Hello all! I am new here and still getting used to manuevering within these boards and the site. Quick history, I am 36 and was just diagnosed in September with Type 1. Lucky me, I’m the first in my family from both sides with it. Anyhow, I am just now being encouraged to start working out again. I started my P90X program this week and have been waking up with lows in the middle of the night regardless of me snacking right before bed without taking my Apidra or Levemir. Is this normal? What can I do to prevent this? I am typically eating fruit or granola before I work out and check my sugar levels before and after my workout. They are normal all evening up until about 3 a.m. Not sure what I can change… Maybe cut back more on my Apidra with dinner rather than taking the normal shot with dinner after my workout? Looking for suggestions that are working for actively working out people. I’m also about to get on the pump after the first of the year, so I’m not sure how that will affect it as well.
I’ll let people answer specifically questions about working out and blood sugar. However, one thought: You don’t say what time you work out, but if you are fine until 3AM my guess is your low is caused by your basal being too high; perhaps you need to cut your Levemir by a unit and see how that works out; also possibly change the time you take it or split your dose.
I’m working out after work between 6 and 7ish… I take a shot of Levemir in the morning and one at night…I stopped taking my night shot of Levemir and still had a low last night… although not as severe as the first night…
kaayle, this is very normal. working out can increase your insulin sensitivity for up to 48 hours, depending on how intense the exercise was. Also, in strenuous exercises where you use glycogen stores in your muscles and liver, your blood sugar may stay constant or even increase during the exercise, and then drop like a rock a few hours later, which may be what is happening to you.
for example, last week i had a spike after dinner. i was a little upset, and wanted to bring it down quickly. i took a unit of humalog and exercised for about an hour, then checked again - my blood sugar had barely moved, still hovering around 180. before bed it had come back down to 130, and i was relieved that it finally was back closer to normal range. then, at 3 am i woke up covered in sweat, crawled to the bathroom to test, found out my bg level was 40, and was very thankful to have glucose tablets near my bed.
i was diagnosed in august, so i’m a newbie like you. i play in a soccer league though, and exercise around 3-4x a week on average. things take a bit of figuring out in the beginning, and i am definitely still working through similar issues. if you could exercise a little earlier it might be helpful, or exercise at a lower pace it might be helpful. if your blood sugar isn’t decreasing while you exercise, be aware that it’ll drop a lot in a few hours. also be aware that you’re increasing your insulin sensitivity by exercising, and if you’re now beginning a routine after a period where you didn’t exercise, you might find that you need to reduce your basal rate. when i play soccer, i need to eat around 50 grams of carbs with no insulin spread out over the few hours following my match, and then need to cut my bolus rate at dinner by half since i’m more insulin sensitive than normal.
a few resources that helped me in the past few months that might help you:
think like a pancreas - great book, and in the back there are tables with typical carb replacement rates for different kinds of exercise. this can be a starting point for you to figure out how much you need to eat after you exercise to avoid going low in the middle of the night. there’s also a fair amount in the body of the book about exercise, how it affects blood glucose, and strategies for dealing with it.
http://www.1happydiabetic.com/apps/videos/channels/show/1499150-sports-and-diabetes - a series of sports lectures by a doctor who is t1 diabetic, about 20 minutes total, and very informative
the athletic diabetics group on tudiabetes - very friendly people, and they helped me a lot when i was starting exercising again for the first time after being diagnosed.
Hi Kaayle,
I was also diagnosed with Type 1 in my mid-30s with no family history. (I actually have LADA, the slow-developing type.) And I also work out a lot.
I’m not sure what to advise about your 3am lows, since you’re already skipping your nighttime basal. But I did want to encourage you about the pump. You’ll find it very helpful in managing your blood sugar. You can exercise without any insulin on board and can really fine tune your basal rates.
I highly recommend the book “The Diabetic Athlete’s Handbook” if you want to get into the nitty gritty of what’s going on with your body when you exercise and take insulin:
Wow! Thanks for the input… I am getting ready to workout and I think I will try cutting back on my insulin by a unit or two depending on my carb intake and see where that lands me. Looks like I have got some more reading ahead of me.
I’m glad you replied about the pump… Thanks! I will definitely check out the book on Amazon… hopefully they will have it on Kindle.
It is available for Kindle, but I have the print version. Hope the Kindle version can handle all the charts and graphs!
Oh good point! Hmmm…
Hi Kaayle,
Lots of good advice here and I second the book recommendations.
Its possible your night time lows are unrelated to your workouts. An intense program like P90X can sometimes even cause blood sugars to RISE!!
The best tools for finding the culprit are testing and logging. What’s your BG before and after your workout. How much carbs have you consumed after the workout. What’s your BG at bedtime. How much insulin, if any, did you take? After getting a few days (or more) of data look for a pattern.
Since you’ve already cut down the night time insulin, you might also consider upping your nightime snack and use some slow acting carbs, such as in an Extend Bar.
Best of luck. Hope to see you in the Diabetic Athletes group soon.
Terry
Thanks for that info… A girlfriend of mine recommended that one too… As for the Diabetic Athletes group I will check it out now.
