Going high with exercise

[Antje77]

I know there are threads about this but I can't find the right search terms I think.

I'm a fat couch potato, although I know how to handle a mildly intensive swimming session, which I do twice a week. Those are easy, anything over half an hour needs a close eye on a drop, and I can prevent the hypo with a couple of bites from an apple.

But now I'm dabbling with more intensive exercise, motivated by an upcoming first appointment with a rheumatologist to diagnose or rule out Bechterews/ax-SpA. No idea yet if there is a diagnosis to be had, but if not I'll likely end up with a physiotherapist, and I'm pretty sure that both rheumatologist and physio will tell me to up the exercise.
The waiting list is 3 months so I thought to get a headstart, and that's how I found myself in the gym today and a week ago.

I went for a group lesson because there is no way I can motivate myself to do gym things without someone tellin me what to do and to keep on going, and ended up in a group of young, fit and thin people doing circuit training.
Which being fat, lazy, and 46 is erm, quite interesting...

And it looks like my liver thought the same.
It must have feared I was running for my life to keep the lion from eating me, considering the ridiculous amount of glucose it so helpfully dumped in my bloodstream to provide extra energy!

Too bad that said liver hasn't been informed of my having diabetes, and jumping up to 11+ makes me even more sluggish and out of breath than I already was from the exercise.

It was the same pattern last week so it looks like I need to do something different. I did take some insulin halfway through the lesson, but of course that only started to work afterwards.

My first thought is to take some insulin before the exercise next time.
Is anyone taking insulin to counteract this liver dump with exercise?
Other ideas or approaches?

I went in with no insulin on board (except my basal, I'm MDI) and no carbs on board except for a splash of milk in my morning coffee. I usually don't eat breakfast so this wasn't any different from my normal eating pattern.

Tagging @In Response because of your experience with exercise. Although things may be different if you're well trained, and things are definitely different on a pump.

 

[Deleted member 527103]

@Antje77 it looks as if you were stressed by the exercise.
My liver would do the same if I tried to cycle up a steep hill in the pouring rain against a strong wind. I chose not to cycle when it is wet and windy now and focus on cycling in less stressful environments.
However, the liver dump does not stop me climbing which is also stressful but fun. When climbing on MDI, I would give myself a bolus to target a BG of about 3.0mmol/l under normal circumstances but would counteract the liver dump.

So, if I was you, I think I would have two choices
- bolus (but keep a close eye on BG) before exercise.
- start gentle and build up as your body gets used to the exercise so you will be less stressed and your liver will hold back.

This is only based on my experience - others may have other suggestions.

My definite advice is don’t give up. Keep trying to find what works for you.

 

[Antje77]

Thanks a lot @In Response , looks like my thinking does make sense to someone more familiar with exercise than I am.

So, if I was you, I think I would have two choices
- bolus (but keep a close eye on BG) before exercise.
- start gentle and build up as your body gets used to the exercise so you will be less stressed and your liver will hold back.

The second option is likely more sensible but knowing myself, my chances of keeping up the exercise are much higher if I stubbornly go all out, so I'll have a go with option 1 (and of course keep a very close eye on BG).

With a bit of luck, my liver will learn this is a weekly thing anyway, and stops overreacting in a while.

 

[Antje77]

However, the liver dump does not stop me climbing which is also stressful but fun. When climbing on MDI, I would give myself a bolus to target a BG of about 3.0mmol/l under normal circumstances but would counteract the liver dump.

Very useful to get an idea on what works for someone else, and what might work for me.
I think I'll go with a conservative dose next week and see what happens, so I can adjust again after that.

