Managing exercise and insulin

I train and compete in powerlifting, which is a strength sport based around squat, bench and deadlift.

My typical training week currently centres around 4 training days. Training takes 2.5 hours each time, and I start with my heavy worksets and then finish up with accessory work which can be skill work on a movement pattern or hypertrophy to build more muscle. Heavy, low-rep lifting causes my blood glucose to rise so I take extra insulin before training, as high blood sugars make me very sluggish. After that, the high-rep light work from technique and hypertrophy work make my blood glucose drop, in the same way cardio would so I need to take on about 15g carbs in the middle of training.

Competition days can be long, as I compete and also step in as a referee after I finish competing! I usually compete in the 56kg category (at 54.8kg weight last time) and my last competition, I hit a 85kg squat, 55kg bench and 115kg deadlift. My blood glucose normally runs a little higher on competition day due to nerves, but I am getting better at controlling it.

My best tip for diabetes and exercise - test frequently and don't be afraid to challenge yourself.

I used to play tennis, but had some issues with my coach also didnt have more time for it anyways so now I go everywhere with bicycle and thats my daily sports. It keeps my BG extremely in control, I would recommend it to anyone. )

I never called myself a runner when I could just run whenever I wanted, I was just someone who went running, however I have been saying "I was a runner" quite a bit. Totally a case of not realising what you have until it is gone. It wasn't really about fitness (though I was fit), it was about head space and getting some time to think. I used to do it to process ideas like "should I make this big financial commitment" or "should I move into that flat" or "I have type 1 diabetes and that is horrifying." So I basically can't do the thing that I usually would do in order to deal with the problem and I didn't really know I was using it like that.

I have tried to go running, I have not been able to do it without feeling really bad. Right now as I sit here I feel like I am just getting over a bout of flu as I have for weeks, and if I run I can only go at half speed and one quarter distance and the feeling gets worse until I get the shakes and have to stop.

If I can only run if I do a bunch of preparation and mental arithmetic and risk feeling bad, then I will just be thinking about those things all the time and it will defeat the purpose of doing it. Looking back I realise that the purpose of running was to be free of day to day cares and spend some time going over things in my head, and if I can't do that then frankly it is totally pointless.

To end on something useful if not positive, anyone who suspects they have this disease needs to see a doctor absolutely immediately because part of my problem is ketoacidosis which has completely torn up any level of fitness I had. Do not delay, I could have had it for WAY less time and been WAY less damaged by it.

I'm checking my levels lots and lots, definitely before I go running and afterward and yes when I start feeling low I am always low although "low" can mean high fours for me. Above 7 I start feeling sort of mainly okay, but obviously/apparently/presumably I shouldn't be above 7 under any circumstances.

Running does make my blood sugar drop incredibly quickly, I have seen 7.2 to 4.8 in under twenty minutes which basically tells me I can never really go for a proper run again because stopping every ten minutes to stick myself is just going to ruin it. On that basis I have determined that a reasonable treatment for morning highs is to run around the block but that's not really a "run" Presumably the fast drop is a combination of using the sugar up as fuel, and the running making the lantus work harder, but I'm not really sure.

If you work it out there's about 5 grams of actual glucose in the blood of an average person (around 100mg/dl ideally, roughly 5l of blood is 50dl, 100mg is 0.1g, 50*0.1 = 5g), at a bit less than 4 calories per gram is only about 20 calories, which you can burn through easily in a few minutes running. There's more in liver stores and so on but if I am going to spend the rest of my life on drugs which are designed to minimise the amount of glucose in my blood then I'm not sure how that is ever supposed to work.

Juicyj said:

A number of members have posted recently about sport and exercise and ways to manage blood glucose levels before/during/after the event, and as someone who rides a bike, swims regularly and since 2 months ago has started running twice a week (with the help of a libre sensor), i'd be keen to hear from others about what exercise you do, what achievements you've had, what tips you have for exercise/sport and just a general chat about how you manage it.

Personally I do it to stay well and fit as well as to challenge my t1 status and to prove that nothing can stop me from living a 'normal life, and each time I feel like slowing down or stopping I grit my teeth and keep going..

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Hi @Juicyj . . .

I recently read the book "Bright Spots and Landmines" by Adam Brown . . . this topic of adjusting Insulin doses to manage exercise is covered in detail. He does not offer a magic solution, of course, more like a series of pointers and hints to guide you on figuring out how to make appropriate and flexible adjustments for how your exercise regime is affecting you.

https://diatribe.org/bright-spots-and-landmines-now-available

Interesting to read that you exercise to prove that you can live a normal life with Diabetes . . . I am the other way around! I am extremely lazy and don't like to go to the gym or go out in the cold much. Adjusting my diet, rather than implementing an exercise regime, is what has enabled me to keep my life 'normal' and achieve mostly normal blood-sugar levels. We all need to find our way . I certainly recommend the book, it's nice to read something from a T1 Diabetic who knows the subject from the inside. The book will be useful for those trying to incorporate lots of exercise into their T1 routine.

