Exercise, insulin adjustments and avoiding hypo/hyper

Hi @katmcd Next time you see your consultant, ask him what he would do to avoid hypos and to be able to exercise without having one ? Saying that he's not happy about the number of hypos you are having is not constructive or useful advice at all, he doesn't live with type 1, you do, so unless he can answer the above he shouldn't be saying this to you.

Sadly there is no golden rule to exercise and insulin management simply because we are all unique, our bodies use glucose at varying rates, I could do the same class as you, start with the same BG level and achieve a different outcome, simply because our physiology's are so different. I find I cope better with exercise if I have carbs on board and reduce my bolus by 50% prior to exercise, I prefer to remain above 6 mmol/l to 7 mmol/l before I start and keep jelly babies to hand if I start to dip, if I am doing more intense exercise then I have a small banana beforehand. Still there are times when I go low, but to be honest my attitude to exercise is to avoid going low at all costs, so if I am running high then I am not so bothered as I know I can correct and that very often in the 3-4 hours afterwards I am still burning glucose so can go lower then.

It's good to keep an exercise diary, so record what you did to manage you BG before, during and afterwards and use this each time you exercise to fine tune what works for you

Well I would guess that if you ate along with exercise small portions of long and short acting carbs .. and maybe ate really a lot of proteins before exercising, then maybe you can keep your blood glucose up and at the same time not too high...

here are some suggestions to help the problem in type 1 diabetes :
http://www.joslin.org/info/why_is_my_blood_glucose_sometimes_low_after_physical_activity.html

@katmcd To avoid lows, I start at a slightly higher number and then top up with glucose/carbs if and when needed. I reduce any bolus beforehand and also set a temp basal.

If you test frequently, you should be able to ward off actual hypos by acting early.

I think your consultant was being overly optimistic. I often wish a week of managing Type 1 on people who fail to appreciate the difficulties and think there's some magic formula that just works for everyone 100% of the time. We're humans not machines.

katmcd said:

I'm getting conflicting information from my diabetes team in relation to exercise. My DSN has suggested it's hit and miss whether I go hypo or not whilst the consultant says if the formula is right there is no reason I should ever go hypo. He mentioned a study looking at Type 1s cycling across the states where pretty much no one suffered a hypo due to their good management. He wasn't happy to see the number of times I was hypo in a week, which was mainly due to exercise and a basal dose being slightly too high (now lowered).

I've tried halving or omitting insulin the meal before I exercise. The result is my BG spikes (around 10 to 12) but I can still drop to under 4 at the end of my hour long exercise class. I've tried starchy carbs to see if they have a longer lasting effect but they don't seem to. I've tried omitting carbs at breakfast to the same effect.
I'm loathe to continually sip on sugar during exercise just to keep it elevated (I never used to before so I'm just not used to it and don't particularly like it) especially as it's not excessively prolonged exercise. I don't exercise to just need continual sugar.

Is there a way to exercise and avoid having elevated sugars before? It's not good for me. But if BG is lower, how on earth am I going to avoid a hypo situation without topping up with drinks (even just sips)? Or is this how I'll have to be now and just accept it?

I'm honeymooning, so my insulin needs are low at the moment compared to what they will be. But it also means things will be a bit more variable.

I am steadily working through think like a pancreas but wondered if anyone had any practical tips or advice which has helped them through a similar situation.

Thanks!
Kat x

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It's a tough one to answer, but your DSN is more correct (and realistic) in my opinion. As there are countless variables that can affect our BG rising and falling (illness, temperature, diet, mood, alcohol consumption, stress, etc) - it's very hard to find and apply that magic formula. The truth is, you'd need hundreds of different formulas for every given situation, accounting for every given variable. Impossible right?

What I do, is keep topping up with sports drinks and gels throughout the duration. I know my rough BG drop per half hour of various types of exercise, so I make sure to replace what I've lost with the relevant amount of carbs from my drink. It's no different to keeping hydrated by the way, which you should be doing anyhow, and it's not like your throwing fizzy drinks down your neck either - the carb based sports drinks are actually quite refreshing. Especially the High5 variety IMO.

The other alternative is to take less basal insulin. The problem with that though is that on MDI, chopping and changing basal doses to account for exercise frequency, quantity and intensity is almost impossible. This is where pumps truly come into their own however, you have the ability to change basal rates at an instance and also entirely suspend insulin delivery. Because I don't have a pump, and don't want the impossible task of changing my basal dose twice daily to suit - I'd rather drink some juice from my drinks bottle

With regards to that study by the way, I bet they were all using expensive CGM's to assist with their BG management. And I can almost guarantee, they would have had the assistance of a specialist team and also been topping up their BG with carb drinks/gels. So it's not like they're miracle diabetics, just seasoned diabetics and seasoned athletes with fancy tech to help And I wonder how many were pumping too; that makes a HUGE difference to management.

Hi @katmcd

It is frustrating trying to find the right balance between exercising, insulin and bg control, some time ago when doing a Google search I came across this website that was aimed at those who are insulin dependent:

http://www.excarbs.com/

There's also Runsweet which was set up for people who have type 1 diabetes and enjoy sport/exercise:

http://www.runsweet.com/

Just don't give-up or get disheartened, exercise is great and with a few tweaks I'm sure you'll get there. Good luck.

