Type 1s - Does anyone increase bolus for exercise?

[oldgreymare]

I am fairly unfit and definitely not an athlete, but I try to take 2 HIT style sessions a week with an experienced personal trainer (has other Type 1 clients). Short sessions 30 min of weights/resistance circuits plus about 15 min warmup/cool down strecthing. Purpose is to build muscle and hopefully strengthen bone (I have borderline osteoporosis).

These are morning sessions before breakfast and I will cancel if fasting BG is below 5.0. But without fail my BG rises post HIT exercise - definitely suffering adrenaline induced glucose dumps. Yesterday was a slightly extreme example - pre-exercise 7.9, post exercise and still pre-breakfast up to 18.3! Highest I've seen in a long time. Breakfast is typically 15-20g carbs. Even with correction doses I was still high at 13.3 four hours later. Back to normal levels by the evening.

When I motivate myself to consistently add in more aerobic exercise - walking, jogging, etc then my insulin sensitivity goes up and I can reduce my basal (Levemir 2x/day). I am not willing to give up high intensity training, so interested if anyone has a strategy to increase short acting to allow for the exercise induced glucose dump? I have good hypo awareness and do test regularly post exercise to look out for any rapid switch to a hypo state.

Looking for ideas!

 

[Bebo321]

I am fairly unfit and definitely not an athlete, but I try to take 2 HIT style sessions a week with an experienced personal trainer (has other Type 1 clients). Short sessions 30 min of weights/resistance circuits plus about 15 min warmup/cool down strecthing. Purpose is to build muscle and hopefully strengthen bone (I have borderline osteoporosis).

These are morning sessions before breakfast and I will cancel if fasting BG is below 5.0. But without fail my BG rises post HIT exercise - definitely suffering adrenaline induced glucose dumps. Yesterday was a slightly extreme example - pre-exercise 7.9, post exercise and still pre-breakfast up to 18.3! Highest I've seen in a long time. Breakfast is typically 15-20g carbs. Even with correction doses I was still high at 13.3 four hours later. Back to normal levels by the evening.

When I motivate myself to consistently add in more aerobic exercise - walking, jogging, etc then my insulin sensitivity goes up and I can reduce my basal (Levemir 2x/day). I am not willing to give up high intensity training, so interested if anyone has a strategy to increase short acting to allow for the exercise induced glucose dump? I have good hypo awareness and do test regularly post exercise to look out for any rapid switch to a hypo state.

Looking for ideas!

Hi there,

Sounds like you've already discovered that high intensity exercise can give you a blood glucose rise! Certainly you can correct for the high, you just need to be aware that your blood glucose levels will drop later on in the day as your liver and muscles re-stock their glycogen stores.

A few suggestions:

Take a look at http://www.teambloodglucose.com/TeamBG/Type_1_Basics.html ,and watch through the type 1 case study movie.

Secondly have a look at www.runsweet.com for some more technical info.

Thirdly, have you thought about moving onto a pump? This would allow for more control - for a high intensity session you could increase your basal for a limited period of time just after the exercise - and for more moderate endurance exercise where your blood levels may fall, you could reduce the amount of infused insulin during the exercise.

You may also like to join the Sporty Diabetic Type 1's facebook group (link from TeamBG) and see what people advise there too.

Hopefully there will be some more people along on the forum soon too who will be able to offer advice. @ElyDave is a runner and has great blood glucose control, so you may want to research him on the forum to see what he does to manage his BG levels.

 

[ElyDave]

Hi there,

Sounds like you've already discovered that high intensity exercise can give you a blood glucose rise! Certainly you can correct for the high, you just need to be aware that your blood glucose levels will drop later on in the day as your liver and muscles re-stock their glycogen stores.

A few suggestions:

Take a look at http://www.teambloodglucose.com/TeamBG/Type_1_Basics.html ,and watch through the type 1 case study movie.

Secondly have a look at www.runsweet.com for some more technical info.

Thirdly, have you thought about moving onto a pump? This would allow for more control - for a high intensity session you could increase your basal for a limited period of time just after the exercise - and for more moderate endurance exercise where your blood levels may fall, you could reduce the amount of infused insulin during the exercise.

You may also like to join the Sporty Diabetic Type 1's facebook group (link from TeamBG) and see what people advise there too.

Hopefully there will be some more people along on the forum soon too who will be able to offer advice. @ElyDave is a runner and has great blood glucose control, so you may want to research him on the forum to see what he does to manage his BG levels.

Thanks Bebo, but I don't generally dose increase.

I'm not a HIIT advocate but I do do some intervals, 800m repeats, 2k hard/1km easy and that kind of thing, so although I'm going outside of the aerobic, it's not the same power-based stuff.

