hypo vs diet

[insanity]

Hi all,
Quick question, how are you meant to maintain or lose a few pounds if you keep going hypo with exercise??

I'd say about 60% of the time i can avoid a hypo by reducing my basal for 2hours before exercise but sometimes my body just does whatever it likes and i go hypo. Thing is though, if you burn off calories in the gym and thus burn fat but then have to eat toast to help you out of.the hypo, will that then put the few pounds you've lost back on? Hope this makes sense, just a random thought I had tonight after a hypo...

 

[Snodger]

yes it's not easy!
One tip - don't eat toast to bring you out of the hypo. It's actually going to be quite slow, and so you'll end up eating more than you need. Bring a bottle of lucozade (or any sugary drink) with you and drink some of that instead. It will work fast, so you won't need as much, and although it has calories, it doesn't have that many compared with something that also contains fat.

When you talk about reducing the dose, did you mean basal (background like Lantus/levemir) or bolus (eg humalog, novorapid)? I personally wouldn't reduce basal unless I was going to be very active all day, as opposed to a single trip to the gym.

Here's what I do when I exercise (a swim before work):
Keep basal dose the same as normal
Check blood (let's assume it's at a nice level)
Eat my usual breakfast (slice of toast) but reduce the bolus (humlog) dose: normally it's 6 units, on a swim day it's 4
For interest, check blood (it will be high at this point, but that's ok coz you are about to exercise and you have insulin in your body)
Swim 20 lengths (it's easier to keep it the same amount each time, but of course you can experiment to see how much more you should reduce your bolus)
Keep a bottle of lucozade with me in case I decide to swim a bit further than usual, and take a swig if needed
Check blood if needed, or out of interest to see how much the blood sugar reduced

What time of day are you going to the gym and how does it fit with what you are eating? Can you get to the gym shortly after eating rather than waiting till after work, for example?

 

[insanity]

Hi,

yes I mean reducing basal - i'm on a pump sorry, i should have said. I did try reducing bolus a while back but I went high bs and it took ages to come back down, I never tried it again haha

I usually have lucozade with me all the time but I've been trying different things to see if it helps. Having a bit of a fed up mood with lucozade at tje moment so i've been trying jam on toast, toast, crackers and fruit. So do you find that your sugars will stay stable reducing your bolus? I might have to give it another go. I carb count but occasionally find foods that don't play by the carb counting rule. Do you do other exercise?

I only really get time to exercise after work, I try to eat dinner amd then wait 2 hours and go the gym. sometkmes I do go straight from work but the results are always mixed.

 

[hanadr]

Exercise isn't the major part of weight loss. In fact exercise alone won't take weight off you unless it's extreme.
Diet is the answer to weight loss and luckily, the best diabetic diet is also good for that. The Low carb/high fat diet controls blood glucose as well as helping with weight. A modified Atkins is a sticky on theis forum.
Hana

 

[insanity]

hanadr, yes i've been reading about the low carb/non low carb diets to see where i fit.

I seem to be on the high end of a low carb diet. I eat really healthily to be honest but I think because i'm also a coeliac, i wonder if the absorption of the foods and insulin work differently?

Like last night, I ate 50g pasta, tuna, sweetcorn, carb counting told me to do 5 units but I knew that would be too high so I only gave a bolus of 3.5 units. I waited 2 hours checked my bs which was 5.2 went off to the gym having 1 swig of lucozade and came home to a bs of 2.0 (I didn't even feel hypo)!

But i'll bet if i do exactly the same tonight I'd get through it hypo free...

 

[Snodger]

if you are on the pump then are you even using background? Sorry for my ignorance. I thought pumps give little bits of fast acting insulin? What is the insulin you are using?

 

[Mileana]

I believe pumps work to give a steady stream of RA as basal rate, and then you have to press a button for a bolus to be added on top.

Insanity... What is your starting BG when you start exercising, what type of exercise do you tend to do (gym? weights, cardio?), and do you have a nugget of food just before exercise. Is it just at the peak of your bolus action? Do you think about your need for fuel during exercise while doing it, or only really when you notice yourself going low?

Have you thought about delaying the basal reduction until after exercise? If you hypo AFTER and your basal is RA, maybe you need to reduce it in the hours following exercise? It could be -60 percent at hr 1, -40 at hr 2, -20 at hr 3 or something of this nature would be the answer.

I am not on a pump, so just trying to ask some questions to 'help you think'. Maybe someone else can do something with the answers too.

-M

 

[insanity]

Yes Snodger the pump delivers a continuous background basal insulin but I can give extra insulin as the bolus for when I'm eating meals etc. It's all Novorapid. It regulates the basal over a 24 hour period, for me I receive 0.15 units of novorapid per hour as the basal. Hope that makes sense.

Mileana: BS before exercise is usually between 5-7 I would usually have a swig of lucozade before an aerobics class but wouldn't need to have lucozade before doing any weights. I have eaten before exercise but even if I half the bolus the insulin would hit me first so i'd hypo and then I'd just go really high following the exercise.

