High blood sugars before running

Hopefully some of the type 1 runners will be along in a while with some advice.

I know @ElyDave takes regular carb snacks while running, and tests regularly.

You might want to check out some of the other threads in the exercise section of the forum, there is masses of info in older threads.

Lambey said:

Hi all,

I'm new to the forum and have just recently started running (six weeks now!). I'm a T1 diabetic, running 5k between 3 and 5 times a week and have also just started dosing my bolus by carb counting. I tend to run after work, which is usually three and half hours after lunch time and just inject the dose needed for my meal. However, I've found I am starting most runs with a BG of 13.5 or higher, but this always comes down to around 4 post run. Today it was 16.5 before my run and finished on 4.5 post run - I had to postpone taking my tea time injections until after I had eaten. Is it causing any harm for my sugar level to go this high and could I approach exercise in a better way? My BG consistently falls with running, even with a BG of 13.5 and eating an apple 15 minutes before running (35 min run), I will finish on 4 and possibly risk a hypo later on.

Any advice appreciated
Thanks

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Hi Lambey,
You seem to be experiencing a significant drop in BG more consistent with a drop caused by too much on- board insulin. It is pretty tricky trying to get a handle of BGs with exercise - particularly if you have recently changed your insulin regime (injecting to match for carbs will be much better - so great news!)

Hard to really to offer too much advice, but from the information you've given it suggests that firstly you haven't quite got your bolusing ratios right yet - 16.5 three and a half hours after eating is high. Secondly I wondered if perhaps your basal is a bit high? (which may account for the speedy fall)
Falling BGs does happen with exercise, but not as quickly as you are experiencing, and ordinarily for a 5k (30mins or so) you shouldn't really see much if any of a drop.

Really for a 5k, you want to set off at around the 6 mark, and stay pretty stable throughout and then reduce your bolus with your next meal (or snack if you're not going to be eating for a while) The trouble is that it can take quite a bit of experimentation to get to that point!

Have you considered joining the Sporty Diabetic Type 1's Facebook page and post the question? Most particularly to get a bit more input on the basal/bolusing side.
For more info about diabetes and exercise, and a link to the facebook group, visit http://www.teambloodglucose.com/TeamBG/Type_1_Basics.html

Ask for a pump. Exercise is so much easier and you wouldn't get these huge swings in levels. These swings especially having starting levels at 13+ is not good.

Cannot help with mdi. I garden and a lot of physical work but on a pump I have complete control, on mdi I never had such good levels.


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Bebo321 said:

Falling BGs does happen with exercise, but not as quickly as you are experiencing, and ordinarily for a 5k (30mins or so) you shouldn't really see much if any of a drop.

Really for a 5k, you want to set off at around the 6 mark, and stay pretty stable throughout and then reduce your bolus with your next meal (or snack if you're not going to be eating for a while) The trouble is that it can take quite a bit of experimentation to get to that point!

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Lambey, be careful. How fast or slow your levels fall (or rise) during exercise is dependant on so may different factors and varies from person to person.

Firstly, I was originally told to aim for higher levels by reducing my lunch time insulin as, like you, I like to run after work. However, this lead to high levels all afternoon and made me lethargic and not really wanting to run! I don't adjust at all now. I aim for normal levels and have a snack an hour before I run to boost my levels. Ideally, I want to be between 6 (absolute minimum if aerobic exercise - where levels will fall) and 8.

To keep your blood sugar levels from falling too much during exercise there are a couple of easy things to do. 1. Take on sugar during your run, jelly babies are ideal. 2. Before you start your run do some sprints as this anaerobic exercise will cause BG levels to rise.

Most importantly, test during exercise and see what's happening. It's a pain if you want to run your 5K non-stop but once you realise that, eg, a jelly baby every mile will keep your BG levels up enough you will know what to do. Trial and error.

Scardoc said:

Lambey, be careful. How fast or slow your levels fall (or rise) during exercise is dependant on so may different factors and varies from person to person.

Firstly, I was originally told to aim for higher levels by reducing my lunch time insulin as, like you, I like to run after work. However, this lead to high levels all afternoon and made me lethargic and not really wanting to run! I don't adjust at all now. I aim for normal levels and have a snack an hour before I run to boost my levels. Ideally, I want to be between 6 (absolute minimum if aerobic exercise - where levels will fall) and 8.

To keep your blood sugar levels from falling too much during exercise there are a couple of easy things to do. 1. Take on sugar during your run, jelly babies are ideal. 2. Before you start your run do some sprints as this anaerobic exercise will cause BG levels to rise.

Most importantly, test during exercise and see what's happening. It's a pain if you want to run your 5K non-stop but once you realise that, eg, a jelly baby every mile will keep your BG levels up enough you will know what to do. Trial and error.

