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Very high or very low BS after exercising

KarenG

Well-Known Member
Messages
52
Type of diabetes
Type 1
Treatment type
Insulin
Hi all

Type 1 of 37 years.

I'm after some guidance, if you don't mind, regarding exercise and impacts on BS levels. Someone suggested I should post here so here goes! I'll try and summarise below:

Train five/six days a week, combination of HIIT style cardio plus weights, running.. I was doing long runs leading up to a marathon a couple of months ago but I'm concentrating on speed and Half marathon distance for now.

I'm right on the edge of normal BMI (as in, right at the top / close to 'overweight' so trying to still reduce weight gradually but I've lost most of what I wanted to over the last few years do that's not my primary focus any more - but DO NOT want to put it on again)

I'm on 3xnovorapid 1xinsulatard and have been for 20 years. Over the last few years I've reduced my insulin from c. 80 units / day to c. 38 (combination of weight loss, increased exercise and less carbs). Half of that is my overnight insulatard dose.

Anyway... My specific question is, I experience bizarre patterns when exercising. Sometimes BS lowers (as I'd expect) but sometimes, almost always when exercising at high intensity / lifting heavy weights it jumps up to high 20s or worse. It happens once in every two or three times exercising at high intensity. Also, sometimes, the following day, despite minimal insulin, I can't eat enough carbs to avoid hypos - for hours, and hours. All very annoying.

My HBA1C is pretty good at 6.8 but I'm v worried that this masks my highs and lows. Like the idea of a pump because on the hypo days I could reduce the basal in real time rather than accepting the insulin in my body is already injected and can't be undone.

I've read Sherri Colberg but I just can't figure out the patterns despite tracking, measuring and monitoring for months. It's getting a bit depressing now.

Any thoughts or advice on this. Is the pump a way forward? I've had a really great suggestion already to try Levemir which would be quicker than the pump, so I'm going to ask about that, but all thought gratefully welcome!

Cheers - so sorry it's so long!
Karen
 
Hi Ka
Hi Karin....I'm sure there will be more expert advice but it sounds to me like you are experiencing "liver dump" ie at a certain exercise intensity your liver dumps glucose either because it's wants to ensure there is enough glucose for your muscles or b) because u r training so hard there has been an adrenalin release which triggers a liver dump. Thresholds for these reactions vary but normally any exercise above VO2 80% is when the liver dumps glucose.... (VO2 80 is calculated by taking 220-age x 80%).... please do me a favour and check on Facebook "team blood glucose" or sporty diabetics t1....they have lots of advice in this regards....especially wrt to pumps and reducing basal insulin etc etc....
 
I always find that I have to take on some form of carbohydrate and insulin prior to exercise in order for my levels to remain stable.

If I have insulin in my system but nothing for it to be used up by then I tend to get those big dumps of glucose too and end up way higher than before I started.

Wasn't that happy about it to be honest as I was going early morning fat burning sessions which I wanted to do on an empty stomach but couldn't.
 
Hi Karen, I'm not as fit as you, but generally speaking yes I experience exactly the same patterns. I'm on an insulin pump which makes it a fair bit easier, but by no means an exact science.

With low intensity exercise (for me yoga or walking for example) i tend to get low BG readings, which tend to last several hours.

With high intensity exercise (sport like netball or zumba classes) my BG typically sky rockets which I understand is due to the adrenalin. Then it can dip low 1 hour plus after exercise onwards. Its really hard to predict accurately - as you say, at other times I have gone low with high intensity exercise but the "hypo" symptoms have been masked by the lovely endorphines and adrenalin.

Not sure if that helps, but just to let you know I experience the a very similar pattern. Definitely got more manageable since being on pump therapy, but not perfect

Good luck with it, Overall, I find the by far the MOST stabilising thing I can do for my BG is exercise, which means we are doing something right anyway!
 

Hi Karen,

I have found the only way to deal with the highs during high intensity training is to inject insulin. If I am doing 8 x 400m reps then my bloods will get into the mid-high teens if I don't take some insulin on board. I normally do a couple of reps and then inject some insulin to stop the spike being too high. Trial and error as to how much you inject and when.
 
Hi Karen welcome, I would definitely say the pump is the way forward, I used to be the exact same when exercising now the pump has stopped all this and it saves me going hypo 2 hours later as you can set the temp basal tor longer. I do high intensity bootcamp and metafit and my bloods are always perfect after thanks to the pump.
 

