1. This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies. Learn More.
  2. Get the Diabetes Forum App for your phone - available on iOS and Android.
    Dismiss Notice
  3. Guest, we'd love to know what you think about the forum! Take the Diabetes Forum Survey 2019 »
    Dismiss Notice
  4. Diabetes Forum should not be used in an emergency and does not replace your healthcare professional relationship. Posts can be seen by the public.
    Dismiss Notice
Dismiss Notice
Find support, ask questions and share your experiences. Join the community »

Peaks and troughs

Discussion in 'Fitness, Exercise and Sport' started by CC1, Aug 30, 2019.

  1. CC1

    CC1 Type 1 · Active Member

    Messages:
    27
    Likes Received:
    11
    Trophy Points:
    23
    Hi all, recently diagnosed T1. On insulin (2 units) before meals and long lasting insulin am and pm. So just been cutting the grass both front and back (after having lunch) and started to shake. Tested bloods and 7.1 (low for me as 2 weeks in and bloods currently low teens as they need to come down slowly). So sat down and literally half an hour later re tested and they went back up to my normal rate of 12.2. can bloods naturally go back up again after being low? This is all very new to me so still learning.
     
  2. Kim Possible

    Kim Possible Type 1 · Expert

    Messages:
    6,624
    Likes Received:
    6,451
    Trophy Points:
    178
    Hi @CC1 welcome to the T1 club.
    It is a but daunting to start so feel free to ask as many questions as you want. Just don't expect to know everything. Partially because there is so much to learn, partially because more is being discovered/tested/suggested, partially because there are things we may never know and partially because our body seems to decide to just do what it wants for no particular reason. That last one is very annoying.

    Anyway, with regards to your question, the short answer is "Yes". The longer answer is there a few reasons why this can happen
    - when our liver notices low BG, it can release glucose into our blood stream. As you will learn, as your body gets used to the lower BG, it is better to treat a hypo than wait for the liver to take over.
    - your insulin may have "run out" around the time of your low. This could be your basal (many people find Lantus, for example, last 20 -22 hours rather than 24) or it could be the bolus you had with your lunch. Over time, I am sure you will be introduced to carb counting so the insulin you take will match the carbs you eat rather than the other way around. The fixed dose you are on at the moment assumes you eat a certain amount of carbs - you may have eaten more. And to confuse things further, some carbs are absorbed quicker than others (fat usually slows down carb absorption ... which is why chocolate is not a good hypo treatment, unfortunately). So the slow release carbs may have kicked in, with no bolus (short actin) insulin to "mop it up".
    - our BG rises when we are stressed. This could be mental stress (e.g. going to an interview) or could be physical stress (e.g. trying to push a heavy weight up a steep hill) or "medical stress" (e.g. cold or injury). It is possible, your Bg rose as a result of you being stressed my your low BG.

    As you have been exercising (cutting the grass), you may find your BG is lower over the next 24 to 48 hours. Nothing to worry about but something to be aware of. It is normal.

    I hope this make sense and I haven't bombarded you with too much information.
    As I said, the short answer to your question is "Yes. bloods can naturally go back up after a low." But don't rely on them doing so.
     
    • Like Like x 1
    • Friendly Friendly x 1
  3. CC1

    CC1 Type 1 · Active Member

    Messages:
    27
    Likes Received:
    11
    Trophy Points:
    23
    Hi Helen thank you so much for your reply it's so confusing at the moment. I was originally diagnosed as type 2 last October, so I got fitter lost 4 stone and am now a regular gym goer. I haven't had the confidence to go to the gym as yet since being diagnosed as I'm not sure what my levels are doing. Theyve come down since 2 weeks ago (they were 25mmol) at the clinic and now in the low teens which is were they need to be for now. I've being doing my regular walking and found they come down a little with the odd 4-5 miles but just a bit nervy at the gym. I so cardio (jogging) and resistance to tone up my flabby bits from weight loss. So cutting the grass was a real shocker to see how low I'd gone. I knew I had as I felt shaky so rode it out and they went back up again with no help. Thank you for explaining. I'm on 2 units of novorapid before each meal at the moment but will be carb counting soon x
     
    • Friendly Friendly x 1
  4. Scott-C

    Scott-C Type 1 · Well-Known Member

    Messages:
    2,485
    Likes Received:
    2,722
    Trophy Points:
    158
    Hi, CC1, indeed they can, but as a T1, there's going to be times when you should help it out with some dextrotabs, lucozade, apple juice, jelly babies, oreos, jelly babies, Jaffa Cakes, Tunnocks Caramel Wafers, etc.