Regards
Antony

I've only been diagnosed for about 8 weeks now and have found exercise the most challenging thing to sort out. Its not even 'big' exercise (like running or something really aerobic), but I have 2 horses and have found I have to be really careful otherwise the woozy head & shaky hands hits in the middle of a field. I had a feeling I was very sensitive to exercise as they treated me as a type 2 for a few weeks and my blood sugars would drop A LOT after hauling wheelbarrows around even though I didn't have any insulin on board.

The first week of taking insulin showed me pretty quickly that I needed to back off on the breakfast dosage otherwise I'd be hypo by 10am. I now rarely take any more than 1/2 unit with breakfast - I'd rather run high for an hour.

We've just come back from Spain and did a couple of walks of around 10km. After the first one led to me having a whole afternoon of not being able to get my numbers up above 5 (I'd hit 5 and then 30 mins later the shaking would start again), I decided that walk # 2 I'd just go in with high BG readings. It was 12 at the beginning of the walk and 6.1 by the time we stopped for lunch. It was a hot day and a hilly route, but it goes to show that any exercise is good for you even walking!

Circus that's basically my experience, any kind of serious exercise just makes you feel awful after a few minutes. It is really annoying to realise that it isn't even diabetes that is causing this, exactly the opposite, it's the TREATMENT for the diabetes which is causing this, not that we have any choice.

I usually take 0.5 to 1 unit with breakfast because I am trying to eat low (well no) carb and I have to admit some sort of carb content for the peppers and onions in a vegetable omelette or whatever it is. Probably half a unit is still too much but I would rather be low than high given the long term risks. Before running I have tried eating apples (14g each) and so on but either it isn't enough or it isn't fast enough. Sometimes if I am below 6 before bed I will eat a couple of crackers (5.3g each) and they go in far faster but I would be terrified of trying to do that as a way to fuel running because you'd end up at some scary number before you knew it.

It just doesn't seem like there's any way to have enough fuel on board to actually do a half hour run, without the drugs ruining it. That's probably about what I used to do, half an hour each way. The only backup plan I have is to just keep sipping glucose drinks as I go but that seems very easy to get wrong and end up damaging yourself. At the end of the day it feels like there are a lot of things you can in theory do with diabetes, you can eat big slices of chocolate cake and meals with chapatis and white rice and you can go running. While I wouldn't want to speak for anyone else, for me the risks of doing these things outweigh the reward. And I do not say that lightly.

Juicyj said:

I'm also tagging @Snapsy as she also is a keen runner with some good tips

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Oh bless you @Juicyj - keen but not doing well with it right now! I can only do 20 minutes at a time at the moment before my right leg wants to complain.....! Still, I'm FINALLY going back to running club tonight to run gently at the back. Fingers crossed.

Sorry to hear about your issues, @NoKindOfSusie - from what I gather it takes a good while to feel top-notch again after DKA, so do be kind to yourself.

Exercise makes me high in the short term, then low much later. If I run for 30 minutes rather than my (for the time being) 20 minutes running, 10 minutes limping/swearing, I do find I drop, so if I know I can keep going for half an hour I will turn my pump's basal rate down. Once I stop running, though, I find I go high, so will increase my basal rate for an hour or two afterwards. Six hours later though - BOOM - I'll drop like a stone, so to avoid this, and as I run in the mornings usually, I will halve my lunchtime insulin or turn my basal down at the 5-hour-post-exercise point.

If I weren't on a pump I would experiment with trying to find the 'right' amount of carbs - which relies on the hard hard work of trial and error. Pre-pump I used to swim having had a small bowl of porridge, timed and dosed for according to my fasting blood glucose. It took me many weeks to work it out. The maths - considering the variables - was pretty full on! I pump now, and I follow a lower carb eating style, and these days I swim before breakfast, and always have 0.5u - 0.75u insulin on board before I go to the pool, otherwise (as I have to take my pump off to swim) I would just climb and climb. As soon as I reconnect my pump I have 1.20u -1.70u insulin to cover my breakfast of two boiled eggs, which I then have when I get home. It's taken an awful lot of testing to work out what works for me, but I don't consume high carbs requiring high amounts of insulin, and if I'm running during the day or in the evening I will NOT have any bolus insulin on board, preferring instead to exercise before food. I rarely need to snack before exercising, but I always always test before and after running and swimming, and always have glucose tablets shoved down my sports bra. Preferably a full tube, so as not to rattle....