Hi

I do karate twice a week for 2 hours. On these days I have a late lunch @2pm with a couple of extra units of insulin (novorapid) I have 2 slices of toast at 430 with coffee (no insulin) and class at 630pm. When I come home I will have a slightly higher blood sugar but I will eat and have the normal insulin.

I was told to half my insulin at my meal before class but I was going hypo constantly.

The doctor is happy with this as there is still insulin working when I eat at 430 but has disappeared by the time I start class.
This means I don't have the exercise and insulin trying to push my bloods down then taking lucozade and feeling rubbish from the internal battle.

With aerobic exercise it will push your blood sugars up. Do not treat these highs as they should return to normal. Discovering this was a key feature in getting things mostly right.

We are all unique so what works for one won't necessarily work for another.

Good luck I hope you find what works for you.

I know it doesn't help you to hear me say but, I would like to say it makes me feel a whole lot better when I hear these stories so I don't worry that I'm not the only one having these problems! I've been diagnosed about a year and find exercising a mine field! I have been trying all this time to experiment and find the right balance, initially I was gaining weight rapidly as I was having to eat more before and after exercising. I do a lot of classes and my motivation was weight loss, the weight gain did stop (it was probably to do with putting false weight loss back on after diagnosis as well) and I have plateud. I have managed through highs and lows (no pun intended) to get some sort of plan for the classes. However, now my motivation has changed since I want to start running for further and longer. I think I am discovering (from reading lots of stories and posts on here) that longer steady cardio past about an hour or so will require me to top up glucose during the session with tablets or drinks perhaps. This initially made me disheartened as I thought non diabetics would not be doing this but it turns out most are, some friends who are seasoned long distance runners and cyclists regularly have to use glucose products- not to prevent hypos I know but to make their performance optimum and prevent them feeling really rough after! I mainly treat hypos with orange juice but I find this can cause a spike, also I seem to have a sudden drop after running and the juice isn't quick so glucose products seem better.

As I say I am so glad to hear about others stories to get my out of my lack lustre state, I am learning that no fitness journey is ever easy whether you are diabetic or not. Keeping the detailed fitness log and experimentation does help to get a plan but at my next appointment I am going to ask more about how my insulin actually works - beyond the description of it lasts four hours peaks at two.

The key to success is testing and not to give up and when you finally get it right the victory feeling is awesome

maria030660 said:

The key to success is testing and not to give up and when you finally get it right the victory feeling is awesome

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Thank you , I think you are right there is no quick fix. There isn't really with training anyway - diabetes or not.

For me the solution is plain store-bought grape sugar tab (or what you would call "dextrose"). It helps immediately when I feel low-ish, and doesn't increase my blood sugar as if I were to give less insulin for the meal prior to exercise OR eat more carb heavy prior exercise. Don't know why. We're all different. I find that the time it takes to eat a meal also influences my blood sugar. The longer I eat, the higher the results will be.

Forgot to add: when I exercise and start to feel like I'm losing energy, then I immediately pop a tab. No questions asked. That is because I make sure to do my exercise following the most nutritious meal of the day (lunch) that is completely sugar free, is rich of protein, fat and carbs and knowing that it will give me stability for hours to come. If I were to exercise at a time where I'm most unstable (morning), then I'd be hypo/hyper all over the place. Timing/nutrition/preparation and good safety treatment is key.

With this method, I avoid hypos during exercise and gain extra energy. Win-win situation. Just make sure you were to be stable during the time of exercise. As said above, there's no way (me personally) could exercise in the morning and get away with it. I'd become very sick. We're all different.

I exercise a lot (cycle to and from work and usually at least one gym session a day) and find timing my sessions in relation to meals makes a huge difference to whether I need to take on additional carbs. I don't eat at all before my morning cycle and gym session as the exercise actually increases my BS levels so I never get hypos from early morning exercise.
My afternoon gym sessions I aim to have about two-three hours after finishing lunch. If my BS is below 7 I will take a sugar boost but I have a pretty regular daytime diet so I can usually judge my insulin well enough not to need extra sugar. I don't like exercising just to take on more calories to avoid a hypo. Feels counter productive.

I keep my gym sessions fairly short, about 45 mins and instead double up with a morning and afternoon when I can. This also reduces hypo risk as I'm not going too hard for too long.

Appreciate not everyone has the flexibility in working hours I have, or a nearby gym, but this seems to be working for me.

I did my first longer run (for me) yesterday I was going for about 2 hours. I set off at lunch time as I'm trying to emulate an event I have next week. I did exactly what I didn't want to do - my friend had told me to eat something every mile (she uses jelly babies I had broken up a cereal bar). But I continually pushed this back until it was about 35 40 mins before I nibbled some cereal bar. I did first hour and felt smashing (i haven't gone past an hour before) checked my bg and it was 5.5 which is ok but I felt a bit weary and the arrow on the libre said falling fast - plus I now had another hour of running to go. So I has 2 lucozade tabs but after 10 mins it wasn't coming up so I ended up having 15g glucose juice a 25g glucose gel and walking back to the car a carton of oj. This was definaitely over kill I know but I was worried. I managed the run but the glucose surge made me feel ill really. Does anyone know -should I have eaten the jelly babies during the first hour or had more before setting off? My bg was steady during the first hour but the subsequent 30 mins seemed to make it go down so much.