Spikes after Sport

Sawds said:

I was diagnosed type 2 about 4 weeks ago and have managed to consistently got my levels down to between 4.5 and 6.5 since then by cutting out a lot of carbs from my diet.

I am 34, not overweight and have always been active and fairly sporty but my diet I have to admit has probably let me down. Although not anymore as the perk of this condition is it has made me far more healthy than when it comes to food than I have ever been.

I am a little concerned though as hockey season has started again and as something that I have done for over 20 years I do not want to stop. My issue is that after I have played my levels spike (15.6 and 10.4 straight after playing), is this normal? I know that Adrenalin can affect levels and I am pretty competitive!! I do find that my levels drop to normal within and hour but the problem then is that they continue to drop to hypo range! Before diagnosis I think I had this problem as quite often an hour and a half after playing I would have what I know now is hypo symptoms which I would treat by binging on sweet treats until I felt normal. I have a sandwich now and in a way pre-diagnosis experience has actually helped my with hypos but my question is has anyone else had the same issue after high intensity exercise? I do not plan to give it up but wondered whether there is any way of reducing the spikes or preventing the hypos?

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Hello @Sawds
I occasionally have a similar problem with sugar spikes after a weightlifting work out. (strong man training - in the short and old category) I test before and right after each session as well as other times of the day.

More often than not, I will see no difference in readings. This is what I am aiming for. I get super excited when I go to the gym. my resting bpm is around 55-60. On entering the gym, it immediately shoots to 90 plus - anticipation - I know what's coming next and my body is preparing for the flight/fight. Adrenalin levels up, breathing rate increased etc etc.
There will be a sugar output from the liver - as part of the exercise process, glycogen stored in the liver will be released as glucose to feed the muscles, so I would expect my blood sugars to go up. The trick is to be able to utilse all of the sugar released so that when the work out is finished, the 'spare glucose' has been used up.

This takes a lot of practice, fine tuning diet and possibly, more importantly, having a good handle on how much energy is being used - something that's easy to do with sets, reps and weights, but probably impossibly to do in a participation sport like hockey - how much running, sprinting/jogging etc will you do in a match?

If I train to exhaustion, I am by definition, using up the glucose in my blood to a sufficient level.

Sometimes I over do it - especially on leg day (deadlifts, leg curls, squats, leg press (up to 1,000 lbs on a good day) followed by calf raises, and then either Farmers Walks or Prowlers. My plan is to take it to the very edge. I know I've done well when I have trouble concentrating and can just about make it home! On those occasions the blood sugar drop might be in excess of 1.5 (drop, not actual level)

Sometimes, I ignite the fuse, get the glycogen released but don't use it up as much as I should. Then I will see an increase. Nothing too horrifying, but I have to go home and eat. I would prefer not to do that on top of a sugar spike.

Practice is the key, but practicality in a hockey match might be illusive, but eating management may help (not just what you eat but when you eat.

One last point, I use metformin time release - I believe that this helps a lot. It may be worth having a chat with your nurse. I know what works but I am not a health professional. I pick heavy things up, move them a bit and put them down again. I'm not a doctor.

I hope this helps.

Sean

Hi @Sawds what you are experiencing is perfectly normal, when you exercise the body will release its stores of glycogen and will cause a spike during and just after training, the body hasn't potentially used up all of its stores so you will see a spike. But what tends to happen is that the body still requires a vast amount of energy from its system up to 24hrs after exercise to aid in repair/building muscle, so after exercising any glycogen left in the system ids then used by the body as fuel to repair itself and aid in the recovery of the central nervous system. after I train I eat a small meal consisting of carbs and protein (I will leave the choice up to you) this is usually 30 mins after finishing, this is all the same as a "normal" person does, we are no different just our bodies don't want to work properly any more.
If you think you are competitive and will chase anything that moves for your team, then you can "front load" with simple sugars from fruit (pears are my favourite's) this enables the body to have something for fuel during the match, and the spike will be before your match, with hopefully normalish BS's during the match (more energy) then slightly lower after, food after the match will hopefully stave off the hypos afterwards.
even after training for all my diabetic life (21yrs) I still get hypos during the night, whilst asleep, after heavy workouts. I'm not saying what I used to do when I competed is the right way I found it worked for me especially on my event days (extremely hard for diabetics and non diabetics alike, used to lie down behind the couch after, crying LOL) good luck with it, and don't give up sport I didn't after I was diagnosed just made me work harder at it with added toughness!!!!!!

Hi @Sawds,
As has already been stated, having high BGs after intensive exercise is not unusual. An adrenaline/cortisol surge triggers your liver to release glucose into your bloodstream in order to fuel your activity.
There are a few factors you might want to consider when you are trying to manage your bloods though:

1. If you are very low carb (in effect Ketogenic) your body will be adapted to burning fats. As you increase the intensity of your exercise however, the body switches over to burning more glucose. (Think of fat as burning coal - slow and steady, vs glucose as lighter fluid - rapid high energy output). Once you've finished your activity and continue with low-carb eating, you have to understand that your body will have to work pretty hard to convert fats/protein to replace the lost glycogen. Therefore, after a decent bout high intensity exercise you might want to at least take on board some carb.

