# Help needed when cycling (exercise) and dealing with hypos during and after...



## M Perks (Jan 13, 2020)

Hi - apologies if this has been discussed already! 

I'm type 2. Have a Freelibre sensor (which is a godsend). My HbA1c is 6.9. Been injecting rapid insulin for about year. Basal 5 units per day.

I cycle moderate effort for 1 - 2 hours (30miles). Can go longer (but see below). 

I'm 13st. Have calculated I roughly need about 60g carbs per hour. I make homemade flapjacks with sugar, rolled oats, honey, dried fruit etc. I'll start off with say dried eggs, sandwich, or peanut butter etc. But won't bother bolus injection (or basal). 

As my problem is I burn through the carbs with a rapid rate with a dip showing on my sensor chart. If I don't continue to eat through 60g carbs per hour, I'll quickly be in trouble. 

This continues after exercise ends. Typically for 2 - 3 days. Where if I don't continue carb eating for dinner, I'm guaranteed a hypo mid-night. 

I love cycling. Breaks fat down. And keeps sugars low. I'd like to do more cycling in spring. But I'm now genuinely worried about managing the anticipated hypos. 

Does anyone have any advice? Better foods to level them off? Or should I eat rice for dinner before bed? 

Until I've worked it out better, I'm reluctant to go on longer rides, not least because of the after-effects of hypos. 

Any wisdom, expertise, tips and so on, would be gratefully received!

Thanks in advance,

Martyn 

ps. I don't take any insulin (Basal or Bolus) when I cycle as above.


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## Bruce Stephens (Jan 13, 2020)

M Perks said:


> ps. I don't take any insulin (Basal or Bolus) when I cycle as above.



That's weird. Normally the advice (for Type 1) would be to cut down on insulin (before and after). But it sounds like you're not giving yourself any, so I'm not sure why you'd go hypo. A non-diabetic presumably wouldn't. I suggest talking to your diabetes team and see if they understand what might be happening.

If this is happening after you've been hypo then I could understand it (I think the advice is not to do much exercise the day after a hypo, because reserves are depleted so you're much more likely to go hypo again). But you've got a Freestyle Libre so you can see whether that's the case (including overnight).


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## everydayupsanddowns (Jan 13, 2020)

I’m not sure of any T2 specific sources of information for insulin management around exercise, but I wonder if Extod (T1 based) might give you some ideas?

http://www.extod.org/


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## rebrascora (Jan 13, 2020)

It sounds to me a bit like you are feeding your insulin. If you are Type 2 then it is likely that you are producing plenty of your own insulin. By eating more carbs you may be encouraging your body to produce more insulin still as your muscles are burning it off, ending up in a vicious circle. Have you tried eating low/very carb and reducing or even stopping your insulin to try to break the cycle (if you will excuse the pun). You are obviously stopping your insulin on the days you are cycling anyway, so the only difference would be eating low carb and higher fat rather than feeding the monster. Obviously you would have to start steady with the cycling and see how you go if you were changing your food regime quite drastically like this so that your body could get used to running on a different fuel but it just seems at odds to me to be Type 2 diabetic and pouring carbs into your system to fuel your muscles and then going back to taking insulin on other days and struggling to balance things.

I am by no means an expert so feel free to shoot me down.

I wonder if @Benny G might have some input as I believe he cycles and eats low carb??


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## Bruce Stephens (Jan 13, 2020)

rebrascora said:


> By eating more carbs you may be encouraging your body to produce more insulin still as your muscles are burning it off, ending up in a vicious circle.



Is that plausible? (I honestly don't know.)

One thing that's worth trying is not injecting any insulin on the day after exercising. (One thing we (people with Type 1) often find is that after exercise, we need less insulin that night and sometimes the next day. It's a fairly limited effect for me, but people who do more intense exercise find it significant.)

It still sounds odd to me, so I still recommend asking your healthcare people and see if they can suggest what might be happening.


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## rebrascora (Jan 13, 2020)

If the OP is producing surplus insulin because he is insulin resistant (as many Type 2s are) and he throws huge amounts of carbohydrates into his system as he is doing, in order to fuel his cycling, those carbs will likely trigger his pancreas to produce more insulin still. Muscles being worked hard are less insulin resistant but he has a surplus of insulin in his system so his BG keeps dropping  and he has to throw more coal on the fire....