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Hi Scardoc,

Absolutely right that blood glucose levels can rise with intense exercise. With regard to falling BG however, the mechanics of the body are pretty much the same for everybody with diabetes.
For somebody without diabetes, as soon as they begin exercising, their pancreas shuts off their insulin production. For anyone with diabetes who had circulating insulin, this obviously is not possible. This not only causes blood glucose levels to drop rapidly, low insulin levels are part of the feedback loop that trigger the liver to release glucose into the bloodstream - keeping BG levels topped up.
As I understand it, for the first 20mins or so into exercise, the body draws on it's on-board glycogen stores within the muscle cells - so really very little glucose needs to be drawn from the bloodstream. This is why I suggested that blood glucose levels should remain fairly level over a 5k run. Get the insulin regime right, and this does happen in practice (though it is obviously far easier to manage on a pump - after a lot of practice!)

Although it's obviously essential to stay safe, and have gels or sweets ready to treat falling bloods, I still think long term it would perhaps be better to keep the focus on insulin regime.

Lambey said:

THANK YOU ALL! Your advice has been really useful and is greatly appreciated. I've not been able to run since as I've strained my ankle on the last run. However, I took the advice of Bebo321 and scaled back my basal insulin this morning to 9 units instead of 12. I carb counted my meals and allowed a couple of units of insulin extra and maintained better BG level today: 5.8 before breakfast, 7.8 at lunch and 8.0 three and a half hours later. I had a yoghurt and a small biscuit before a 40 minute bike ride and finished on 4.3 and 5.6 by tea (after Kiwi fruit). I guess the real test will be when I run tomorrow! Just don't want any huge spikes and big drops. I do try to keep safe and never leave the house when exercising without testing kit and glucose tabs, so will continue to experiment. I've also started to keep a really detailed exercise log for when I get my new diabetic appointment (last one was cancelled), so I can show my consultant.
Thanks again!

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Wow Lambey, that's awesome!
I'm keeping my fingers crossed that you're going to get more manageable results for your run too.
Let us know how you get on.
If you like cycling why not try to get down to do a cycle ride around Box Hill on 6th July with TeamBG?
Free and open to all - and you may find it particularly useful to talk your experiences over with others. There will be a few mHealth tour seasoned riders there to offer advice and support.
http://www.teambloodglucose.com/TeamBG/Box_Hill_Cycle_Ride.html
Andy12345, RosieDred and I will be going - hope to see you there!

Lambey said:

Hi Bebo321,
I've been out for my run today with similar success! Started on 10.1 at breakfast (bit higher as I had a few beers last night) and had normal bolus but reduced basal to 9 again. Three hours later it was at 11.0 and I had an apple and biscuit and went out for my 5k. BG was 7.8 at half way point, had one glucose tab and finished on 6.5 (32m15 - getting better!). Think I will tweak this a little further for future runs with 1 unit more bolus for lower starting BG and one unit less basal to reduce drop.

I would have loved to come to the Box Hill cycle ride, but I've got a cricket match that day and hope to be scoring runs for the mighty Hope Hawks Ladies! Does team BG have any events in North Wales / Liverpool or Manchester way?

I've also figured out from what your advice the other day why my BG is so awful when I play cricket - I've been reducing my Bolus, but the nature of the game wth lots of shorts sprints means my blood sugar climbs and not falls. I'll take normal dose with lunch before I play. Hopefully with a little bit of experiementation I will get better control when exercising - at least I'm not reducing the wrong insulin now!

Thanks again.

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Well done you! I am chuffed to bits!
Yep, I'm with you on your suggested modification for the next run. Way to go!

Shame you can't come and join us on the 6th - it should be a bit of a laugh. Loving the cricket though! Again it sounds as though you've got the measure of how to manage your BGs. Just remember that because your liver has been working hard giving you extra energy, you will need to be mindful to watch for dropping BGs after the game as your liver (and muscles) re-stock their stores.

TeamBG are currently putting together a program of events - which will include parkruns that will cover the whole of the UK. I just takes time to get the support in place from the pharmas etc to ensure that we can make our presence felt and help as many people as possible wherever we go.

Keep checking back on the teambg website, and keep us posted with progress.
You rock!

Bebo321 said:

Hi Lambey,
snip...
Secondly I wondered if perhaps your basal is a bit high? (which may account for the speedy fall)
Falling BGs does happen with exercise, but not as quickly as you are experiencing, and ordinarily for a 5k (30mins or so) you shouldn't really see much if any of a drop.

Really for a 5k, you want to set off at around the 6 mark, and stay pretty stable throughout and then reduce your bolus with your next meal
...snip

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I would really have to disagree with this. By much experimentation, I think basal should have absolutely no impact on a 5k run, which for me is going to be 25min at a staedy pace, nearer 19 at max effort. Previous bolus has a massive effect, even as late as 4-5 hours afterwards for an aerobic effort where I could easily see a drop from 6 to <4 in that period.

If running a hard effort, where i am definitely going anaerobic towards the end, I may see a slight rise, followed by a drop.

