Had my first soccer practice today, and first heavy running since being diagnosed with t1 less than a month ago. I sort of had a plan on how to do things based on some video lectures someone sent me a link (http://www.1happydiabetic.com/apps/videos/channels/show/1499150-sports-and-diabetes)
However… I thought our practice was Sunday, but it was actually Saturday at 10 am. I woke up at 10:10, so the idea of having a meal 2 hours before practice went out the window. It’s a casual league, so I didn’t get in any trouble for being late :). I can also run off the sidelines anytime i don’t feel comfortable to test and eat.
I’m going to give specifics about eating, timing, and BG readings in hopes of getting help answering - what would you have done differently from me today? I’m still here, so things didn’t go that badly, but I’m hoping to learn from the experiences of others and make improvements.
My basal dose was 15 units of levemir the night before at around 10:30. Didn’t change that. Right now my doctor has me on one dose a day.
10:10 - wake up, BG reading: 84
10:20 - eat a granola bar with 30 grams of carbs. I’d normally take 4 units (i do well on an 8:1 ratio) but I only took 2 units to give myself a little cushion for exercise.
10:50 - get to the field BG reading 98 - kind of surprising - i thought 30 grams of carbs from a granola bar would’ve entered my blood by this point, and was expecting something closer to 150-170. Since I still don’t have my BG cushion and I’m afraid of going low from running around, i take a few sips of gatorade, probably ~6 oz / 10 grams of carbs
11:10 - first water break after 20 minutes of decent running with some sprinting. BG reading is up to 156 - could this be the granola bar finally kicking in, or adrenaline from running? At least at this point I’m grateful I don’t have to worry about lows, so I can run more freely.
11:35 - finish playing
11:50 - get home, BG reading 181
12:15 - getting hungry, but with my high reading I don’t want to eat too much. In the video lecture the doctor mentioned eating something with a 4:1 carb:protein ratio to recover post-exercise. I eat a yogurt, which has 16 grams of carbs to 5 grams of protein (close enough, right). For this 16 grams of carbs I’d normally take 2 units of insulin, but I took 3 instead to help bring my BG back down. (maybe my mistake?)
1:00 - still hungry but afraid to eat carbs, so i have a little piece of cheese, and chug a big glass of water to help bring BG down a little faster.
2:00 - don’t feel quite right - check my BG - holy crap, 47!
2:10 - eat half a banana and a salad with some cheese, a tiny bit of oil/vinegar dressing, and pine nuts. All in all about 25-30 grams of carbs, all with no insulin because now i’m fearing the post-exercise lows.
4:15 - BG check, only 70 - so, the meal I ate at 2 with no bolus only raised me barely out of a low.
4:20 - eat the other half of the banana, again with no insulin. ~15-20 grams of carbs.
6:25 - pre-dinner test, BG reading 120. Is order restored to the universe? Or am I just not going low this time because i don’t have any more bolus insulin in my system (humalog stays about 3-4 hours i think).
Going to try a normal insulin dose for my dinner. If my body is done recovery i should be fine. otherwise i’ll be running for more fruit in an hour or two.
So, can someone with more experience give me a hand here? What would you have done differently to avoid the little BG roller coaster I went on today?
Also, what should I do differently under normal circumstances, assuming I don’t oversleep next time.
Thanks a lot for your help!
Hey Dan,
You don’t mention how or what you’d normally eat over the course of a day. Would you normally get up and eat a granola bar for breakfast, bolus for it, then head out? I’m looking at what you ate and I wonder about just your total caloric intake as well as the amount of protein and fat you are eating daily.
Personally, when I was competing, I ate full meals as often as possible. I found that a nice mix of carbs, protein, and fats in combination with workout doses of carbs kept me off the roller coaster better than just eating carbs to try to keep from going low. My typical pre competition meal was a turkey and swiss sandwich and small glass of OJ. I generally tried to eat well in advance of a workout or competition, but if it came right down to it and I had to decide between skipping a meal or suffering a bit of nausea during a workout, I always chose the bit of nausea. Low or high BGs brought my workouts to a grinding halt.
