I have decided to start (cardio) exercising on a regular basis, the two things I would like to try out are jogging and training on an exercise bike.
I am new to basal insulin (currently on 5 units in the evening and 2 units in the morning of Levemir).
Before I started on basal, I already did some jogging and biking here and there, and because I am not very trained/fit, I noticed that my BG can drop INCREDIBLY after only 10-20 minutes of exercising. I ve seen drops of 60mg/dl within 15 minutes)
I m on pens, so reducing basal like with a punp wont really work...
I was thinking maybe with Levemir though, since it only lasts 12-16 hours, could I maybe skip my 2 units in the mornings when I want to go for a run?
Or is this a totally stupid idea because it would mean I wouldnt have any basal on board, (I presume with doses like I have my pancreas is still doing some of the work), therefore I d go really high while exercising?
So my best option I guess would have to be to eat additional carbs for exercising, is there any rule of thumb I could start with, like if I m around 100mg/dl before the run I ll eat a 15g carbs muesli bar?
Any suggestions that help me not having a dangerous hypo while running down the road would be really helpful!
Rather than skipping the basal entirely, I might try adjusting the timing so you are taking the basal after you run? If you're doing one shot/ day, perhaps the lower activity some people report might mimic turning a pump basal rate down and work well. The other thing that you can do is anticipate the carbs you burn off by eating something before you go. Some of the books, e.g. TLAP suggest more carbs than I need, like 2 hours of moderate exercise (c. 1/2 marathon...) came to something like 90G but I've usually run them with a shade less than that. For a 5K run, probably my most frequent distance as I can fit them in after work, I run about 24-27 minutes and it takes pretty close to 10G of carbs so, if I come home from work, test, am at 90, I'll have a glass of skim milk and start running. The CGM (I know you don't have it but I think it provides a somewhat useful example...) will bleep about a mile into it "predicted high" and show something like 110 but, 20 minutes later, will warn of a "predicted low" and be back down in the 80-90 range. It doesn't work out that precisely or happily all the time but that seems to be pretty repeatable. The only way to know for sure is to test. It's a pain in the ■■■ to pull over and test but, the more you can force yourself to do that, the better data you'll have.
My other tips are: Race Ready Shorts, at the recommendation of Jerry Nairn. They have 5 mesh pockets across the back, including one that will hold a OneTouch Ultra Mini securely for 26.2 miles. There's also two roomy "key pockets" with velcro flaps that can tote quite a bit of stuff along if you need it.
I also like powdered gatorade for longer runs. Most people concur it's useful to have fuel and hydration for longer runs and Gatorade has both and is Dextrose so it works quickly if you need it. It was handy as I explored numbers as, if you buy the big powder vat (enough to make 5 gallons...), you can weigh it out very precisely into a bottle. I don't usually bother with that for < 10 miles but if it's warm out or something I can decide if I want a 20G of carb thirst quencher or if I want really concentrated 45G of carb bottle in case of emergencies.
I have an Amphipod belt with a bunch of pockets that I use for the bigger stuff and my phone and ipod I don't want to get sweaty.
Re the hypos, I bring little baggies of a mix of Smarties (dextrose candies...) and Starburst jellybeans. One is ok for most shorter runs for me. During the winter, I just tuck it into the sleeve of my warm compression shirt and they tuck into pockets in the summer:
The Smarties are like little glucose tablets and the jelly beans help the texture not be so dry/ powdery. I like the taste of this combo a lot but the chore of mixing it up gets it into my head that they are medicine rather than munchies.
hiya jules, i love sport and got the beetus about 16 months ago. im honeymooning or LADAing and currently take 8 units of levemir in the pm and 2units in the am. i also am on a 1:30 insulin:carb ratio. lots of times ill eat a meal with like 15 grams of carbs and wont bolus cuz my pancreas will take care of that. i know that you are kind of the opposite of me with the insulin-youve depended on the bolus to start, and i tend to lean towards the basal, if i remember right.