Thank you! I will check out that FB group.

I agree with you on the glucose lived dump, I can't see what else it could be.
 
Thanks Gemma.

I sort of do this already (insofar as there should be some insulin floating around already and I usually eat something with carbs immediately before) but do you mean extra insulin on top of that? That feels intuitively wrong to me but that could just be years of me following NHS advice re carbs, lol.
 
Exactly this!! It's such a relief to hear it's not just me!!
 
Thank you, and that perhaps answers my question to Gemma. Thank you.
 

Thank you! In my head the pump sounds like a great answer. I do stuff like boot camp, insanity, GRIT etc - I've already said it but will say it again - so reassuring to hear from others.
 
Karin Team bg are a good bunch (mainly type 1's). I joined them on a 2000km alpine ride last year during which they were part of a research project on exactly this kind of issue.... as a lowly type 2 I cannot possibly give u advice but I know they can. We interesting for me was being hooked onto a dexcom cgm and being able to monitor sugar levels fatigue and influence of food....ie haribo ***** bears and gels spike very quickly where as chocolate takes much longer. Not much help to u I know but check them out none the less. In fact if u can pm me somehow I will invite u to the fb page.
 
just saw this on the team bg sporty type 1's FB page....this clip will explain a lot.
 
Brightside said:
just saw this on the team bg sporty type 1's FB page....this clip will explain a lot.
Click to expand...
Thanks Brightside!

I sort of knew that from reading Colberg, but it was a fabulous way to explain it.

I'm still not sure how to change further what I've already been doing, which is fiddling, tracking, fiddling etc.

I have a heart rate monitor on order now though so I'm hopeful that will give me more data.
 
Levemir sounds like a good option to give the flexibility to reduce background insulin the next day without a pump. The idea being it works for 12 hours so you could reduce the morning dose the next day for example to avoid hypo. Certainly more flexible than the 24 hour insulins (e.g. Lantus) where effects of a reduced dose is eventually seen 3 days later!

It sounds like you're on the right lines already, monitoring your BGs and efforts, as others have suggested anaerobic = BG up, aerobic = BG down.

After anaerobic exercise and a liver dump, be aware that your liver will say hey give me my sugars back and reduce your BG in response some time later, so always need to be careful not to overcorrect that high BG with insulin. Having said that I fully appreciate it's frustrating to see BGs going into the 20s having had this experience myself!

Runsweet makes an attempt at quantifying the effect of HR on BGs here: http://www.runsweet.com/HeartRate.html
 
Thanks, Zicksi! Really helpful.
 
Hello! I'm experiencing the same thing, I've just been swimming and when I tested prior to going I was 7.7 just tested again and I'm now 17.3. Last time I had eaten was around 2pm, swimming about 6.30pm.
 
From what I've read and experienced, the highs post training seems to be a common issue amongst T1D.

Most of my training falls above my anaerobic threshold (i.e above the 80% VO2 max). One thing that has been suggested to me whilst I am still on MDI's is to finish the training with an aerobic cooldown for 15 or 20 minutes. This is to allow the muscles to slowly soak up the excess glucose in the bloodstream as a result of the earlier liver glucose release during training.

It hasn't stopped my spikes but it has lowered the intensity. I'll be moving to a pump pretty soon though.
 
Another option to discuss with your diabetes team is whether changing from insulatard once a day to twice in every 24 hours might give you more flexibility. I find that Humalin I at bedtime and getting up time works well for me, especially when competing or working on endurance events, which may last into night.
 
Jemzor - thank you. I can incorporate a longer cool down I guess (now I know I'm just making excuses!!) but it's just extra time to squeeze in. A good solution might actually be to walk home from the gym which is more palatable in the summer months.

Copepod - help me understand! Do you mean half the insulatard units I take now at bedtime and the other half 12 hours later? Excuse my stupidness but I'm not getting how though could possibly work.

To give real numbers (today)
Novorapid 6 units 7am
Novorapid 10 units 2pm ish
Novorapid 12 units 8pm ish
Insulatard 18 units 11pm ish


How would I split the 18 insulatard over two doses....? Or would I just reduce the Novorapid by the same units the Insulatard was for (in the day time)?
 
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