The Hyper effect

[Colquig]

I am a 53 year old diabetic on a current regime of 15 units of lantus plus roughly five units of novo daily. I am also prescribed eltroxin. I love to play five-a-side football, however I have been dogged all my diabetic life with the dreaded 'hyper' effect. I was diagnosed when I was 13 years of age.
Once the ball is thrown in - and I play with players of a similar age and ability - the energy just quickly evaporates from the leg and body muscles. I always manage to get to the end. Sometimes I have a good day, however 95% of the time the opposite is the overall effect.
Anybody got any good practical tips and ideas??

 

[GrantGam]

I am a 53 year old diabetic on a current regime of 15 units of lantus plus roughly five units of novo daily. I am also prescribed eltroxin. I love to play five-a-side football, however I have been dogged all my diabetic life with the dreaded 'hyper' effect. I was diagnosed when I was 13 years of age.
Once the ball is thrown in - and I play with players of a similar age and ability - the energy just quickly evaporates from the leg and body muscles. I always manage to get to the end. Sometimes I have a good day, however 95% of the time the opposite is the overall effect.
Anybody got any good practical tips and ideas??

Are you under the impression that your fatigue is diabetes related? Also what is the 'hyper effect'?

You're taking 5u of rapid acting insulin daily, so what is your I:C ratio? For example, if your I:C was 1:10, that would mean you'd consume roughly 50g carbs daily which may not be giving you the energy you need for football.

If your BG is going high when exercising you may want to try a bolus dose prior to starting. That dose will be individual to you.

 

[catapillar]

I'm not sure I've heard of a hyper effect before. Do you take your blood sugar when you feel like this? Are you actually hyper when you get these symptoms?

 

[Colquig]

Yes, interested in that notion of the bolus dose before I start the exercise. Have long brought the problem to the attention of the diabetic carers. Naturally, they are reluctant to suggest the injection of insulin before playing sport. The 'hyper' effect relates to the sugars climbing high during the quickfire movement in a five-a-side game.
Only came across the notion of injecting before the game starts quite recently, on this site.
The sugars tend to start climbing one hour before I start the 'ball' and is certainly related to the impact of adrenalin..
I presume that it is the novo insulin - the fast acting one - that is suggested as the bolus.
I tested during the game last week, and I was up near the 14 m/mol mark - much too high for me. The sugars then drop for the next 15 hours when the hypo kicks in.
Do you suggest taking the bolus 5 minutes before the game starts or sooner than that? Will try this tomorrow eve.

 

[GrantGam]

Yes, interested in that notion of the bolus dose before I start the exercise. Have long brought the problem to the attention of the diabetic carers. Naturally, they are reluctant to suggest the injection of insulin before playing sport. The 'hyper' effect relates to the sugars climbing high during the quickfire movement in a five-a-side game.
Only came across the notion of injecting before the game starts quite recently, on this site.
The sugars tend to start climbing one hour before I start the 'ball' and is certainly related to the impact of adrenalin..
I presume that it is the novo insulin - the fast acting one - that is suggested as the bolus.
I tested during the game last week, and I was up near the 14 m/mol mark - much too high for me. The sugars then drop for the next 15 hours when the hypo kicks in.
Do you suggest taking the bolus 5 minutes before the game starts or sooner than that? Will try this tomorrow eve.

So you attribute your tiredness to high BG? What about your total daily carb intake, what is it?

Bolus insulin will take around 15-30 minutes to start working, peak around 90 minutes and has an action time of between 3-5 hours. It's recommended not to exercise when the insulin is peaking (for hypo reasons) but as you're experiencing high BG and are unlikely to hypo; I have no idea what the correct course of action would be.

My BG only decreases during exercise so I'm afraid I cannot advise here...

 

[Colquig]

Appreciate that.

 

[GrantGam]

So you attribute your tiredness to high BG? What about your total daily carb intake, what is it?

Also, you may find something of use in these links:

http://www.diabetes.co.uk/forum/threads/why-do-blood-sugar-levels-rise-after-some-sport.20892/

http://www.runsweet.com/

http://www.teambloodglucose.com/TeamBG/Home.html

 

[Colquig]

Thanks again. Great stuff. Will certainly check out the sites you listed.

 

[Colquig]

Thanks again. Great stuff. Will certainly check out the sites you listed.

Not trying to avoid the question re carb intake. I do not leave a meal hungry. Carb intake would be appropriate for my general BMI. The general fitness is probably an aspect that needs work. Difficult when the sugars are so fragile and unpredictable.

 

[donnellysdogs]

It depends what your levels are 2hrs before your game as well.. whether you've at before or running on protein/fat etc.

Very hard to give any real advice without carb intake especially as 15/5 ratio of basal to bolus is not near the 50/50 or 60/40 that most T1's would be averaging at.

If you are anywhere over 8 bg pre playing then it may well be that you are reacting to higher levels. I was always advised as a T1 not to exercise if over 12 as this can push levels higher (dependent on the type of exercise). I know that any level over 8 for me and exercising can cause my levels to go up rather than down. It also depends what I eat before exercise. I can recall saying here a while back that 100g of peanuts pre workout had thrown my levels afterwards into chaos.

You are only giving a snapshot, and that limited snapshot does not really allow us to give better advice...