i definitely wouldnt skip the basal. i only lower my basal after a long cycle. if i take a 40 or 50 km cycle, then i will lower my basal by one unit that evening. keep in mind that levemirs action will not really start the little peak until like 5 hours after injecting, so if you are going to exercise in the morning, the morning levemir shouldnt really have that much of an effect?? i would make sure your bolus is all used up-i always wait two and a half or three hours to start moving.
i hate the hypo anxiety when im exercising, especially being out on cycle trails. the friends i go with are great and know im t1, but really, where are they taking me if im all severe hypo in the middle of nowhere? i make sure i test before we leave and keep in mind my last bolus time. then i test like every 45 minutes or hour. saying that, there have been times where i thought i was all good and...i wasnt! i really try to pay attention to my body but sometimes its hard as exercise makes me kind of immune to the early signs of hypos-the sweating is happening cuz of exercise, the trembling muscles cuz im really putting in a lot of physical effort! i know that each gram of carb raises me about 5 mg bg wise, so i eat/treat acoording to my meter. i will have some fast acting sugar-glucose tabs or sometimes fruit. do you know how much a gram of carbs raises you? when we get to the halfway point, about an hour and a half into it, i get to eat loads of carbs, whatever i want, basically, what a treat! and without a bolus. that way im good for the way home. and then, as i said, 1 unit less on the pm basal.
for other exercise of an hours duration or less, i just make sure my bolus is pretty much gone. i dont lower my basal at all, even if the workout is intense. i like to start out at like 130 or 140 and by the end of the hour im usually around 90 or 100, though as you know, ydmv.
The whole key for me, on similar small doses of basal mdi, is to just make sure there’s no bolus on board when I exercise. Novolog wears off pretty fast for me, so as long as I haven’t taken any in about 3 hours I don’t have any problems. For me, very small doses of long acting don’t cause any issues
I'd adjust the basal down in increments, first, before skipping it entirely. Or, as Acid suggests, adjust the timing of your basal injection.
Bottom line, you're just getting started so how you end up dealing with exercise related diabetes issue is going to end up being tailor made to you, with suggestions here being decent starting points.
I'd strongly suggest staying as consistent as possible, in the amount you exercise, type of exercise you do, and time you exercise, while you are working on your insulin dosing and pre and post work-out meals, for a few weeks at least. Once you get an idea about how his particular exercise program affects you, it will be a lot easier to ramp it up or down while being able to adjust your treatment in response.
Changing the type of exercise, like cardio to aerobic to anaerobic weights is going to greatly affect how you approach your treatment options.
I am also on MDI and Levemir for basal. I take about 30 units of insulin total/day though. I am fairly new to this and haven't quite mastered my insulin needs for working out but depending on the timing and intensity of my workout, I do a 50% reduction of my bolus. So every evening I work out right after supper for 1 hr. and will reduce my supper bolus by 50%. This works most of the time, but it is a bit of trial and error. It's the spontaneous activity or more intense workouts that seem to have poor results for me. I have snacks on hand for that.
No doubt. 20 minutes of intense cardio will drop my BG 60 to 100 points. The only question about fitness level is whether or not I can actually keep my HR up into the cardio range for 20 minutes.
wow Shawnmarie – a 100 points drop sounds scary! Is this with bolus on board, since I figure with your very small dose of Levemir that cant be whats causing the impact...Or is this a drop not related to your exogenous insulin intake at all? How do you make sure to avoid hypos with drops like this? Do you eat before you start exercising, or during?
