How can I exercise without having my blood sugar go very low?

Type 1 and LADA
1

I am a pump user and depending upon the exercise I usually use a temporary basal rate. If I am taking a 30 minute walk, I usually put it a temporary rate for an hour of 50%. If I take a walk after eating lunch, I just count less carbs when I bolus and it all evens out after the walk.

However, any harder exercise than just a walk is very difficult for me to bolus. I went on a 45 minute bike ride with my husband last night and used a temporary basal rate of 1 hour at 10%. My blood sugar was 47 when I came home. Sometimes if I am going to bike or run/walk on a treadmill, I stop the pump for an hour. But I still go low.

What to do?

Rebecca

2

You might try eating something before biking - like an apple

3

maybe you can have a snack before your exercise? I do the sometimes but I'm on mdi.

4

You most likely need to start your tempy basal rate sooner. I use Humalog in my pump and figure it will last for 3 - 3.5 hrs with its peak activity around 1.25 - 2.25 hours in. So, if I am able to plan for an activity, I will set my tempy basal to start at least 1.25 hours beforehand and run at or near the end of the activity.

Sometimes adding some protein with a little carb can help too, plus I always carry my "TUBE OF TEN!" with me just in case ... (note I also have had lots of 47s)

5

YES! I agree - cut back the basal sooner for these more intense workouts. I have to do the same with running. It makes it hard to be spontaneous, but at least it makes me get out there and I don't have to stop in the middle because of lows. I suggest reading the Diabetic Athlete's Handbook. It was a HUGE help for me when I got back into running. Good luck!

6

I second Kate's suggestion on the book by Sheri Colberg, I own it and it is a great resource for those of us addicted to insulin. I would also recommend her website which contains many useful articles, you might even find most of your questions answered there.

Also, a trick I use when doing endurance exercise is to mix in "sprints" which raise my blood sugar. This avoids having to mess with basal or worry about glucose. Every ten minutes or so (as needed), run or ride as fast as you can, even up a hill, far harder than you can sustain. Do it a minute, then go back to a leisurely place. This may or may not work, in my case it does.

7

I run 3 miles several times per week, and I typicially “carb up” prior to the run with a smaller bottle of Gatorade of around 21 carbs about 10-15 minutes before the run. I had found that running makes me drop around 100+ points which can be scary! If I’m eating before my run, instead of carbing-up, I “bolus down” for the meal by taking about 20% less bolus dose. For each activity, like your biking, you just have to trial and error a couple times to know the exact amounts to carb-up or bolus-down. Even when you get that figured out, watch your blood sugars for several hours after the exercise to see if it drops for several hours post-exercise because I often have to do a -20% basal decrease for about 4 hours after the run too.

8

I found Sherri Colberg's book interesting however it struck me as more of a collection of "war stories" than a "how to" manual. Perhaps I would benefit from reading it again?

I run several times/ week and have been at it for a few years. I have a CGM which has been very helpful and I devote some effort to keeping my BG pretty flat ahead of time, as it makes it easier for me to get going for exercise,without having to fix much!

I don't usually eat much before I run in the afternoon however I eat before long training runs in the AM. I've run the last two summers with a marathon training group that "blasts off" at 6:30 to beat the heat. I try not to eat inside of two hours before running, or not to bolus, in the AM, I get some DP so I will bolus while I'm in bed and then get up and eat in a bit, which is perhaps a bit risky but has worked. In the afternoon, there's neither food nor insulin on board when I get home from work. I've figured out, pretty much through trial and error that 8-12G of carbs will cover me for about 3 miles of running and my normal, midweek run is usually 3-5 miles although as training season starts (0720 is the first long run...) I may crank that up a bit, time permitting. I can cover 3 miles with a glass of skim milk and come out pretty even, w/ the CGM alerting me to a "predicted high" about a mile in and then a "predicted low" towards the end as it burns off. That's ideal and it doesn't always work out that way but it's my goal.

I always bring little bags of Starburst Jelly Beans and Smarties mixed up along. Dextrose and yummy together. The effort in mixing them and taking out the green ones is incentive not to eat them and the jelly beans cut down the dextrose dust, like glucose tabs that suxx when you're running:


Another tip I got in the DiabeticsWhoRunMarathons group, from Jerry Nairn who is *in* Sherri Colberg's book, is Race Ready shorts, which have a mesh pocket which will hold a One Touch Ultra Mini meter. This is super useful to me as I have phones, keys, ipods, SmartieBeans, etc. which can be quite a load. More running= more carbs.

I also use an Amphipod belt. Most of the people in the running group, even the straight people w/o diabetes, have these (go figure, the group is run by the store....hee hee) to carry junk and they have clips for bottles and I use powdered Gatorade for hydration and more fuel. When I started, I'd put in 45G, more for emergencies but, as I got better at cutting basals and boluses, I've cut it back to 20-30G/8 oz but you can do more experiments w/ this. You don't want too many carbs if you're hot but you want enough to be safe!!


[OMG, I keep thinking of other things, it can be complicated but hugely rewarding too!!] One other thought that I have is that if your basal is hotter than it needs to be, it may be useful to step back and take a look at your basal/ bolus ratio, %basal to bolus. If you cover some meals with basal, it can produce nice flat BG but I think that leaves extra basal that can pound you when you work out. It may be easier to see if you can put more insulin into Carb Ratio at mealtimes and nudge back the basal a bit to see if the balance might make it easier to work out. This is, of course, another huge experiment that may or may not work and may require consulting a doctor however I do this sometimes and just go "hmmm, what if I try something a bit differently?" I like hot basals though...