Foods to eat pre-exercise

Type 1 and LADA
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I do have a pump, but I am currently doing MDI. I’ve been doing that for a few weeks. (well, actually I did MDI for 45 years, and then used a pump, but now I am BACK to MDI…)

Lantus doesn’t quite make it 24 hours for me. It’s more like 20 hours. Because of that, I started splitting it into two different shots, about 12 hours apart. I started by splitting it evenly, and then began adjusting the amount of the split based on what workout I have to do.

For normal length runs, they are close to the timing of the nighttime Lantus dose, which is worn out by then (if I dose at 9pm, and I run at 7 pm, that nighttime Lantus shot is basically finished). So the only Lantus in my system is the one from the morning shot, which is less than half of my Lantus total for the 24 hours.

So when I run in the evening, I have only a small amount of my basal (less than half) from only the morning shot.

On days of a long run, I will skip or GREATLY reduce my morning Lantus shot, which means I have almost ZERO Lantus by the time I am doing the run.

Does that all make sense? I know, it probably sounds confusing! I can put it in a timeline if that would help you.

So this is great. Once you have that basal number perfect for non-exercise, it’s time to work with it so that it can be perfect DURING exercise. I think this would be a tremendous help for you to get that number. Instead of eating to prevent a drop when swimming, work toward creating a perfect basal schedule that lets you not drop WITHOUT needing food. It’s just a matter of experimenting with different percentages and timing. Like I mentioned before, as and example cutting down to 80%, then 60%, then 40% for several hours prior. Since your duration is 4-4.5 hours, you need to figure out a way to get your total insulin in your body to be at the barest minimum, and then you can swim with no fear of dropping. And with no food, you won’t rise either.

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Hi SandiTX,
After reading your post, there were a few things I wanted to mention to you. For dealing with using Lantus for basal, you can do a bit of adjustment with it by splitting it into morning and nighttime doses, and adjusting the percentage of those two doses and also the timing, so that they coincide with game time. I can detail this for you if you’d like.

For blood sugar during exercise, I have always been extremely skeptical of what my Dexcom says. So much so, that I actually tossed it aside on mile 17 of my last marathon because it was so far off, it became worthless. I have finally seen some validation of my skepticism about using the Dexcom during exercise. Michel sent me a study (thanks Michel!):

http://online.liebertpub.com/doi/pdfplus/10.1089/dia.2015.0394?src=recsys
Conclusion:
However, a lower accuracy was observed during exercise for both sensors, necessitating a fine-tuning of their performance with physical activity.

If he isn’t already doing this, I would strongly encourage him to do an actual blood test whenever he gets a minute on the bench. The Dexcom lag during exercise is problematic, and a quick BG test would be extremely helpful.

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i swim in the afternoon, so i actually prefer to swim with food in my tummy. I am hungry then. i eat 1 hour before i walk to the pool (about 15 - 20 minutes). today, i ate my yogurt and 1/2 Ucan bar, but after 1 hour, my BGs only came up to 153. i took a little more of the Ucan, and think i will wait another 15 minutes or so and then re-test and then walk to the pool. i think it will be a good experiment for me to see what happens with the Ucan bar on board and how it might sustain me while i swim. i will get out every 20 min. and test. if i go below 70, i will get out and try a different routine for the next time. also, i need to keep in mind that if i am on the low side before i eat my pre-workout snack, i will need to eat a little more in order to raise my BGs into a healthy range. trial and error, persistance and tenacity. :smile:

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Eddie, Thanks for that article, I’ve been wondering about that. My own theory is that with hard exercise it’s common to get dehydrated to some degree and that throws the Dexcom off.

FYI I play ice hockey and have found that a somewhat different approach works better for me with hockey. I always have a smallish snack about 1 1/2 to 2 hours before a game and I bolus for that snack. Lately it has been a large apple with 2 units Humalog. Immediately prior to game, I check BG and use 15gram glucose gel to raise my starting BG if I am 120 or below and falling at game time. During game I drink watered down PowerAde and try to get anywhere from 10 to 20 grams of sugar depending on what my Dexcom says my BG is doing. These steps keep my post-game spike under control. When I used to play with no IOB I would spike to 180 or higher after the game, even if I was at 70-90 (according to Dexcom) during game.

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John,
This is great to read! Thanks for sharing. It is very interesting because hockey is so different than a steady state long run or swim.