5k is nowhere near the kind of effort that should need a reduced bolus at the next meal, in my opinion

for me today, morning 10k before breakfast (6am), so no bolus at at all, and delayed by basal by 45 minutes till after the run.

Pre 5.3
5km 4.9
Post 5.2

Within the meter tolerance, no change at all.

Should have reduced the breakfast basal though as a combination of previous exercise and then walking aorund town shopping resulted in a 2.7 hypo, first that low for a while. Good hypo awareness though, but it came on bloody quick.

So far fasted running is working, buut need to watch the insulin afterwards.

Don't agree at all with altering basal... Sorry if you ate bolusing pre a run.. Then its ur bolus that needs to be changed and ideally the time of food pre run as well so that peaks are not whikst u r running...


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donnellysdogs said:

Don't agree at all with altering basal... Sorry if you ate bolusing pre a run.. Then its ur bolus that needs to be changed and ideally the time of food pre run as well so that peaks are not whikst u r running...


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Don't entirely agree

Although there's no need to be altering basal for shorter stuff, if you're going longer than about 90 mins then I think a basal reduction is required.

How much is an individual choice, but for me, I take it down by about 2/3 and have minimum bolus as well.

I'm looking forward to working it all out again on a pump

Depends on how long after the breakfast bolus is given to when drops occur.... I would agree that depending on timings that basal may have to be adjusted but it depends on the timing of both injections really...


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T

ElyDave said:

Don't entirely agree

Although there's no need to be altering basal for shorter stuff, if you're going longer than about 90 mins then I think a basal reduction is required.

How much is an individual choice, but for me, I take it down by about 2/3 and have minimum bolus as well.

I'm looking forward to working it all out again on a pump

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Thanks for that ElyDave,
Appreciate your experience on this.
The reason why I suggested it may be connected to basal in this instance is that @Lambey saw such a significant drop. To drop from the 16 mark to around 4 in around 30mins of running three and a half hours after the last bolus - hmmmm. Seemed a pretty sensible suggestion - particularly if the insulin regime was recently changed.
Ordinarily I totally agree that a basal reduction wouldn't be required for such a short period of exercise, in this instance it suggests to me that the starting basal regime may need looking at though. So far a bit of a reduction in basal appears to have helped - but you make a very sensible suggestion to generally focus around bolus adjustment over fiddling with basal for these 30min or so runs. As someone who has been able to get their insulin management so tightly controlled, I am sure Lambey will take note of your words of wisdom.

Thanks also for your comment about the effects of bolus lasting for up to 5hrs too - I was aware it could still have some impact up to fours hours later, but not longer.

Hope your running is going well! Hubby is doing the half Ironman on Exmoor tomorrow. Great weather for it!
Sun cream on for us spectators me thinks!

I'm still honeymooing (the joy, I wish it would just stop) so my regime might be an exception.

I don't adjust my insulin at all for running. I do between 20-30k per week. Typically if I do a 5k run, and my bloods are in the 4-7 range I'll have 30-35g of quick acting carbs immediately before my run (or slow acting carbs an hour before if I have time). My 5k runs are always 20m-25m. I don't need any carbs during my run, and my levels normally return to between 4-7 afterwards.

For longer runs - I'll normally need to eat a cheeky Jelly Baby (approx 5g carbs) every kilometer or so to keep my blood sugar levels up.

I did a half marathon in training last month, and needed 3 packs of wine gums to cover the 21km, and a bottle of Lucozade Sport during the run. My bloods immediately after the run were 5.6.

If my bloods are higher than 7 before the run, I'll reduce my usual dose of pre run carbs.

Post run - my bloods sometimes go up, sometimes down. I'm well prepared for drops below 4, so just handle them as and when they happen.

For me, the key thing is keeping my blood sugar levels up during the run. Jelly Babies and Wine Gums seem to do the trick. Although if anyone has any better suggestions - I'd love to hear them

I personally run 3K every other day and usually start with higher readings to stay safe, sometimes higher than you and after the run they can be down to normal 4-8mmol. I dont see this to being a problem. It depends if you may continue to drop or weather you continue to do more exercises.

Lambey said:

Hi all

Not been on here for a bit. I've now been to see my diabetic nurse and have discussed the issues I seem to have when running. I'm still having tp push my BG up quite a bit before running and still experience the big drops. My nurse has suggested I think about using an insulin pump as this would help give me greater control with my active lifestyle and then I wouldn't be as restricted by what dose I had took four hours ago. Also as I run every other day and am not getting my bolus quite right for exercise, this has had an impact on my BG readings and no doubt my HBA1C. Has anyone recently made the change to a pump and would they recommend it for someone who exercises regularly?

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Hi Lambey,
Absolutely - if you have the opportunity to have a pump then I would suggest you try it. Most people I know who exercise regularly are on a pump and wouldn't go back. As you say, the control that you have is far better and long term you want exercise to benefit your health, not be the cause of erratic BGs.