Dear Dani, Grace and Jude,
Note: This page is advice for Grace, Jude and John. For any other reader, it’s information only. No therapeutic relationship is formed – read this.
The tactics on this page have changed my life forever.
I am sure they will do the same for you.
GAME is all about using FAST movers of glucose between meals.
Recall this graph?
Remember how much better my Christmas day was by using high knees?
Here is what we have been building towards!
How does GAME work?
We learned it all in the Foundations section.
Grace: “Daddy, surely you are the only one mad enough to do this?”
Not at all, check these young people out.
First, an eight year old boy on injections using a Dexcom.
He was managing 60% time in range using lots of correction between meals, and his predicted HbA1c was 7.3%. Not bad at all.
However, he was getting frustrated by the glucose rollercoaster, but did not know how to get off.
After reviewing GAME, the family decided to start the high alert at 11.0mmol/L (200mg/dL). They decided to use jogging on the spot (high knees) for 15 minutes when the high alert sounds.
This graphic shows he needed the high knees once a day, and they worked a treat. The glucose quickly came back below 11.0mmol/L (200mg/dL) within half an hour. Obviously, he still used corrections overnight!
He improved time in range from 60% to 75% immediately and kept lows below 4%.
This young lady had a fantastic time in range of 73%. However, she was having to pump corrections in left, right and centre. She was stacking insulin all over the place leading to over 13% of the time hypo.
Just look at the improvement once she swapped corrections for short 5-10 minute bursts of skipping or jogging on the spot, when the alert hit 9.0mmol/L (160mg/dL). Straightway a boost to 85% time in range and hypos less than 4%.
One final example?
This young lady wanted to go to the penthouse!
By anyone’s standards this young lady was dominating diabetes. She consistently had over 80% time in range with less than 4% low. However, she is a competitive soul who is up for a challenge.
She wanted to take my crown of 98.9% time in range.
She decided on star jumps for 5-10 minutes when the glucose hit 8.0mmol/L (145mg/dL). On average, she needed to do the star jumps twice a day, a maximum of 20 minutes flapping her arms and legs about.
BOOM, all the way to the penthouse, 98.8% time in range with virtually no lows! Only 0.2% to go for the record!
GAME sounds like a lot of exercise, I am not sure I will be able to do it?
Grace and Jude, we will start with baby steps.
We will set the high alert at 12.0mmol/L ( 215mg/dL) and keep it there until you are about six. We will then drop it gradually to 10.0mmol/L (180mg/dL), and only move it down if it seems sensible.
If you follow SET properly, only one short burst of exercise a day is usually needed. On days where you eat crap food, expect to do more!
Remember, to stay healthy you need to do at least three lots of twenty minutes vigorous activity a week, as a bare minimum!
Just think of GAME as getting in the minimum effect dose of vigorous activity, anything on top is a bonus.
Will using GAME cause hypos?
100% it will at the start!
Using GAME is more of an art than a science.
To become Picasso, you need to apply trial and error with continual tinkering whilst remembering!
At the start I would often drop too fast after doing ten minutes high knees when I should have done five. However, I quickly learnt what was needed.
The exercise times in GAME are a guide. Grace and Jude, it’s your job to adapt them and make them your own.
Does it have to be jogging on the spot?
Absolutely not. Any exercise that uses most of the body will do.
My favourites are; high knees, rowing, running round the city centre at work, and sometimes jumping jacks.
Other people I have helped use; cycling, trampoline bouncing, burpees and lots more.
There are no rules, whatever works will do, remember, The Glucose Never Lies.
Should I use corrections at all?
Grace and Jude, I will need to correct your high levels overnight with insulin. Not even I would consider a session of high knees at 4am!
School will also be a challenge. It will depend on our relationship with the people supporting you. If the teaching assistants are happy to support GAME, we will use it. If not, then corrections for highs at school will do.
At secondary school you will be old enough to decide. In lessons you might decide to bring highs down with insulin. At break time you may feel confident enough to start doing high knees anywhere, or go to a toilet cubicle and do them.
I am sure I hold the world record for the most high knees done in a toilet cubicle! Maybe I should call the Guinness book of records?
As you artistry with GAME develops, you will no doubt trial half insulin corrections with short bursts of exercise to drop stubborn highs. I usually have to do this after eating pizza!
GAME is not all or nothing. The more you use it, the better your time in range. However, you can implement flexibly depending on circumstances.
Again, trial and error with continual tinkering is required. I will help you.
What if I cannot exercise?
There are two good options:
- Automated pancreas system – T-Slim x 2 with Control IQ, Minimed 780G, CAMS APS FX or DIY looping.
- Sugar Surfing: this teaches you how to micro-dose corrections in a proactive way whilst not stacking insulin. This book is worth reading full stop!
Net step: SET
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