Have you experienced late-onset hypoglycemia after an increase in your exercise?
For example, after you joined a gym, started a new walking program, participated in a race, went on an athletic vacation, etc. have you had an hypoglycemic reaction 4, 12, 24, 36 hours after the exertion?
I’m just learning about PEL hypoglycemia and I’m in interested in hearing how you’ve learned to cope with a second-wave glucose drop (i.e. due to a sudden decrease in insulin resistance, or your body grabbing all the glucose to restore the glycogen in your muscles) at an unpredictable time, long after the exertion/event?
Thanks to bsc for pointing me towards this line of research. I’ve been experiencing this but I didn’t know what it was and my former doctors have been no help at all in helping me figure this out.
One suggestion is trying to replenish your glycogen right after the exertion/event. I think this would work great for the glycogen replenishment issue, but what about a sudden, temporary decrease in insulin resistance 12 to 48 hours after an exertion/event? How to cope with that? Anyone?
Not that long after-- but I can certainly have a delay – an hour and sometimes even two. For me – intense cardio will do it – like if I’m doing cardio intervals. Swimming laps can also cause it. But now that I know what causes it – I’m generally armed and ready for it with glucose tablets close by and a snack at the ready. Fascinating that you have found that this on a longer term delay. I’m looking forward to reading the responses to your post.
Thanks, Donna H. I have heard of the short-term drops (within an hour to four) but I didn’t know that dropping 12, 24, even 36 or more hours later was “a thing” that researchers and sports physiologists were aware of. Why didn’t they tell me!!! ;0)
I’m enjoying learning more about it, because I’m trying to get into better shape and I’ve been derailed several times now by these PEL hypoglycemia attacks. I thought that once my blood glucose was stabilized post-exercise, I didn’t have to worry about it. Apparently, my body has different ideas.
I have been a type 1 for about 1 year and I have not exercised much b/c of a fear of lows. The few times I have, I have dropped very low 2-3 times for the next couple of days. My endo tells me this is not possible, but it has happened a few times now, twice from cycling and once or twice from shoveling heavy snow. I did the heavy activity in the morning, managed it ok with temp basals and snacks and then the next evening dropped down to 46 and the next evening again dropped to 48. My endo says unrelated, but it happened again, and then again with shoveling. Scares the crap out of me.
I hear you on the doctor’s response. Mine have been, shall we say, less than helpful?
It makes no sense that they’re resistant to the idea, as there is peer-reviewed research all over the internet about it, not just anecdotal evidence like yours and mine. I think there is a big disconnect between doctors who treat athletes and doctors who don’t. The ones who treat diabetic athletes are the ones who have seen this phenom enough to “get it”. The others are skeptical or ignorant – who knows why?
It’s possible that you’re both T1 and have some genetic components of T2 that causes some variability in your insulin sensitivity.
Everyone and their dog will tell you that T2 insulin resistance can be improved with exercise, which is just the flip-flopped way of saying that exercise increases insulin sensitivity in the insulin resistant.
From what I’ve been reading today, it seems like a slow, steady increase in exercise and then maintaining it at the new level is the key to avoiding crashing and burning. This delayed hypo response seems to be worse in people who go from being sedentary to being very active – also known as the “weekend warrior syndrome” – and shoveling snow after being fairly sedentary fits perfectly in that profile.
If I don’t much for a few weeks (stress, work, weather) and then do a lot of walking over the weekend, that’s when I’m crashing and burning in my sleep or even the next evening. What’s weird is that if I test while I’m walking, even at 1-1/2 to 2 hours in to a long hike with hills, I won’t see any drop in my glucose. It comes much, much later.
The more trained you are the later the tendency to go low after exercise. For me this is around 4-6 hours after the exercise. To compensate this I will often eat chocolate - it is slowly digested and peaks after 3-4 hours for me.
Type 2 = insulin resistance, not a lack of basal insulin, right? One day this copious amount of insulin won’t open my cells (hyperglycemia) and the next day it will (hypoglycemia).
If that’s not a change in insulin sensitivity, what do you call that? Duck, duck, goose? ;0)
I’m Type 2
I can have a hypo 2 hours to 20 hours after exercise.
I will zonk out. Did that at my doctor’s office once. He said to increase the carbs.
My dietitian told me increase my carbs (add 15) after exercise.
After exercise a glass of milk works best for me.
I would cope with any glucose drop the same way, by eating? When I run > 10 miles, it can be sort of challenging to get my BG up afterwards, perhaps aggravated by losing weight/ sweat while running (post-run weigh-in= :-)) and not wanting to pile it back on?
