Advice needed re: adjusting insulin to account for exercise.

[G2ADY]

Hi All,

I newly diagnosed ( 6 weeks ago) as type1. I'm a male aged 45. I've started to carb count and seem to be settled on 12 units of Basal (Solus) and a ratio of 1 unit of bolus (Apidra) to every 10g carbs. I've lost around 1 1/2 stone since being diagnosed. I've just bought a new bike ( one without an engine for a change) and I intend to cycle regularly in addition to some light weight work and other cardio activities. I was wondering if anyone could provide advice as to how I should adjust my insulin intake prior and after exercise.

Kind regards
Steve

 

[copepod]

Quick response to guide you to www.runsweet.com which is a great resource for all aspects of exercise with type 1 diabetes, inckuding general principles, case studies of specific sports / activities/ However, bear in mind that you are probably experiencing honeymoon period , when your pancreas is still producing some insulin, but it will gradually cease to do so, probably irregularly.

 

[G2ADY]

Hi Copepod,

Thanks for the info, that is fantastic! You're right, I have been in the honeymoon period, My Basal is half what it was and my bolus/ carb ratio has reduced too. It seems to have been steady for the past couple of weeks but I'm aware that it may change again at some point. I just needed a starting point regarding the exercise and that website is excellent. Thanks again!

 

[SamJB]

Hi Steve,
Expect your insulin ratios, your carb sensitivity and you exercise sensitivity to fluctuate until your honeymoon period is over. So your insulin changes due to exercise might work today, but may need changing in a few weeks.

I've become fairly proficient in adjusting insulin to my exercise regime. First off, you must buy Gary Scheiner's Think Like a Pancreas. It contains loads of advice on how to adjust your insulin dose according to carbs, exercise, alcohol, illness, stress, weather etc. It's a must for anyone on insulin - I learned loads from it after nearly 10 years of injecting.

When you exercise, your muscle cells require more energy (I'm pointing out the obvious here, sorry!), to do this, more insulin receptors come to the muscle cell's surface. This means that they can absorb glucose from the bloodstream more efficiently. It also means that you need less insulin to maintain your BGs. If you've ever experienced a hypo after exercise, then this is why.

What this means is that you will probably require less insulin after you have exercised. You will need to make things nice and predictable, so that you know how much to drop your insulin by (or how much glucose you will need during exercise). I have found that after exercise, I will need to drop my fast-acting insulin for my next meal by 20%. I will not need to drop my fast-acting insulin dose for any subsequent meals. Importantly, I will also need to drop my basal by 20%, by around 2 days. After around two days, the insulin receptors that have come to the muscle cell's surface will retreat back into the cells, so my insulin efficiency will decrease and I will need more insulin.

Confusingly, some exercises will push your BGs up, particularly high intensity exercises. For example, when I do weights, my levels go up, but when I do cardio they drop.

Also, be careful when you exercise within a few hours of injecting fast-acting insulin as it can have a much more accelerated affect on your BGs.

The best advice I will give you, is keep things predictable, try to exercise with the same intensity, at the same time of day and at the same time after injecting fast-acting insulin. It's vital that you test before and after exercise and act accordingly. Also keep an eye on your basal by testing before bed and before breakfast.

Sorry for the essay!

 

[Auckland Canary]

One thing that is important to remember is that after heavy exercise your blood sugars can be affected for hours afterwards. I cycle quite long distances (32 miles round trip commutes and 50 mile pleasure rides) and you can see drops in your levels a long time afterwards.

This is particularly important to remember if you exercise in the evening as night time hypos can start and these are not good at all.

I also notice that my body reacts differently at different times of the day. in the morning I have to actually increase my insulin as my BS goes up whereas in the afternoon and evening it goes down. Sometimes it can be a case of trial and error. Good luck!

 

[noblehead]

Some excellent advice so far Steve, you may also find the following useful which was posted by Phoenix a few weeks back:

http://www.excarbs.com/basic-facts/

 

[G2ADY]

Guys!

Thanks so much for the info and in particular to Sam JB for the essay! I really appreciate all your input as being a total newbie I'm still experimenting. I'm keen to keep my BS tightly controlled but I've been a little nervous about hypos during or after exercise. Your advice is invaluable.

Best Wishes
Steve

 

[G2ADY]

Incidentally Sam, another member recommended the same book a few weeks ago when I was first diagnosed. I downloaded it to my Kindle but with the pressures of juggling, work, diabetes and Christmas I've only managed a couple of chapters up to now. It is a good read though.

 

[HazelD]

Incidentally Sam, another member recommended the same book a few weeks ago when I was first diagnosed. I downloaded it to my Kindle but with the pressures of juggling, work, diabetes and Christmas I've only managed a couple of chapters up to now. It is a good read though.

Hi Steve, I am not T1 but T2...good to see you! I was diagnosed last April... Hazel.

 

[G2ADY]

Hi Steve, I am not T1 but T2...good to see you! I was diagnosed last April... Hazel.

Hi Hazel, Good to see you too!

Oddly enough, when I was admitted to hospital I had BS of 31.7 and was originally diagnosed T2 for the first 48 hours. Tablets didn't seem to work and then when I was referred to the clinic they confirmed that I was T1.

 

[Miklo]

Hi All,

I newly diagnosed ( 6 weeks ago) as type1. I'm a male aged 45. I've started to carb count and seem to be settled on 12 units of Basal (Solus) and a ratio of 1 unit of bolus (Apidra) to every 10g carbs. I've lost around 1 1/2 stone since being diagnosed. I've just bought a new bike ( one without an engine for a change) and I intend to cycle regularly in addition to some light weight work and other cardio activities. I was wondering if anyone could provide advice as to how I should adjust my insulin intake prior and after exercise.

