Weight loss, exercise and high blood sugar

Hi,

Yeah it does sound like your basal rate is off, if your BGs are going up when fasting. May neeed to see your specialist. You probably have thought of some of these already but just throwing a few possibilities out - underlying infection as you mentioned but especially UTI's (urinary tract infections can be asymptomatic in diabetics). Injection site lipohypertrophy as you probably know, can cause irregular absorption of insulin - are any of your sites thickened or lumpy? Sometimes (bizarre as it may sound) very vigorous exercise can actually push your insulin requirements up through release of "stress hormones" (I haven't made this up!).

When did you do your fast? No long acting bolus insulin injection gives you a perfect basal rate (you need a pump for this) and most rely on you having fairly regular meals to either top up the insulin levels (at times when your lantus might not be enough) or topping up on carbs (when you have too much on board)

What is your BG level before exercise? If its too high something funny happens and causes it to shoot
Up even higher. Mine did this the other day. I didn't eat before exercise and was 13. I normally work out when it's about 10-12mmol/L cos it always goes down to 4-5mmol after exercise. However it shot up to 18 and my usual correction ratio didn't even touch it! However, about 4-5 hours after I then became sensitive to insulin and had a hypo. I had a toe infection at the time so I was thinking maybe that's the cause or maybe it's because it was just a bit too high prior to exercise?
Make sure your BGs are good before exercising (tho not too low as you don't want to go hypo!) to rule it out.

Hi Mary,

I find exercise a very funny thing these days. When I was at school and on two injections a day of Actrapid and Monotard, manually mixed, I didn't worry about post-exercise highs or lows. I took a bit of extra carb before the exercise and that was that.
Now, with basal/bolus using Novorapid and Levemir, I find that I can need extra carbs and a little extra insulin after exercise or my blood glucose readings will rise quite a lot. Typically, now, if I go swimming I'll take a bit of extra carb before swimming (maybe a mars bar or something) and then a banana and a unit or two of Novorapid afterwards. This seems to stop the release of glycogen and the rise in blood glucose.

Not sure if this might be of any help to you.

Steve

Hi Mary,

Sorry to hear of your troubles. As some have already alluded to, exercise can have strange effects on BG levels. Initially when you perform a decent intesity of exercise, your BG will actually raise slightly. If you are already a bit high (>12ish) it can raise substantially, initially.

Exercise OVERALL has the effect to reduce BG independet of insulin. This is because generally skeletal muscle cells upregulate the glucose transport molecules to the surface of their cells so glucose can be taken out of the blood, into the cell, thus lowering BG. Insulin is usually required for this, but a separate pathway for this occurs with exercise.

The key to understanding the implications as a diabetic, is not the science behind it, but simply that insulin (well, normal insulin i.e. fast acting) happens rapidly in a nice short peak. So you take insulin, or pancreas produces it, and it quickly shuttles in glucose to your cells. Exercise however should be considered more like a long acting insulin. The effects of exercise take a little while to occur in terms of blood glucose lowering, but when they do, they do it slowly and normally noticably a number of hours after exercise. So for example if you exercise at 7pm for 1hr, your BG will be at its lowest probably around 11pm-2am.

As you get older as well, and metabolism and fat levels change in the body, this process can slow down and be less as effective. All things to bear in mind.

This would explain why initially you see a rise in BG, then later get a hypo. Really if you are going to exercise, you should try and ensure 1-2hrs before that your BG is <10 ideally.

For me, I exercise twice a day on weekdays, 6:30-8am in the mornings, then 12:30-1:15 or so in the afternoons with a run, and on those days I can keep my levels between 5-7 with a good diet and NO novorapid, just lantis/glargine (basal bolus) injections.

Hope this helps!

J