Hypo's

So, I went up to the maximum dose of ozempic last week. Yesterday, I was due for my weekly injection that I had put off to taking after supper.
So after my one hour swim yesterday, my Dexcom alarmed for a low at my setting of 75. I noted it and thought I’d keep a watch but the next reading was 49!!! Yikes!! So, I treated with 10 g of sugar. It came back up.
So today, before I took a swim, I ate a small mandarin orange. I also ate some nuts after I got out of the pool. After I took my shower, I felt shaky and my blood sugar was 62. So, I treated myself and it went back up.
I am just wondering why this happened out of the blue like this. I’ve never gone low like this before. While I did start a higher dose of Ozempic the week before, yesterday was day 7 and the med should have been getting low in my system.
Of course, I suspect it’s the higher dose of Ozempic. My previous A1c was 6.8 and my average sugars have been running about 149 or 150. I think I’ll write to my Endo and ask his thoughts. I just wonder going forward if I need to pre treat before exercise with more carbs or a different carb. My blood sugar was about 115 before I started my swim. In the past, this wasn’t a problem, but I would often have a 15 g snack before just to make sure I didn’t go low. There are people here with much lower A1c’s than I have.
What do you do to prevent low’s when you exercise?? I was curious about this.

Hi jean63: I’m t1 for about 12 years now. I purchased a swim spa just to help me burn sugar. I eat a higher carb breakfast of flax, chia, and hemp seed(think oatmeal but better), and usually two turkey sausages. I bolus 2 units usually about 30 minutes before eating. I might wake up at 100 but within 5 to 10 minutes I dawn effect and end up at 120 to 150 before even eating. So, I immediately (within 15 minutes if possible) start my 20 minute hard swim against the jets. I have to manually test my bs after 20 minutes of hard swim. And it is always a surprise. Perfection is i am down to 85 and I get out and usually don’t gat dizzy. It can continue down another 15 or so points. If I get a reading of 100 I usually get out to be safe. Sometimes I’m still up like 130 so I swim another 10 minutes. Yes, very aggravating sometimes but usually get by with one strip. I do have libre and it is a big help but when bg is changing rapidly I just have to use strips. So I would suggest exercise right after your carbiest meal or in the am if you have dawn effect. If I start going back down below 120 before I swim I abort the swim. Why the wide range doing the same things? DIABETIES DARN IT!

HI Mark,

Congrats on the SwimSpa!!! Thank you for your response!!! You raised some good points. I think at this new dose of Ozempic, I might have to change things up a bit. Before, I was on a pretty low carb diet and all was fine. We swim in the afternoon and that’s normally the time of day when my blood sugar is the lowest. We really do like to exercise that time of day too, which is a shame. I am not a morning person. I am not olympic swimming either! I take it fairly low and slow. I wouldn’t mind “having” to eat a baked potato for lunch and exercising afterwards. Ha, ha, ha! I miss carbs but had to stay low to keep my blood sugars under control. I worry though, by adding carbs if I’d gain weight. And I will have to check my BS manually during exercise now. No, darn diabetes is not easy!!!

I am a T1 too.

Exercise bike. I use it to stall a climb or bring down a higher number than I like or I will take less insulin for my meal to be able to ride it afterwards. I can also eat something extra to be able to ride it, but I try not to do that. In my case I can adjust my insulin to ride it.

Swimming has been a trick for me. I usually swim 1-3 days a week for 2-3 hours in the ocean. What I was doing was reducing basal insulin on my pump and maybe a 12 gram snack beforehand to swim. But as I got used to swimming for long lengths of time I had to stop reducing my basal. I have a tendency to drop slightly the first hour and then my BG level climbs and climbs.

In my case it’s been problematic as it was explained to me my liver is dumping glucose to help fuel me after a while of swimming. But I have DP or FOTF, so I avoid eating in the am. So trying to eat in the am for fuel beforehand has been an issue as my Bg level skyrockets easily and then I have to have more insulin and time to get it to come down before I swim. I start my swim in the early afternoon. It does keep my BG level more even keel when I can get it to work. So I am still working on figuring it out. But our body does want fuel to exercise within a few hours beforehand or it tries to use the bodies stores.

Swimming is considered cardio and resistance training. Hence the drop but also the potential for the climbing effect you can get from intense exercise…

I am a T1 though and exercise can be a real trick for us to figure out. My hubby was/is a T2 under control and can just decide to go swimming with no issues. So I’m not sure what the answer might be for a T2 on Ozempic as it probably changes what you have to do too. It stimulates insulin secretion, blocks the liver releasing as much glucose and slows down digestion. It might take some figuring out too.

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Do you take any other medications that might contribute to hypoglycemia such as a sulfonylurea or insulin. Below is a list of common sulfonylureas, they work by helping you pancreas produce more insulin.

  • DiaBeta, Glynase, or Micronase (glyburide or glibenclamide)
  • Amaryl (glimepiride)
  • Diabinese (chlorpropamide)
  • Glucotrol (glipizide)
  • Tolinase (tolazamide)
  • Tolbutamide.

Contacting your endo is a great idea he might want to adjust your medications. Possibly turning back you Ozempic or another medication you may be taking,

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Good question Gary!!! No, this is my only diabetes med. I think I am just going to try to eat more carbs today before I exercise to see if that prevents a low. I have been on a pretty low carb diet in the past. Perhaps I can start to add some carbs back into my diet and see how it goes.

I am amazed that as a type 2 you have a CGM when you are not injecting insulin. This is a standard of care that most T2s can only dream of, you must have excellent insurance and an excellent doctor willing to prescribe it.

I would be careful when adding carbs back into your diet, doing so can be a slippery slope. If your diet is healthy and something you have become accustomed to it might be better to first consider adjusting your medication.

Gary, I was on multiple daily injections at one point when I had side effects to all the oral meds they had given me. But, I changed Endo’s and this one tried me on Ozempic and it worked for me with no side effects!!! I kept my CGM and hope that my insurer won’t stop approving it. I love it!!! I learned so much from having it. I tried the Freestyle Libra but it was very inaccurate on me. Yes, I think I did have a very good Endo to recommend it. My insurance didn’t approve it until I got on insulin however.

First off some one on this forum needs to invent a swim watch that allows the Bluetooth of the Dexcom to work underwater.
I had to start artificially raising my BS a little prior to going in the pool, so I didn’t go low by the end of my session. Oh I should mention I use a lap pool for up to two hrs per session. I swim for just over a measured mile. Early on but the time
I got back to the dressing from I’d be low or getting there.
Over the years we all have gleaned what we need to do to survey. And I for one have gleaned a lot from this forum.