was so fun to be with both of you today. I wish we even had more times. There's so much I want to ask you I'm not related to this, but maybe we can stay on for a little bit after.

Speaker 1:

So I really really appreciate both of you being with us today and it's been great fun getting to know you through working with our CGM course, you through working with our CGM course and again, if you work with patients and that's something that is of interest to you particularly. I really think, as this over-the-counter, you know, comes out, I think we're going to get so many questions from patients about CGMs. So, both for people with diabetes and people that don't have diabetes, I think over-the-counter will make it more affordable as well for people who maybe don't have access right now but need it for diabetes and also just for lifestyle. So so I think it's just such an exciting area and I really appreciate both of you being here to talk about kind of a different aspect of it that we, that we don't typically think about.

Speaker 3:

So thank you to you both, thank you. Thank you, yes, we really appreciate it. It was a great opportunity to speak with you, finally get to meet you face-to-face.

Speaker 1:

Yes it's sort of in real life, right? Our in real life has changed, I think. At least it's face-to-face on a computer screen, right, yeah, well, that is it for this week. If you liked this episode, please be sure to share it with a friend or colleague, and if you are a CE plan member, be sure to claim your CE credit for this episode by logging in at ceimpactcom. And, as always, have a great week and keep learning. We'll talk to you all next week.

Speaker 4:

Thanks for listening in. Claim your CE credit by clicking on the link in the show notes and check out CE Impact's other education at CEimpactcom, where we curate the most important information in pharmacy and medicine to deliver straight to you. Join today to connect your learning to practice you.