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TeamBG: Type 1 diabetes and exercise - what questions/issues do you have?


Hi Artemis,
Thanks for your input.
It sounds as though you are already beginning to discover that insulin and exercise don't mix very well.
Really it's just a bit of a balancing act. The fact that previously, when you were exercising and not using insulin you would get higher blood glucose readings, suggests that you were just exercising at quite a high intensity. This is because when you raise your heart rate, it can cause a stress response in your body, which triggers your liver to release glucose into the bloodstream.
Exercise such as walking can actually be quite tricky when it comes to BG management, because it is not enough to raise your heart rate (and trigger a liver response) but it is enough for your muscles to burn through glycogen (their stored glucose stores), and begin to take glucose out of your bloodstream (hence the drop).
We'll try to get some info on the website that addresses these problems. Certainly we don't want you feeling scared about exercise.
 

Hi there Adamski,

Can I ask, are you bolusing at all with your lucozade or bananas?
Also, what sort of distance are you running?

Gobbling jelly babies is one way to keep your BGs up - have you calculated yet what your average requirements are per hour of exercise? It sounds as though you may be okay with your 1 jelly baby per km.
I think jelly babies are about 4-5g of carb each, so that would work out to be approx 60g carb per hour?

My initial thoughts would be that you shouldn't really be carbing upfront for a run with something as fast acting as lucozade, and it could be that the bananas are unnecessary, unless they're just a standard mealtime food. Certainly your first 5k you should be able to run carb free too. Remember your muscles already have on-board glycogen stores of energy which are called on in advance of anything being drawn out of the bloodstream. I would be interested to hear what your current regime is, and what sort of blood glucose readings you're getting. You have probably already had a look at @ElyDave's data - really he keeps his carbing remarkably low, though I think he does eat some slow release carbs upfront.

Exercise Gels are quite useful - they combine sugars that maximise the efficiency of glucose absorption. Certainly having seen trace data from cyclists on the mhealth tour, taking gels every 30mins or so doesn't give a BG spike, but just keeps bloods level whilst they're cycling. They have the added advantage of including electrolytes too - useful to help avoid muscle cramps.

Hope your training is going well - even if it is a little windy!
 
@Bebo321 - I think I may be an exception to the normal rules. However, I am very sensitive to insulin at the moment (I'm 12 units of Lantus a day, and 1 unit of Novorapid per 15g of carbs - down from early honeymoon ratio of 1 unit per 30g carbs!).

I once had low blood sugar as a result of not carbing up for a 5k run. Not a full blown hypo, but bloods under 4 mmol/l. I've always needed some form of carbs for 5k runs. My bloods are usually around the 6/7 mmol/l mark afterwards.

I've calculated I usually need around 60g carbs per hour. For my recent half marathon training run, I needed 3 packs of wine gums, and a bottle of lucodaze sport for the duration of the run. My bloods were 12 mmol/l at the start (I read somewhere than starting out with higher BG levels means you don't need as much sugar on the run). When I finished up I was 5.6 mmol/l. I was running for 1hr 42mins. Total cab intake was around 140g.

I'll maybe give the gels a try and see how I get on
 


Many thanks for this advice. I've watched the type 1 case study and found it very useful. Also, I will swim slower and see how that affects my BG level.
 

Sounds like you're doing really well Adamski,
60g per hour is very sensible. You will find that you have to start adjusting bolusing the fitter you get and perhaps even start reducing your basal. Funnily enough I was just reading a comment on the sporty type 1s facebook group where somebody gave the advice to exercise as far away from your insulin dosing as possible - just to avoid the rapid falls in BG - it's good advice.

It's not a great idea to have higher bloods at the beginning of your exercise (though in competition environments this is sometimes hard to avoid). With a high BG you won't physically perform as well as you are able. It's not the end of the world, but I wouldn't suggest that you try to do this as a rule.

Just for interest (it may help you get your head around things), when somebody with a working pancreas begins to exercise, the pancreas immediately shuts off it's insulin supply within the body. Human insulin has a very short lifespan - only a matter of minutes, whereas injected or infused insulin hangs around for hours.
Consequently, if you have eaten and injected relatively recently the circulating insulin will act very quickly to get glucose into your working muscles, and you'll get a very rapid BG drop. Exercising muscles don't actually need the insulin to take up glucose, as they have 'transporters' that are capable of doing that job. Someone with a healthy pancreas will have a blood glucose reading of 4 or even below when they do endurance exercise.

You're doing a great job. Keep doing what you're doing, and start refining your dosing. Make notes of everything you do so that you can work out what went right and what went wrong. Remember to keep well hydrated too - one bottle of lucozade over 1.42hrs doesn't sound like much, so you may want to research more about best practice on hydration.

Have you started to think about having a pump or CGM?
 
Thanks for the advice - really useful. I think I'll invest in some gels, and avoid increasing my BG before a run. I suspect it'll be easier to have a gel pouch every 20 mins instead of jelly babies.

I have been offered a pump at my last meet with my DSN. I'm trying to get my head round my current regime and then might look into swapping.

Just want this honeymoon to finish up, so I can tighten up my control.

Will check out the hydration bit too - cheers.
 

It's a good idea to get to grips with injections before you get the pump, but once you do move on I suspect that you will love it - especially because of the control it gives you when you exercise. For a prolonged period of exercise you can reduce the basal right down, so it can really help manage those nasty drops in BG.
Honeymoon is not necessarily a bad thing - better to preserve as much function as you can. I saw some other clever ****** post a comment on the forum about managing BGs - 'Use insulin for the heavy work, and leave the pancreas to do the fine tuning'. I think they hit the nail on the head.

Keep up the great work Adamski, you really are doing exceptionally well considering you're so new to all this.
Any issues or questions and you can always get in touch with TeamBG through the website. Always happy to help.
 
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