Exercise and bolus

[Snazeh]

Recently diagnosed type one here (mid december) 23 years old, obviously there’s so much to take in and I have a fair few questions, but the one thing I can’t wrap my head around is bolus injections post exercise, last Thursday I played football for around 110 mins, (I tested my blood essentially every hour upon starting football (4:30pm) and until about 11am the next day) I’ll post my BG results below;
8.2 430pm - started playing football

3.9 6pm - ate nature valley bar

5.3 639pm - finished football

3.6 735 - ate steak beans and new potatoes (check carbs&cals app) didn’t take any insulin with meal...

11.2 839pm

10.5 938pm

10.2 1026pm

5.9 1251am

4.8 0308am - ate 5 jelly babies

4.9 1110am

my main questions is, is it okay that I didn’t bother taking any bolus insulin with my 7:35pm meal? The reason I did this was because I knew for a fact my BG was gonna just keep dropping so thought to myself it’s pointless to take any when my body is gonna drop in sugar levels naturally due to the exercise.. hopefully someone can point me in the right direction, and I’m so sorry for the long a** post, thankyou in advance!


** I should add, I do also take basal levemir, 18 units a day at 8am/pm

 

[kaylz91]

As your so newly diagnosed it is highly possible you are still producing some of your own insulin, one day you may find you need to bolus even after exercise but if you don't at the moment then that's perfectly fine, as you are on 2 doses of basal you may find you need less at one point, many find the AM dose needs to be higher than the PM dose, as I'm on a different basal that's only taken once a day and extra long acting it isn't very flexible in regards to doing more exercise one day so I combat that by reducing my bolus doses for up to 24 hours later, things change all the time in regards to diabetes so nobody will ever be perfect xx

 

[Snazeh]

Thankyou! Was just worried I might be doing something dangerous by not taking my mealtime insulin, cheers for clarifying! Didn’t even know this forum existed, learning so much more than the doctors have told me already and only been on here about a hour! Thanks again

 

[KK123]

Recently diagnosed type one here (mid december) 23 years old, obviously there’s so much to take in and I have a fair few questions, but the one thing I can’t wrap my head around is bolus injections post exercise, last Thursday I played football for around 110 mins, (I tested my blood essentially every hour upon starting football (4:30pm) and until about 11am the next day) I’ll post my BG results below;
8.2 430pm - started playing football

3.9 6pm - ate nature valley bar

5.3 639pm - finished football

3.6 735 - ate steak beans and new potatoes (check carbs&cals app) didn’t take any insulin with meal...

11.2 839pm

10.5 938pm

10.2 1026pm

5.9 1251am

4.8 0308am - ate 5 jelly babies

4.9 1110am

my main questions is, is it okay that I didn’t bother taking any bolus insulin with my 7:35pm meal? The reason I did this was because I knew for a fact my BG was gonna just keep dropping so thought to myself it’s pointless to take any when my body is gonna drop in sugar levels naturally due to the exercise.. hopefully someone can point me in the right direction, and I’m so sorry for the long a** post, thankyou in advance!


** I should add, I do also take basal levemir, 18 units a day at 8am/pm

Hi there, it's different for everyone BUT...it seems like you left out your FOOD bolus because you anticipated going low later on. That isn't necessarily the best thing because your meal requires bolus insulin to combat the food you ate at 7.30pm regardless of your exercise. The bolus would most likely have run out after 4/5 hours so by 1230am ish it most likely would not have made you go low but your earlier exercise might well have done. Generally speaking, take your insulin when you eat (maybe try a unit or 2 less if you are worried about going low because you've exercised) or you will spike, as you did.

The general rule of thumb is to take action BEFORE you exercise, so you might try having less basal at 8am to counteract the future exercise and anticipated later lows. I exercise a fair amount too and it really is trial and error, you will find what works for you. Test, test, test as you did but I find that I generally do not alter my insulin with food unless I am really low just before that food. x

 

[EllieM]

Welcome to the forums.

It sounds to me that you managed the situation very well.

Exercise can be tricky for T1s to manage - stress can put blood sugar levels up, so sometimes you need more insulin instead of less if you are doing very intense exercise. (Stress hormones put up bg levels and are also released during hypoglycemia, so if I feel "shaky"during an intense workout session it can be because
1) I'm just really tired
2) I'm hypo and need glucose
3) my blood sugar is going up because of stress hormones and I need insulin
No way to differentiate without doing a blood test)

As @kaylz91 said, there are a number of factors affecting your insulin needs during exercise, including your own body's possible insulin production during the honeymoon period, so really you just have to experiment and see what works for you. Long term (in a year or so?), you may find it easier to go on an insulin pump, because then you can alter your basal insulin levels immediately rather than being stuck with levels that are too high for a while after/during exercise.

T1 diabetes is one of the few diseases where the sufferer actually has much more control than the doctor - you get to learn your own body's reaction to food, exercise, insulin and though the doctors can give you advice they don't have time to give you all the information that you need and most of that information is obtained by observing your own body's individual reactions over weeks, months, years.

Good luck, 49 years T1 here and I'm still learning.

 

[Snazeh]

Hi there, it's different for everyone BUT...it seems like you left out your FOOD bolus because you anticipated going low later on. That isn't necessarily the best thing because your meal requires bolus insulin to combat the food you ate at 7.30pm regardless of your exercise. The bolus would most likely have run out after 4/5 hours so by 1230am ish it most likely would not have made you go low but your earlier exercise might well have done. Generally speaking, take your insulin when you eat (maybe try a unit or 2 less if you are worried about going low because you've exercised) or you will spike, as you did.