Thanks pw for your great and detailed reply! Reading your experiences make me realise once again how different each of our Ds are..If I exercised for an hour without any additional food, even starting on 140, I d be more in the 60s at the end of it.. I think its really great that you are such a vigorous exerciser even though you ve only been beetusing for 2 yrs, good way to show the D the finger ;)
I hope I ll get there too eventually, my jogging episodes will most likely be like 10 minutes of running, testing, sitting down on a park bench trying to crunch the numbers, 10 minutes of running again, testing, getting scared at the drop i ll see, panicking and overtreating with 4 glucose tabs and a muesli bar then going home frustrated--- Good times ahead ;-)
100 point buffer is recommended, which heavy exercise/exertion can easily eat through. Whatever your ideal target number, add 100 points to that number, before you do your first squat, lap, warm up. You want to be much higher than normally "preferred"
If you have to keep checking (ie afraid of getting a dangerous low), it strongly defeats the purpose! You don't want to have to worry, you want exercise, fun, enjoyment, sweat... not endless fear your dragon is going to awaken! The buffer will achieve that goal
Absorption site. Connected/injected wherever you used your fast acting insulin, you do NOT want to heavily exercise that body part specifically! It will change the absorption rate, if you do. See the buffer idea above. I'd add another "50 points" to that buffer (eg 150 point buffer) if I was concerned I was going to be running, and had used my legs the last injection (sic. of short acting).
Reduce your short acting insulin by 20% before exercise.
Dr. Sheri Colberg-Ochs http://www.shericolberg.com/exercise-diabetes.asp wrote a book about insulin dosages specific to different exercises, but was pretty worthless on a huge number of levels. Perhaps her latest edition is better...? It was severely generic and lacked a huge number of exercises, activities which should have been included in her original publication. Did not find it frankly useful. No clue how she came to her conclusions, what her "database" was to make the recommendations she reached per particular sports.
I don't like the 100 point buffer idea. I did that all the time when I first started working out and I think that it's burdensome on your body and very likely interferes with working out. I should read Sherri Colberg's book again but my recollection of it was more like "war stories" about various amazing athletes rather than a how-to manual. A lot of the directions seemed to have fairly broad ranges "adjust basal to 10-30% of normal" which, while it may be what I do in practice, may not be precisely precise enough to rely on. The only thing to rely on is your meter and your experience.
i completely agree with acidrock. i start at about 120-140 and just top up my glucose as i go along, stopping to check frequently if im doing something for a long time, or if the activity is not something i usually do. the mere thought of starting at 200, (or 250!!) makes me feel ill!
i also have colbergs book and yes, very general and for me not very helpful, as im still on low doses of insulin, lada-ing or honeymooning.
I am not training for a triathalon but I have been doing some sort of exercise every day since mid-October (which incidentally coincides with the start of the Big Blue Test). So far my basal needs have dropped by 30% going from 30 units of lantus to 20 units of levemir split in 2 doses equally. I do a lot of different stuff I always walk the dog for 40 minutes in the morning, walk after lunch, every night has something different to keep me interested so tonight I am playing racquetball, last night I played tennis and the night before I went for a swim. I find in order to keep motivated and stick with it the exercise has to be fun and has to be varied enough so I don't get bored. I was having some bad lows in the pool when I first started so generally if I am having a low carb dinner I don't bolus for it and just rely on the basal to carry me through. So far that has worked fine. Also I always have some glucose tablets at the side of the pool and some juice - I like carrot juice but any juice is fine. I swim 5 laps, take a sip of juice and then swim another 5 laps. If I start exercising while my blood sugar is high, it remains high or goes even higher in spite of the exercise and then plummets later on. So I do not let my blood sugar get high in preparation for exercise. I'm not sure there are rules of thumb for this. My exercise and insulin doses have taken me 7 months to work through and it is still a work in progress. And what works for me may not work for any other PWD because we are all so individual. Don't make any big changes. Just try small adjustments until you figure out what works for you.
I dunno if skipping bolusing is a totally realistic goal for people but the amount of carbs or low carbs plus TAGing the protein onto the "dose" is probably consistent with an 8-15G snack before a run and makes sense for a reasonable workout plan?
Ok, so exactly how do you or I GET sufficient blood glucose, so that moderate or heavy exercise (intended or otherwise) is possible, without a causal "crash and burn" low guaranteed by it?