At 53 as well you may just be experiencing less energy when playing footie??

I have a 83 year old playing table tennis and still thinks he should be playing like he's 23... at some point we all have to accept less energy from age.. no matter how much exercise is done (this chap still runs marathons!!)... but he cannot bend down to get a ball off the floor...

 

[GrantGam]

Not trying to avoid the question re carb intake. I do not leave a meal hungry. Carb intake would be appropriate for my general BMI. The general fitness is probably an aspect that needs work. Difficult when the sugars are so fragile and unpredictable.

You have completely avoided the question. But that's your choice. As @donnellysdogs has said, you're not helping any with the wee snippets of information you're providing.

FYI, don't expect correct advice or remedial action if you're not going to give the required information. Remember that it's you who has come to the forum with a problem which you cannot remedy yourself. If you would like the help from forum members who are taking the time out to assist, then please provide as much relevant information as possible.

Just because you don't "leave a meal hungry" does not necessarily mean that you've filled your stomach up with the correct foods to provide sufficient energy for high intensity exercise. If I was to, for example, eat a whole chicken for my dinner - I'd be full. But that meal would not provide much energy required for intensive exercise. As in, there's trace carbs and not much fat.

Good luck to you

 

[tim2000s]

Not trying to avoid the question re carb intake. I do not leave a meal hungry. Carb intake would be appropriate for my general BMI. The general fitness is probably an aspect that needs work. Difficult when the sugars are so fragile and unpredictable.

I'd be interested to understand what level your BGs run at normally?

 

[Colquig]

Yes I know that the ratio is probably unusual. But I am well and truly T1. 40 years. From time to time I have to speak in front of a group of my own peers. The hyper effect is similar. The Blood sugars rise inexorably, and that leads to awful dryness in mouth etc. But in terms of the age? I do of course appreciate that I am not the youth I once was!!!!!

 

[noblehead]

Anybody got any good practical tips and ideas??

Have a read of the following thread from yesterday, @brighty14 overcame some bg control issues to continue playing football and has been selected for the Wales Futsal Team:

http://www.diabetes.co.uk/forum/threads/striving-to-defy-the-odds.110072/#post-1285924

Hopefully be tagging him above he'll reply to your thread.

 

[Colquig]

In terms of carbs, the meals are all high in fibre, plenty of fruit and veg plus the proteins. Every day I start with a bowl of porridge oats and fruit. Plus, slice of my own baked brown bread, or a high fibre oat, nut and fruit 'breakfast biscuit'. Freshly squeezed orange juice, and only discovered recently that it is not pushing up the sugar readings.
Mid-day is two slices of my own high-fibre bread - no white flour used - plus salads etc. Evening meals are all similar with slow releasing carbs. Anything other than the slow releasing types of carbs will simply hike my sugar levels. All the time looking for the slow release. When I increase both the foods and the insulins, the hypos will inevitably catch up.

 

[brighty14]

Hi @Colquig.... what levels are you coming in at directly before and after?

From my experience if I'm high i will take a very small dose of short acting insulin. (I'm novo rapid) directly before playing. I've learnt from doing it a few times roughly how much to take to reduce my levels adequately enough to feel like I'm not treading water!!

I Always have a lucozade sport on hand though just in case I get it wrong!!

 

[Colquig]

Getting the HbA1 down near 8 - in the old scale - has always been a challenge. Usually around the old 9's and yes that does tend to lead to difficulties. It is the perennial issue of achieving the optimum control and balance.

 

[tim2000s]

If your Hba1C level is in the 8-9 mark then your average blood glucose levels tend to be in the range of 10-11.5. Which tends to indicate you either run consistently quite high or you yo-yo between very high and very low.

Given what you've said about your footballing issues, my guess is that you never get particularly low and then just go higher when exercising (which is quite a well known phenomenon). Would that be a fair assessment?

Exercise and the increases you see as a result o f it would certainly be easier to handle if you got your average down to somewhere near the 6mmol/l mark.

 

[catapillar]

I think thing you need to consider in deciding whether and how much and when to correct for your match day highs would be:

- you start going up 1 hour before kick off, where are you going up from? What is the starting point for this peak?
- when you start climbing, would you usually have active insulin on board? When would your last bolus be in comparison to kick off?
- when you start climbing do you have any carbs in action? When would your last meal before kick off be? What would it be? And how do you bolus for it?
- do you take any carbs on while playing?
- what do you do after the match? Do you eat a meal and bolus for it? Do you correct for high blood sugar post match? Do you take your basal insulin as normal or do you make any exercise related adjustments?
- you mention hypoing 15 hours after kick off - do you think that's a delayed exercise thing? Or could it be related to any corrections that you are currently doing?

Sorry, it must read like an interrogation, but I think that's what I'd be asking myself if it were me and I was trying to figure out what to do about it.

 

[donnellysdogs]

An hba1c that high states issues rather than just jigher peak before footie...
Carb overload??? That is one helluva lot of bread and carbs to me..
I used to garden all day.. big jobs and never came in with a hba1c above 6.0.... carbs aren't necessarily the best thing for all actibities that you are doing during the day...

I really suggest you cut the carbs, do some basal testing and start with a new look at foods in general and for footie...

There's huge carb differences in what you have in a day than basing your meals around protein and fats. You'd see the need for the basal to drop too...