Help for Adrenaline Rush

I’d like to know how other Type 1s handle an adrenaline rush. Here’s what I mean…

I’m a church singer and musician. I play three services in a row on Sunday mornings. Singing in front of a couple hundred people can be quite an adrenaline rush. I enjoy doing it very much and look forward to every Sunday. The thing I don’t look forward to is what the adrenaline rush does to my blood sugar.

Today, for example, I walked into church with a beautiful 105 blood sugar. After the second service my blood sugar was 358. I check it between every service and take several units based on what my reading is but it’s like the insulin doesn’t do anything. I have tried eating a small snack between services so I have something in my stomach, and I have tried not eating at all. Either way, it’s disastrous. In contrast to this, during the week I work a desk job. I’m calm, it’s pretty relaxed. I can enjoy nice, low blood sugar at my regular day job where there is no adrenaline rush involved.

Again, I really enjoy singing in church and would like to not be forced to give it up. It’s the skyrocketing blood sugar that I don’t like. I spend the rest of the day on Sundays trying to get back into control.

Since this is planned activity every week, I’m open to suggestions as to how to head this off every Sunday. I can’t stop the adrenaline. It just happens. And I’m afraid of taking too much insulin and then bottoming out in front of a whole bunch of people. I guess some would also call this a liver dump for the fight or flight reaction. Again, open to suggestions as to how to deal with this challenging situation. Lately, I feel like it’s gotten worse.

You gotta hit that with some insulin right before the service. It might take some time to experiment and get the right amount and the timing correct.

Don’t be afraid to bolus at 105 when you are about to sing. If adrenaline is predictable for you, it’s the same as taking insulin before eating. It’s something you need.

Since I don’t know your dosing, I can’t give you any recommendations on amounts. And the amount I take would be totally different. But I would suggest looking at that 358 number, and seeing what it would normally take to correct that, and taking a much smaller amount to start with. Than adjust until you get it figured out.

This is important - you will need less insulin to prevent getting to 358 than it takes to come down from 358, if that makes sense.

I have been taking between 5 to 7 units of humalog between services. That would be enough to cover me for a substantial lunch. When I take it it does nothing. My blood sugar just goes up even higher after the next service. I wish there was a way to shut off the adrenaline a little bit.

I totally understand that you are afraid of bottoming out. 358 is not close to bottoming out. I often eat an unnecessary snack before attending a meeting. I hate being at 200 after the meeting. However, it gives me piece of mind. I only have to attend a meeting once a month. It won’t kill me. Try to figure out how much insulin you need to take to stay around 200. This will give you piece of mind and not do you much harm.

Less insulin would be required to prevent it. Take it before you spike!

It takes a little guts to bolus when you are not eating and your BG is not high. Be brave but build up the amount slowly to make sure you get the right amount.

Okay, thanks, people. I’ll try to work on this a little harder. Today was especially bad for some reason. That 358 number really shocked me. I don’t see that very often.

Cinderfella - nothing is better for corrections than afrezza. It a monomer human insulin which mimics natural first phase pancreatic release and its very predictable. Here is a demonstration

The better course of action here is to prevent the spike rather than correct it.

True, but afrezza looks interesting.

to answer the basic question, yes, I do experience this sort of rush. Today at church I started at 98 and finished the service at 189. I was giving the message. I test often, cover often and allow myself to run up when I am doing a portion of the service. Obviously, I do not want to be low while I have a part, so I let it ride a little.

Do you take communion every time? I realize it’s such a small amount it probably shouldn’t do much but it’s worth thinking about, particularly when multiplied by 3.

Eddie - if its possible to prevent the spike that would be great but probably not likely in her situation.

Since she is stressed, the body is preparing itself by ensuring that enough sugar or energy is readily available. Insulin levels fall, glucagon and epinephrine (adrenaline) levels rise and more glucose is released from the liver. At the same time, growth hormone and cortisol levels rise, which causes body tissues (muscle and fat) to be less sensitive to insulin. As a result, more glucose is available in the blood stream.

As a result she needs something very predictable and fast. In this situation subcutaneous absorption will probably vary from time to time which make injectable a bit more unpredictable and of course much slower.

Have you considered an insulin pump? I’m a criminal lawyer and have the exact same problem if I go anywhere near a courtroom! With the pump I temporarily increase my basal rate by 60-80% an hour or two before court starts, and for the duration I expect to be in court. It’s much more effective than taking a large dose before the stressful activity, because the slow release prevents a blood sugar crash and matches the duration of the stressful activity giving you enough insulin for the entirety of it. I also find I have to increase my meal boluses by about 60-80% as well, even if I eat within a couple hours of finishing court.

Good question, but I don’t take any communion. I’m singing at this time during the service so don’t want to inhale any crumbs. I have done it before only to cause me to cough and sputter. No communion when I’m singing.

Yes, definitely a similar situation where we are being called to perform an important function in front of a lot of people. I can relate.

I’m not on a pump. I do pretty well with MDI. I’ll have to give it more consideration.