Micro managing insulin to that degree is severely problematic. Identical issue pump or injections. Whether too much or too little (insulin) as potential problems, need avoided summarily and easily can be.
Food, ok, but even taking in some amount of calories/carbs before exercise to counter balance the blood sugar used by it will have the same effect, that buffer. Yeah we could do the "patch" food routine, micro snacks, fat protein combos before, during and after to delay the expected food spike but complex carbs are a difficult thing to guarantee the required iron-plated flooring someone requires. The wrong thing mid morning, the wrong site used, and the benign cheese and crackers snack attempts won't do the job.
The testing nightmare (too many are infatuated with) is misguided. The test four times (take your pick how many) during some exercise forbids the focus being on exercise, the release, being in that moment and concentrates solely on our diabetes. That kind of zeal, hyper focus is not mentally healthy. To me its dangerously so, the "diabetic paranoia" idea? Never a fan of any approach which demands excessive vigilance, effort, and fears the next result.
I advocate the buffer being a blissfully simple solution with zero vigilance necessary. Concentration, focus upon the exercise not the diabetes for that hour, two... diabetes is there when we are finished. For a blissfully short time we can set it aside. A blanket approach, not a "scalpel" one...
I usually just test during at the turn on some of the long runs as we do out and backs and there's always a pause that's a good break. I feel like I run better, at least BGwise, when my BG isn't flying all over the place. I need a little bit of carbs to offset the burn from long cardio stuff but I've found through testing and practice that the 8-12/ 3 miles works pretty well. If I run 3-4 times/ week, I don't want to run up to 180 that often. I did that for a long time but, after I got better at it, I can run things more tightly and like the way I can run and control my BG that way.
i also noticed that my sugars roofed to 317 from 124 last morning after brisk walking and running. prrviously it used to go down. i thinj exercise upto 20 minturs is safe as a rule of thumb
There are a lot of factors influencing BG though. In the AM, my BG often pushes up, likely dawn phenomenon. I have my pump set to pump more insulin during those times but I always found that challenging on shots. Most of my theories on this stuff are based on running since the winter of 2008, when I started running to get in shape for a Tae Kwon Do test. I had to move in 09 and, w/ the adjustment, I stopped TKD but kept running. That winter, at a party some friends said "let's run a 1/2..." and I pushed the distances out and ran it, and then a second two weeks later which, now that I think about it, may have been a bit nutso.
Since then, I've just kept at it and run 6 more 1/2s and 2x fulls, anywhere from 15-45 miles/ week, not huge but I'm 45 and rarely run every day [and, FWIW, I haven't run since April 6, when I trashed my calf in the Hollywood CA 1/2...boo!]. My initial food approach was to crank my BG up and "run it off". I've had a CGM since 2008 and noticed that if I had "regular" food (cereal, bread, chips, whatever...) before runs, a lot of times it would spike BG since, of course, it takes a couple of hours for the food to deploy, even if I'm working so I try to have any food like that, needing a basal, "administered" at least 2 hours, if not more, so the food is "peaking" during the run and the insulin is gone or mostly gone. My basals are set ok so I am confident that I will be reasonably flat so the carbs I'm taking in are solely to fuel the running. I try to use the Gatorade for "fuel" carbs and then the jellybeans/ Smarties for emergencies. In a few dire situations that I've had, I will also add anaerobic sprinting to provide a free "boost" to BG. During all this time, my A1C hasn't been > 5.6, most recently 5.1 so if I figure I've run a few hundred times, I've "saved" running my BG up high. Except for the times when I "screwed the pooch" and ended up high anyway which, of course, happens sometimes.
Not pretending my method is the only one "brother", by no means, merely trying to explain/explore the perspective behind the idea, as I understand it. I can be swayed to new thinking...
Even with the buffer, there is soda in the bag 3 feet from anywhere I am. No testing if I believe the "crash" is imminent, drink first (conservatively) and test after if I need that proof for some weird reason... otherwise I'm "in the exercise", and not a DIABETIC exercising... semantics?