A long steady state aerobic endurance run or swim is sustainable and lets us use a large amount of fat as fuel. But in hockey, with the short frequent high intensity bursts, your muscle cells use ATP and CP, and restoring that energy system is so different. In a game, your heart rate probably varies from Zone 1 to Zone 5, which is also very different from the long endurance activities where we mostly stay in Zone 2 or Zone 3.

It’s not surprising that you have to do things differently for this activity. It’s great to read what you do. I think hockey is much closer to basketball and soccer than long distance running or swimming. So these are all great things to read and learn about.

I agree with you 100% on this. After any extended distance, my Dex is worthless. As I stated in this thread previously, I encourage you to use any opportunity on the bench (or in the pentalty box :open_mouth: ) to test your BG with an actual meter!

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Thanks so much for this information, Eddie! I’m glad to read the study and it coincides with his experience. He has finger tested at times on the bench, if he “felt” way off from his Dexcom reading. This will prompt him to be more proactive. :wink:

I have heard about people “splitting” their Lantus dose, and by reading your post below explaining specifically how you plan for your runs, it makes clearer sense.

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John (and Eddie),

Do you add any type of protein after your workouts, in recovery? My T1 son HAS to add a protein drink/source post intense athletics to ward of a low BG. (My non-T1 sons drink protein shakes after workouts too, but I think that’s more about muscles. Ha.) Perhaps the only reason my T1 “needs” the post-athletics protein is because he is honeymooning… Hmm.

Thank goodness basketball is climate controlled. Extreme temperatures would add a whole new factor to this equation. Maybe you guys can start a T1D athletics blog for the rest of us! :slight_smile:

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I do both protein and carbs right away. Getting it in as soon as you are done with the exercise makes the refueling much more efficient.

I don’t use protein for BG control, I do that for rebuilding muscles. My post-run routine is a little bit unconventional, in that I immediately take insulin AND carbs (and protein), even if I am low. I take the insulin so the carbs can go to work (if I am low, I just take a little less). But I pile on a bunch of carbs to restore glycogen right away. And I take enough carbs that I need a bit of insulin, even if I am low.

So for me it is insulin, simple quick carbs ( things like chocolate milk, Ovaltine, the regular sugar Gatorade) AND protein. A normal meal with good complex carbs comes a bit later, but by quickly dumping in the carbs right away, I don’t need to rush with a meal.

My thinking is that I want to follow the recommendations for non-diabetic athletes as far as protein and carbs, just for the sake of improving performance. And then I just manage my insulin so that it works correctly.

Here are some comments I posted on this above:

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I wanted to mention this to you also, since you said your son was not on a pump. Is he using pens? You don’t have to be limited to 1 or 1/2 unit increments!

I use a pen for 1/10 unit increments, particularly when exercising.

Take a look at my comments on this post:
back-to-mdi

All you need is an extra pen, and insulin diluent.

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Wow. Would never have imagined! Right now he can micro-carb, but in lieu of a micro-bolus he’s gotta do pushups or go shoot some hoops. :wink:

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This would be a welcomed contribution probably for alot of us here. Exercise is truly a necessity for everyone but especially for us diabetics. I am still struggling to apply all of your advice that I’ve read in this thread but what I can say is that I definitely am seeing good results. I need to get better at timing though, rather place a priority on timing of my temp basal. I can’t imagine trying to do this with lantus, without a pump! Yes, corrections is another issue I struggle with especially after a run when I can go high then low without any good reason. I’m so adverse to highs so I tend to over correct, hence a pending low. Another good topic which you’ve already been covering is nutrition especially ways to maintain energy level for daily runs, and recovery after a run. I know I don’t pay enough attention to recovery. I might eat a handful of nuts but it sounds like that might not be enough even though it is protein packed.

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i’ve gotten into Fage 2% Plain Greek yogurt. 1 cup has 20grms protein and only 6 carbs. its great for pre-workout and even better for post. and, its excellent for us Ds GI tract. (i admit that i still am a peanut better adict, though; i buy the Smuckers Naural Creamy)

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Going high after a run or during a run has reasons that are perfectly normal - they are reasons that are the same for both diabetics and non-diabetics. The only difference is that the non-diabetics don’t see it because their pancreas takes cares of it.

If you go high during a run, it is just a normal response to the stress of the activity, the cortisol that is released, and the glycogen that your body is dumping out to prepare you for what is happening. It’s the normal “fight or flight” response. A tiger is attacking me, I need to make sure there is fuel to prepare for whatever happens next…

If you go high after a run, it is just the body trying to replace the fuel that you burned up. It is dumping out everything to restore the muscle glycogen you used in your workout.