The video mentions burning through your glycogen stores which means you need to eat enough to replace them. But, you’ll also be losing muscle mass if you don’t eat enough protein. Eating a 4:1 ratio of carbs to protein post workout is a good rule of thumb, but you also have to think about how many absolute grams of both you’re going to require to replace glycogen stores and maintain muscle mass over the course of your season. I would have wasted away in no time if all ate was a cup of yogurt post workout.
FHS, thanks for the reply.
On the diet issue, I’m sort of adjusting to my new body… In July I lost about 30 pounds to DKA before diagnosis. I gained about 10 back in the hospital and now weigh 165, which is a weight I’d like to maintain. I’m 5’8 with an average build, and feel good at this weight.
On the calorie end of things, I’m trying to get into an eating routine, but usually wind up around just 1500-1800 calories a day. This is because I try to limit my carbs to around 50g per meal (around 120-180 a day total) but I also don’t want to make up for eating too few carbs by loading up on way more fat or protein either. I typically have around 50-75 grams of fat and 80-100 grams of protein a day. I probably could afford a bit more carbs, but I’d have to dial up the insulin as well. I usually have around 18-20 units of humalog as it is, which seems like plenty for me. I feel like if I start eating higher carb meals to fill the extra calories I’m missing, then my margin for error on insulin dose also decreases. By that I mean - I’m comfortable eating a 50g carb meal and taking 6 units, because I know my BG will fall into a good range post meal, however, I’m less comfortable eating a 75g carb meal and taking 9 units of insulin, because I feel like “the stakes” are higher when I have more of each. There’s a higher potential to have a swing in either direction.
At this caloric level, I’m not exactly wasting away, but I have probably dropped around 3 pounds since leaving the hospital on 8/10.
You mentioned the total carbs I need to replace the glycogen stores from my workout - that’s probably a good place to start because based on my #s from yesterday I definitely could’ve eaten more carbs when I got home from practice. However, this was a bit psychologically difficult after seeing a reading of 180. It’s a leap of faith to eat more carbs and take less insulin.
Do you do things like cut your bolus in half on days you’re exercising heavily? Yesterday I ate a small meal with no insulin and my BG barely moved, so it seems like I could eat a high carb meal after matches, but I don’t know yet how much insulin I should take or how many carbs to shoot for.
Typical daily meals for me from the past few days are:
breakfast - bowl of cereal (1 “back of the box” serving, don’t just dump it in) with a cup of soy milk and an egg white omelet with cheese.
lunch - peanut butter and sugar-free jelly sandwich on thin bread
dinner - some protein - usually chicken or tofu, with vegetables and a small serving of a starch, like rice
snacks - only snack if i’m going low. since my doctor switched me from apidra to humalog i tend to go low around 4 hours after a meal if my 2 hour post meal BG is around 120. In these cases I might have yogurt or a hand full of grapes, or if I’m below 60 I might have some OJ.
For your first time out and little time to plan, I’d say you did a pretty damn good job for a first go! I don’t have much experience in burst exercises, so hopefully someone can offer more general help, but here is what strikes me:
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When you do eat a normal meal a few hours beforehand, you can probably take close to your normal dose. I’d just avoid anything high in carbs so that you don’t need a large amount of insulin which could drop you later. If you do need to take a fair amount of insulin (for bg correction or carbs) then you may need to turn your basal down 30 min before and during ex.
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The 156 you’re seeing at the first break is probably a combination of the granola bar and the adrenal response. For what you’re doing, you may be able swap the granola bar for something with fewer carbs/more protein. Watch this number carefully as time goes on – as you get more accustomed to the exercise level/stress your liver may dump less glucose and you could start going low here in the future and you may need to revisit your pre-ex snack.
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The high when you get home looks like the post-ex spike that I get when I get home for running. I take a small bolus (0.5-1.5U for me) in the last 0.5 mile of my run or immediately when I stop as long as I’m >80 and not declining. If I don’t, my bg will shoot up even if I don’t eat anything.
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The low you see later, I would also see that in this situation. I take about 1/2 to 3/4 of my usual insulin dose when I eat, which is usually about 30-60 min after my run. Part of this is probably increased sensitivity, but also possibly the insulin I took post-ex.
