Friday, January 20, 2012

Very Carefully, Tha'ts How.

One of the questions I get asked the most from non diabetics with regards to exercise is, "How do you do it?"

My first response is always, "Very carefully."

Which I then follow up with, "Trial and error."

Every diabetic knows that diabetes is entirely unpredictable with a zillion factors that ultimately effect the outcome. We also know that no two of us are alike. (Like a beautiful snowflake? *gag* ha). Basically what works for me, is highly unlikely to work for someone else.

This week I spent a bit of time trying to analyze some blood sugar outcomes. Since having to switch my workouts to the evenings again I've been struck with so many issues that I was happy to not have to deal with for awhile. My insulin sensitivity in the morning is absolute crap. I take 3 times more insulin in the morning than I do for the rest of the day. This means that I can easily work out without having to lower my insulin or make any special requirements. It's pretty awesome. Makes me feel like a normally functioning human being.

Three days in a row I did the exact same workout at the exact same time on my trainer at home.

Day one I set my temp basal for -70% 1.5 hours ahead. I went low mid-way and again at the end. I treated my low with only 10g of carbs because I knew if I had any more than that I would rebound. I set another temp rate at 160% for 3 hours as soon as I was done.  Later in the evening my blood sugar jumped up to an 18mmol/l (325mg/dl). I chased highs all night.

Day two I set my temp basal for -80% 1.5 hours ahead. I finished a bit higher than expected.  I then set another temp rate at 180% this time for 3 hours. I hit 16mmol/l (288mg/dl). I chased highs all night.

Day three I didn't want to do the same workout again but my desire to see some results trumped my boredom. I set my temp rate for -75% (in between the previous two days). My blood sugar stayed mostly steady during the ride and I finished with a perfect number. I immediately set a temp at 200% for 3 hous and at the same time bolused 2 units. I didn't chase highs all night :) I went to bed with normal blood sugar. 

What did I learn? Well first of all 3 days of the same trainer workout was snooze inducing. I almost went for a 4th except that I was afraid of it causing me to avoid the trainer. I learned also that as much as I want to be and as much as I don't want to disappoint my friends, I have to admit that I am not in love with Battlestar Galactica. In fact after 2 full seasons while on my trainer, I sort of want to throw the discs out the window. I tried guys... but it bores me to no end.

The biggest thing I learned?  I have a SERIOUS problem with post exercise highs. This frustrates me because I feel guilty when I am hungry after a workout because I know it will never end good. It also concerns me that my body requires SO MUCH insulin after supposedly working out. I mean, that much insulin means that there is glucose in my blood that needs to get into my body.  Glucose = calories that I just spent an hour burning off.

I know from experience that I can go very low and often during evening workouts because I am very insulin sensitive at that time. But whatever I'm doing right now just doesn't seem to be good enough.

I thought about trying to NOT use a lower pre exercise temp basal, or maybe half the reduction. I am really interested in trying some other way of managing this. I am wondering what would happen if I eat something an hour ahead and not set a lower temp basal rate. I question if the food would sustain the exercise and maybe I won't dump so much glycogen and end up with those evil post exercise highs?

Any thoughts?

Are there people out there that are able to maintain normal blood sugar before, during and after exercise?!


  1. Too bad about Battlestar. You're still pretty cool in my mind but maybe not AS cool as before :)

    As for battling post exercise highs - I have no perfect solution but, when I'm working out more than an hour (running or cycling) I will often have a snack before (20 carbs or so). I'll bolus but only 20-30% of what the pump tells me to. That helps me combat the highs because there's a wee bit of insulin floating around in my system. I do reduce my basal by about 50% but I find that the tiny bolus helps.

  2. Good post... It really IS about trial and error, isn't it?
    First thought: I really only go high after the workout if the workout is highly anaerobic, which makes me wonder if you're doing that type of workout and if so, why 3 days in a row?

    Second, I only reduce my basal rate for workouts of greater than an hour. Not sure how long these were? But even then, I never reduce more than 50%. Instead, I consume more calories during the workout. One of the advantages of being a diabetic athlete is that we're used to eating when we don't want do. I exploit that by consuming more fuel than the average non-diabetic athlete would... as much as 60g. per hour for a really serious workout. Because I'm not reducing my basal rates as much, another benefit is fewer post workout highs. :)

  3. I'm going to ditto Celine's sentiments re: Battlestar Galactica. :) As far as exercise and blood sugars, the thought I have is protein. For me, glucose tabs + exercise = spike then drop. But if I snarf some cheese or peanut butter or chickpeas before hand, things stay more steady. I'm becoming very fond of protein.

  4. Thoughts about post exercise highs... I get them SO BADLY when I have hard stress inducing workouts. But you shouldn't not eat.
    I don't know if you ever bomb low a few hours later, but personally, if I give myself any insulin to correct the post workout High, I BOMB and it's awful.

    All last season I dealt with this this is what I can suggest:

    Eat something.. ANYTHING after you workout. Give yourself a bolus ONLY for the carbs in what you're eating. And if it's a tough workout, DEFINITELY have some carbs, no matter what the blood sugar is.

    Basically, what I found was that the stress of the workout was telling my muscles to release glycogen, so that flooded my system, raised my blood sugar to epic numbers and then after the workout was over, and my body was rest assured that it wasn't going to have to do that anymore, it would begin reabsorbing the glycogen into the muscles, and then poor me, fearing not to ingest carbs with such high blood sugar would go to MAJOR bonk town -- like 27 bg's. It was awful. And I was super confused.

    So now no matter what, after a race, I pop a few tabs, eat a snickers, enjoy a banana-nutella sandwich, and only bolus for the food. Then in two hours, I'm riding easy again at normal bg's.

    I think it makes sense in theory, it's the same reason that non diabetic athletes at the end of a hard race will chug a coke. It's to revamp their muscle glycogen to avoid post workout fatigue.



  5. A few thoughts...

    I almost always eat something before working out, no matter what time of day. I do not reduce my basal rates...I found it to be so much of a problem. Some days I don't exactly know when I'll be running until I actually hit the streets, which does not make temporary basals possbile.

    I sometimes go high post-exercise, but it primarily happens after high intensity workouts, like speed work on the track. I bolus for the high and add a little onto that rather than adjust my basal. It works for me...

    I hope you find something that works for you, too.

  6. Totally chuckled at your snowflake *gag* line. hehe!

    It is all trial and error, isn't it?

    I also very much appreciate and agree with how exercising at different times of the day can goof things up.

    I mostly have my afternoon basketball down (mostly). But every once in a while I play in the evening, and it's a totally different thing. Amazing how the time of day can make such a difference!

  7. I, too, had problems with post-exercise highs. (Had? Have? Sometimes have?) It took me a while to figure out what I'm doing now.

    Is it possible that your post-exercise temp basal isn't acting fast enough?

    When I exercise, I use a much less aggressive temporary basal than you do (only -30% starting about 2 hours beforehand) and I sometimes have a snack before I run/ride/swim. I find I almost always have to bolus between 0.5 and 1.0 units right when I get done. (My insulin sensitivity is about 1 unit = 50 mg/dL, which is... uh... 2.5 mmol?) While I get a little bump in the hour afterward, this keeps me from going super sky high.

    I have to do this whether I workout in the morning or in the afternoon. The best I can tell is that the post-exercise high is the result of (1) the temporary basal reduction, which is finally catching up with me, (2) the last bit of the pre-workout snack, which is also catching up with me, (3) being slightly under-hydrated, and (4) all of those stress hormones, which raise the BGs.

    Good luck!!


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