 

[MrsA2]

@Antje77 Your liver might get more used to more exercise if you introduced some mild (and enjoyable) exercise on other days. Then it wouldn't be so reactive to a sudden high intensity session, perhaps?
Could you walk or dance or something? Just while your liver acclimatises

 

[becca59]

@ANTJE I do my hard swim sessions early morning when I get up. No breakfast therefore no bolus. Like yourself I found a sudden steep rise, which consequently messed up the rest of the morning. Depending on my level when I wake I now take a half unit or a full unit of basal before I swim. I tend to take before I leave the house which gives me a 15 minute head start before I plunge in. If I wake quite low and it’s a day when just getting out of bed doesn’t give me a rise I wait til I get to the pool. However I now always inject at some point. Without it I get that rise. I also have a teaspoon of Greek yoghurt before I go out of the door. This has taken a lot of experimentation and a bit of bravery but on the whole works. I haven’t needed to eat anything whilst swimming. 40 minutes and 70 lengths later I get out of the pool, shower and inject again ready for my 10 carb breakfast when I get home.
The way I have rationalised it is my basal is the correct amount for everyday life. But as I am MDI also It is not enough to cope with that exercise driven sugar dump, and needs a little basal help. It also needs that insulin to utilise the sugar for energy. Without it your muscles will be starved and exercise will be harder. In the same way that you shouldn’t start exercising if levels are above 13.
Well done on upping the exercise, don’t give up, experiment and beat the dump.

 

[JoKalsbeek]

You could take up long distance walking... Not sure how the dog'd take it, though. Mom was treated for rheumatism and she mostly used a treadmill and an excersise bike, on top of her medication (Tocilizemab/Roactembra, immune inhibitors plus steroids) . Nothing strenuous, just calm and steady movement, which your blood sugars would probably prefer too. As long as she was moving about twice a week for an hour, the rheumatism didn't rust her joints all too much. Overdoing it could mean a local flare, doing nothing (like during C19) certainly would. I think it's slow and steady that may win you this race, if it does turn out to be a rheumatic issue.

Sorry, my head's still all over the place, or I would've mentioned this sooner!

 

[Deleted member 527103]

Very useful to get an idea on what works for someone else, and what might work for me.
I think I'll go with a conservative dose next week and see what happens, so I can adjust again after that.

Keep us informed (if you want) about how it goes.

 

[JoKalsbeek]

And another thing I just remembered... You know I don't see anyone for my own rheumatism anymore, right? No specialist, anyway. But the physical therapist told me never ever to join a club where regular, healthy, no-problem-whatsoever people work up a sweat, but only in an enviroment where there are physical therapists present who are familliar with what is going on with you. I know my very young, broad trainer told me to fight through the pain. My hip's been a mess thanks to THAT advice for the past 16 years, it never recovered. Just do stuff with people who know what your personal limits are, preferably once you've got a diagnosis, so YOU know what your personal limits are too. I get the wanting to be proactive, but you might need something tailored to your needs. Just something to mull over, I know you're going to go with your gut anyway, haha. (Guts are often right, so who knows!)

 

[Antje77]

Lots of useful replies again, and things to consider, and possible things to try next, thanks all!

@Antje77 Your liver might get more used to more exercise if you introduced some mild (and enjoyable) exercise on other days. Then it wouldn't be so reactive to a sudden high intensity session, perhaps?
Could you walk or dance or something? Just while your liver acclimatises

You could take up long distance walking... Not sure how the dog'd take it, though. Mom was treated for rheumatism and she mostly used a treadmill and an excersise bike, on top of her medication (Tocilizemab/Roactembra, immune inhibitors plus steroids) . Nothing strenuous, just calm and steady movement, which your blood sugars would probably prefer too.

I already go to the swimming pool religiously twice a week for aquajogging/aquarobics. I hate swimming laps and I need to join a class to find lasting motivation to go. And those classes happen to be at a time that suits me so that's how I found myself between people 10 to 40 years my senior, the complete other end of the spectrum from the class at the gym.