I always try to hit some protein when I get home, milk if I’m low or cheese if I get a post-run (or post-jelly bean?) spike. A lot of times, my BG will spike up (130 or so, still…) within 1/2 hour of finishing and then run low for a while afterwards. I try to exercise often enough that it there’s probably always some low action going on but I don’t worry about naming it specifically. I am always testing and watching the CGM so I just nudge the tiller in the proper direction as I sail along…
yeah i get severe hypos even up to 2 days after strenuous exercise. an interesting article on it here from Sheri Colberg about it, she says an increased intake of carbs 30-60 minutes after and then 7-11 hours after to prevent the second wave of hypo.
But am not sure if this prevents up to 48 hours after
I think you had asked why I tested so frequently in the “# of tests” thread and, even when I take a couple of days off, I still test a lot. If you are hitting it every 2 hours (or 5 min, w/ a CGM…) it is much harder for hypos and hypers to sneak up on you. If you are testing 5-6x/ day, it leaves more ‘openings’ for ‘guerrillas’ to sneak up on you?
Yes, thanks for that link. I found that when I was Googling around yesterday. This part caught my eye:
The period in the first 30 to 60 minutes after exercise is the critical time when your muscles can take up glucose without much need for insulin. Second, you may have more than one time following a workout when it feels as if your body is rapidly depleting your blood glucose. A recent study showed a biphasic increase in carbohydrate requirements—both right after exercise and again from 7 to 11 hours afterward. Be on the alert for this second wave of potential postexercise hypos and prevent them with adequate food intake and medication changes.
That’s probably where I’m messing up; I haven’t been as careful about testing later, just during and right after exercise.
I also have found in several places a recommendation of drinking something like milk or a protein shake within 30 to 60 minutes – apparently the mixture of sugar, protein and fat does the trick of restoring glycogen better than just plain “sports drink”:
Glucose declines after dinner were least in people who drank the whole milk. So, although carbohydrate is most important to replace in the short run, for longer prevention of lows, extra protein and fat intake may also help.
I don’t usually get a sudden large drop after excercise, though in part this might be because I usually excericse before dinner. Also the more I’ve trained, the less I get low (I think because I’ve readjusted my basal and bolus) so it would only happen if I change to a new type of excercise or doing an extrenuous workout (like my long runs when I was training for a 1/2 marathon). Then I would just drop my basal a little because for me it tends to last throughout the next day.
I exercise after work, so my PEL hypo hits in the middle of the night for me. I simply cut my basal by half starting when I go to bed and ending about 1/2 an hour before I wake up. Works like a charm. Woke up at 83 this morning after going to bed at 92 last night and doing intense cardio for 30 minutes yesterday. Works the same whether it’s intense cardio or strength-training, which is kind of weird.
I also usually exercise at night, and so the lows tend to hit me overnight. For me, it’s usually enough to skip my square wave protein bolus for dinner/recovery snack. In the past, I’ve also had to have a different basal pattern that omits my typical dawn phenomenon rate from 4-6am because I would go low then, though that hasn’t been necessary lately probably because I’m not training hard right now. On rest days that follow a long run day, the overnight can be a little tricky because I need something but not as much as when I’m taking several days off. So, I guess my trick is plenty of protein.
Since starting insulin in December, the hardest thing has been managing exercise. I suffer from the Late-Onset Hypoglycemia (LOH). When I first started, I would just exercise and was skipping post exercise eating. I was having sudden drops at about 2 hours after exercise. I think some of what was happening is that my body was just restoring my depleted glycogen levels and for a short period of time I became a “glucose sucking monster.” Over time, I’ve found that following my exercise with nutrution can almost totally eliminate this effect. So after exercise, I have a protein shake (with milk), 12 g carb, 25g protein. And then withing two hours I try to have an actual meal with perhaps 30-45 g carbs and a good serving of protein.
So that helps the sudden drops, but I also have significant changes in my insulin resistance. In the meals following exercise, my I:C ratio drops to perhaps half. So for the rest of the day after exercise, I adjust my I:C. And then my basal rates are affected. I drop my basal rate by 20% the first day after exercise and then 10% the second day. Even with this change, I still run markedly lower the day after exercise. These constant changes have been the real pain. It is now driving me to rething my whole exercise regime. I weight train and being “older” I struggle to fit in three sessions a week and recover properly. This causes a constant up and down. If I exercised more consistently, perhaps every other day, I’d probably have less problems.