I think FHS has a great point, too. Based on the total calories you’re burning, make sure the absolute quantity of what you are taking in is enough. Your body is going to be hungry to restore the glycogen and repair the muscles, which is why it’s so important to make sure that you get enough for recovery.
The reason I give ranges above is because a lot of my specific decisions are based on all of the other variables – how far I went, how hard I worked, how much I decreased my basal, what I ate beforehand, etc. I think you have a pretty solid start though so good luck!
Tom, thanks a lot for the advice, very practical.
Would you recommend switching to syringes from pens so I can take half units? First choice is pump, but that may be a year off.
Also, should I consider splitting up my levemir so that I can adjust doses based on activity levels?
Hey Dan, a couple of things.
I’m 5’10", 160 lbs. My daily meal plan is actually pretty close to yours except I eat closer to 2000 to 2500 cal/day and I a bit more protein and fat.
I don’t generally alter my insulin doses for my workouts. I’ve found that working out consistently means that I’ve increased my insulin sensitivity a lot, nearly cutting my TDD in half. Since my heavy days are sprint and strength training centered, I found that I can eat normally and take my usual insulin dose without worrying about going to low. My light days are more aerobic, so I eat and dose normally but when I’m jogging, my BG can drop as much as 100 pts in 20 minutes so I’ll take some carbs halfway through. I get a bit of a post-workout spike, and I’ve found that if I just maintain my insulin dose, meal intake, and watch my BG during a workout, I can minimize the peaks and valleys.
You said you’ve lost 3 lbs in the last 25 days or so? I wouldn’t call that wasting away either, but over the course of the year, it adds up. I have to fight tooth and nail to maintain every pound. Have you been working out all that time and did you work out consistently before you went DKA?
If you’re working out consistently, you might want to try to up your protein and fat content. Upping your protein does two things: 1) You’ll help maintain your muscle mass and weight. 2) Since some dietary protein can be converted into glucose, you’ll also be helping to rebuild your glycogen stores without having to increase your carb intake. Overall, the combined effect of more fat and protein should be to cut down on the peaks and valleys which is what you were concerned about.
+1 to what Tom says. You’re doing great! It takes some time to work things through.
I should say, everything I mentioned is based on MDI, not pumping. I did 4 years of college track and field another 3 years of club track and field, and the last 25 years of generally working out on MDI.
That’s probably the biggest reason why I decided to base my meal and dosing routine on how much I work out consistently rather than changing meals and dosing for particular work-outs.
I just went on a pump 3 days ago. I managed to fit one workout in while I’m establishing my basal rates. I tell yah, the ability to adjust basal rates is a game changer.
Hey Dan!
Nice work and good for you to stay after it. This will be a series of experiments and each day will pose new challenges, but you will get a good routine down. FHS commented that the ability to change basal rates during exercise being a “game changer” on a pump. - I couldn’t agree more. I used to go low when I was on MDI just walking down to the park, and I could never control it well by changing meal boluses - the insulin/carb changes were so imperfect and I’d always be too high or too low. Now, with being able to change my basal rate only I can finesse my insulin and BG throughout the work out and after. It’s saved me from the gnarly lows I used to get post exercise. I’m also on a tight ratio of 1:7 (like your 1:8) so I also relate to your eating patterns of lower carb, or basically, lower insulin… I do the same.
On your day that you outlined:
I think granola bars are slow enough to absorb that the 1/2 hour between when you ate it and when you checked at 10:50 (starting out at 84) doesn’t surprise me. Perhaps there was a little adrenaline going for you because it was your first practice? Maybe that would burn through more glucose as well. Another question - what did you do the day or night before? Perhaps could you have been burning through some more sugar because of activity the day before?
I would look at the 11:10 sugar and think that the granola bar and the gatorade hit. Good that you were able to finish playing without worry
Correcting after exercise (even at a meal) is something that I rarely do. At the time you ate at 12:15, you probably still had 1/2 to 1 unit of active insulin from your bolus for the granola bar.
I think that after exercise, especially something like soccer where you will have depleted much of your glycogen stores, that your body will be “restocking” those glycogen stores for some time after exercise. For me, it often hits 12 hours after I exercise. For you, it looks like it hit 3 to 4 hours later. I’m not surprised by your post exercise low.