The dogs would love going for walks, and 'long distance' wouldn't be all that long for me because I never walk.
But anxiety prevents me from going for a walk outdoors, and I'm very sure I wouldn't use a threadmill or such indoors, and then I would feel like a failure for not doing it, which would nicely feed my depression. I have to be very careful with the goals I set for this reason.
I am going to try a weekly walk with diabetics for 20 weeks, but those walks are in the evening so I'll have to see if that doesn't mess too much with my evening and sleep. If it doesn't work for me, I'll stop.

 

[JoKalsbeek]

Lots of useful replies again, and things to consider, and possible things to try next, thanks all!


I already go to the swimming pool religiously twice a week for aquajogging/aquarobics. I hate swimming laps and I need to join a class to find lasting motivation to go. And those classes happen to be at a time that suits me so that's how I found myself between people 10 to 40 years my senior, the complete other end of the spectrum from the class at the gym.

The dogs would love going for walks, and 'long distance' wouldn't be all that long for me because I never walk.
But anxiety prevents me from going for a walk outdoors, and I'm very sure I wouldn't use a threadmill or such indoors, and then I would feel like a failure for not doing it, which would nicely feed my depression. I have to be very careful with the goals I set for this reason.
I am going to try a weekly walk with diabetics for 20 weeks, but those walks are in the evening so I'll have to see if that doesn't mess too much with my evening and sleep. If it doesn't work for me, I'll stop.

Anxiety does tend to throw a wrench in... Dunno what is at the core of it, but maybe if you go when the entire world's asleep...? Otherwise I wouldn't've been doing my sunrises. (The Jack-meneer is ruining my courage for morning walks now, because he's always out there yelling at his dog and talking at me if I dare show my face by the riverside. But without him it'd be a lovely walk!).

But, yeah, those diabetic treks... I've heard of those, think my GP is in on them too. Just would rather have syrup in my veins than go for a walk with a group. I do find I sleep better then I've had an evening walk, but no telling what it'll do for you of course.

You'll figure it out. Nothing that has to be sorted overnight.

 

[EllieM]

I personally find that walking is excellent for bgs, no stress so gently lowers my bgs.

Gym sessions, while excellent for my fitness, heart etc raise my bg as soon as I heavily exert myself. As this is kind of the point of a gym session I usually end up taking a little insulin at the start. (But if I start low and dropping I have very occasionally gone hypo. Cgms are wonderful devices).

But I agree with @JoKalsbeek that it's worth being careful not to strain any injuries. (When I had a frozen shoulder I just didn't do things that stressed it too much).

I need to rejoin the gym when we get back from our latest planned travels (my dad's 92 so am trying to visit every year). And I desperately want to get a new dog (over the last 4 years our 3 dogs have died of old age but we need to have a long period at home before going to the pet rescue or getting a puppy.)

 

[Antje77]

Aaaaargh, lost a whole post by hitting the wrong button!

Nothing strenuous, just calm and steady movement, which your blood sugars would probably prefer too.

I think it's slow and steady that may win you this race, if it does turn out to be a rheumatic issue.

And another thing I just remembered... You know I don't see anyone for my own rheumatism anymore, right? No specialist, anyway. But the physical therapist told me never ever to join a club where regular, healthy, no-problem-whatsoever people work up a sweat, but only in an enviroment where there are physical therapists present who are familliar with what is going on with you. I know my very young, broad trainer told me to fight through the pain. My hip's been a mess thanks to THAT advice for the past 16 years, it never recovered. Just do stuff with people who know what your personal limits are, preferably once you've got a diagnosis, so YOU know what your personal limits are too. I get the wanting to be proactive, but you might need something tailored to your needs. Just something to mull over, I know you're going to go with your gut anyway, haha. (Guts are often right, so who knows!)

So sensible!

But I don't do too well with good sense or sensible people telling me what not to do. If anything, it makes me want to do the thing more to prove, erm, something?
Convenient because in this case it adds to my motivation to keep doing something I don't particularly like! External motivation is motivation too, after all.

