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Managing exercise and insulin


I could have written your post today! I seem to spend most of my life with a slightly woozy feeling since diagnosis. It doesn't seem to matter whether my BG is in the normal spectrum or out of it (apart from hypos - that's shaky instead of woozy!). About 30 mins after injecting I feel peak woozy.

Plus I think my pancreas has decided to wake up again and join the party. I've knocked my insulin dosage right back because otherwise I was having hypos even after a mocha and a bacon sandwich! Riding my horse and feeling the shakes come on was very unpleasant .

Ho hum - got my first appointment with the consultant this week. I'm armed with questions!!
 
Wow, I did this 18 months ago and it was a FABULOUS weekend (apart from severe bruising between my ribs from a fall in the hotel room shower onto the side of the bath, so the second day's exercise was a challenge - and I wasn't even drunk or hungover when I fell..........!).

I digress. Sorry. A wonderful weekend which gave me the confidence to start exercising for the first time ever, pretty much! I'd recommend it to ANYONE with type 1!

 
Juicyj said:
Hi @katmcd your weekend sounds great was Roddy Riddle a famous t1 ultra marathon runner speaking there ?

Any tips you would like to share too ?
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Roddy Riddle was there. His before dinner presentation was phenomenal and is a wonderful example of what you can achieve if you put your mind to it but also that saying no is the best thing for you sometimes. Although now he has applied to go on Bear Grylls Island show.

There was so much good information, some might find it obvious but I thought it was really valuable. Twitter has some slides on from various people taking pictures which probably explain things better.

There was a way of managing BGs during exercise with carb quantities depending on CGM/Libre arrow direction.

That raising a BG before exercise (even to 30!!) wouldn't necessarily prevent you going hypo after 1 hour exercise due to the amount of glucose actually in the blood actually being quite small.

Drip feeding carbs during exercise is better than having it all at the start.

Resistance then aerobic exercise dropped BG less than the other way around so if you start high do aerobic then resistance. If normal or low then do the resistance then aerobic.

I'm on MDI but pump advice was that, in adults, suspend 60 min before exercise and overnight reduce the basal rate.

Don't have the pump off for more than an hour. If this happens a lot (say because of swimming) may have to consider a small amount of basal injection to cover you because euglycaemic DKA (ketoacidosis in presence of 'normal' BGs) is a thing.

Sometimes just going back to basics is the best thing. Forget the adjustments and tweaks. Just exercise, test and see how your body reacts. Then you have a fresh starting point to make a change from. Dr Gallan says we are our own diabetes detectives. I agree.

And most importantly, don't best yourself up if it doesn't go to plan. Figure out what went wrong and think of ways not to let it happen again. Baby steps is key.
 
It was wonderful. In a way I feel so privileged to have been able to go on this so soon after diagnosis. Some people have waited their whole life before now to get this information to help them exercise smartly and safely, and I've managed to cram in so much information and support into my first year.
I'm not going to say the spinning and then running immediately after was a fantastic experience but it brought us all together!
So yes, if anyone is thirsty for knowledge on exercise and T1D, wants to meet people, make friends and have a whole weekend focused on you then this is the course to go on!
 
Fabulous post @katmcd

It is definitely about being your own detective and learning about your own bodies capabilities and how to manage exercise. On Saturday I went out for 5km, but had raised Bg levels so started out at 15mmol/l, I still put a 30% basal pattern on but I found running so much harder as my legs felt weaker and my breathing was much harder so in some respects was pushing myself harder, within 10 minutes of finishing my Bg levels were back down to 6.5 and an hour later I was at 5.2. In future I wouldn't start so high as I was tough, my ideal start is around 7.5-9, with a temp basal pattern and a snack to finish, it's always about trial and error.
 
So when I read those slides above I realise why I could ride my horse well when I was sick, but I'm struggling now I've got insulin on board. When I was diagnosed my BG levels were usually over 25, only falling to high teens after exercise (I had a week where they treated me as type 2, so I got to measure the high points before the A&E admission).

Since diagnosis I tend to start at what I would consider an upper end of around 8. After 10 mins or so of the more aerobic exercise I am absolutely exhausted. I've been blaming my fitness levels (although having ridden consistently for 40 odd years, it did seem odd that fitness would fall off after just 2 weeks), but now I think I just don't have enough juice on board. I'm regularly getting into work and needing chocolate to stop the hypo I can feel approaching.

The dietitian did suggest a smoothie to me, but I thought that seemed like a lot of sugar at the time. I need to have a think about how to manage this.......
 
Hi @Circuspony - I have found that I need carbs before I exercise with quick acting to cover the carbs eaten, it's getting glycogen into the muscles so there's enough energy. I went out 2 weeks ago for a 5km run when my levels were at 14mmol/l thinking great i've got enough glucose on board to do this, wrong, I was out of breath, breathing hard and muscles were tired no energy, it was the hardest 5km yet, then this Sunday I went out for another BG levels were at 8.2mmol/l and I flew round it, breathing was easy and muscles were working hard, it's amazing the difference, however last Sunday I needed carbs afterwards to stop me going low - but otherwise levels stayed steady throughout.