I think i'll have to look at my bolus's

I've gone off my original dilema though - do you think hypo's like this stop you from keeping the weight off because you have to keep eating?

 

[Snodger]

ah ok, that explains the confusion - when I said 'background/basal' I meant my injectable insulin that stays in my body the whole day. I see why you'd reduce your basal in terms of pump basal.

in answer to your question, yes I do think hypos from exercise can sabotage weight loss. But if you keep to the really quick acting stuff (not toast or fruit) and you don't overdo it you can minimise the problem. And sounds like you are already tweaking your dose so sooner or later you'll get it spot on for your exercise?

 

[insanity]

Thanks Snodger, the things they don't tell you in clinics ey! I might start again and try the different basals/bolus combination and see which one i'm less likely to hypo on and go from there maybe. Just when you get ahead in the game you have to go back to the begining lol Thanks for all your advice guys

 

[Mileana]

insanity, do you know how much 10g of carbohydrate will raise your BG? For most people it would be around 2-3 mmol.

Let's say I caught myself at 2.5 (it's happened a few times). I'd then want somewhere around 10g of carbohydrate to get me out of the immediate hypo zone, right?

That would be 3 of my glucose tabs.

If I was 3.5, I'd need 1.

Now if you consider that you may be on a downwards trend, you'd perhaps want to double it, but probably not more than that.

Say 20g of carbohydrate total on top of your normal meal schedule. Now if 1g of carbohydrate is 4 kcals, then that would mean an additional 80 kcals, or perhaps in the area of 5 percent of a normal weight loss diet. In comparison, you'd need a daily deficit of calories of around 500 kcals to lose 1 pound of fat in a week. So it wouldn't be a great delay in itself, if you don't overtreat.

However, the fact that hypos can make you less likely to start or complete exercise could contribute - at least in so much that you would be less likely to retain muscle mass during weight loss because without resistance training, you tend to lose muscle as well as fat where as with, you can normally slow down that 'decay' or even pack on a bit of muscle.

Good luck working out the rates.

 

[Snodger]

I eat really healthily to be honest but I think because i'm also a coeliac, i wonder if the absorption of the foods and insulin work differently?

insanity, I have just come across an article (I'm studying T1) which mentions undiagnosed coeliac disease as causing extra hypo problems.
http://journals.lww.com/jpho-online/Abs ... ry.18.aspx
Saw it and thought of you!
- but of course yours IS diagnosed and you are presumably treating it/eating for it, so I don't know how useful it actually is. Anyway, it suggests that there is an impact on absorption.

 

[insanity]

I eat really healthily to be honest but I think because i'm also a coeliac, i wonder if the absorption of the foods and insulin work differently?

insanity, I have just come across an article (I'm studying T1) which mentions undiagnosed coeliac disease as causing extra hypo problems.
http://journals.lww.com/jpho-online/Abs ... ry.18.aspx
Saw it and thought of you!
- but of course yours IS diagnosed and you are presumably treating it/eating for it, so I don't know how useful it actually is. Anyway, it suggests that there is an impact on absorption.

haha that's interesting actually although I've already been diagnosed with coeliac! ****! Very interesting though. I'll give it another good read once i'm home from work. Thanks for the article. I Tried my run yesterday by having a snickers bar before I went out, seemed to help as I didn't go as low. I'll get there eventually

 

[insanity]

insanity, do you know how much 10g of carbohydrate will raise your BG? For most people it would be around 2-3 mmol.

Let's say I caught myself at 2.5 (it's happened a few times). I'd then want somewhere around 10g of carbohydrate to get me out of the immediate hypo zone, right?

That would be 3 of my glucose tabs.

If I was 3.5, I'd need 1.

Now if you consider that you may be on a downwards trend, you'd perhaps want to double it, but probably not more than that.

Say 20g of carbohydrate total on top of your normal meal schedule. Now if 1g of carbohydrate is 4 kcals, then that would mean an additional 80 kcals, or perhaps in the area of 5 percent of a normal weight loss diet. In comparison, you'd need a daily deficit of calories of around 500 kcals to lose 1 pound of fat in a week. So it wouldn't be a great delay in itself, if you don't overtreat.

However, the fact that hypos can make you less likely to start or complete exercise could contribute - at least in so much that you would be less likely to retain muscle mass during weight loss because without resistance training, you tend to lose muscle as well as fat where as with, you can normally slow down that 'decay' or even pack on a bit of muscle.

Good luck working out the rates.

I'll have to work it out, I know 1 unit of insulin lowers my blood sugar by 4mmol so I assume 10g carb would raise me by 4mmol as I work on a 1unit:10g ratio. It's interesting to look at exercise/sugar/weight loss, I'm not sure many 'scientists etc' really go in to this field. I believe I treat accordingly, I guess every now and then I go a little overboard (Probably with the Jam on toast). Thanks for this though, some good things to think about. Do you do much exercise how do you cope?

 

[Mileana]

I mostly do long walks - 5 miles, 10 miles and so on. I'm very predictable normally in that sort of exercise environment, but wind or rain or heat will change things.

