For example, today I went snow shoeing for a bit over an hour. We headed out about an hour and a half after lunch. I’d had lentil soup and grilled cheese sandwich. (I make no apologies: I eat what I consider a normal diet and adjust my insulin rather than the other way around but that’s a topic for another conversation ) (and that approach gets me about 85% TIR and A1C of 6.3%)
To prepare today, I gave exactly half of my usual insulin dose, that is I told the pump I was having 20 g of carbs when it was actually 40.
I switched to weekend profile about an half an hour before going out: that is different from my usual profile in that the basal rate is reduced by half. I engaged exercise mode at the same time. I target about 8 mmol (140 in US numbers) for exercising. It can drop fast esp if I have any insulin on board.
The pump indicated that IOB was about 2 units as we were about to leave. So I was a teeny bit concerned. I took two juice boxes and three granola bars with me and drank another juice box before leaving. Each juice box is about 20g of carbs. Same with the bars. My sugar was dropping so I had a granola bar as we were starting. Sugar continued to drop, a bit more slowly and I took another bar about 20 minutes later. Sugar leveled off and climbed a bit but then began to drop again. Finally it was really dropping again (down arrow, not straight down) and hit 5.5 (about 100) so I took another juice box plus a granola bar. That brought it back into line until I got home and switched the pump back to normal modes. Now of course it’s double-up arrowing up and at 12.3 (230). Argh! overshot the mark. Give insulin bolus!!!
Who wouldn’t love to have ultra fast acting insulin and immediate acting carbs?
Anyway, for prolonged reasonably intense physical activity, I don’t leave the house with fewer than 100 g of fast carbs - usually a mix of juice boxes, granola bars, and gels. That usually helps keep me in range. But I pay attention to my Dexcom numbers and trends.
At the very least a “tube” of 10 Glucose tablets (4g carbs each) for a “quick trip” (just an hour or two). I might typically take 6 of these for anything but the most minor dips which get 3 or 4 of them.
There have been times where the 40g of carbs was not enough - “double whammy”.
Otherwise an at-least-half full (at least 25 out of 50) jar of glucose tablets.
I have carb gels in my car and in my computer bag. I have them in my desk at work.
I almost never need them anymore, the system I have now really prevents most lows, as I’m going lower I can just eat a banana or something.
I havent had a severe low or even a symptomatic low in over a year.
I really hate the roller coaster where I would go low then I would eat 100 carbs then I would go high and I would need a lot of insulin to bring it back down and go low again.
1+ bag of Swedish Fish. Each full bag of Swedish Fish has 50G of Carbs and each Swedish Fish raises my BG 10 points. Looking at the G6 Dexcom and the rate my BG has been falling in the last 20 minutes, I can get a pretty good idea of exactly how many Swedish Fish to eat to get back into a normal range.
Although I am a totally numbers-driven individual I am not smart enough to mix and match Juice+Granola bar+Glucose Tab(s) etc. to have any idea in advance where my number will land after loading all those mixed carbos. That is just way too many variables especially when I am starting to get a little fuzzy brain from dropping BG. Sticking with 1 known carbo variable and knowing it will take 15 mins to kick in and then about 1 hour to peak, I can dose as BG drops and know within 20 points of BG where I will land based on the number of Swedish Fish ingested.
If I have any insulin on board to cover a meal and then exercise, I will go low 100% of the time. So meals combined with exercise is a tricky proposition.
But to answer your question, I have a camelback filled with more carbs than I’ll ever need when I now I will not have easy access to carbs.
And that’s the crux of the problem. How does the healthy normal person without diabetes do it? Before catching diabetes I had no such problem! But now it’s a blessing and a curse this exercise with IOB. I can use it to my advantage if I’m going high after eating; but if I want to do something needing exertion, I cannot do it after eating!!
I have about 20 vegan gummy bears which are 2 carbs each and then something like a candy bar or fig bar pack. The gummy bears are the quick fix and the other is if I am trending down and know I need something more substantial and lasting.
The overshooting of carbs might not be an overshoot. My Bg level goes up after I swim even with no carbs which is a harder exercise than when I use my exercise bike which helps to lower them.
All the comments related to your post were interesting. There are times when I just disconnect my pump for 1-2 hours if I realize insulin on board is too much. Then I don’t have to keep eating carbs to address low BG or trending low pattern. Often this will avoid the rebound high values.
) (and that approach gets me about 85% TIR and A1C of 6.3%)
