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Erratic blood sugars since beginning diet?

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suzanasyayavuz

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Hiya, Suzan here, I have been a type 1 diabetic for about 8 years and havent always had the best track record with my blood sugars, but lately my body has been going completely nuts and I have no idea what to do about it! When I first became diabetic I gained 30 kilos in a year and was unable to lose that weight for the next few years to come. This year, I finally decided that I had had enough of feeling uncomfortable in my own body and began a diet - the combination of exercising a lot more and eating a lot less was very bad for my blood sugars. I use my meals to bring my blood sugars up enough to exercise, so I dont have an exact and consistent number of carbs I use before workouts - but I would estimate around 30-40 grams of carbs, but I have not been able to balance the timing or amount of these carbs so that I do not have either hypo's or hyper's. Coming back to university has been incredibly hard on my blood sugars - and the brain fog and mood swings that come with high blood sugar have not been easy. I have had a blood sugar above 25 mmol once every day for the past week (normally in the afternoon or after exercise). I just checked my blood sugar and it was a 28. I gave myself an appropriate correction that I suspect will lead to a hypo. If I had given less (as I have in the past) my blood sugar will remain high for the next few hours - which if it is above 25, is not ideal. This is incredibly worrying to me and I dont know how to approach it- I dont want to stop exercising completely, but this seems to be the biggest issue. My body's response to exercise and carbohydrates also seems to be constantly changing - an hour of running used to bring my blood sugars down about 15 mmol, but lately it hasnt been bringing them down at all. I am also constantly waking up with blood sugars around 2, which is incredibly scary and disorienting. Although my blood sugars are high in the afternoon, they are ALWAYS low in the evenings. I dont know what to do! All I know is that I am incredibly worried for my health, and am really suffering both bodily and mood wise. I am also very very very worried about my eyes. Does anyone know what is going on? I feel like going to the doctor wont be very helpful because they usually have about as much knowledge as google. Does anyone know the science or what I can do to prevent these hypers and hypo's! I feel like such a failure and my sugars seem to be completely out of my control!
 
I am sorry to read about your struggles.

I will start by saying I am not a doctor so what I am about to write is based on my experience and we are all different.

The first thing I would do would be to have a couple of days without exercise and, on the second day, do some basal testing to make sure I have my basal dose correct. There are a few threads around about this. But basically, we want to remove as much as possible that would change our BG such as food, alcohol, drugs, exercise, ... and check our basal is keeping our BG level. Typically, this is done for up to 8 hours at a time.
Once I was comfortable with my basal, I would move on to my bolus injections. Again, without exercise to change the BG.
(You may want to do this over a few days/weeks so you can exercise in between).

Now I am comfortable with my default insulin dose, I would move on to what I want to do with exercise.
For me, there are some things I try to do before I start exercising
- make sure my BG is at a good starting point. For me, this is around 7mmol/l. This is not too high to make me feel sluggish but gives me some leeway if/when my BG starts falling
- avoid having any insulin on board. My body becomes very efficient at using bolus insulin when I am exercising so my BG can plummet if I have insulin on board. So I try to avoid injecting 3 - 4 hours before exercising.

If I have these two points, I don't need to carb load before exercising. However, if I know am doing a tough work out, I will add some fruit squash to my water bottle to provide the carbs during exercise rather than before.
This takes a bit of trial and error but I find
- if my BG is too high to start with, it rises whilst exercising and fills my muscles with lead.
- if my BG Is too low, I hypo

After exercise, my BG can drop. Therefore, I often reduce my basal a little for the nest 24 hours.


Another couple of thoughts
- Hypos during and after exercise was the main justification for me to move from injections to pump. The ability to change my basal by the hour has greatly helped. Have you spoken to your doctor about a pump?
- When my BG gets high (for me this is over 15), I become insulin resistant and need extra insulin to bring it down. When my BG gets into the high teens, I need twice as much correction per mmol/l than I do when my BG is under 10. I can imagine I may need more than this if I get into the twenties. I understand insulin resistance is common with a high BG and may explain why you need the large doses to bring you down from the 25.
- University can be stressful. Trying to lose weight can be stressful. Watching your BG ride a daily rollercoaster can be stressful. And all this stress can make it even harder to manage your diabetes. If you can, find some time to unwind. It may help your levels.

Take care and look after yourself!
 

Hi, thank you so much for responding! I recently fell down the stairs and had to take 3 days off from running and found that my blood sugars were far more predictable and normal. I dont really know what or why my body is doing the things that it does! Thank you for your advice there are some good tips there, I will speak to my doctor about a pump. I definitely think you are right in that stress is a contributing factor, so I will contact my GP (although I do fear the criticism) and see where to go from there :////
 
Hi @suzanasyayavuz, just to add to @helensaramay 's excellent post above: and not as professional advice or opinion.
Some of us T1Ds react to exercise by A) our BSLs rising during and for sometime after exercising (probably the adrenaline causes this), B) others seem to have no particular change in their BSL and C) others have a drop in BSLs.
A)s like me tend not to need something to eat before exercise, B)s maybe if the exercise is prolonged and C)s will eat beforehand.
You will need to find out for yourself which type of response out of A), B), or C) you have. Test your BSL at the end of a bout of exercise for example.
I think most of us (at least what I have heard and read will tend to notice a fall in BSLs at the 6 hours mark and onwards as the exercised muscles, after repairing themselves, decide to refuel their glucose stores from the easiest source which is the blood stream. The increase in sensitivity of insulin caused by the exercise may last 24 hours. I reduce my basal insulin (I am a pumper, too) by 20 to 30 % depending on the type and length of exercise from the end of the exercise (as I need the insulin at normal or slightly higher levels to combat the BSL rise) to last til past the 6 hour mark. This is particularly important if that time is night/early morning as night time hypos are not fun!! And you say that you tend to be high in the afternoon ? after exercise and low in the evening (e.g. ? 6 hours later) and very low the next morning(insulin sensitivity increased)..
I do not exercise if my BSL at the proposed start of exercising is 13mmol/l or higher. As @helensaramay says, one's muscles feel sluggish and ache and the BSL rises - no benefit at all. (the liver releases sugar because the body at 14 mmol/l and higher is sensed as starving - at least that is the explanation I have been given).
Because I am an A), in terms of response to exercise, I have found that doing gentle exercise, perhaps building up speed a bit as I go - say walking, to quick walking , is much less likely to push my BSLs up. The various heart foundations talk about exercise 4 to 5 times per week of 30 minutes at least per time. Running whilst healthy for most may increase damage to some people's feet. I am not saying it is not good just that I found gentler exercise was better for me, weight and BSL-wise.
If you think your GP will be critical of you ask him or her to be part of the solution - how does he/she think you should manage your exercise? How much should you alter your insulin to deal with the evening and early morning lows?
Also exercise can increase appetite so one has to be careful not to negate all the benefits by eating more!!
And of course, hypos tend to cause adrenaline (and glucagon )release which puts the BSLs up and the correction dose drops them again (like a perpetual see-saw)!. So getting the adjustments right to prevent hypos from exercise lets you enjoy the process with less hassle!!
 
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