It's about eating the right carbs, and for me that's having a couple of slices of brown bread first.
 
Interesting to hear peoples experiences with running... I'm currently training for a half marathon in March (Bath!).
I managed ok when I was running for half an hour but with longer distances have been struggling to keep my blood sugar up. Once it's going down its very hard to stop it going low, it drops faster than the carbs can be absorbed. I guess practice makes perfect!

katmcd said:
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Interesting stuff! Those strategies are really helpful. Would love to more about managing carb intake depending on Libre arrow, if you can remember any more about it?
 
Mathematics time. I have no idea if this is right, any ideas gratefully received...

The average human has about five litres of blood.

Assuming he or she was at a reasonably high level of 8mmol/l, the blood of an average human therefore has roughly 40 millimoles of glucose which is 0.04 moles.

One mole of glucose weighs 180 grams, 180 multiplied by 0.04 is 7.2, so the blood would contain 7.2 grams of glucose.

Various places state that glucose contains a bit less than 4 kilocalories per gram of energy. So, very roughly, for every 1 mmol/l of increase in blood sugar, you get... three and a bit kcal of energy.

Which is next to nothing.

Which is why having higher blood sugar before doing exercise doesn't really help.

Does that sound right?
 
Hi @NoKindOfSusie - It depends what you mean by high ? What level do you consider to be high ?

My primary goal in exercising is to avoid going low - so whether that means starting at 7-9mmol/l and having a a small carby snack to get me going, it's to work out how I can exercise for XXX time and not go low. Runsweet.com gives some good advice about safe exercise with diabetes:

Metabolic Control Before Exercise
• Start exercise blood glucose levels should be between 7-12mM (120-210mg/dl).
• Consider ingesting extra carbohydrate at the start if levels are <7.
• For levels >12mM without ketosis delay glucose replacement during exercise until glucose has fallen.
• Avoid exercise if ketosis is present.
Blood Glucose Monitoring Before, During and After Exercise
• Measure blood glucose before, every 30minutes during and at the end of exercise.
• Identify when changes in insulin or food intake are necessary, where possible sudden unaccustomed changes should be avoided e.g. if a reduction in insulin is thought to be required trial a 20% reduction insulin first don’t jump straight to a 75% reduction.
• Learn the glycaemic response to different exercise conditions
Food Intake
• Consume additional carbohydrate as needed to avoid hypoglycaemia. As a general guide for moderate intensity endurance activities high glycaemic index carbohydrate should be consumed after 20minutes of exercise at a rate of up to approximately 1g/kg/hr. Lower intensity activities or intermittent high intensity activities are likely to require smaller rates of carbohydrate supplementation.
• Carbohydrate-based foods with a high glycaemic index should be readily available during and after exercise.
• Adequate hydration is essential.
General Safety
• Where possible avoid exercising alone and alert others to potential signs of hypoglycaemia.
• Extra care should be taken when exercising after a recent hypoglycaemic episode as risk of hypoglycaemia during exercise is increased.
 
All credit to Ian Gallan,Alistair Lumb and James Moran for the slides (from the OneTouch Diabetes Sports Weekend 2017).
Found the slide on treating according to CGM arrow direction which also included Libre. Also the thought behind splitting your 1g/kg/hr carb into little and often rather than all at the start for a more steady BG rather than a peak and sudden drop.
 

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I cycle reguraly to college. So this is bassically what i do:
Wake up at 7am
7.10- have breakfast and do my stuff
7.15- Sort my college stuff out
7.55- Get ready to cycle
8- Cycle to college
8.30- Lock bike up
8.35- Go inside check my blood
9am- Do college day
(On mon & tues i finish at 3.30pm so since it hadn't been 3 hours since lunch i don't test in when i cycle home i just test when i get home. on weds when i finsh at 4.15. I test in the break we have around 3pm. (and then cycle home at 4.15) It's only takes 30 mins to cycle to college and back for me.)
At weekends because i cycle a lot i'm trying to work on climbing up hills which is one of my weaknesses. The main thing with trying a new exersize/sport is to be confident which helps if you have the right protective equipment on e.g helmet if you cycle a lot and if you feel low just stop what your doing and you can just continue it after your better because e.g If you cycling. If you become low it's best to stop what your doing and conitue later without putting yourself or/and other road users at risk because if you kept cycling when you were low you could loose concetration and cause an accident and then you would probably be at fault for the accident (most likely). Kinda like how people shouldn't drink and drive/ride/cycle as alchohol also makes you loose contratration.So people shouldn't cycle when they have low blood sugar. It doesn't mean your missing out you can always go back afterwads or try again another day. Also when our levels are at the normal range that's when we do our best.
 