The other thing - when you were 47, you ate a meal, but did not take a fast acting sugar to correct the low? I would rather take glucose tabs or drink milk or juice to come up quickly. I would try to right that wrong much more quickly and I avoid all things with fat (salad dressing, chesse, nuts, etc.) until my sugar is right. THEN, I would eat the mixed meal. Using mixed meals to correct a low can take too long and or cause you to over shoot and end up high later, (though that didn’t happen to you this time).
How do you feel about protein shakes after a workout? Many of them have enough carb that it will help keep your sugars stable afterward, and will help you feel satisfied and not starving. Also, you won’t have to dose much insulin at all after working out which seems like it fits with your goals.
Thanks for sharing your thoughts and your workout - it always helps me to see other’s thoughts and hear the responses too.
Keep up the great work!
Rachel
FHS - sounds like we’re at different activity levels. The soccer is going to be 1 practice and 1 match a week. I’m also about to start badminton, which will be about an hour or two a week. When I lived in China I discovered that badminton can actually be as intense as soccer if you play with people who know what they’re doing!
So, I think I need to tailor my eating to my workouts on a per-workout basis, opposite of what you’re doing.
Congrats on the new pump. What kind did you get?
For setting temporary basal rates - is that to reduce the chances of going low while doing endurance exercises, reduce post-workout lows for when your body is recovering, or both?
If I were to get a pump, if I’m doing a burst exercises and getting a shot of glucose from my liver, would I actually want to increase my basal rate to prevent highs? Then decrease it after exercising to prevent lows?
Rachel, thanks for your response. Yes! Guessing and correcting boluses and carb counts mixed in with exercise is difficult!
For treating the low - I’m not sure if I believe it was really a 47. I had another reading of 47 two weeks ago and I felt miserable. This one felt more like a 60. I was just starting to feel a bit shaky, but I wasn’t sweating and my heart wasn’t pounding. Eating half a banana was my solution for this, because the first few times I saw low #s on my meter I tended to panic and overcompensate, sending myself from 50 to 150. So, the banana was the correction, and I was expecting it to put me up to around 100, and then the 10g of carbs, coupled with fat, were supposed to slowly release in my system and restore my glycogen stores. That was the idea, anyway, but apparently my liver wanted its sugar back faster than that! Next time I clearly need to go a little higher on the carbs by eating a real meal after soccer. I think my gut reaction was to just go in moderation with everything - low carbs, low insulin, to try to avoid any big swings.
I do think adrenaline played a factor in my first practice - and to be honest I hope this trend continues, even if it lessens, because it will keep me from worrying about lows. According to this article Florian posted on the group board (http://www.diabeteshealth.com/read/2010/07/08/6751/exercise-often-raises-blood-sugar) I should be able to get an adrenaline boost if I do some sprinting and push myself above 80% of my physical threshold.
See if this makes any sense. Sort of a theory I’m putting together based on comments and my little experience to date:
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If I had 30g of carbs from a granola bar, and 10g from gatorade, along with 2 units (enough to cover 16 or so grams of carbs for me), then my “unanswered” carbs without insulin to cover it would be 24 grams.
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If my BG goes up 4 points per gram (they seem to impact me more earlier in the day), then I should’ve been at around 180 by noon even without exercise.
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However, obviously running around for 40 minutes is expending a lot of available glucose.
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From previous experience of playing a little basketball, I went down 100 points in 50 minutes, so I’m guessing this more strenuous 40 minute workout probably used slightly more than 100 mg/dL of available glucose.
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Since I ended my workout at 180, the glucose released from my liver basically canceled out the effect of soccer, and I only went up because of food without enough insulin.
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Had I just had a normal meal (~50g carbs) with normal insulin 2-3 hours before exercise, and a normal meal with 1/2 insulin after exercise, everything would’ve been fine. My liver would’ve taken care of me while playing, and I would’ve taken care of my liver with extra sugar for recovery after
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Should I begin having smaller adrenaline boosts as the season progresses, I might need some gatorade before the match and during halftime to prevent lows.
Does that make sense?
Thanks! I went with the Omnipod.
