According to my doctors, we keep always lantus at constant dose and we correct with the humalog. you should not have had hypos with the correct amount of lantus. if you have already found the appropriate dose. maybe you are still experiencing to find the appropriate dose.
It is true that exercise can raise blood sugar especially when you are doing weight lifting and hard exercises. My doctor tells me that the best blood sugar for exercise is 150. If the blood sugar is high then exercise takes it higher.
also one unit of lantus insulin can give you so much higher BG value 171 instead of 100?
Will need to remember Lantus has a VERY slow activation time of about 4 hours, so really your 7 units only kicked in mid way through the time you were being asleep. You don't mention how often you have Lantus, so am assuming it's one a day not on a twice a day dose. 7u over a full 24 period is pretty low, and Lantus has a tendency on small doses to really decrease in its effective use time, so it's probably already well on expiry by the time you have the next dose. Once it's on it's expiry it's tail can linger for up to 2 days, but that's at a very small effective level which tends to do nothing but cause the odd random effect on BG. I know the medical types like to try and split Lantus into multiple doses when it get's to small doses as it can then balance the times initially takes to get up to speed, and counter it's tail off at the end also. From past experiences, changes to a Lantus dose change doesn't really take full effect for about 2-3 days though due to the annoying tail it has.
The morning high could be a number of things. But personally would assume it down to a combination of that lovely thing which whacks many of us, the dawn phenomenon and quiet possibly fun with your liver. Your liver can raise you BG no matter at whatever level your BG maybe at (others have said 170+ but I've actually seen it with finger tests between 70-110 before also). If it kicks in, usually caused by what your body feels as a massive burst of excessive activity (when I go crazy on a silly sprint it's guaranteed I've learned and watched it on a CGMS jump from 95-255 in such a sprint) it'll dump a huge amount of sugar from your bodies reserves. If that's the cause of the high though, it will regain it at some point though, usually 4-6 hours later though just as a warning.
Seems to be quiet a few unknowns on what's going on really though. Both over the night time and so forth what with possible rebounds from hypo's and/or possible run downs from the long term Lantus' tails.
How does one know what to respond when no one seems to mention what type of diabetes they have! There are different ways to treat diabetes and different ways to make correction depending on what type one has.
It Tudiabetes only for Type 2?
Thank you
Lee
T`1D for 56 years
Some of the biological phenomena, e.g. dawn phenomena, boosted BG from adrenaline, are shared by the two types so it's reasonable to toss them out there. The OP mentions insulin so that tool is at least available for him. There's several of both types in the thread but, since the OP just tossed it out there, we can share what we know. I wouldn't know what to tell a T2 w/o insulin though, since I have no experience with metformin. Do you take two? Cut it up and sniff it? Get a syringe from your T1 buddy and shoot the stuff?
One of the things I like about Tu is that the "forum" page is nicely "mixed" between the types. I've learned a lot of things from my T2 buddies and hope that I can help them here and there.
@ Lee
Well, the original question was posted in the Type 1 Diabetes Forum so I just made an obvious assumption. Seems my experience is nothing like the rest of the diabetics though. I don't eat or exercise when I have a high bg, I fix it and then go about my business.
Over 215 I was always taught exercise is actually bad for us due to it increasing problems for various organs...well it feels pretty bad anyhow and I know my performance drops off massively even approaching that high a level.
But while exercising, and it causing to go high, treatment with I personally correct and go very gentle so not to trigger the liver again. Due to my exercise (biking) meaning I tend to be in the middle of no where, I don't like to stop on the roadside for an hour and wait for my BG to drop below 215 again before continuing, or if I'm in an event I don't like stopping at all for anything D related if at all possible, and so just inject a correction and go very gentle till it's at a safe level again. I also cease all my usual consumption of carbs till it's lower and back in the safe band again though.
A lot of this comes down to learning our own bodies, and also what in our exercises are causing the triggers. As I mentioned earlier I know a hard sprint triggers me, sometimes but not always a very hard climb. While normal slogging in the miles doesn't. But this is all down to our own bodies, and also what sugar our bodies has stored at that particular time. If you've already depleated your reserves than all it's going to do is make us drop lower faster.