Hi, I'm new here, I've had T1 since the early 80s, I managed to play amateur rugby & football back then but wouldn't have dared swim for fear of hypo, I could always seem to keep going at the sport but would often throw a sickie on a Monday due to high's & lows. These days I swim (safely) 3 or 4 times a week by raising my blood glucose to 12-14 and by swimming 1500m (breaststroke) in around 35 - 40mins I usually get out to find my blood's dropped to 6-8, sometimes I'll hypo but feel a weakening of my arms or cramp, the time of day & where I am on my Lantus & Humalog can affect this, the odd time my blood sugar will raise, which is annoying but that's life.
I also weight train, and aim for 4 sessions a week, I weigh 80kg but at 50 years old doubt I'll put any weight on, and by swimming I kind of make sure I won't.
I'd hoped to get a libre on prescription but it appears our CCG aren't funding them, but I doubt one would survive very long on my arm....

Edit: For management I'm finger pricking 10 time plus daily, and use between 2 - 4 Humalog injections thru the day with Lantus on a night, my hb1c was 52 last time, overall I have good control but can shift between 18 & 2.2 in a day some days.
 
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Hi @kev-w Thanks for posting your update on your exercise, I proceed with caution when swimming as sometimes I only feel low when really low so try to start out at 8+ before a 30 minute swim and reduce my bolus beforehand, I then correct if necessary afterwards but prefer to run higher than normal just in case. I find it's the pool temperature which can drop me as my body is working harder on glucose stores to keep my temp up if it's cool.

Have you been on a DAFNE course ?
 

Thanks for your reply, I'm similar to you with hypo awareness hence me setting up at 12, I've never thought about pool temp mind!

I've never been on a DAFNE course (or any other course diabetes related) as our local hospital doesn't do them, I did hear they recommend a blood sugar of 12 as standard and I feel that's too high.
 
Hi @kev-w Personally I would try and stay below 9mmol/l for this simply because over 10 and I need more bolus to correct and it's sometimes harder to get back down below 10, I also feel exercise is harder when i'm running high as my muscles don't seem to have the energy with too much glucose floating round the blood and not getting to the muscles when needed, so the closer I am to my target range the easier the exercise. I don't feel your hospital was providing good advice with this level, hence why I asked you about doing DAFNE as you would get much better advice from doing this course to help you manage exercise. You can try BERTIE online which is a good resource and includes exercise content: www.bertieonline.org.uk also take a look at www.runsweet.com a brilliant resource for exercise and managing insulin.
 

Hi JuicyJ and thanks for your reply, A long time ago I needed an ambulance recovery in the old pool dressing rooms, I was teaching my 2 eldest kids at the time, we'd finished, gone for a shower and I dropped unconscious and came to in the back of the ambulance outside having been injected with glucagon but minus my kids, so I didn't swim for 15 years after that as I lost confidence, I agree that we don't feel a 100% with a sugar up at 12 and I'd postpone a gym session if I was that high, but for me, and I like to swim non stop, I'll drop between 4 - 6 mmols in 40 minutes on an afternoon where my Lantus is working strongly.

Swings and roundabouts

I'll have a look at the links you posted up later, so thanks for that.

Edit, I use one of these for recording sessions. https://connect.garmin.com/modern/activity/2332253034/share/1?lang=en
 
Hi @kev-w Crumbs I can understand how you feel, I was swimming with my daughter a few years ago and eyesight went a little blurry so thought i'd get out and test, except i'd left my meter and jelly babies in the locker and the journey there was a blur, when I finally got to my meter I was about 1.6, it was an incredibly scary experience and put me off swimming for a while now, am a bit wiser now so keep a bag close to the pool with glucose and meter now, but also try to ensure I don't have quick acting insulin on board and if lower than 8 then I have a carby snack so bag of crisps. Been ok since then though, so just make sure you have food on board and no quick acting ? Also get out to test after 20 minutes and test again every 20 minutes ?
 
New longest run today (8 miles) in training for my half!

But completely opposite experience to the last time, when I went low mid-run.
This time I woke up high in morning so ended up running with a BG of about 11. Not ideal I know, but I figured it would fall quickly. I'd had my morning levemir but no short acting (no breakfast), but based on past experience figured it would fall quickly and I could have a snack mid way through.

But, it didn't. It actually rose a bit first (adrenaline?) and then stayed around the starting level until 1hr in when it eventually started to drop a little. No snack needed and BG of 7 when I got home.

Needs more investigation but it could be that having no rapid acting on board has a massive effect for me. Or maybe it was just effect of morning vs afternoon last time. Or maybe just my body being weird/fighting off my cold!
 
Im a long distance cyclist and runner with type 1 this years a completed a few 100+ mile cycles and stuff I find cycling to be the best way to control my sugar levels and i dont have to be to strict with my diet
 
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