Hang on in there - test, test, test, and I hope you'll find your confidence will grow. Hugs!

Love Snapsy xxx

For what it's worth (which is nothing) I am not that keen on the whole pump thing, I've seen some very gory photos of what it can be like and personally I would prefer to remain "unmodified" if you see what I mean. People swear by them and that's fine but personally I am not keen.

One of the biggest questions I have about this is "feeling top notch." Except when I've been incredibly dangerously high I have not felt anything other than just lethargic and **** for weeks and it is just exhausting to feel bad for this long. People who think they know me well enough ask me "what's it feel like" and they mean "what does diabetes feel like." The answer right now is that it feels like being weak and sick but a few months ago my answer would have been that I assumed it didn't feel like anything because if your blood sugar is in the normal range you should feel entirely normal.

Is that actually right?

Should I ever expect to feel normal, like I felt normal in, say, June, when I still had a working pancreas?

I have read articles where people say you never feel quite right, you always feel a bit off, and if that's true that's going to be very hard to deal with. I should separate this from feeling totally nauseous and disgusted when I sit up in bed in the morning and see all the stuff lying there ready but that's just me being totally mental and I just need to get over it.

I am one of the people who has struggled and asked about diabetes and exercise over the past few days.
Love my pump although seems to be the reason for a little hiccup at the moment.
I've always exercised on and off for about 4 years. Gym based and was always a little run or uphill walk on the treadmill followed by a series of strength training exercises.
First the BG would come down slowly due to treadmill based exercise. Then would stay steady or raise slightly due to strength training. And I got that it was fine. After deciding I wanted to br able to run for a longer time I joined a couch to 5k class and this week have suffered with a lot on low bgs between 3.2-3.9.
I have assumed in the first instance it was the change of regime. I now think it was the pump. Anyway I'm waiting on a replacement.
I also joined a parkrun group. The thought of running alone scares me a little so the company is great. And I found another T1 diabetic on the group on the first week. This guy runs half marathons. So I know 20/30 minutes is possible it's just finding my possible. I too like to exercise in the morning on a reduced basal and no IOB.
And aside from the physical health benefits the mental benefits are great. Just that feeling of achieving something however small to others. 5k is my marathon. It just might take me a little longer than the 10 week programme to achieve it.
I did, but the first week manage to start my second session ( 5min warm walk, alternate walk/run 1 min, for 6 intervals and a 5 minute cool down walk) on a 6.4 mid session 6.2 end session 6.6. That was half basal 2 hours previous. And a banana with no bolus an hour before.
I do find legs feel heavier/sluggish at times. I should be doing the full 5k by December. I'll keep my profile updated on my achievements.

Juicyj said:

A number of members have posted recently about sport and exercise and ways to manage blood glucose levels before/during/after the event, and as someone who rides a bike, swims regularly and since 2 months ago has started running twice a week (with the help of a libre sensor), i'd be keen to hear from others about what exercise you do, what achievements you've had, what tips you have for exercise/sport and just a general chat about how you manage it.

Personally I do it to stay well and fit as well as to challenge my t1 status and to prove that nothing can stop me from living a 'normal life, and each time I feel like slowing down or stopping I grit my teeth and keep going..

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This is music to my ears. I'm hoping a libre will help me along. My DSN is loaning me one in a week or so to try as I've said I'd like to self fund. No NHS here at least for 6 months. I'm hoping this will enable me to attempt my couch to 5k sessions with more gusto.

Juicyj said:

Also to add that I do parkruns too @lely if you start to flag there’s always a friendly pat in the back and words of encouragement and the feeling of satisfaction at having completed it is huge - great way to start a Saturday morning

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I did attend my first Park run last sat as an extra go for the couch to 5k. Done exactly the same as I had it was brutal as ours is along a beach and a grassy verge. Completely different to track running and a little harsh on the knees. I was 111 th out of 112. But I completed it.
Can't make it tomorrow as I have a dress maker appointment for my daughters prom Dress. But I will be back next week and yes great support with the marshals.

I've just come back from an amazing diabetes and exercise weekend in Loughborough. I'm sure others will have been on it in the past but if you have a chance, look up the One Touch sports weekend (previously was Animas) and the #OTSW2017 on twitter.
It was an amazing 2 days of about 50 people withT1D, health professionals and speakers Dr Ian Gallan, Alistair Lumb and James Moran, mixing research findings, strategies for effective, safe exercise and opportunity to put the theory into practice. Not to mention a fantastic opportunity to network and meet new people, share the trials and tribulations of T1D and have some time just learning about what could work for you.
I hope it will be on next year again, as it was a wonderful chance to get the most up to date information on how to manage exercise. And it was suitable for those on pumps and MDI; for those who were life long T1D and the newly diagnosed.
And the social scene wasn't bad either!