Given that I have found that those intervals, weights and yoga can all increase my BG as can shorter races (5km, 10km, 10 mile TT etc), but never to the extent described by @oldgreymare .

In my experience so far, whilst I may see a short term rise taking me above my desired threshold of 8.0, it soon drops off and i actually need to be careful of the delayed hypo as my body replenishes muscle glycogen.

 

[mrman]

Mornings are known to be problematic for many due to dawn phenomenon. This where the body produces extra sugar to prepare for the day. This can be greatly exaggerated by not eating/bolusing and working out. Have you tried a snack with qa or just having qa. Obviously by using qa hypos may happen mid session,but, if you monitor 15 mins into first one, and at end, then check hourly after you will see how your body reacts, and will lear what works. Personally, I eat before every workout. Body needs fuel, and if you don't give it the fuel, your body dumps it into you anyway.

Sent from the Diabetes Forum App

 

[mrman]

Also, why cancel if below 5? If between 4 and 5, have a snack with bolus, as above , but, may ned a reduced dose.

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[ElyDave]

Mornings are known to be problematic for many due to dawn phenomenon. This where the body produces extra sugar to prepare for the day. This can be greatly exaggerated by not eating/bolusing and working out. Have you tried a snack with qa or just having qa. Obviously by using qa hypos may happen mid session,but, if you monitor 15 mins into first one, and at end, then check hourly after you will see how your body reacts, and will lear what works. Personally, I eat before every workout. Body needs fuel, and if you don't give it the fuel, your body dumps it into you anyway.

Sent from the Diabetes Forum App

Body has fuel, it's called fat.

Train the fat metabolism, no need for carbs first thing. I've been getting back into fasted workouts again, going well until I crocked my achilles.

 

[mrman]

Body has fuel, it's called fat.

Train the fat metabolism, no need for carbs first thing. I've been getting back into fasted workouts again, going well until I crocked my achilles.

Not disagreeing with you but, not quick enough fot HIT training depending on the person.

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[Bebo321]

I am aware that some people experience high blood glucose rises with exercise - particularly relating to exercising on an empty stomach or first thing in the morning in conjunction with dawn phenomena. Unfortunately I haven't seen any scientific evidence as yet to back this up (perhaps the research hasn't been done yet).
Theoretically it's not a good idea to eat before you exercise - simply put, any carb you consume will begin to raise your BGs before you even begin. I do wonder however (for those who are frustrated with high blood glucose rises that are not only linked to intense exercise, but also to what time of day and how empty their stomach is) if a small non-carb snack may curb the liver's glucose dump.

@brett , something else you may like to give a try if you have a problem with high BGs after exercise, is to consume some vinegar (diluted for taste) both during and most particularly after your exercise.
Studies show that acetic acid (and to a lesser extent citric acid) speeds up the rate of glycogen replenishment, and also influences the liver to switch it from churning out glucose.
If you are prepared to give this a go, would you please let me know what impact it has, and how quickly? I know the science says it works, but I would appreciate it if you would be a bit of a guinea pig for me on this.

 

[mrman]

Bebo, thanks for the info but I don't have high levels after excercise because if I do ever excercise without food, I can increase my temp basal as I'm on a pump, which also deals with my dp which I did have on mdi. Any activity on an empty stomach, with too little insulin causes a rise im my levels, don't need anything scientific to tell me what my meter tells me. as for the diluted vinegar, not a chance lol.

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[hale710]

I have been running at 5am, before breakfast (ok fine it's more of a stagger than a run!)

I find I do rise to about 11 or 12, I don't correct this though as I know I will drop back into a safe range by mid morning. If I corrected I would then need a further snack later to prevent a hypo.

This worked for MDI. As I've now got a pump I've been on a mini exercise ban while we iron some things out. I'm hoping to play around with the tbr (both increase and decrease) to eliminate this spike as far as possible in the next few weeks


Blogging at drivendiabetic.wordpress.com

 

[ElyDave]

Not disagreeing with you but, not quick enough fot HIT training depending on the person.

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have you read Phinney and Volek - teh Art and Science of Low Carb Performance?

Reading it now, interesting, but may be hard to implement as T1 I think.

 

[oldgreymare]

Hi All,

Apologies for the delay in replying and thanks for some very interesting comments!

Bebo, do agree that ultimately a pump is likely to give me the best options. But I am sticking with MDI at the moment as pump support is available but not quite state of the art here in SE Asia (CGM use almost non existant). Plus this is a high heat, high humidity environment and my skin really doesn't like adhesives...

Brett, I am starting to experiment with qa (novorapid) prior to exercise to see if I can balance the adrenaline induced liver dump. Don't think my exercise sessions are long enough to warrant adding carbs LOL! Curious to know if anyone else takes this approach. I use a BG of 5 as a cut off just to give a safety margin as in the morning this is usually as I'm recovering from a hypo and feel really lousy anyway.