Right now, I’m not sure what it means for my workout and daily routines. I’m sure I’ll be asking a lot of questions in the weeks to come I imagine. I’m just establishing my basal right now by doing as little as I can and seeing what my insulin requirements are based on sitting around watching T.V. I imagine that I will have have more than one basal program for different days and different activity levels to go along with temp basal settings and the ability to suspend my basal completely. We’ll see!
Dan,
I play soccer and racquetball, combined total is 3-4 times/week. I think you’re on the right path to figuring out what works for you but I wanted to add one interesting point: at practice I have no spike from adrenalin (and can often go low), but at games… the adrenalin hits me soooo hard that I have to increase my basal rate by 25% or more to compensate!! I tend to need to eat before practices and I don’t bolus or maybe just a little, but I am really careful about not eating too much before my games because of the extreme spike due to adrenalin-- so I end up eating a couple eggs and maybe one piece of toast, for which I do bolus.
Thanks for the interesting and detailed discussion!
Vanessa
Sorry I forget that not everyone is on the pump:) If you still see yourself rising after the match then a unit by pen will probably give you what you need. Pens are so much better more convenient than syringes especially in public. FHS’ suggestions on meals snacks are probably more applicable. A 154 mid-match isn’t bad and I think a small amount of tinkering will have you in great shape!
If you do go on the pump, then you may need to increase or decrease your basal depending on the situation. When I run, especially within 2-3 hours of taking any insulin, I have to turn it down before/during my run in order to keep from going low. But if I’ve eaten and haven’t taken any and I’m going to do a shorter more intense run then I have to turn it up. But I think for now messing with the snack will give you what you need.
I’ll also ditto that basal adjustments are the hugest benefit of the pump. It takes time for the adjustments to have any noticeable impact – about 30 min or so – so it isn’t a cure all but it really simplifies planning. Combined with 0.1 U increments and more consistent absorption, the pump is great for athletes. And this is coming from a certified anti-pump person before he went on the pump!
Vanessa, sounds like we have pretty similar workout patterns. That’s interesting that you have such a big difference between games and practice. Our first practice was actually a scrimmage, so maybe my body behaved like it was a match, and it would be different doing drills.
One day Tom, one day I too will have a pump.
My older brother has a minimed and he’s trying to give me advice on things and then he says - oh wait, you can’t do that.
One annoying thing keeps happening to me at dinner to me lately. My wife loves eating fruit to end a meal. I’ll spend 10-15 minutes figuring out and adding up all the carbs that I’ll be eating, take my shot, start eating, and then right after I’m done my wife says - oh! we should cut open that watermelon/cantaloupe/papaya/honey dew! Gotta work her out of that habit… or more likely adjust my habit to ask if there’s any surprise fruit coming my way. It’s usually not worth it to give myself another unit, but with a pump I’d just be one click away!
Everyone who responded to this thread, thanks a lot for the advice! we had our first game today and all my readings pre and post game bg levels, including through dinner, were between 80 and 130. oh yeah, and we won 5-0 
basically, i had normal breakfast and normal lunch of about 50g of carbs each with 6 units of insulin. I went into warmups around 70 so I had a little snack because I figured my blood sugar would just be dropping before the game. Started the game around 80 and had a few sips of gatorade. Halftime I was at 130, end of game i was at 128. Went home and had around 20 grams of carbs as a snack. Heading into dinner, despite 20 grams of carbs without insulin my bg was 100, so it was definitely falling fast throughout those first 2 hours. Had around 45 grams of carbs at dinner with only 2 units of insulin. Now, 2 hours after my meal, i’m at a nice, happy 120, and am probably done replenishing my system.
thanks again for the help. Seems like I have to worry more about post-game carb intake than going low during the match, which is nice because it’s a lot easier to manage things once i’m home. it looks like if i do without the pre-game sugar from gatorade or some other source i’d stay pretty constant the whole match, but i’m still a little worried about the possibility of maintaining a BG of 80 for the whole match, especially since i have to drive home after and my sugar levels seem to drop really sharply in the first few hours.
Nice! Congratulations!
+1 on having a little sugar at the start of the game. I’d think that 80 is a bit low to start any kind of athletic activity…