2. The highs after finishing - this is simply down to your liver continuing to release glucose into the bloodstream, but with a reduced rate of uptake from your muscles. You can manage this in a couple of ways;
a) Have a 'cool down' period of exercise after your game - jog slowly/walk for a further 20mins or so. It's a case of lowering your heart rate, but continuing to keep mopping up the excess glucose.
b) Have a snack. Whenever you eat, you get a corresponding insulin response. Insulin should counter the other hormones that lead to your hyperglycaemia.

3. Hypoglycaemia. This is the odd one. Are you taking metformin?
Remember if you are ketogenic then blood glucose levels can actually fall lower than what would normally be classified as 'hypo', without you feeling any of the symptoms.
Hypothetically, I suppose it could be possible that your adrenaline surge is overriding the action of metformin within the liver (metformin suppresses glucagon action - a trigger for glucose release). Once your heart rate becomes normalised however, you have insulin already circulating along with heightened sensitivity and glucose absorption potential within your muscles. At that point, metformin in it's role of moderating glucose release might actually be doing more harm than good - in that it is preventing your liver from keeping up with your body's demand for fuel. High demand, but suppressed supply = hypoglycaemia.
What are your thoughts?

Sawds said:

Wow, both those comments are really helpful and very thorough! I’m on gliclazide and so I’m told this can contribute to hypos more so than metformin and so I guess that doesn’t help. A cool down period certainly might be an idea rather than getting straight in the car to sit down at home, guess it depends on how quickly I want to get away from the pitch afterwards!!

The hypos don’t actually bother me too much as I know they’re going to happen and had experience of them for a couple of years before I was diagnosed. I tried drinking lucozade sport during and after games and this seemed to cure the hypos (as I know them now to be) back then and maybe that might help now. I used to drink two bottles of the lemon and lime flavour and so perhaps I need to work out whether that was too many and one now might be sufficient. The one benefit of the prediagnosis hypos is that I know what to expect in everyday life and I am aware of early symptoms and don’t therefore allow them to progress.

Thanks so much for your comments, have only played 3 matches since diagnosis so I guess like everything I need to get a balance but I’m certainly going to find that rather than giving up on something that I have enjoyed doing for about 25 years or so.

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Ooooh @Sawds,
Do you really need to be taking gliclazide? That certainly explains the hypos and I’m surprised your HCP is unsure why it is happening. Obviously, I can’t really comment on your specific situation because I am not qualified to and don’t know your medical history. You should understand however that gliclazide forces the pancreas to release more insulin than it normally would. This is to counter insulin resistance (the higher levels of insulin help shunt glucose into cells and out of the bloodstream).
Your muscles have the greatest impact on blood glucose levels, and within your muscle cells the main transporter for glucose is the GLUT4 transporter. I don’t want to get too technical, but ordinarily these little transporters are stimulated by insulin (when insulin is present they proliferate in number and rush up to the surface of your muscle cells). The great thing is (and this will help you to understand why you’re having hypos) these GLUT4 transporters are also stimulated and proliferate in number with muscle contraction (exercise). For people without diabetes, their pancreas shuts off insulin production almost as soon as they begin to exercise. This is to allow for the fact that the muscles have this in-built ability to take up glucose without insulin being present. This situation only changes if a blood glucose rise occurs due to liver glucose release from a stress response (elevated heart rate). The point is, that your body has a heightened sensitivity to insulin because of these extra glucose transporters (increased sensitivity can last for up to 48hrs) so if you are taking a drug (gliclazide) that overrides your body’s natural checks and balance you can get into trouble - your muscles are already gobbling up glucose, so adding excess insulin may result in a possibly rapid and unpredictable fall in blood glucose.
I have a couple of pieces of advice - the first is to look up the work of Kraft and hyperinsulinemia. Try to understand that elevated insulin levels are not something to encourage - indeed, if you are deliberately trying to bounce low blood glucose levels back up with a sugary drink you will only make matters worse by exacerbating insulin resistance.
Secondly, have a read yourself around diabetes drugs to understand how they work. On gliclazide you are heading on the path towards burning out the beta cells you have. If you’re not on metformin, read up on how it works, because it could be a suitable fit.
Make sure you really are following a low carb diet (it’s easy to miss hidden carbs) and get back to your doctor armed with your information and talk it through. It’s unlikely they will know about muscle glucose transport with exercise (it’s a fairly specialised field), but if you explain it to them they should understand and determine if your current prescription really is the best choice.

Sawds said:

I had thought about not taking my meds on a Saturday but might run this past the doctor first. Still early days for me as was only diagnosed a month or so ago. Thanks for your advice, I’ll look into that as certainly want to know more. As I had this situation pre-diagnosis without the gliclazide it certainly suggests that the medication might not be a good thing on match day!! Planning on front loading some carbs and having a more sugary sports drink tomorrow as this worked pre-diagnosis and might bring me down more gradually from the 15 to 3.6 in an hour!!

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The fact that you were having hypos prior to diagnosis...instinctively it seems that gliclazide is a wrong choice, but only your HCP has the full story. Hypos only occur when you have too much insulin in your system, so adding more doesn’t seem a logical choice (certainly not on match day). If your doc could review your meds to build in flexibility around exercise, that would be great - front loading with carbs is far from ideal. Good luck and I admire your perseverance.