As for what I am, well 34 years t1. But think that was also pretty obvious from our ways of dealing and treating things.
The other thing I do when I get high is to use the exerchart from "Think Like a Pancreas" and take a "cut" bolus, usually 1/3 if it's a long run, > 2 hours, just to nudge it in the right direction. I've had a few times where I ate too much, often running low beforehand, breakfast hit slowly or whatever, I'll be lowish at the start and overcorrect so an hour later I'm running up. A 1/3 bolus isn't a huge amount and I wouldn't do that if I was running low on carbs or something but the being out in the middle of nowhere I still want to make the attempt to get things closer to where they should be.
Which is a great way to go. One thing that can happen when you exercise with a high bg, your body senses that your cells aren't getting the glucose they need - that's cuz the glucose is hanging around in the blood stream. So...your body secretes stored up glucose to see you through the moment. I find that 250 asw a bg is the cutoff point to avoid exercise in order to avoid increasing even more,. Seems oxymoronic - but then so is type 1 diabetes.
I've had this happen to me many times before. I think is is related to sugar saturation of your liver. As an example if all night my BG is in the 90-100 range I don't get a huge morning bump. If I'm in the 140 range all night I'll get a huge bump in the AM if I don't take some rapid as soon as I wake up. We're evolved to have this happen so people had the energy to go crawl out of their cave and kill another woolly mammoth!
-Michael
One thing I'm not 100% sure is if the AM boost hormones are the same stuff as the workout/ adrenaline (??sic??)-type of hormones. If there were two different groups, it may be that there's a "double whammy" with two things hitting at once, for either type.
Kinda yes, and kinda no. It's never a simple answer.
Glucagon is the insulin antagonist. When BG levels fall, regardless of the cause, a negative feedback loop kicks in and glucagon is released to stimulate gluconeogenesis in the liver directly raising BG.
Under fasting conditions, adrenaline can work to increase BG levels through the glucagon negative feedback loop to increase BG levels, but it also stimulates the breakdown of glycogen directly in the muscles which does not contribute to BG.
The "AM boost" "Dawn Phenonemon", involves adrenalin and also the stress hormone cortisol, which also breaks down glycogen, AND growth hormone which suppresses insulin. These three hormones working together can result in a huge BG spike.
Certain exercises releases adrenaline and growth hormone so you can get the resulting BG spike, and can also release cortisol, but not necessarily.
Of course, all of these effects are pretty well studied, but they are highly individual, the effects of which depend on a gazillion other variables.
The one variable we can control, as insulin injecting diabetics, is the amount of insulin we inject if we can accurately and precisely anticipate any one, or all, of these occurences in a timely manner.
There is the proverbial rub, which is why I will not make big changes to my regimen unless I'm getting consistent and significant changes to my BGs in response to consistent and significant changes to my lifestyle. If you're new to exercise, or DP, or particular stressful situations, they can wreck havoc on BGs until you can work through your management program to take them into account.
If they are one off occurnces, I, personally, just can't worry myself about them.
I have this pretty regularly, especially after leg workouts. Seems to be more the lifting than cardio that does it. Lately I often have hypos about 4-5 hours later. Spike after lifting is rarely more than 10-20 points, however. My workouts are always early morning, though, so morning DP comes into play. Often am over 250 at start with no apparent effect on performance. Iām over 60, though, so my workouts are likely less intense than those younger.
My wife, Nicole, finds the Dawn Effect to be a very real phenomenon. She takes 1 unit of regular every morning upon arising to cover the Dawn Effect.
Different people have different theories for the Dawn Effect. Some believe it's there to purposely raise your blood sugar in the morning to give you an extra boost. Others that it's a result of the body cleansing itself and washing insulin out of the bloodstream.
The second theory makes more sense to me.
Anyway, 1 unit of regular will cover the Dawn Effect for Nicole. it may more or less for you.
Some T1Ds, I've heard, find it hard to exercise in the morning, and maintain normal blood sugars, because of the Dawn Effect. Nicole always waits until after 10am to exercise, and that works out.