    A non-T1 has one hormone, insulin, which lowers bg, and four which raise it: glucagon, cortisol, adrenaline and growth hormone.

    T1s don't make insulin anymore, so we have to inject it, and we will often get the amount wrong, but we do still make the four which raise bg. That means that even if you make a big screw up on insulin amounts, you still have four hormones working away to knock your bg back up.

    The way they do that can take time and be unpleasant (hypo shakes aren't because of low bg, they're because of the adrenaline rush), so it's normally best to chip in with some fast glucose to raise before adrenalin etc. get involved.

    If you can't do some biccies cos you're sleeping, the four hormones will pull you out of it. They basically tell the liver and muscles to release stored glucose to raise bg.

    The gardening situation you mention looks like this to me:

    You've injected the 2u and had lunch and then you've exercised by pushing a lawn mower around.

    The insulin will hit peak activity about 90 mins after injecting it. That will be dropping bg, and the exercise will also drop bg because that's what exercise does.

    So, it looks like you've had a "double whammy" of insulin hitting peak and exercise.

    A lesson for the future when the docs give you free rein on carb counting would be to say, hmm, eating now with x units, but will be exercising shortly afterwards, the exercise will drop me, so tail back the amount of insulin taken for lunch.

    It's basically a complex balancing act involving three variables operating over several hours: how much insulin/how much carbs/how much exercise.

    You'll inevitably make mistakes on those calls - we all do - but just as a hint at the sort of things you should be looking for to understand it is your comment that your bg went back up: my call on that is that the insulin and exercise were dropping you, but, as this was just after lunch, the carbs from the lunch were getting into your bg to balance that out, so a sit down instead of chewing sweeties was enough to raise you.

    T1 can be an incredibly complex game, but get those basics of what is the food doing, the insulin doing, and the exercise doing and how they play together over 6, 12, 24 hour periods, and it makes more sense.

    Good luck!
     
    • Like Like x 2
    • Informative Informative x 1
    • Friendly Friendly x 1
  5. EllieM

    EllieM Type 1 · Well-Known Member

    Messages:
    1,766
    Likes Received:
    1,045
    Trophy Points:
    178
    Thanks for that very enlightening explanation. I only really knew about the glucagon.
    I've always wondered about the mechanisms of false hypos, is that just because the body is pumping out adrenaline because the levels are unusually low? So presumably a "false hypo" isn't going to send you in a coma even if you ignore it?
     
  6. Scott-C

    Scott-C Type 1 · Well-Known Member

    Messages:
    2,485
    Likes Received:
    2,722
    Trophy Points:
    158
    The way it was explained to me is that the body has an "autonomic" system which takes care of basic things like keeping you at the right temperature, breathing, heart rate, and bg level without you needing to think about them (although, obviously as T1s we do need to think about the last one!), and the adrenalin rush is part of the autonomic system.

    I expect you'll have had hypos where you're shakey, sweaty, jittery, but still thinking straight. That's just got to the stage where the autonomic system is engaged.

    But hypos where thinking is getting muddled, confused, has a "neuroglycopenic" aspect to it - brain isn't getting enough glucose.

    I suspect with false hypos, it's just an autonomic thing, and nowhere near neuroglycopenic, so the adrenalin etc. would sort it out without any real risk of coma, seizures.

    It seems that the autonomic responses kick in before the neuroglycopenic bit, but, in the fun world of T1, a slow steady glide down can bypass the first and take you straight into the second. I can still remember one of my first hypos a few weeks after dx - was sitting watching telly, no shakes or sweating, just started feeling dreamy and out of it.

    If nothing else, "autonomic" and "neuroglycopenic" are handy words to have for Scrabble and pub quizzes!
     
