Temp Basal Rates

[hynes48]

Hi Everyone. I am on the pump and have been for a few year now.

I have started cycling to work. It is 7km and i do it in 25-30mins. However, I'm really struggling to manage the sugar levels post the activity. They can go insanely high (20.2 as i write this!!!! - before the cycle it was 6.2) or low. I have tried Temp basal for an hour, starting 30mins before the cycle - Temp basal ranging from reduction of 25% up to 100%. I have tried breakfast before the cycle, no breakfast before the cycle.

I've been doing this for three weeks now and it is doing my head in! I feel it should be very easy - exact same cycle, same route, same time. It's not excessive exercise.

I am guessing today was an issue with the pump being loose - nothing else makes sense. However, in general can the more active members of the forum please let me know what you do regarding temp basals, eating before or after etc.

I knew exercise was hard work .......................but i didn't appreciate how much hard work!!!

 

[azure]

Some people find vigorous exercise raises their blood sugar (I dont). Have you tried increasing your basal cautiously?

 

[hynes48]

I never heard of exercise causing sugar levels to rise. I'll look into it. Thanks.

 

[azure]

I never heard of exercise causing sugar levels to rise. I'll look into it. Thanks.

There have been some mentions in the Type 1 section. You could try asking there to get feedback from those affected. It seems to be vigorous exercise in particular.

 

[Ann1982]

My sugar usually rises after vigorous exercise but not by as much. You are not alone.

 

[tim2000s]

Hi @hynes48, what does your cycle to work look like? Is it (like mine) a series of sprints between traffic lights, or is it a longer, more steady ride? Do you have some big hills that are tough to ride up? That will make a big difference!

 

[noblehead]

I am guessing today was an issue with the pump being loose - nothing else makes sense.

That won't have helped matters and will explain the 20.2 bg reading.

I have tried Temp basal for an hour, starting 30mins before the cycle - Temp basal ranging from reduction of 25% up to 100%.

Changes to the basal rate need to be made 90mins before exercising, have a look at ExCarbs for some useful advice on exercising with a insulin pump:

http://www.excarbs.com/insulin-injections-pumps-and-exercise/

 

[Snapsy]

@hynes48 cycling, swimming and running all cause me massive highs afterwards - or at least they would if I didn't do what I do!

Before cycling or running I set a TBR of 50% of my standard rate.
The moment I stop the exercise I set a TBR of 150% for an hour or sometimes 2 hours.
I check my sugars on my Libre throughout.

When I swim, early in the morning, I have 0.5u insulin when I wake up, then head to the pool. When I swim I disconnect my pump, and as soon as I get it back on after the swim I test, take my breakfast bolus (I always have breakfast half an hour after my swim) AND set a TBR of 150% for an hour or sometimes 2 hours.

This strategy means for me that:
a) I don't go low during exercise
b) I don't go high after exercise

It has taken me a lot of trial and error and testing to work out this 'me-specific' strategy. Your body will be different.

But test, experiment safely with TBRs and exercise, keep testing, always have glucose nearby, and you'll crack it!

 

[Snapsy]

8-10 hours after exercise I often go low. I will reduce my basal rate and/or use it as an excuse for a snack attack.....

 

[hynes48]

Thanks everyone. This has been really helpful.

PS - Is diabetes the most complicated thing EVER!

 

[Snapsy]

Is diabetes the most complicated thing EVER!

Yes!

 

[hynes48]

Just to give feedback on my original post above. Did the same cycle again this morning. I reduced the basal rate by 50% and then immediately after the cycle increased it to 150% for an hour. Current reading is 140 (7.8).

Next problem to work on is my sugar levels at night after exercise (3o min cycle home at 6.30pm). Reading was 7.2 going to bed - with no exercise i would wake up with a very similar reading........after lots of work on the basals over time. Last night, at 1am my pump started beeping - 3.4! I took carbs to rectify it. Woke up this morning with a reading of 4!

I thought exercise was meant to be good for your health

I'll get there in the end but i never used to have this problem with sugar levels and exercise. Maybe I'm getting old

 

[Snapsy]

That sounds great, @hynes48 - and you've got the same issue as me of going low many hours afterwards, which us something I haven't yet practised enough to avoid.

I try to remember to reduce my basal rate again at around the 4-hrs-post-exercise time, but I often forget until I'm low. After my long run on Sunday morning I ended up having a bowl of porridge, no insulin, which got me through the night.

Ideally I'd generally rather turn down the insulin tap rather than turn up the carb tap, but that's just how it worked for me on Sunday. Haven't done enough trial and error testing and experimenting with long-post-exercise TBRs. Still learning!

 

[richyb]

basal rates can take longer than the 30mins to take effect. You might try increasing the before ride time probably even 90 mins. you could increase the before cycle ride time a bit at a time.

 

[Julian_Hands]

Hi @hynes48
I'm starting on a pump this Monday due to my cycling regime, I had exactly the same issue as you and I'm MDI.
I've done allot of work on my control and with insulin dosage I've found the following:

Daily Commute: Cycle 30km each way with 300meters elevation. The night before I cycle I would reduce my basal insulin (in my case Lantus) by 15%, in the morning I take 50% of my normal Bolus insulin and eat my normal breakfast (porridge) and start my ride about 45 minutes after eating breakfast.

Halfway into my ride to work is the hilly bit and have been stopping to take BG levels after all the climbing. This is where my control was falling apart as I found that the climbing obviously burns the carbs and was going low to around 2.8mmol/L. I then found that when I got to work without treating this low would result in a huge spike to 18-21mmol/L, which is your Liver and adrenaline producing the survival spike.

Now I take 2 water bottles, one carrying water with an SIS tablet and the other with Lucozade sport., I ensure that I'm sipping on the sport drink (usually have 50% from a 500ml bottle) prior to the climbing which keeps me on target throughout the ride, I now get to work wth a BG of around 5.2mmol/L (perfect).
Once at work I will take the other 50% of my morning insulin Basal rate and this then keeps me smack on target until lunch time.

If I cycle the next day I will reduce my Basal rate further by an additional 5% (20% total) as my sugars just keep dropping without this correction and then I'm eating more calories than I'm burning.

Cycling is a tough sport as its both Anaerobic and Aerobic, therefore it can really mess with your control unless you identify the areas of impact. I Highly recommend you think about the areas your working hard and then stop and do a BG test to confirm. I use to be a bit shy about my diabetes but due to the benefits that the testing has given me I now don't think twice about stopping and testing in public as its the only tool we currently have to understand what's going on.

I've also cycled on 200Km Audax events which last all day in the saddle and for these events I will test every 30Km and reduce my basal insulin by 20% the night before.

It seems to work, but diabetes will always throw some curb ball in to the equation that will keep you guessing 'what on earth went wrong?'.

Good luck and don't let it beat you, its a bit of work, but life is so much better once its controlled.