In my observation, the Dawn Effect starts at 6am and goes to about 10am. Doesn't matter if you sleep in or not. I also think it may not start until 7am if you are following Daylight Savings time. I believe it's a function of the biological clock, which goes into cleansing mode at 6am equator time.
For me Dawn effect really starts at 3:00am thru 8-9 am. I would wake up every am with Blood glucose at 238.
In fact my liver leaks during the day and on going sub 70; wants to throw the whole liver buffer at the problem.
My read that dawn phen, leaky liver and dumps go together as a package due to faulty liver signalling. Liver signals on reverse of insulin levels. Lower the insulin level, and liver assumes one needs more glucose and you get it.
So if pancreas is off not putting out sufficient insulin , liver belts more glucose at one.
Metformin works by cutting off the excess glucose release. Metformin by passes this faulty signalling and can signal liver directly to cut off glucose release.
I work out with weights and my BG always goes up. In varied situations (when I haven't eaten for a while, ate my regular low-carb meal recently, or even some carbs closer to the workout) the result was more or less the same - a rise in BG. My trainer tried to change my program to include more or less aerobics, but it didn't affect the basic result. So I just correct for it a little afterwards, when I have my dinner (not too much, because I think it corrects itself to a certain degree, and I have had hypos when I treated it as a real high). BTW when I do other kinds of exercise - a lot of walking, for example - this does not happen.
I was told not to exercise if my BG was over 250 because the exercise would make it go higher. IT does not lower blood sugar if BG is already too high. I am not sure about the 171, maybe you are especially senstive or possibly are sick with something?
I've read that but, if my BG runs up there, I'm going to correct it. If I do some sort of moderate activity, take the dog for a walk (we have handy 1/4 mile or 1.5 mile loops...) or go for a moderate bicycle ride, it will make the correction work faster so I "bank" less time at the elevated BG level. Last year during the Chicago Marathon, I ran up to 190, as I had a moderately panicky gatorade at 3 miles b/c my BG was trending down but that and the Luna bar I ate in the corral both hit at the same time and my CGM peaked around 190. I corrected but, as I mentioned before, since it as like an hour into a 4 1/2 hour race, I just took 1/3 of the recommended amount, which wasn't a whole lot, like .3 or something like that. The CGM pic shows the # of correction boluses as the little black marks along the bottom of the graph, w/ the start of the race pretty close to the left side of the pic. 4 1/2 hours later I finished and was like 68 or something like that, which was perfect for me as they had 312 beer (wheaty and full of carbs...) and potato chips @ the finish line!
10-4 acidrock23;
That is what I do. I hav ebeen up to 340 and beat it back.
Initially, yes one may see blood sugar go up a little but once enough burned off muscles, they will start to draw down.
Of course if got/intestine loaded one will help move that faster but I ALWAYs get my big numbers down by walking a one mile pass and sometines an additional one to keep it trending down.
WHere this idea comes from that one should not exercise if numbers are high escapes me. Until I figured out how to coral my livers excess morning dawn effect to 238, I would walk 2 miles to beat it down and DID.
You are probably experiencing the dawn phenomenon. I have found that my blood sugars will keep on rising in the morning, exercise or not, until I take insulin AND eat something. The body (and the liver?) apparently rev's up for the morning's work, including "fight or flight", and so starts generating glucose. I never fast in the morning now if I can help it, and my blood sugars don't go up too much (unless I am delayed in having breakfast!)
I constantly have this problem and it's the opposite of what I was taught about diabetes/exercise. When I first started working out, I'd go low every time. Now that I'm fit, my body has to work harder and you get adrenaline going, which boosts my blood sugar. Your muscles work really hard and your liver will dump out sugar. I notice it particularly when using weights with my routine. I'm on a pump, so I'm able to boost my basal for 3-4 hours after and that helps a lot. I usually go up an extra 25% and I'll give a unit of insulin after my workout (helps with the protein I have afterwards). I advise lots of testing. If you can get your blood sugar in a good range I find you might not have that big spike.