MDI T1D: High BG after anaerobic exercise -- expected?

Thanks in advance to anyone who can help with this question (searched the boards briefly but saw nothing relevant to MDI, only pumpers): I played two hours of volleyball, an anaerobic sport, moderate to high intensity. Tested a couple times during and noticed a slight rise (hovering ~165), 267 at finish, 329 one hour later, 325 at 90 minutes. I ingested nothing but water, previous meal was more than six hours before, Lantus at 11:00AM.



Why the high readings?

You exercised in essentially a fasted state with presumably no bolus insulin remaining on board. It would be expected that intense anaerobic exercise would lead to a blood sugar rise and yours did. But when you stopped exercising, you were high and in fact despite having taken lantus you basically ran “dry” of insulin. The lantus was fine for covering your basal, but it was woefully inadequate to “correct” such a high and in fact the adrenaline and cortisol hormones were probably still telling your liver to produce glucose. Hence, you ended high and continued going even higher.

Two key things would have averted this. First, you could have eaten and bolused before exercise. Second you could have eaten and bolused (or simply corrected) after exercise. It is actually recommended that you not exercise without insulin on board as what you experienced could happen. Should you have actually kept up exercise in that state all afternoon you might have gotten to the point of inducing DKA within a couple of hours.

bsc, you’re simply amazing; a well-deserved TuD award you received!

I’ve not played ball in seven years and certainly not since Dx. Normal exercise routine is walking, often with meal bolus still on board; I assumed the effect of playing ball would be similar to walking, in lowering BG. Now I know better.

Wish I had known to eat and bolus before; hoping this falls under the category of “some mistakes you make only once.”

Happy New Year.

Don’t go and thank me yet. Keep up with the volleyball and let me know if next time things work out better. Volleyball is a great sport.

Intense exercise sends me high & this is often the case for many. Cortisol stress hormones (adrenaline) cause the high with no insulin to regulate. I eat protein before strenuous exercise to help keep things level. Some people eat more carbs, but that doesn’t work for me. I take an injection several minutes after warming up. Keeping hydrated is good because even slight dehydration can send numbers up. I’m careful not to overdo insulin because the highs are followed by serious lows later ( even without a correction dose). I’d be in a coma if I used a normal dose. For more moderate exercise, I don’t inject because that causes lows.

I have been at fairly intense exercise for a while and am still trying to come up with a solution but taking insulin appears to be the key? I am totally horrible at making MDI suggestions, as I went from R/N to a pump but, in your scenario, I might have a correction bolus at 165 if I knew for sure it was going up? That would at least have gotten into some of the later 329/326, etc. w/ some insulin to beat it up? I think too that BSC’s suggestion of eating first and having some insulin to boot is also correct.

The last time I played volleyball there was quite a bit of beer involved (as well as Speedoman…yikes!) so I’m sure I was hitting the insulin. That would have been maybe 1992 or therabouts though?

Hi Gerri! Wow, how much fun is this to figure out?

Talk a bit more about injecting after warm up; when you say ‘intense exercise,’ what are we talking? I view running and cycling to be in the intense category, with weightlifting not too far behind. I would assume racquetball, volleyball and golf to be close behind, and in that order… I don’t know if/when I’ll play VB again, but most assuredly will eat and bolus before.

Yeah, dehydration. As I left the gym I was aware that my lips were really dry. Gosh, I can’t believe I used to blow four nights a week and entire weekends between pickup games and tournaments. As ill-prepared as I was today, you’d have thought I was a freakin’ rookie.

I’ll let the thanks stand because you really are amazing.

As I mentioned to Gerri, don’t know when/if I’ll pick up a game, won’t be anytime soon. But it makes complete sense that I should have eaten before because I ended up going nearly ten hours without. Bad dog.

So much fun! Is it right to be hogging all this joy?



I use Apidra & it hits me fast, so I wait until after warm-up to inject in preparation for the heart thumping exercise that starts raising BG. Kind of similar to timing bolus for meals Guess intense is a relative term & it’s how hard a person plays & for how long. Yea, I’d put golf at the end of the list also & the others at the top. I’m just cautious about not taking large doses because exercise invariably leads to a low hours later for me. Did you experience this? I read an article theorizing that evening exercise might be responsible for overnight lows.



Excuse the bad pun, but it’s a whole different game with diabetes. No way you could be prepared before you knew what would happen.

After I got back to the office I ate a lite meal, injecting for it and the correction from 325. Within two hours I was down to 62; juiced and flopped on the couch for a couple hours and tested a 56. Seven hours post-exercise and a few carbs post-56, BG is back where it should be and I’m hunkered down to dinner. So all is well except for viciously sore thigh muscles which will prevent me from going out dancing with friends tonight (can you hear it – ow, ow, ow…).

