Diabetes & Physical work

Type 1 and LADA
1

I’m gonna need to do some physical work this summer and I am super out of shape.

My strategy is to start small by doing some swimming. Swimming is the summer equivalent of cross country skiing. Today was my first day because we finally got a day with no rain. It made my sugar low ALL day where I didn’t need to bolus insulin all day. I just ate.

Swimming is hard core and I refuse to do it upfront without a bunch of teenage lifeguards. I’m sousing these kids out to see if they can be trusted to haul my walrus ■■■ out of the water in the event of a near drowning. So far, I don’t trust them, but I’m giving them the benefit of the doubt.

2

I often do the opposite.
I swim but I don’t eat and my sugars stay awesomely stable.
I only started swimming again because I feel like I can do it with pods, where I struggled more with a tubed pump, although it is doable.
Anyway I discovered intermittent fasting 2 years ago and it’s really fantastic for sugars and insulin sensitivity.
The only caveat is that fasting 24 hours causes a level of ketosis and switching back to glucogenesis requires more insulin than one might think.
So Friday 7pm is my last meal. 7 pm Saturday is my first meal.
I hike and swim during the day and I only drink black coffee and water.
When I break my fast I use 50% more insulin. For that first meal, but the next day I need far less.
I’m slowly losing weight this way. Only fasting on weekends.
I end up losing 5 lbs a month and I’m getting close to my goal. 25lbs. Seems easy to say it but losing 25 lbs with out crashing was being really difficult to manage.
But the best part is feeling better and my control is better even on non fasting days.
Average for 90 days is 95.6% in range. Part of that is I allow myself to go as low as 60 without correcting.

Before intermittent fasting I was lucky to hit 90% in range most days.
My a1 c is also better at 5.4 on my last one. I have been happy
At 5.8 for years,but the insulin sensetivity and lower a1 c is an u expected bonus.

I’m doin all of this in an experiment to lower my daily dose of insulin. I was reaching 70 units a day and it was alarming to me even though for my height and weight, it’s considered normal range.
So my average is now 40 units a day and I eat high carb low fat. I’ve been doing that diet for 3 years now. But I try different things as I go.

I learn something every day about how my metabolism works.
So much of what we were taught is incorrect at best.
I’ve struggled for years to reduce my insulin under 50 units, and still stay in range.
Metformin didn’t help, low carb didn’t help.
Increased exercise and intermittent fasting seems to work for me.
Not one thing works for everyone though.
And I’m not hungry when I fast. I really have no idea why.

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3

Does a fast still count if you have to treat a low? I can fast all day if I am not counting the stuff I have to eat for lows. But there is usually something I will need to eat just for BG.

4

That all depends of your purpose for fasting.
If you are trying to get into ketogenesis, then correcting lows will break your fast and you will revert to glycogenesis.
That’s typically how we lose weight.
I’m on omnipod so my basal rate is adjusted to my needs and I almost never go low during fasting. It was the same when I was on Tandem.
If you are on injections, you would need to lower your dose for that morning or day depending on how long.
As a rule of thumb goes, when you go low during fasting, you are getting too much basal insulin.
That’s how standard basal testing is computed.
You fast 8 hours and see what your sugar does and make adjustments to your basal based on that.
That 8 hour rule is for people uncomfortable with a24 hour fast.
You can just do it in 3 chunks , even different days.
But in injections people usually just have 2 12 hour injections of their long acting insulin
When you get to 24 hours and no crashing or going high, then you reached your correct basal rates.
For me it’s right around 1 unit per hour. But my pump lowers it when I’m exercising and raises it at night when I get a predawn spike at 330 am.
Today for example ,I used 23.1 units of basal insulin. And 14 bolus.

5

Here’s my 2 cents - one of the reasons we are unique in how insulin, carbs and physical activity affects our glucose management is that inherited insulin resistance is probably a spectrum from near zero to high.

I remember reading a T1 member of NovoNordisk professional cycling team how as a child he could ride and not need insulin. There are those like me, a late stage T2, needs insulin during physical activity. It may need to be reduced.

I use a Tandem X2 pump with C-IQ. My trainer suggested I turn on exercise mode 45 minutes before a bike ride. That just made my BG continue to rise. I just ride in regular mode. Sometimes I will have to treat a low, but not often.

For others regardless of type it may be different. The important thing is to learn what works for you.

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6

This is a pattern I see when I am: 1.) Out of shape; and 2.) Swimming.

Cross country skiing actually, usually, spikes my BG.

I’ll do this a few times and see if the pattern holds, but I fully expect it to hold for a while. I can drop my basals if I see the pattern hold. I’ll start loosing weight and that just makes it really tough to find the right basal rate. Fingers crossed.