Different runs will probably affect you in different ways. If you are doing a very easy and long run, you will be using much more fat metabolism to fuel the run, and won’t see as much of a spike. If you do a harder more challenging run, your body will be using more muscle glycogen, and that will cause more of a spike after the run. If you are doing a very hard run that is shorter and very fast, you may see the spike during the run.

Try to make notes of which types of runs make you spike, and know that these things are perfectly normal, and nothing to be worried about. Bolus for it aggressively, and have a supply of sweets available for the hours that follow.

When you are done - protein and carbs and fluid. See my notes above!

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Yes. I also eat the same yoghurt but only for breakfast :slight_smile: I mix 1/3 cup of it with mixed fruit mainly bits of apple and berries for a full cup :slight_smile: I don’t think I’d enjoy eating the yoghurt by itself though.

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Yes, I understand the body should be doing all of this without my noticing but since I’m diabetic I do notice!! My goal is of course not to have such varied drops and rises. Is that not realistic then if I’m going to run? Or is it possible to stay in range and do daily runs? Do you ever stay in range all day? I find that very illusive. I might have had less than a handful of days in range 100% over the last year. I don’t mind being borderline but lows exhaust me as do highs. I usually just keep running regardless of my bg trend. If low, I might take a glucose tab if I still have a ways to go on the run. Anyway, I think you are right, I need to pay more attention to the timing of my insulin, food intake and run time. My runs are mainly long trail runs which have mixed terrain and elevation. Occasionally road runs or bike paths, too, which are long and easy. And you are totally right, the long bike path runs do not spike me afterwards generally!

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I think doing an easy run without rising or falling is not too difficult. A speed run or tempo is more challenging.

If you can find a pattern to what happens, you can be confident in aggressively treating it. If you know you will always spike after certain types of runs, bolus for that before you see the spike. On many days I will take insulin as soon as I finish, sometimes even before I finish.

I think it’s realistic for most days, but maybe not all days. Are you running with no meals and no IOB? Just basal? That makes it much easier for me. For some runs your body will do crazy things with your BG, you just have to accept that. But you can treat it aggressively and fix it very quickly.

If you want, pick a recent run and share the timing of insulin, meals, run, and what happened to your BG before, during, and after the run. Let’s take a look at it.

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SandiTX, sorry for late reply:
LOL, I doubt my post hockey diet would work for your son (I’m 60 yrs old). I have gotten into a rhythm where I can expect a rise of BG after hockey for an hour, maybe 2 hours, followed by a steady drop. The small IOB seems to be enough to keep that rise in the reasonable range.

But to answer your question, I’m pretty random with my recovery food after hockey, sometimes I am driving an hour home and eat 2-3 oz. of nuts and lots of water. Other times I’ll stop and have chicken, burger, etc. So overall protein and fat while I’m still in the car after playing, plus lite beer when I get home. Of course, some nights things are off kilter and I have to carb up immediately before I can drive home if that BG rise does not occur. 9 times out of 10 I don’t need to bolus for any of the post hockey carbs or protein.

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I would love to go over some of my runs to see if you can identify what I should be doing. I don’t log these details down in general so let’s do it on my next run, as I apply these new strategies of zero temp basal. Yesterday I went for an easy 8+ mile run along a paved bike path. Somehow I hurt my ankle and I don’t even know how! About a mile before the end I just had to stop and limp back home. Not sure if it was just from the hard surface of the pavement or I actually twisted it stepping into a hole or something:( It is still sore and I’m unable to bend it so I won’t risk running on it. I rarely get injuries from running so this is unusual. I should have just stuck to the trails! I just hope I don’t have to take too many days off to recuperate.

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Sorry you hurt yourself! Make sure you take care of it before testing it out again!

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Although I’m not using exogenous insulin yet, I’ve started doing something similar to protect against lows during long/intense rides. I don’t eat to get my BG up before I ride except if I’m below 70 mg/dL. I test at 45 minutes into the ride, and when (rather than if) I’m at 65 mg/dL or below, I use a Clif gel pack (24g carbs, half dextrose half starch). I repeat that after another hour. That seems to keep me quite stable during the ride, although I do tend to triple my normal intake of carbs in my dinner following a ride. Glycogen-depleted muscles are really good at scavenging free blood sugar, and for me it seems there is about a six hour post-exercise window where anything I eat goes straight to refueling.

And for reference, I try to stay between 70-126mg/dL as much as possible. If I’m riding, the up to 48g of carbs never seem to take me over 100 mg/dL unless my intensity drops (in which case I shouldn’t have taken it in the first place…)