Thanks again for ringing in, and be well!

That sounds like what I experience. Hey, wait, exercise is supposed to be healthy. As soon as possible after exercise, I eat some protein to keep from bottoming out. Protein before & protein after. Sorry you won’t be clubbing tonight. You could be gorgeous sitting at the bar & pass on the dancing:) While the others are shaking it up, you can reflect on your firm thighs!

Plus, of course, if you eat protein, you will get ripped!

Hey, swell – and what diabetic wouldn’t want to be ripped??

I did stay home last night since I couldn’t figure out a way to climb onto the barstool without using any leg muscles…

You need an obliging six-footer to help you with that. Maybe acidrock can help lol?

At the initial onset of anaerobic activity your body’s natural reaction is to release a large shot of glucose from the liver. This is to supply the muscles with enough energy to continue the short burst of exertion. As you are extending that “short burst” over 90 minutes, your body continues to release more sugar. It’s much more sugar than your body needs, and someone with a healthy pancreas will auto correct after the anaerobic activity. Unfortunately for us diabetics there isn’t much we can do but fiddle and correct.



I weight train up to 5x a week and when I was on MDI (basically until Tuesday), depending on my glucose readings before a workout, I would take anywhere from 4-8 units of Humalog before working out. It’s interesting if you look at the body building world, there is a lot of literature coming out regarding insulin as a very very good supplement for building size. I’ve noticed a significant increase in size since starting my injections right before working out.



Those readings are to be expected though, so don’t worry.



You will also find that a few hours after an intense anaerobic exercise session, your insulin requirements drop significantly. On mornings without a workout the day before, I would wake up around 6-8 mmol/L (108-144) but on mornings after a workout anywhere from 3-4 mmol/L (54-72). You probably won’t notice quite a significant decrease. Anaerobic exercise elevates your metabolism for significantly longer periods as opposed to aerobic. Intense weight training can elevate it for up to 14 hours. Something like volleyball with a little more of an aerobic component will probably result in an elevated metabolism closer to 6-8 hours post workout.

So in short, try some rapid acting right before volleyball, bring some extra glucose tabs (and a glucagon kit JUST IN CASE) and test often. You will notice a steady increase as the game progresses. Eventually you will nail down a good dose.

Unfortunately the literature on anaerobic exercise is scant for us diabetics. At this point it’s basically trial and error.

Protein certainly does help, but us diabetics have a natural edge over regular body builders. Insulin is all the rage with body builders these days. I have noticed a HUGE size/strength increase since I started doing pre-workout injections. I usually just upped my levemir dose before workout days (which some weeks was every day). Insulin does a lot of good if you are looking to build size and strength.

I just started a pump this week, and I admit I am a little worried as to whether I will still experience those benefits. I up my basal rate two hours prior to lifting, and leave it high for two hours prior. I am still fiddling with my post-workout basal rates as I didn’t get a very good idea of what my body does after last nights workout (my first since being on the pump).

The other downside to being ripped is finding decent sites. I am still unsure as to how long I will be able to pump if I develop callouses or scar tissue. I have a few viable options on my lower torso and on my back, but we’ll see.

Ok, it is very hard to gain weight and muscle without insulin. I’ve basically stalled over the last two years. But I guess I would suggest that you focus on post workout nutrition and think of insulin as enabling the uptake of nutrients that enables your body to recover from exercise. You don’t become big strong from lifting weights, you become strong “recoveving” from lifting heavy weights.

Yeah, I went to a presentation on exercising while on the pump. While it was pump-specific it was pretty universally applicable. The doctor speaking had type 1 and participated in competitive sports and mentioned that while aerobic exercise lowers blood sugar, anaerobic causes the release of glucose. This was totally news to me. He actually recommended a short burst of anaerobic exercise to counter hypos during regular aerobic workouts. Wish I had heard that before, as it explains a lot!

Your body naturally pumps your blood full of much too much sugar when you engage in intense anaerobic exercise. Even a large bolus or injection right at the beginning of your workout will rarely cover all the glucose your system releases. If your anaerobic exercise goes longer, your body releases more sugar. It also shuts down fat metabolizing function, to get energy from muscle, so increasing that sugar in your muscle is a good way to prevent protein digestion.

THere are a lot of really interesting articles on body builders utilizing injectable insulin to maximize strength and size increases. Trying to naturally cause your body to release that amount of insulin would require an unhealthy amount of binge carb-eating.

As long as you aren’t using heavy weights for that burst of anaerobic exercise! I would caution against anything requiring a lot of focus, dexterity, or strength, just because of your slightly (or largely) incapacitated state during a hypo episode.