7

Just read this post this morning, might have a bit that is helpful. Matches everything I’ve experienced exercising with T1D

Swimming is great exercise and a good start since it is low impact. After a week or two definitely start adding other forms of exercise. Mixing what I remember from the HS swim team and life now with a CGM, swim sets consisting of a stroke for a distance then rest for a minute with your CGM out of the water so if its time to transmit it has a good chance of being received. Repeat x times to make a set.

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8

Agreed and I believe that is always a good place to start; stop eating (like, no snacks, no coffee, nada.) Wait. BG goes down correct, glucose, as little as possible (break the tablets in two, weigh the powder). Continue. At 8 hours, or 24 if you ate a whole pig before starting, things should flatten out.

Problem: @mohe0001 said swimming, (I assume laps, not paddling around with a cocktail), cross country (great, no cocktails possible, downhill does not count here) or a few K on a bike, or hiking with at least 1,000ft of ascent (descent is pretty good but not good enough).

In all of those situations if we start doing them our bodies have to find glucose from somewhere. If I keep doing them after, in my experience, one day my basal drops massively. Oh, my TIR goes up massively too. Exercise is really great for us.

I suspect if I went back to cubicle-death (it’s too much not life) I could eventually stablise with my current loop systems but I’m not sure a good HbA1c and no excercise would not kill me faster than a bad HbA1c and lots of excercise.

I’ve never much liked the Jim either. Too much like the djinn; I’ve already used up way more than three wishes.

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9

So, I haven’t been able to get sensors/transmitter for a while. It’s a combination of pharmacy and insurance issues. I’ve been going off manual BGs. Swimming was hitting pretty hard upfront. I think this is just me being out of shape. I’m a solid 190 lbs., which is a healthy fighting weight for me. Ideally, I’d be around 160. I’m large Midwestern ranching stock.

I switched to painting my brothers garage. I painted for 7 hours today. No super intense lows. I got a transmitter today. Once I get sensors I’ll resume swimming. Heat advisories tomorrow.

It’s 1:30 in the morning. I’m up all night again with low BG. I haven’t slept since this exercise experiment began. I need sensors data. I gotta drop this basal at least overnight on exercise day. I’m writing to keep myself accountable so this experiment doesn’t end with a bad car accident somehow. I’m not particularly hypoglycemic aware.

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10

I have had to switch off my pump and cgm a few times over the years and it never goes well for me. Short term is ok, but I’ve never gotten it to be anywhere near what a pump with algorithm can do.
I go to bed with a glucose of 70 mg/ dl and I don’t think twice.
My pump will suspend until I come up.
This is something I could never do before. And I would eat food just before bed, as directed by my doctor at the time and now I just never do that, and ther is no need.

Most of the time my lows are caused by sleeping on my sensor and aren’t real lows.

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11

In an order other than your post:

Yeah. Happens to me. Drop the basal. Too low a basal is not an issue if we test, no DKA with a low basal, just irritating sticky high BG. I spent too much of my life on too high a basal; I still hate the fact that I can’t remember the 1978 Reading rock festival, though bits have come back over the years. I am intensely hypo aware these days, though it’s not hypo; it’s rapidly dropping BG. Still works; if I correct at 180 and dropping fast I don’t hit 50.

Yeah, every time. Swimming when we do laps is the single exercise every part of my body hates. I can wear myself out easily with 20 lengths (10 laps) of our above group 33ft (10m) pool. Nothing hurts; it’s not like walking up 100ft of steep ascent which I do regularly and which can burn. Swimming is pure unadulterated exercise.

Take heart, drop basal, dive in.

So, on to lighter matters:

Roller or sprayer? Now I didn’t really paint until I was 50+. In my youth I might slap a paint brush against a wall in a repetitive fashion, or even a roller, but only when I was 50 did I find the joy of rollers on 6ft poles and mighty sprayers. I use a Magnum XR7 and it is a masterpiece, very much a Clint Eastwood sprayer; an older model requiring careful maintenance but very effective when used.

It’s also a golf cart, as are all sprayers in the world of painting (including HVLP); no exercise. The 6ft roller, particularly on a ceiling. That’s a whole different story! It burns. Not the legs, it’s the arms here.

I recommend sticking to swimming. It’s a lot more effort for a lot of less pain and, in my pool, with the caustics from the sun creating amazing patterns on the bottom it is way more interesting that watching paint dry (though, I admit, that is pretty interesting too, compared to some other exercise I won’t mention.)

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12

Mostly roller, but I broke out the tiny paint brushes my niece uses to cut in. These are good suggestions on painting tools. I’m gonna get a sprayer and paint my dads house when there’s time.

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13

I swam again today. It’s like playing with fire.

Sensors obtained. To my diabetic comrades, do not go swimming if you don’t have access to sensors. I have learned the hard way that I do not even touch water without dropping those basal 25% - 50% across the board for 24 hours. It’s incredible.