I promise to not let anyone tell me to 'fight through the pain' though!
During the past two sessions I already found out that any exercises laying flat on my back are a definite no. But there's nothing wrong with doing a slightly different exercise with my knees pulled up, or even skipping one completely. And the difference between me and the young 'regular, healthy, no-problem-whatsoever people' is big enough that I have nothing to prove there so no risk of overdoing it for trying to keep up, it won't happen anyway.

As for physio supervised exercise, I don't have the insurance for that, and besides, it's my body so I'm pretty sure I can feel what is right and what isn't. And I'm too old to fall for the trap of doing things that don't feel right because someone tells you it is right.
I'd rather be overasked to find my own boundaries than have someone be too careful with me and telling me to not do things, so I think this circuit training is fine. If I keep an eye on my personal limits I don't need a trainer to think they know my personal limits. I think.

 

[JoKalsbeek]

Aaaaargh, lost a whole post by hitting the wrong button!




So sensible!

But I don't do too well with good sense or sensible people telling me what not to do. If anything, it makes me want to do the thing more to prove, erm, something?
Convenient because in this case it adds to my motivation to keep doing something I don't particularly like! External motivation is motivation too, after all.

I promise to not let anyone tell me to 'fight through the pain' though!
During the past two sessions I already found out that any exercises laying flat on my back are a definite no. But there's nothing wrong with doing a slightly different exercise with my knees pulled up, or even skipping one completely. And the difference between me and the young 'regular, healthy, no-problem-whatsoever people' is big enough that I have nothing to prove there so no risk of overdoing it for trying to keep up, it won't happen anyway.

As for physio supervised exercise, I don't have the insurance for that, and besides, it's my body so I'm pretty sure I can feel what is right and what isn't. And I'm too old to fall for the trap of doing things that don't feel right because someone tells you it is right.
I'd rather be overasked to find my own boundaries than have someone be too careful with me and telling me to not do things, so I think this circuit training is fine. If I keep an eye on my personal limits I don't need a trainer to think they know my personal limits. I think.

I do think you have things covered! (I never did do well with peer pressure...)

 

[Deleted member 527103]

Maybe I have been lucky but whenever I attend exercise classes, the instructor starts by telling the class that we know our own bodies best. If we don't feel we can do something, don't. Over exertion is not keeping fit.
My Spin class is very varied - some super fit people, some who come for "active socialising" and only one who thinks it is the place to be competitive and many people in the class very vocally suggest he keeps his mouth shut more often.
When I have done circuits, we are all too busy focusing on our exercises (with guidance form the teacher if necessary) to compete with others.
And climbing classes have been technique focused with my usual "actively social" climbing buddies. So the goal has been to optimise strength whilst minimising effort.

As for physio supervised exercise, I have only done this to build up the strength in very targeted injuries which is different to overall body fitness.

 

[Antje77]

Anxiety does tend to throw a wrench in... Dunno what is at the core of it, but maybe if you go when the entire world's asleep...?

But, yeah, those diabetic treks... I've heard of those, think my GP is in on them too. Just would rather have syrup in my veins than go for a walk with a group.

In a group I can hide in the middle and have the others be eaten by mean dogs first! And by the time they've finished eating the others they're hopefully to full to eat me.Yes, I love dogs but I'm also scared of them. Especially outside when I can't outrun them. And the fear is worse when I'm on my own.
Plus a general anxiety when I'm too far from a safe place where I can hide, like my house or my car, or my own, unshared cabin when sailing.

And I desperately want to get a new dog (over the last 4 years our 3 dogs have died of old age but we need to have a long period at home before going to the pet rescue or getting a puppy.)

You'll have to tell me all about the dog once the time is right to get it!
I think @VashtiB has a new dog and I need pictures.
I think every thread I ever started derailed within the first page, and usually to include dogs so this thread seems to be no different!