Kind regards
Steve

Hi Steve

Some excellent techicall advice given already and to add to that I would say on a practical basis firstly start off on a pretty easy flatish run generally cylcling does not use that much unless you push the gears or are hill climbing.

I commute on a Brompton into town to purchase odds and sodds from home bargains and fill a ruck sack and numerous other bags strapped around me on the way back. The total round trip is 10mile in busy traffic the way in easy and lower my dose by 2 units into the stomach after carrying the bike round town weighing 11kg and loading the shopping I consume a full bottle of lucozade sport and 3 digestives and on the way home I jump red lights and chase any cyclist thats ahead of me. I do this all year round and my readings are usually between 4 and 8 when I get home I should take my meter with me but I use Jedi methods and rely on experience but you should be ok if you start out slow and test and take your blood meter with you to test on the journey home if unsure warning signs when on a road for hypos is decision making if you notice it is impaired stop immeadiately and test and eat I say that with 35 years of cycling with Type 1. Always carry fast acting glucose and be carfull of traffic as there are some idiots out there get safety equipment and I recommend reading Richard Ballentines City Cycling.

 

[G2ADY]

Hi Steve

Some excellent techicall advice given already and to add to that I would say on a practical basis firstly start off on a pretty easy flatish run generally cylcling does not use that much unless you push the gears or are hill climbing.

I commute on a Brompton into town to purchase odds and sodds from home bargains and fill a ruck sack and numerous other bags strapped around me on the way back. The total round trip is 10mile in busy traffic the way in easy and lower my dose by 2 units into the stomach after carrying the bike round town weighing 11kg and loading the shopping I consume a full bottle of lucozade sport and 3 digestives and on the way home I jump red lights and chase any cyclist thats ahead of me. I do this all year round and my readings are usually between 4 and 8 when I get home I should take my meter with me but I use Jedi methods and rely on experience but you should be ok if you start out slow and test and take your blood meter with you to test on the journey home if unsure warning signs when on a road for hypos is decision making if you notice it is impaired stop immeadiately and test and eat I say that with 35 years of cycling with Type 1. Always carry fast acting glucose and be carfull of traffic as there are some idiots out there get safety equipment and I recommend reading Richard Ballentines City Cycling.

Great advice Mikio, especially the warning signs for a hypo, although I get decent signs now, I was wondering if they would be apparent when cycling. I'm liking that you rely on "The Force", that raised a smile I've gotten into the habit of always carrying glucose tablets. They're my security blanket I suppose.

Re the idiots, don't I know it! I'm a keen motorcyclist too so i've been exposed to some of the clowns out there, and to think, it's us Type 1s that have restricted licences!

Thanks for taking the time to reply

 

[Miklo]

Great advice Mikio, especially the warning signs for a hypo, although I get decent signs now, I was wondering if they would be apparent when cycling. I'm liking that you rely on "The Force", that raised a smile I've gotten into the habit of always carrying glucose tablets. They're my security blanket I suppose.

Re the idiots, don't I know it! I'm a keen motorcyclist too so i've been exposed to some of the clowns out there, and to think, it's us Type 1s that have restricted licences!

Thanks for taking the time to reply

Glad you like the advice when i was diagnosed at 17 in 1980 I purchased a Hondac50L then a Kawasaki AR80 and then a Suzuki GT250X7 of which I stil own today. I always remember on the c50 putting taking my foot of the footrest at the light and nearly falling over due to low blood sugar they never told me at the hospital about that sort of thing. Once diagnosed it was in hospital for 2 weeks and realeased straight into work in them days and a metal syringe was given to me which I stored in meths. I became an expert on the X7 with clip ons microns and k&n filters and never once had any trouble this is because commuting early in day and late in evening you are pretty stable. Jetted incorrectly once on my way to donnington to watch Barry Sheen racing trucks and seized piston in bore at approacing 100mph.

Yes always carry the tablets at all times as they do save the dat I have never passed out but came close out walking the dog years ago and realised into the walk I had forgot my biscuits and tablets I did make it back to a highway and went in a local shop and had to ask for something as I had no cash on me they thought I was a muggers and thats my nearest mistake.

Hope you intend to keep motorcyling I wished I had not stopped bur thats the wife wanting a car.

 

[G2ADY]

Glad you like the advice when i was diagnosed at 17 in 1980 I purchased a Hondac50L then a Kawasaki AR80 and then a Suzuki GT250X7 of which I stil own today. I always remember on the c50 putting taking my foot of the footrest at the light and nearly falling over due to low blood sugar they never told me at the hospital about that sort of thing. Once diagnosed it was in hospital for 2 weeks and realeased straight into work in them days and a metal syringe was given to me which I stored in meths. I became an expert on the X7 with clip ons microns and k&n filters and never once had any trouble this is because commuting early in day and late in evening you are pretty stable. Jetted incorrectly once on my way to donnington to watch Barry Sheen racing trucks and seized piston in bore at approacing 100mph.

Yes always carry the tablets at all times as they do save the dat I have never passed out but came close out walking the dog years ago and realised into the walk I had forgot my biscuits and tablets I did make it back to a highway and went in a local shop and had to ask for something as I had no cash on me they thought I was a muggers and thats my nearest mistake.

Hope you intend to keep motorcyling I wished I had not stopped bur thats the wife wanting a car.

Oooh some of those bikes bring back memories! I've heard about these old metal syringes at the clinic, I suppose I'm really lucky that medication has moved on so much from those days.

Re motorcycling, yeah I'm confident enough to keep riding although I'll perhaps sell one of the bikes, I have a new Vstrom and also a Bonnie but I'll perhaps sell the Bonnie. Filling in the DVLA form has knocked me a little. I realise they have to ensure that for our own sake and for the sake of others we're safe on the road but it does make you feel a bit victimised all the same.