ElyDave, so sorry to hear about your achilles . I've been looking up a lot on fat metabolism as an energy source as opposed to glycogen stores including impact for both strength and endurance activities. Pragmatically I think pretty much all advocates of the ketone adapted exercise approach feel that they must make a disclaimer that this could be dangerous for Type 1 diabetics due to the cross over with DKA. But this approach does seem to be advantageous especially in endurance sports.

If you don't mind wading through a lot of detailed biochemistry I can really recommend going through all the historical posts of Peter Attia on the Eating Academy http://eatingacademy.com/

 

[Bebo321]

Hi All,

Apologies for the delay in replying and thanks for some very interesting comments!

Bebo, do agree that ultimately a pump is likely to give me the best options. But I am sticking with MDI at the moment as pump support is available but not quite state of the art here in SE Asia (CGM use almost non existant). Plus this is a high heat, high humidity environment and my skin really doesn't like adhesives...

Brett, I am starting to experiment with qa (novorapid) prior to exercise to see if I can balance the adrenaline induced liver dump. Don't think my exercise sessions are long enough to warrant adding carbs LOL! Curious to know if anyone else takes this approach. I use a BG of 5 as a cut off just to give a safety margin as in the morning this is usually as I'm recovering from a hypo and feel really lousy anyway.

ElyDave, so sorry to hear about your achilles . I've been looking up a lot on fat metabolism as an energy source as opposed to glycogen stores including impact for both strength and endurance activities. Pragmatically I think pretty much all advocates of the ketone adapted exercise approach feel that they must make a disclaimer that this could be dangerous for Type 1 diabetics due to the cross over with DKA. But this approach does seem to be advantageous especially in endurance sports.

If you don't mind wading through a lot of detailed biochemistry I can really recommend going through all the historical posts of Peter Attia on the Eating Academy http://eatingacademy.com/

Hi there,
Already a fan of Peter Attia!

Just a quick question, do you follow a fairly low carb diet? A collegue of mine found that by reducing the amount of carb in their diet seemed to have a knock-on effect of reducing this over-zealous response by the liver after exercise. It took a week or so to really come into effect - and that was reducing the carb to approx 50g per day. Anyway, I just thought I would mention it.

 

[phoenix]

I think there are 2 considerations here.
1) exercising after fasting
2) high intensity exercise causing glucose to rise (ie immediate need for glucose)
(and the two are compounded)
Theoretically, I think that if your basal was perfect then you could exercise before eating without anything to eat.
I have a pump and whatever I do. I still find that I get a rise if I don't eat and bolus something before exercise.
Anaerobic exercise also makes glucose levels rise, indeed a short sprint is recommended to pre-empt a hypo. The liver reacts by producing glucose.

I won't exercise fasting and I won't normally exercise within 1.5 hours of eating; it is restrictive but I haven't found a solution. When I go for multi day, long distance walks and set out after breakfast , I inevitably have to eat something within an hour of setting out.

.
I haven't read the Volek book, I have read most of his research and it always seems to me that there was nothing left in the tank after low carb exercise. His bicyclists would not have been able to sprint. He uses very small samples and it seems that the averages mask what happened in individuals. Cassandra Forsythe who worked in his lab wrote :

We had subjects do terribly on ketogenic low-carb, and others do fantastically. But, when you're writing your results, you're stating the average results, and on average, in the study population we researched (while I was in the lab), most responded more favorably to keto low-carb vs low-fat

I posted this quote some time ago, the link is now dead (I'll try a search)
Found it: it's a very long discussion and obviously not to do with people with diabetes of any sort but interesting all the same.
http://jpfitness.com/index.php/foru...-protein-or-carb-reduction?limit=30&start=120

 

[noblehead]

Bebo, thanks for the info but I don't have high levels after excercise because if I do ever excercise without food, I can increase my temp basal as I'm on a pump, which also deals with my dp which I did have on mdi. Any activity on an empty stomach, with too little insulin causes a rise im my levels, don't need anything scientific to tell me what my meter tells me. as for the diluted vinegar, not a chance lol.

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Much the same here Brett, don't do anything too strenuous but any form of exercise in the morning (without food and insulin) would see a significant rise in my bg levels, good old liver eh

 

[ElyDave]

Much the same here Brett, don't do anything too strenuous but any form of exercise in the morning (without food and insulin) would see a significant rise in my bg levels, good old liver eh

that just goes to show the individual differences in the "same" design.

I can run 8-10km fasted with no change in reading for all intents other than the meter variability

 

[ElyDave]

Hi All,

Apologies for the delay in replying and thanks for some very interesting comments!