Gym sessions, while excellent for my fitness, heart etc raise my bg as soon as I heavily exert myself. As this is kind of the point of a gym session I usually end up taking a little insulin at the start. (But if I start low and dropping I have very occasionally gone hypo. Cgms are wonderful devices).

But I agree with @JoKalsbeek that it's worth being careful not to strain any injuries. (When I had a frozen shoulder I just didn't do things that stressed it too much).

Good to know that you're another who takes insulin before gym sessions, looks like this may work well.
And yes, I'll try to be careful!

 

[JoKalsbeek]

In a group I can hide in the middle and have the others be eaten by mean dogs first! And by the time they've finished eating the others they're hopefully to full to eat me.Yes, I love dogs but I'm also scared of them. Especially outside when I can't outrun them. And the fear is worse when I'm on my own.
Plus a general anxiety when I'm too far from a safe place where I can hide, like my house or my car, or my own, unshared cabin when sailing.

You'll have to tell me all about the dog once the time is right to get it!
I think @VashtiB has a new dog and I need pictures.
I think every thread I ever started derailed within the first page, and usually to include dogs so this thread seems to be no different!

Good to know that you're another who takes insulin before gym sessions, looks like this may work well.
And yes, I'll try to be careful!

Yeah, that makes sense... Then walking in the morning, when some are out there with their dogs before going to work or somesuch, really is a no go... I thought maybe walking up and down the street in front of your own house'd be alright, but that'd get tedious very, very soon. But hey, if a smidge of insulin'd help, nothing else is going to stop you going to the gym!

 

[Antje77]

@ANTJE I do my hard swim sessions early morning when I get up. No breakfast therefore no bolus. Like yourself I found a sudden steep rise, which consequently messed up the rest of the morning. Depending on my level when I wake I now take a half unit or a full unit of basal before I swim. I tend to take before I leave the house which gives me a 15 minute head start before I plunge in.

That's interesting that you use your basal to counter the rise from excercise, I would think it would be too slow.
Very much worth keeping in mind though, depending on the outcome of experimenting with bolus!
I use Tresiba for my main bolus, which would be useless for this, but I also use Levemir to top up depending on variable basal needs, and that would be just the right insulin to use in this way.

On most days I need to take some bolus insulin for getting out of bed (no breakfast) so to my thinking that rise is comparable to the one from exercise.
However, during the past two weeks I haven't needed to dose for Foot on the Floor, or just a very small amount. If that changes again my approach for the gym may need to change again as well.
My overall needs for insulin have lowered over the past few weeks, I'm starting to suspect it's the ibuprofen reducing inflammation. Time will tell.

It also needs that insulin to utilise the sugar for energy. Without it your muscles will be starved and exercise will be harder. In the same way that you shouldn’t start exercising if levels are above 13.
Well done on upping the exercise, don’t give up, experiment and beat the dump.

This makes perfect sense!
I really felt the difference once my BG went that much higher than usual, the exercises started to feel harder than I thought they should feel.

And yes, I'll keep experimenting, getting things like this right is one of the things about diabetes I find quite interesting, and I'm not afraid to make mistakes.
Nothing worse is likely going to happen than having to take a break while munching winegums. Which I don't particularly like, but it isn't a particular bad thing either!

 

[EllieM]

@Antje77 are you willing to tell the class instructor that you are diabetic andmay need to stop for insulin, hypos etc. (Just a due diligence thing really, I always tell mine).

And I should mention that my basal reduces when I have regular gym sessions, not sure how that will work with tresiba...

 

[Deleted member 527103]

On most days I need to take some bolus insulin for getting out of bed (no breakfast) so to my thinking that rise is comparable to the one from exercise.
However, during the past two weeks I haven't needed to dose for Foot on the Floor, or just a very small amount. If that changes again my approach for the gym may need to change again as well.

I find my FotF is much less the morning after exercise even if it is "stressful" exercise that requires additional bolus such as climbing.
So keep an eye on that morning bolus dose.