Intense exercise that lasts approx an hour, how to manage?

I am a Type 1 Diabetic with Addison’s Disease. Addison’s Disease adds and interesting mix to things considering that I take an oral steroid twice a day. As you may know, steroids interfere with my blood sugars. I have minimized the effects of steroids, but I do have a small peak up to 165 after 4pm. I like to exercise around noon and I aim for a brisk 7 mile walk, but my blood sugar dictates how much walling I actually do. My goal is to get back to my ideal weight and run again. I ran a 10K and more everyday pre Type 1 Diabetes and fear has kept me from getting back into running. I think I’m ready to try, but I need to lose a few pounds so I don’t destroy my knees. I need to drop 20 pounds.

I normally suspend my pump around 30 minutes before I exercise and keep it suspended until I am finished. I check my blood sugar every 18 minutes or so and when I see that I’m getting below 60, I stop. I then have a small protein snack and unsuspend my pump. My blood sugars are awesome for several hours, around 65-70 and I feel great. Around 2pm I will sometimes have to take a couple glucose tablets and insulin to keep Ketoacidosis from coming on even though my blood sugar is well below 100.

My questions are:

How can I exercise for an hour, intensely without bottoming out? and how can I prevent the tendency for Ketoacidosis on some days? Any advice is appreciated.


Hi @Daletri,

I have a good friend who is a T1 diabetic and a great fitness pro. All around super guy. He was the first diabetic I ever knew before I was diagnosed and never steered me in a wrong direction. Here is his blog:
He reviews different fitness products and writes about diabetes too. You can see his credentials on his website.

Anyway, I asked him the same question about how not to bottom out. He said a great snack is a peanut butter sandwich or alternate “butter” if you are allergic to peanuts on whole grain bread. He said just a peanut butter sandwich but I always add a little jam for taste. I kid you not, the first time I ate it before an hour and half long workout, my BGs headed down on my CGM and bounced back up without me doing anything. This happened pretty consistently when I ate this snack before my workouts. Its pretty awesome how that mix of food does that. Its a great snack for working out, whether running or weightlifting. If you don’t want to feel too full, try just a half sandwich and carry the other half with you if needed.
I hope this works for you,


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Thank you Busybee! I appreciate your reply and I’ll check the website out in a bit. I love peanuts and peanut butter. I have a few varieties of natural peanut butter, on hand at all time. A sandwich like that is going to spike up my blood sugar pretty high, from experience I know it will put it above 300 without a bolus. I suppose the intense workout quickly brings it’s down or keeps if from getting that high in the first place. I’m gonna try a half sandwich tomorrow and see where I get. Thanks again for your reply.


Yes, I agree. It shot me up high pretty quick and I stayed in the mid-200’s with a whole sandwich. Best to start out with a half and go from there. I cut back to a half too. Everyone has different reactions. Maybe, if you find you need more, eat a whole then try use the temp basal setting on your pump instead of just suspending. This is an awesome feature. You get some insulin- you pick the percent and yet, your BG can stay high enough for a workout. I use it a lot when I work out. Don’t know if you have tried that either, its worth taking a look at.

at 2pm you are taking glucose tabs and insulin to keep ketoacidosis away? the insulin lowers your blood sugar and your glucose will raise it. am i missing something?

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i don’t get it,you take glucose tabs, & ues insulin to keep ketoacidosis away, & the glucose will raise it,. ?.

insulin keep my ketoacidosis away, & insulin lowers my blood sugar, & sometimes glucose will raise it, not all the time,.

@Daletri,you want to work to find a “balance point” between carbs and basal adjustments that will allow you to stay relatively smooth for runs that stretch out to an hour and beyond. I’ve done a couple of marathons and 9 1/2s and have played around with different things. At first, I’d run my basal low, down to 10% having encountered someone who suggested that zero can lead to clogs when you fire it back up. A lot of times, I’d use 7 or 13% as they are lucky numbers (ha!). Then I’d bring along some carbs. At first, I’d use 2x bottles, on an Amphipod belt, and have high-octane Gatorade using the powder, to pack it with like 45G of carbs and lower strength with just 10 for hydration.