I test after 30 minutes to know how fast things are going to go today, my initial drop gives me a good idea of how the rest will be, and then once I hit 5 mmol, I'll have an unripe banana - those tend to release slowly and reliably for me. I'll get up to 6 ish and stay there for maybe an hour. After that, I will have 5g of carb per 30 minutes and test quite frequently too as I will tend to hypo otherwise. After 3 hours, I will have a rapid drop regardless what I do, so I will make sure to catch that one at 3.5 and get it sorted.

It's very individual, I think and this is what I can get away with doing without having to drag a whole pharmacy around

I start exercise on the tail end of a bolus, around the 2.5 hour mark, then I will have no further insulin until my evening meal. I am LADA tho, so I do make some of my own.

If I do more than 5 miles, I'll normally need a 25 percent reduction in my basal dose on the morning and the evening after.

When I do weights, swimming and running, I'll aim for 1 hour after a meal, releasing my stress hormones when my insulin begins to peak and then I'll have protein after exercise and fruit about an hour later - around 3 hours after injection when my numbers start coming down again and I might hypo - if I then 20 minutes after that am above 6 mmol, I will inject. If not, I will leave it. I can't tell before then whether I will go one way or the other, really.

Hardly simple, lol.

 

[insanity]

Thanks for that Mileana, It's interesting to see someone elses routine. Your right though, nothing's ever simple with it all.

I might try to time my exercise an hour after a bolus and see what happens. Whether, Knowing my luck, I'll go hypo quicker I don't know but it may help. I'm dancing tonight so I'll see how it goes and let you know afterwards.

I've started a little diary to see if depending what my tea is, if that makes me more liable to a hypo on exercise etc, I've sorted my saturday 5k run out, I don't seem to go hypo any more which is good. Just need to sort the rest out

 

[Klang180]

As the OP is a type 1 i am very uncomfortable with people proscribing a low carb diet especially as he is also talking about diet. Yes LC might work for T2s but for a T1 good quality comple carbs should be the basis of your meals especially when exercising.

For example i am extremely insulin sensitive and this is increased when i exercise. For a 30min walk i require something to the effect of 50-60 carbs to cover it. If i was on a low carb diet how would i do any exercise at all?

For the OP, i would recommend the ExCarbs system (google it), i think it is the best guideline on this and can help you stay in control. I do a lot of exercise and i am really starting to get a hold of my control whilst doing it because of this system. I have also noticed that exercise is also the best BG regulator out there so the more you do it the more you want to do it!

Please don't be drastic and go LC without serious research. I know it is fashionable and the majority of people on this forum seem to do it but don't forget most people are T2 and the majority isn't always right.

 

[phoenix]

i would recommend the ExCarbs system

there's a good page about that on the runsweet site.
http://www.runsweet.com/CarbsAndExercise.html

 

[Klang180]

hanadr, yes i've been reading about the low carb/non low carb diets to see where i fit.

I seem to be on the high end of a low carb diet. I eat really healthily to be honest but I think because i'm also a coeliac, i wonder if the absorption of the foods and insulin work differently?

Like last night, I ate 50g pasta, tuna, sweetcorn, carb counting told me to do 5 units but I knew that would be too high so I only gave a bolus of 3.5 units. I waited 2 hours checked my bs which was 5.2 went off to the gym having 1 swig of lucozade and came home to a bs of 2.0 (I didn't even feel hypo)!

But i'll bet if i do exactly the same tonight I'd get through it hypo free...

Hey insanity, if your BS is 5.2 after 2 hours then you cannot go to the gym. The fact is that your bolus is only half done and so even without the gym you are goign to go hypo. You need to make sure that after 2 hours you are a little higher than that unless you are eating very very low GI food.

As someone already mentioned. You need to carb count and work out your IC ratio. Once you know what your normal none exercise IC is you can start to adjust for goign to the gym. I would say however that unless you are very light or very fit then 50g probably isn't enough to cover the exercise. You always have basal in your system as you pump is providing it in small doses all the time. So with this in mind i would be tempted to eat your meal of say 50g, have 0.5 bolus and then go to the gym within 2 hours. You will of course shoot up to a relatively high level but as long as it is below 13 when you start you will find it rapidly drops once you start exercising.

As you are on a pump however you can probably also have a mixture or bolus & basal reduction. I don't know much about pumps but "Think Like a Pancreas" is a great book to explain how to do this effectively.

 

[Klang180]

Oh and the best tip that i ever had about diabetes management is to always do some moderate exercise (10 min walk) after each meal. This makes you more sensitive to the insulin you injected and creates a more stable and flat effect of the insulin.

I used to have my bolus and then sit around and all would be fine. Fine that is until i started to do things and i would fall rapidly. So for greater flexibility and predictability i now just make sure i go for a 10 min walk after every meal. This means that i have a lower I:C ratio and means that when i do more activity i don't need as many ExCarbs, if at all.

Oh and the biggest take away i have is that exercise as a diabetic is very hard to get right but once you do it is also your most powerful tool.