Bebo, do agree that ultimately a pump is likely to give me the best options. But I am sticking with MDI at the moment as pump support is available but not quite state of the art here in SE Asia (CGM use almost non existant). Plus this is a high heat, high humidity environment and my skin really doesn't like adhesives...

Brett, I am starting to experiment with qa (novorapid) prior to exercise to see if I can balance the adrenaline induced liver dump. Don't think my exercise sessions are long enough to warrant adding carbs LOL! Curious to know if anyone else takes this approach. I use a BG of 5 as a cut off just to give a safety margin as in the morning this is usually as I'm recovering from a hypo and feel really lousy anyway.

ElyDave, so sorry to hear about your achilles . I've been looking up a lot on fat metabolism as an energy source as opposed to glycogen stores including impact for both strength and endurance activities. Pragmatically I think pretty much all advocates of the ketone adapted exercise approach feel that they must make a disclaimer that this could be dangerous for Type 1 diabetics due to the cross over with DKA. But this approach does seem to be advantageous especially in endurance sports.

If you don't mind wading through a lot of detailed biochemistry I can really recommend going through all the historical posts of Peter Attia on the Eating Academy http://eatingacademy.com/

Thanks, achilles much better, from 110 to 2 on a 1-10 pain scale since seeing the physio and being rigorous with the rehab.

Lots of people have mentioned Peter Attia, and I'll take a look agfter finishing P&V, but I think the issue with all of these is that they are not written with us deranged pancreas individuals in mind.

 

[oldgreymare]

Hi there,
Already a fan of Peter Attia!

Just a quick question, do you follow a fairly low carb diet? A collegue of mine found that by reducing the amount of carb in their diet seemed to have a knock-on effect of reducing this over-zealous response by the liver after exercise. It took a week or so to really come into effect - and that was reducing the carb to approx 50g per day. Anyway, I just thought I would mention it.

Lowish - I stay pretty much gluten and starch free. My weakness is Starbucks cappuccinos at work (at home I drink black) plus the odd piece of fruit (apple, pear, guava, dragonfruit, etc). Also a glass or 2 of wine with dinner. I usually stay under 100g per day, not so often under 50g. Psyching myself up to go more hard core 30-50g...but wait there's those weddings and formal dinners in my calendar...

 

[oldgreymare]

I think there are 2 considerations here.
1) exercising after fasting
2) high intensity exercise causing glucose to rise (ie immediate need for glucose)
(and the two are compounded)
Theoretically, I think that if your basal was perfect then you could exercise before eating without anything to eat.
I have a pump and whatever I do. I still find that I get a rise if I don't eat and bolus something before exercise.
Anaerobic exercise also makes glucose levels rise, indeed a short sprint is recommended to pre-empt a hypo. The liver reacts by producing glucose.

I won't exercise fasting and I won't normally exercise within 1.5 hours of eating; it is restrictive but I haven't found a solution. When I go for multi day, long distance walks and set out after breakfast , I inevitably have to eat something within an hour of setting out.

.
I haven't read the Volek book, I have read most of his research and it always seems to me that there was nothing left in the tank after low carb exercise. His bicyclists would not have been able to sprint. He uses very small samples and it seems that the averages mask what happened in individuals. Cassandra Forsythe who worked in his lab wrote :

I posted this quote some time ago, the link is now dead (I'll try a search)
Found it: it's a very long discussion and obviously not to do with people with diabetes of any sort but interesting all the same.
http://jpfitness.com/index.php/foru...-protein-or-carb-reduction?limit=30&start=120

Yes I was referring to short duration high intensity exercise and the liver response. While my aim is firstly strength building I would also like to burn some fat, so reluctant to add extra carbs before exercise. But for longer duration aerobic exercise (long walks) or just multiple active days (normally I am a desk jockey) I will go low if not eating more frequently or reducing insulin.

The Peter Attia blogs are fascinating if very detailed. He has performed some in depth studies using himself as a subject (N=1). In his own experience low carb when fully fat burning (ketone adapted - which can take months to achieve) was beneficial to endurance performance eg long distance cycling, but he did find a reduction in his maximum explosive strength (I think about 20%) on low carb. He also is clear to state there is no one size fits all and the future lies in tailoring diet to fit individuals rather than today's blanket recommendations.

 

[oldgreymare]

Thanks, achilles much better, from 110 to 2 on a 1-10 pain scale since seeing the physio and being rigorous with the rehab.

Lots of people have mentioned Peter Attia, and I'll take a look agfter finishing P&V, but I think the issue with all of these is that they are not written with us deranged pancreas individuals in mind.

If you like P and V you should find Attia interesting. Lots of discussion of basic biochemical pathways - many of which are influenced by insulin.