It just strikes me that he is eating way more carbs than should be necessary for that level of exercise and his BG still keeps dropping, needing more.... which suggests that he has too much insulin in his system even when he is taking none extraneously.

I appreciate that we are all different but I am sure there are other runners and cyclists here on the forum who will be able to give an idea of roughly how many carbs they need to do an equivalent amount of exercise. It always amazed me just how far a simple apple can fuel me, but even without it my body would just burn a little fat. If the OP is stick thin then perhaps he hasn't got any fat to burn but my gut feeling from reading this is that he has too much insulin in his system and the carbs he is eating are just triggering the production of more.


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## M Perks (Jan 14, 2020)

Bruce Stephens said:


> That's weird. Normally the advice (for Type 1) would be to cut down on insulin (before and after). But it sounds like you're not giving yourself any, so I'm not sure why you'd go hypo. A non-diabetic presumably wouldn't. I suggest talking to your diabetes team and see if they understand what might be happening.
> 
> If this is happening after you've been hypo then I could understand it (I think the advice is not to do much exercise the day after a hypo, because reserves are depleted so you're much more likely to go hypo again). But you've got a Freestyle Libre so you can see whether that's the case (including overnight).



Hi - thanks for the reply! Yes, I just burn off the sugar very rapidly. Don't really understand the science/biology, but appears my liver does not retain any sugars, fats with only moderate exercise. The same happens to me when I take a walk, fairly brisk pace.


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## M Perks (Jan 14, 2020)

everydayupsanddowns said:


> I’m not sure of any T2 specific sources of information for insulin management around exercise, but I wonder if Extod (T1 based) might give you some ideas?
> 
> http://www.extod.org/



Many thanks for the reference. Have just registered. Sure many diabetics have the same problem. I just need to reference how others deal with it. Martyn


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## M Perks (Jan 14, 2020)

rebrascora said:


> It sounds to me a bit like you are feeding your insulin. If you are Type 2 then it is likely that you are producing plenty of your own insulin. By eating more carbs you may be encouraging your body to produce more insulin still as your muscles are burning it off, ending up in a vicious circle. Have you tried eating low/very carb and reducing or even stopping your insulin to try to break the cycle (if you will excuse the pun). You are obviously stopping your insulin on the days you are cycling anyway, so the only difference would be eating low carb and higher fat rather than feeding the monster. Obviously you would have to start steady with the cycling and see how you go if you were changing your food regime quite drastically like this so that your body could get used to running on a different fuel but it just seems at odds to me to be Type 2 diabetic and pouring carbs into your system to fuel your muscles and then going back to taking insulin on other days and struggling to balance things.
> 
> I am by no means an expert so feel free to shoot me down.
> 
> I wonder if @Benny G might have some input as I believe he cycles and eats low carb??



Hi - thanks for the reply. Well,, I _think_ I no longer produce much insulin, hence moving to predominately insulin regime. Hence, without insulin, and moderate food, my numbers will shoot up. 

However, I am 'feeding' the beast when I cycle. That is very true. But pretty sure if I didn't, I'd be in a serious state. I could adopt a very low carb diet but would need some advice on that. As for now, I cannot see how I could exercise on it. The same low glucose happens often if I go for a walk, fairly brisk pace. I just burn it off fairly easily. Hence i don't seem to be able to 'keep' the carbs stored as fats. 

Appreciate the thoughts. I'm having a think...!


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## M Perks (Jan 14, 2020)

Bruce Stephens said:


> Is that plausible? (I honestly don't know.)
> 
> One thing that's worth trying is not injecting any insulin on the day after exercising. (One thing we (people with Type 1) often find is that after exercise, we need less insulin that night and sometimes the next day. It's a fairly limited effect for me, but people who do more intense exercise find it significant.)
> 
> It still sounds odd to me, so I still recommend asking your healthcare people and see if they can suggest what might be happening.