The general rule of thumb is to take action BEFORE you exercise, so you might try having less basal at 8am to counteract the future exercise and anticipated later lows. I exercise a fair amount too and it really is trial and error, you will find what works for you. Test, test, test as you did but I find that I generally do not alter my insulin with food unless I am really low just before that food. x

So based on what you’re saying, the fact my BG spiked from 3.6mmol to 11.2mmol and my correction dose seems to be around 1unit per 2mmol, I should have taken maybe 3 units of novorapid with my food? So instead of it spiking to 11.2, technically it would have stayed around 5mmol with the bolus added? Or am I getting the wrong end of the stick

 

[Antje77]

my main questions is, is it okay that I didn’t bother taking any bolus insulin with my 7:35pm meal? The reason I did this was because I knew for a fact my BG was gonna just keep dropping so thought to myself it’s pointless to take any when my body is gonna drop in sugar levels naturally due to the exercise.. hopefully someone can point me in the right direction

Sounds like you're well on your way in finding the right direction yourself!
Food without bolus is fine as long as you don't go too high. Sometimes regular food is simply hypo treatment or prevention, like the 5 jelly babies you ate when at 4.8. (secret tip: When dropping but still above hypo levels, like you were, I see it as a perfect excuse to eat fruit. When already hypo there's no time for that, but I love fruit and find it hard to dose for. If you like jelly babies better, by all means keep eating them!)

So based on what you’re saying, the fact my BG spiked from 3.6mmol to 11.2mmol and my correction dose seems to be around 1unit per 2mmol, I should have taken maybe 3 units of novorapid with my food? So instead of it spiking to 11.2, technically it would have stayed around 5mmol with the bolus added? Or am I getting the wrong end of the stick

Maybe that would've kept you lower than 11.2, and maybe that would've sent you hypo a couple of hours later.
From the numbers you quote you were so close to a perfectly managed diabetes day that the finetuning will be highly personal and by trial and error.
The only thing I can find in those numbers is that you may want to test at an hour in the game instead of at one and a half, and that you should be on the watch for hypo's directly after training.

May I ask what bolus insulin you are on? If you plan to interact on this forum more often, you may want to fill out your profile with type of diabetes and insulins you use to prevent mistakes.

Really, I can only say good thinking and very well done, keep it up (or down )!

 

[Snazeh]

Sounds like you're well on your way in finding the right direction yourself!
Food without bolus is fine as long as you don't go too high. Sometimes regular food is simply hypo treatment or prevention, like the 5 jelly babies you ate when at 4.8. (secret tip: When dropping but still above hypo levels, like you were, I see it as a perfect excuse to eat fruit. When already hypo there's no time for that, but I love fruit and find it hard to dose for. If you like jelly babies better, by all means keep eating them!)

Maybe that would've kept you lower than 11.2, and maybe that would've sent you hypo a couple of hours later.
From the numbers you quote you were so close to a perfectly managed diabetes day that the finetuning will be highly personal and by trial and error.
The only thing I can find in those numbers is that you may want to test at an hour in the game instead of at one and a half, and that you should be on the watch for hypo's directly after training.

May I ask what bolus insulin you are on? If you plan to interact on this forum more often, you may want to fill out your profile with type of diabetes and insulins you use to prevent mistakes.

Really, I can only say good thinking and very well done, keep it up (or down )!

So I guess maybe if after a game, I have my food with no insulin, just have less food so I don’t risk going too high?

Yeah I was thinking planning on testing every hour, just mis-timed it unfortunately! I’m currently on levemir (basal) and novorapid (bolus) I shall update my profile now, thanks for the reminder!

Honestly thankyou everyone for even chiming in, nice to hear from people who can offer help or even their own opinions!

 

[Antje77]

So I guess maybe if after a game, I have my food with no insulin, just have less food so I don’t risk going too high?

I wouldn't by any means have less food, and I'm not even sure you should do anything different than you did today, many old timers would be over the moon with your numbers!

If you want to change things next time, you have different options, they're all good: Leave it as it is (but try to prevent to go below 4), inject a small amount of insulin like you suggested and see what happens (I'm quite fond of 'see what happens' in all cases, it tells you what to do or not do next time you try), eat less carbs like you suggested, but by all means, if you do, eat more of the other stuff, you don't want to be hungry!

No-one on this forum will ever advise you on if and how to dose your insulin, we can tell how we tackle certain issues, but no-one will tell you what to do, that's between you and your HCP.

There's a little bit of information that is very relevant in your opening post that's missing:

8.2 430pm - started playing football

You don't say what kind of 8.2 you started out with. Please note to yourself (not to me, it's your diabetes, not mine, and I don't play footbal anyway!) how long before you've eaten and how much active insulin is still in your system. It can make a big difference to what happens during and after training.

Honestly thankyou everyone for even chiming in, nice to hear from people who can offer help or even their own opinions!

Sounds like you're one of those people who want to take in and try out as much as they can in as short a time as possible. Perfectly fine, but take a step down if you feel it starts to overwhelm you. It's a marathon, not a sprint, and you'll have your whole life to learn, unless they find a cure.

For now, as you're on NovoRapid and eager to learn, you might want to read up on pre-bolusing. Don't go overboard with your experimenting though, we don't want to read about you ending up in hospital with a bad hypo.