Eventually, I found myself tinkering with this and reducing the stronger to 20-25 which is close to normal strength. This was as I was getting into marathon training, with a group, that had lots of discussion of nutrition, the importance of snacks along the way, etc.and it felt good to already be doing what I needed to do as far as that went. I also got a suggestion from @Jerry_Nairn about RaceReady shorts, that have a pocket that holds a meter very conveniently

Eventually, I discovered that w/ the moderately strong Gatorade, I could turn up my basal, as I’d noted post-run highs and found what worked for me was 50-75% and I tinker while I go. If my BG runs up, I’ll turn the basal up and down, I’ll turn it down. Eventually, I found a very nice balance point, about 8-12G of carbs/ 3 miles. I think this works out to a bit less than Gary Scheiner’s suggestion from “Think Like a Pancreas”, which is where I got a lot of my theories about these things. It really boils down to getting out and getting going and testing to see what’s happening. I started using CGM right before my first 1/2 Marathon and it was immensely helpful, although it fell off 3 miles into the first one, before I discovered Opsite Flexifix. Now, if I run 5K after work (I’ve been a slacker lately!), I can have a glass of skim milk and get a “predicted high” alert about a mile into it and a “predicted low” as it “cooks off” as I get home.

I looked up Addison’s and ketoacidosis but didn’t find any specifics as to whether the steroids might cause that independently of BG. I usually assume no KA w/o elevated BG so if my BG is cool I don’t check for it.

Finally, I do notice that adrenaline on race days totally makes my BG go crazy!! I bolused and didn’t eat anything for the first 17 miles of the 2012 Chicago Marathon as my BG was quite high. Then it “broke” and I chowed down the rest of the race…eeek!!

Insulin will bring Ketoacidosis down, it will also lower Potassium levels in my blood. I’m prone to both. When my blood sugar is already 80 and I have Ketoacidosis I must take insulin and I generally take glucose tablets so that I don’t bottom out. The Ketoacidosis frequency is a new thing that I need to discuss with my Endocrinologist next appointment.


Talk to this guy

I thunk @erice is trying to suggest that taking insulin for the glucose tabs is counter to the goal of preventing the hypoglycemia, especially if your BG is 80 right before exercise.

Not what I said at all. I would not exercise with a BG of 80. Point is Ketoacidosis does occur with low BG and I have them routinely. I treat them by taking insulin along with glucose tablets. That neutral action stops the Ketoacidosis. So sorry if this is difficult to understand. This is why I hate groups. It’s full of know it all busy body types who love to argue.

true, it what i do, my bg is always at 80, before i exercise,.

what i like to do, it try to keep my bg, up, when i exercise,.

please accept my apologies if we sounded like busybodies or know-it-alls. i didnt know ketoacidosis could occur with regular blood sugars. you learn something new every day.

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i got to say, sorry to, if we sounded like busybodies,

but you learn something all the time,.

Take the glucose tabs without the insulin.

I am the diatriguy RaDe mentioned. I don’t use a pump anymore. When I did, I did a low carb diet most of the day to minimize IOB, as I do my triathlon training usually in the afternoon. Then I played with suspending the basal like you do, and having a simple sugar snack regularly during exercise. But its hard with injected because of the long tail, requires a lot of planning and discipline.
Since May 2015 I use Afrezza for meals, and ditched the pump so I use Tresiba for basal. Afrezza almost eliminated my IOB issues, because it acts immediately and has a very short tail. So no need for a low carb diet anymore! Pretty cool. It took some tweaking, but now I am very good at exercising as long as I want with no issues. I tweaked my basal and for high intensity exercises (Z3-Z5) I now know I need about 15-25g of sugar every 30-45 minutes. For long aerobic sessions (all-day bike rides for example) I discovered I might need 15g of complex carbs (peanuts bar for example) every 90 minutes or so. And overall I have a huge peace of mind because Tresiba basal induced lows are mild and happen very slowly, so with my CGM I know exactly what I need to do and when.
Regarding post exercise, with Afrezza after intense exercise I can immediately eat all the carbs I need because the thing acts so fast. With injected I had to wait at least 20-30 minutes after bolusing because of the adrenaline of the intense training.
After some practice, I now also can eat with no restrictions in between a long exercise day. Which is awesome. The other day I went with the family for an all day ride. We stopped at midday for lunch. With injected that of course would mean no carbs for me , because then I would crash violently when we resumed the riding. With Afrezza I ate what I wanted (I think around 100-150g ch). One hour later, when Afrezza was winding down and I would normally had a second dose to keep digesting those slow carbs (chinese food!), we just started riding again. The exercise replaced that 2nd dose and my BG was fine for the rest of the ride. No IOB!.
I hope this helps,