Hi - thanks for the reply. Yes, I've stopped doing basal background day after now. Although currently don't take much, 5 units. But reduces risk of a hypo. Will think about reducing mealtime Novorapid. Cheers, Martyn


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## M Perks (Jan 14, 2020)

rebrascora said:


> If the OP is producing surplus insulin because he is insulin resistant (as many Type 2s are) and he throws huge amounts of carbohydrates into his system as he is doing, in order to fuel his cycling, those carbs will likely trigger his pancreas to produce more insulin still. Muscles being worked hard are less insulin resistant but he has a surplus of insulin in his system so his BG keeps dropping  and he has to throw more coal on the fire....
> 
> It just strikes me that he is eating way more carbs than should be necessary for that level of exercise and his BG still keeps dropping, needing more.... which suggests that he has too much insulin in his system even when he is taking none extraneously.
> 
> I appreciate that we are all different but I am sure there are other runners and cyclists here on the forum who will be able to give an idea of roughly how many carbs they need to do an equivalent amount of exercise. It always amazed me just how far a simple apple can fuel me, but even without it my body would just burn a little fat. If the OP is stick thin then perhaps he hasn't got any fat to burn but my gut feeling from reading this is that he has too much insulin in his system and the carbs he is eating are just triggering the production of more.



hi - thanks for the reply. I eat about 60g carbs per hour. Would very much like to see how other cyclists handle it. However, it could be that maybe I try longer releasing foods. 

But in answer to your above, I have fat around my waist which is where most of my body fat resides. 

As above answering someone else, I'm not sure I have much naturally produced insulin left in my body. 

However, I will look at how others deal with this too. 

Cheers,

Martyn


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## Thebearcametoo (Jan 14, 2020)

It may help to understand some of the mechanics of exercise and diabetes. It was explained to us that insulin unlocks the cells so they can use glucose. Exercise mechanically pushes the glucose through without needing (as much) insulin. This effect can last 24-48 hours after exercise too so hypos the day after can be common. Exercise that uses big muscles for long periods like walking and cycling can have more of an effect that short sharp exercise. A DSN would be able to look at your readings and spot your patterns and offer guidance on when to reduce your insulin. If you’re having novorapid at meals that would be what I would tweak more than the basal. It may be that you would need a reduction in the rapid insulin or that you would need no insulin depending on your ratios etc. 
Which basal are you using btw? The time different slow release insulins are in your body varies and some like tresiba are known to be a little trickier to handle with exercise because it stays in your system for longer.


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## M Perks (Jan 14, 2020)

Thebearcametoo said:


> It may help to understand some of the mechanics of exercise and diabetes. It was explained to us that insulin unlocks the cells so they can use glucose. Exercise mechanically pushes the glucose through without needing (as much) insulin. This effect can last 24-48 hours after exercise too so hypos the day after can be common. Exercise that uses big muscles for long periods like walking and cycling can have more of an effect that short sharp exercise. A DSN would be able to look at your readings and spot your patterns and offer guidance on when to reduce your insulin. If you’re having novorapid at meals that would be what I would tweak more than the basal. It may be that you would need a reduction in the rapid insulin or that you would need no insulin depending on your ratios etc.
> Which basal are you using btw? The time different slow release insulins are in your body varies and some like tresiba are known to be a little trickier to handle with exercise because it stays in your system for longer.



Hi - yes, I'll talk to my nurse when I next see her re spot patterns, advice. 

As said elsewhere, I don't take rapid insulin when I'm about to cycle etc. And think I'll be more conscious of reducing it more afterwards for 24-48 hours too. I have also stopped my basal for longer rides. 

I'm taking basal ABASAGLAR which I think is good, and does last full 24 hours. 

Appreciate all the advice! 

Martyn


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## Carlos (Jan 19, 2020)

Hi Martyn

I ride about the same distances as you, and eat about 40g carbohydrate per hour. I reduce the bolus before going out, and then the following doses by about 20% up to the end of the following day, both basal and boluses. I use levemir and novorapid. This works for me, but I am type 1, so you should definitely consult your DSN for further guidance.


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## M Perks (Jan 20, 2020)

Hi - thanks for your reply. 

I'm experimenting with rides and carb intake, to measure it. Not there yet. But I'll get to speak to my DSN too, and see what she thinks.

Cheers,

Martyn


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## Ralph-YK (Jan 20, 2020)

My understanding is if your BG goes up (like after eating, particularly sugar and carbs) your body produces more insulin to use it. Because, as a T2, we have insulin resistance our body may produce more insulin in attempt to get the BG down.
If BG goes down then the insulin levels should too.
However, as you're injecting insulin, that makes it a bit more complicated.
I'm not up on carb loading for exercise. I know a T1 cyclist who went from carb loading to low carb.


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## Ralph-YK (Jan 20, 2020)

Thebearcametoo said:


> It was explained to us that insulin unlocks the cells so they can use glucose.


That's what we're told in my area. (And that T2s have rusty locks.)


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