  7. CC1

    CC1 Type 1 · Active Member

    Messages:
    27
    Likes Received:
    11
    Trophy Points:
    23
    Wow thank you for that explanation I didn't realise the mealtimes insulin worked that long after I thought it was instant. So I guess it was like a false hypo and a combination of insulin plus food plus exercise. So when I do the gym is it wise to take my insulin then eat? About an hour before the gym? I'm just so confused over it all still. X
     
  8. Scott-C

    Scott-C Type 1 · Well-Known Member

    Messages:
    2,485
    Likes Received:
    2,722
    Trophy Points:
    158
    In these early days, I think it might be safer to schedule exercise for before meals instead of after. Once you've got more experience of insulin, you'll have way more flexibility.

    I don't know which fast acting insulin you're on, but, just as an example, I've posted the action graph for a commonly prescribed one, Novorapid, below.

    You can see how it gets to work after about 10 to 20 mins (because it takes a while for it to be distributed around the body), peaks in 1 to 3 hrs, and lasts overall for 3 to 5 hrs.

    Those timing margins are broad, because it varies between individuals - experimenting with bg test strips, and cgm - continuous glucose monitoring will help you find your margins.

    It is good that it operates over an extended time period, because food digestion operates over an extended time period too.

    When you eat carbs, they get broken down into glucose and then absorbed into your bloodstream. That doesn't happen all at once. An average human will absorb glucose at about 30g per hour, so if you're eating, say, a 70g meal, that's a couple of hours, so you want the insulin to still be active to deal with the ongoing feed in of carbs during that period.

    But, because exercise also lowers bg, it means you need to think about how exercise fits in with the insulin "shape" over time.

    If you were going to the gym after eating, the exercise and the still active insulin will both be influencing bg levels, so you need to factor that in. It's not like some conditions where you just "fire and forget" a pill.

    For example, let's say I'm injecting for a 70g meal. These are my numbers, don't use them, it's just an example.

    I'd typically take about 10u for that, and I'd probably inject about 20 mins before the meal to give time for the insulin to get to work.

    10u would be fine if I knew I was just going to be sitting at my desk for the next 5 hrs.

    But if I knew I was going to be walking around doing some shopping for a few hours after the meal, that's mild exercise, so I'd likely reduce the dose to maybe 7u.

    If I was planning on some harder exercise like a long run or hillwalking, I might tail it back to only 3 to 5.

    The message is when you're deciding on an insulin amount, you need to think about what you will be doing in the way of exercise during the activity phase of the insulin shot, typically 5 hrs.

    People do this in different ways. Some get the spreadsheets out, some just wing it a bit.

    CGM helps a lot with this - you get a continuous graph from readings every 5 mins so you can see if you are trending up or down, and them intervene before it gets too high or low, and it also shows how much active insulin you've got on board - IOB.

    Don't be afraid of making mistakes. The vast majority of mistakes can be sorted out with a few dextrotabs, or, my favourite, a Tunnocks Caramel Wafer, and you can learn from them too - look back at the dose and carb amounts and decide whether it would have played out differently with lower or higher amounts.

    Also, be prepared psychologically for the unpredictability of it. Food and insulin get exposed to a whole lot of biological processes after you eat and inject them, so 5u for 50g one day won't necessarily pan out the same way the next. That is not your fault, it's just how biology works.

    Many of us are now using cgm and Stephen Ponder's Sugar Surfing techniques to adjust things on the fly to get around the vagaries of it, but keep that till later.

    There's lots of really advanced ways of living with T1, but the NHS simply doesn't have the time or resources to teach you them, so I'd recommend books like Think Like a Pancreas by Gary Scheiner, Sugar Surfing by Stephen Ponder and Using Insulin by John Walsh. Oh, and ask us on the forum too - there's centuries worth of collective experience here.

    It's scary at the moment, but in a few months time, you'll be surprised by how few limitations there are. I can go into any restaurant and eat pretty much anything on the menu, provided I think ahead a bit.

