# Muscles, ATP and all that jazz



## Robster65 (Aug 14, 2010)

I know it's been asked before in different ways but I've been reading the Diabetic Athlete book again and am getting confused. 

Muscles get energy from ATP.
ATP is synthesized from various fuels.
muscles store small amounts of glycogen for immediate use.
the liver stores glycogen to convert to glucose to supplement BG.
the pancreas secretes glucagon to stimulate the liver to release glucose.

During aerobic exercise, the muscles use up their glycogen and draw on the BG, providing insulin is present. 

If insulin is insufficient, the liver will push out glucose (or glycogen?) which raises BG but muscles can't use it due to lack of insulin.
In this case, fat reserves are circulated to synthesise ATP, after which protein will be used. Hence, high BG for prolonged periods, causes fat loss, then muscle wastage.

The ideal is to exercise with SOME insulin in bloodstream and keep topping up BG as you go so liver isn't called upon (too much) and BG you don't go hypo, causing liver to squirt out too much glucose.

If liver stores glycogen, why doesn't it just secrete that so muscles can store it directly without insulin ?

I'm not running, just walking, but ther's some nasty long hills that hurt, so it's mostly aerobic with bits of anaerobic.

Have I got it right, wrong or somewhere in between ?

If anyone can put me right, I'd be grateful. Thank you.

Rob


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## Northerner (Aug 14, 2010)

Robster65 said:


> ...If liver stores glycogen, why doesn't it just secrete that so muscles can store it directly without insulin ?
> ...



As I understand it, glycogen is the stored form of glucose, but body chemistry does not allow it to travel in the bloodstream in this form, so there would be no way to transport it to the cells that need it (unless we had evolved differently!). I'm sure Tom will explain the chemistry, but maybe glucose is a simpler form and can therefore be tranported around and 'reassembled' into whatever is required of it according to where it is needed in the body.


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## Robster65 (Aug 14, 2010)

Thanks Northerner. That's one little mystery cleared up. I find if I can understand the nuts and bolts, I'm better able to predict, and therefore control.

Plus, I like to know these things 

Were getting fairly good at keeping levels during and afterwards but only because we're doing the same couple of routes at the same sorts of times.

Spontaneity awaits !

Rob


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## Northerner (Aug 14, 2010)

I've found the hardest thing about diabetes is trying to get back some degree of the sponteneity I had before diagnosis.  Before, I could go for a run on a whim (and had been doing so for 30 years), now I have to do it within a 'window of opportunity' or the whole business becomes risky or completely unpredictable. I'm working on it though!


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## Robster65 (Aug 14, 2010)

When is your best time for going ?

ie. before eating, after eating (allowing for digestion) or when you're BG is peaking ?

The book suggests before a meal, but I've ALWAYS been bothered by that.


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## Northerner (Aug 14, 2010)

Robster65 said:


> When is your best time for going ?
> 
> ie. before eating, after eating (allowing for digestion) or when you're BG is peaking ?
> 
> The book suggests before a meal, but I've ALWAYS been bothered by that.



Yes, I tried that once, hoping to rely on my lantus and improved insulin sensitivity, but my levels went through the roof (well, higher than I liked!) and I felt I had little energy. Now I run 1.5-2hrs after eating and injecting. My 'window' is between 1 and 3 hours after eating. If after 1 hour, then I expect my levels to still be climbing, but if closer to 3 hours then I might have some orange juice of a couple of jelly babies before setting off.

The 1.5-2hrs is when I would expect to be peaking on insulin and food.


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## Robster65 (Aug 14, 2010)

Sounds very close to our current thinking. We have tried setting off while still climbing. I had a jelly baby followed by another after a while and ended up about 12mmol/l.

Seems to work better after about 2 or 3 hours and eat a bit before and during. If my fitness ever improves, the need may reduce. At least I've stopped trying to lose weight. I can now do my trousers up again, so mission accomplished.

Thanks for the advice.

Rob


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## Copepod (Aug 15, 2010)

Sometimes it helps to read the same information in a different form, so you might also like to try http://www.runsweet.com/index.html Starting Sports and Diet & Nutrition tabs on top menu bar is a good place to start - both lead to sub menus of tabs, so worth exploring.


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## Robster65 (Aug 15, 2010)

Thanks Copepod.

Some very interesting info there. I've just looked at the diet and nutrition section and already I have a couple of questions forming 

Some experimentation needed. 

Rob


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## Bren101 (Sep 22, 2010)

Robster65 said:


> I know it's been asked before in different ways but I've been reading the Diabetic Athlete book again and am getting confused.
> 
> Muscles get energy from ATP.
> ATP is synthesized from various fuels.
> ...


Everything you say here is correct Robster.  The body's cells can only utilise glucose with the assistance of insulin to get energy into the working muscles. I have a science degree and I am a qualified personal trainer, BodyPump and spinning instructor.  Here is my 2 pence worth.

The issue with exercise, for me, is that when I teach a BodyPump class I work very hard.  I always try to have my levels slightly higher than normal at the beginning of the class.  The class is an hour long but in the past I have lacked enough insulin so after about 40 minutes or so when I get to the lunges (any BodyPump fans will know what I mean), I find it hard to push on because my liver dumps more glucose into my blood but due to the lack of insulin, the glucose cannot get into the working muscles. Therefore I could finish the class after an hour after smashing myself with a BG of 17mmol plus!

I have always been told to exercise late in the evening before eating to prevent the double whammy of exercise and short acting insulin causing a hypo.  What I have discovered recently is that if I take short acting as I would for dinner and have 5 hob nobs and milk or digestives or whatever you're having yourself, I can get through the workout and not suffer when I get to lunges!!!  Instead of 12iu of Novorapid, I will take 8iu and I will have Lucozade on hand should I need it.  The difference is phenomenal.  I can push through and not struggle on lunges.  I know that the glucose is getting into the muscles because I can feel it working.  My pumps are better and my energy is great plus I can finish with a normal BG!  There is nothing worse than finishing a class 17mmol or greater because I feel 'thinner', weaker, dry and needing to drink copious amounts of water and pee.  

This really works for me!  I would be keen to hear from anyone else who could offer their routine.  Diabetes really affects me and it makes me seem very introverted at times and I may seem distant to people.  I find that this changes when I don't have to worry as much about BG's!  Diabetes will never be an exact science, there is no one size suits all.  Stress, genetics, Body Mass Index etc all effect the way insulin works for an individual.  Bring on a cure or an integrated blood glucose monitoring system with insulin delivery.  We have waited long enough!


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## Robster65 (Sep 22, 2010)

Hi Bren. Thanks for that reply. I've gleaned more info over the past few weeks and it's starting to make a bit more sense.

When I used to climb, I did wonder if I should inject a small amount of humalog to get the glucose into the muscles but it seemed to be counter to everything you're told about exercise. I think the problem is, that a lot of the advice is decades old and diabetics shouldn't traditionally do anything more than walking and swimming. 

I've not been for a proper walk for ages but will try to give some thought to how much insulin is in the system for recovery.

Rob


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