In the back of his book “Think Like a Pancreas” Gary Scheiner has an exercise chart, wherein he calculates by weight of person and level of activity (slow, moderate, active), also length of activity, how many extra carbs are necessary to cover 15 minutes, half hour, hour or two hours longer of exercise. Basically, you are covering with carbs so you don’t go low. Of course with an insulin pump, you would basically cover the first hour of exercise with Ex Carbs and the rest with temp basals. He covers reduction of basals, especially overnight, because your body will remain more sensitive to insulin for a period of 12 or more hours after activity. Very important to cover with extra carbs or lower insulin dose when you go to sleep so you don’t go low overnight. John Walsh also has charts in his books “Using Insulin” and “Pumping Insulin” but for us Walsh is too liberal and uses too many carbs. This is individual but you can use the books as a general guideline. You will have to test before, during if you are exercising more than an hour, and after exercise and the rest of the day and overnight to see how you react to each type of exercise.
Excellent! That sounds perfect! Now my next question, is it possible to maintain normal sugar levels consistantly? I have pretty good control but I still get highs and lows from time to time… 
My A1C originally at diagnosis was 11.4 (or around there) and after one month was down to 8.something… so it’s getting there quickly… But I keep hearing the pump will enable to maintain more stable sugar levels especially while working out??? Is this true?
I used to get very low with exercise…to the point I would eat a full dinner (30+ carbs) and take no short acting insulin exercise after dinner, and still get low. My guess is that you might need to lower your dinner apirda and maybe your levemir as well. Did you go high the next day without yor nighttime dose of levemir?
For better or worse, this tendency to get super low with exercise for me has lessened a bit as time has gone on.
And no, it is not possible to have perfect control. I have what would be considered good control by most people, but I still get lows somewhat unpredicitably and go way too high sometimes as well. You have to be on your toes at all time. Sometimes managing BS seems like a full-time job.
The pump has helped me in many ways,especially in terms of exercise, but maintaining stable blood sugar with exercise/activity has proved to be of the more challenging aspects of DM care for me. It can always be done by consuming more carbs during/after excercise, but sometimes a person doesn’t want to burn calories and then take in even more!
FYI, most of us T1’s are the only ones in our families…only about 15% of T1’s have any family hx. There is an interesting thread about this if you search the site.
I have done a whole cycle of P90X, and as a fellow type 1’er - here is what I suggest (I am a MDI, and I don’t have a pump, so maybe someone else can chime in on this.:
Before exercise, cut your insulin for the meal before by at least 2 units. Make sure that you are exercising when you are in the tail end of your Apidra. (Your nurse should have shown you a graph.
Also, The Diabetic Athlete recommends drinking Gatorade (or another sports drink) during your workout. (I like to water it down 50%) I find that I go high during the workout, but it levels out within 40 minutes after the workout.
Finally, you know when Tony is blabbing about the recovery drink? The Diabetic Athlete handbook recommends good old chocolate milk as the recovery drink. I can tell you that it works.
Don’t make the mistake of cutting out your Basal insulin. You may still be in your honeymoon phase, your objective is to preserve beta cell function. You are now utilizing what insulin production you have left, but make no mistake, don’t neglect to take your basal. Your problem usually will lie with your fast acting insulin, and your timing of exercise.
The worst part is that there is really not a lot of help for diabetic P90X’ers. If you have any other questions, let me know, and I will try and help!
Thanks Hope! And I totally know what you are saying about taking in more calories than you burn… That is exactly what I’m trying to avoid… Just need that balance.
Man, I need to get on these Diabetic Athlete and Think Like a Pancreas books… I am definitely not in my honeymoon phase, those days are over. I think you are correct that it is more the fast acting insulin than Basal… However, cutting out the Basal at night has helped a lot. We will see what happens with tonight… Thanks!
how do you know you are not still in the honeymoon phase?..have you tested to see if you are still producing insulin? …have ur doc order this test…b/c honeymoon can still be going on…Also, i would remember fast acting insulins have a 4 hr on average, length…the book think like a pancreas(you can borrow this book as well as the sheri colberg book)…says something imagine like the first hour gives you 30% of that dose, then the next hour is 30% and then another 30% and then finally the fourth hour is 10%…that is why the pump is so nice, it will do this math for you and tell you APPROX, how much IOB(Insulin On Board) you have…you can tell the pump that the insulin will last in your body for a chosen time, like 4 hours or 5 hours…mine is set at 4…also, the basal insulin in alot of athletes doesnt act 24hours and it also had a slight peak in me about 4 hours after i gave the Lantus…because everybody is different…it takes awhile to understand what is happening to you…read these boards, but DONT THINK WHAT HAPPENS TO SOMEBODY ELSE WILL HAPPEN TO YOU…ciao
Yeah, the doc has tested pretty much everything… And goose egg on the insulin…
Wow! I had no idea the fast acting had 4 hr length… that makes sense as to why my dietician wants me eating at least every four hours… lol… I am soooo looking forward to getting the pump and CGM, I can hardly wait… I just wish my insurance company would just do the damned roll over this late in the year… LOL… alas, I must be patient.
I am glad you reiterated the last comment, because some of the stories on here are quite scary… I am seeing how everybody is different and really you are the only one who really knows your body… It’s up to us to take care of it as well as we can.
Pump should help while working out because you can set temp basals reducing the amount of insulin you are getting. BUT, you have to figure out or guess how much to reduce it and it differs with each activity, length of time you are engaging in the exercise, and intensity of the exercise. It’s tricky, and we find this difficult to do. Reduced insulin for three hours of ice skating the other night, by 35 percent. She stayed in the 200s before, during and after. Next time I could reduce less, but ice skating should use up a lot of energy, so go figure. If you do an activity the same time, same duration, same exertion (such as a one hour dance class), you will figure it out. It’s the spontaneous exercise or exercise you don’t do very often where it becomes difficult to factor.