    Good luck!

    upload_2016-12-11_12-9-44.png
     
    • Friendly Friendly x 1
  9. CC1

    CC1 Type 1 · Active Member

    Messages:
    27
    Likes Received:
    11
    Trophy Points:
    23
    Hi Scott wow so much to take in and digest (pardon the pun). I'm just on 2 units at the moment before each meal as advised by my nurse but due to go on the carb counting system soon. So for e.g. I'm going to my regular zumba class tomorrow evening at 6.30 (not been since diagnosed) so I will eat my evening meal after I have been and just have a snack before I go. Would this be the correct way to do it? I will inject 2 units at 12 before my lunch. I'm finding my levels coming down nicely they're not ideal but slowly going into single figures.
     
  10. Scott-C

    Scott-C Type 1 · Well-Known Member

    Messages:
    2,485
    Likes Received:
    2,722
    Trophy Points:
    158
    Yeah, that sounds like a good plan.

    I see from your profile that you're 45. There's a possibility that you might be LADA, Latent Autoimmune Diabetes of Adulthood, which is a sort of subset of T1: T1s dx'd when young have the beta cells which make insulin pretty much wiped out very quickly, but when the onset is at an older age, the beta cells get wiped out more slowly over a period of time, so LADAs still naturally make insulin but need to supplement it with a few injected units here and there. I mention it merely as a possibility as 2u per meal seems quite low, but maybe worth discussing with your docs.

    Another possibility is the "honeymoon period". After dx, and insulin injections, the beta cells can sometimes get a new lease of life and start making insulin again for a while, sometimes a few months, sometimes a year or two. This can mean the need for injected insulin goes down to very small amounts. But it can also make things unpredictable - how do you dose for 50g carbs when you don't know whether your beta cells are going to make insulin for it or not?

    It is complicated, and in some ways, while forums like this can be valuable sources of information, it can sometimes unnecessarily over-complicate things.

    I was dx'd 30 years ago, and the advice was, "try to keep your bg between 4.7 and 7.4, have some sweets if you go too low and have some insulin when you go too high. Sister Carmichael will tell you about Digestive biscuits now."

    That was pretty simple advice which has served me well. Some of us old timers are left scratching our heads a bit when increasingly bizarre methods like drastically reducing carbs and making lasagne with leeks pop up. Keep it simple.


    Don't sweat that. It's a bit like when a deep sea diver comes up, it's in stages to avoid the bends. If your bg goes from high to normal too quick, that can be a big shock to the system, so better to gradually reduce over a month or so.
     
    • Like Like x 1
  11. CC1

    CC1 Type 1 · Active Member

    Messages:
    27
    Likes Received:
    11
    Trophy Points:
    23
    Hi Scott, I was originally diagnosed last October with type 2. So did the low carb diet and lost 4 stone. Gave me the kick to loose the weight I very much needed to loose. After 3 months my hba1 had come down quite significantly so all was going well until this summer when hba1 shot up from 69 to 125. All my bloods were good, cholesterol had gone down etc so I got a referral to the diabetes clinic. That's when they said I am slow onset type 1 and never thought I was type 2 at all so it's been a bit of a shock. The main thing I have to do is to up my carb intake a little over lunchtime as I've been having zero carbs for months on a lunchtime. I'm on 2 units of novorapid for now before each meal but they may put the units up a bit more once I've had my weekly phone call with the clinic. It's hard to remember to take it out with me as for e.g. today I've been running about picking up kids uniforms for school so been snacking on the go and not had a meal today. I need to have 3 meals a day and at regular times I guess. Thank you for the advice however I need it to become the norm and as part of my life but at the moment I'm 2 weeks in and it's a learning curve.
     
  12. CC1

    CC1 Type 1 · Active Member

    Messages:
    27
    Likes Received:
    11
    Trophy Points:
    23
    Ooh ps my nurse said the same she didn't want the levels to drop quickly at first as she said it's not good for the body.
     
  • Meet the Community

    Find support, connect with others, ask questions and share your experiences with people with diabetes, their carers and family.

    Did you know: 7 out of 10 people improve their understanding of diabetes within 6 months of being a Diabetes Forum member. Get the Diabetes Forum App and stay connected on iOS and Android

    Grab the app!
  • Tweet with us

  • Like us on Facebook