# How to get back in to Exercise



## Jon-Manchester (Nov 10, 2019)

Hi,

Since I got diagnosed with T1 6 weeks ago, i havent done any exercise beyond walking the dogs.
I use to go on bike rides at least 3-4 times a week but I am really worried that I will get a severe  hypo while I am out cycling that I am not sure how to start.
I suspect that I am overly worried but i am struggling to take the leap and go for a ride. At the moment, if I go for a walk 30-40 minutes (starting with +7 BS) i will have  hypo by the time i get home (never been a severe hypo but generally sub 4)
I take my long acting insuling (Lantus) in the morning, so i am not sure if I should decrease it on the days I am planning to do an exercise  or if I should just eat carbs while exercise? (if so how much do i decrease it by?)

I am really keen to get back into cycling so I would really welcome people's view on how i should approach this?

Any thoughts/tips?
Jon


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## Lizzzie (Nov 11, 2019)

Hello!

I am a runner and still struggle with this.

You could look at getting an insulin pump.  They only give short acting insulin (Novorapid or equivalent) but give it all the time, so you can turn the speed down when you know you're going to be exercising.

With Landis, which I think is a long acting background injection? - presumably its every 12 hours or something so when it's in, you can't change the dose?   Thats a pain.  Thinking back to my insulin pen days, it takes experimentation at first.  Maybe Eat something short acting AND somethng medium / long acting just before going out for a cycle, take at least 50% less insulin than it needs and experiment?
It 'feels much better to exercise when your sugars right.  At least one person on here used to have a jelly baby every X miles but that's going back a few years.


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## Jon-Manchester (Nov 11, 2019)

Lizzzie said:


> Hello!
> 
> I am a runner and still struggle with this.
> 
> ...



Thank you Lizzzie. I think i am coming around to the fact that pumping seems to be the way to go. Yes Lantus is long acting background insulin so i take it every 12 hours, so though I can change it, it requires some planning ahead. I guess i need to take the plunge and start experimenting.
It seems like most people who do exercise are using a pump.


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## Bruce Stephens (Nov 11, 2019)

Jon-Manchester said:


> I suspect that I am overly worried but i am struggling to take the leap and go for a ride. At the moment, if I go for a walk 30-40 minutes (starting with +7 BS) i will have hypo by the time i get home (never been a severe hypo but generally sub 4)



Yes, I'm the same. (Over the summer I bought an ice cream on the way back from work, but that's not so appealing just at the moment...)

It's something you should talk about with your DSNs. They'll definitely be on board with you wanting to exercise, and will (one hopes) be able to help you come up with strategies for handling it. As you noted, the basic approach is to use less insulin and/or eat more. (It is apparently possible to use anaerobic exercise to increase BG; I've not tried that, since I just walk.) You might find things like https://abcd.care/resource/exercise-strategies of value, though it is talking about using Freestyle Libre (or similar), so if you don't have one then the value might be limited.


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## Jon-Manchester (Nov 12, 2019)

Bruce Stephens said:


> Yes, I'm the same. (Over the summer I bought an ice cream on the way back from work, but that's not so appealing just at the moment...)
> It's something you should talk about with your DSNs. They'll definitely be on board with you wanting to exercise, and will (one hopes) be able to help you come up with strategies for handling it. As you noted, the basic approach is to use less insulin and/or eat more. (It is apparently possible to use anaerobic exercise to increase BG; I've not tried that, since I just walk.) You might find things like https://abcd.care/resource/exercise-strategies of value, though it is talking about using Freestyle Libre (or similar), so if you don't have one then the value might be limited.



Thank you Bruce, really interesting link you shared. So much information in that video, I watched it 3 times and I still haven’t captured it all so I will bookmark it so I can revisit it later again


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## Bruce Stephens (Nov 12, 2019)

Jon-Manchester said:


> Thank you Bruce, really interesting link you shared. So much information in that video, I watched it 3 times and I still haven’t captured it all so I will bookmark it so I can revisit it later again



Here's another one, 



 from the Freestyle Libre Academy, and another one


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## Carlos (Nov 24, 2019)

Hi @Jon-Manchester 

Sorry I am a bit late to the party. It is normal to find things daunting after diagnosis, and it soes take time to find a stable pattern. Things will be easier once that happens, and exercise will help a lot with your control.

My experience is the reverse to yours. Type 1 diagnosed 25 years ago, sedentary job, so decided I should start doing some exercise. I started cycling about three and a half years ago. Initially short distances, so no big effect on my bg, but started building up slowly, and now I am doing around 50 miles a week, between commuting and leisure rides.

My commute is short, but my leisure rides can be up to 60 kilometres. When I do one of those I reduce the boluses, eat around 40 g of carbs per hour ride, and carry my tester and test every couple of hours. I inject my basal at night, and find that reducing the bolus pre ride by two units, has worked for me so far in avoiding hypos.

Another thing you may find, is that you will also need to reduce the boluses in the two to three doses following a long ride, as the liver replenishes the glucagon stores.

In all, it can be done, you just need to take it easy and you will get there in no time.


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## Jon-Manchester (Dec 9, 2019)

Thank you Carlos, and my apologies for my slow response. I have managed a couple of rides, so i am slowly getting more confidence.
I am thinking of self funding a Libre to help me with getting back into training.




Carlos said:


> Hi @Jon-Manchester
> 
> Sorry I am a bit late to the party. It is normal to find things daunting after diagnosis, and it soes take time to find a stable pattern. Things will be easier once that happens, and exercise will help a lot with your control.
> 
> ...


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## Carlos (Dec 10, 2019)

Jon-Manchester said:


> Thank you Carlos, and my apologies for my slow response. I have managed a couple of rides, so i am slowly getting more confidence.
> I am thinking of self funding a Libre to help me with getting back into training.



Well done on getting back into it. As you build confidence you will worry less and enjoy more!

Keep up with it.


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## Amity Island (Dec 29, 2019)

Jon-Manchester said:


> Thank you Bruce, really interesting link you shared. So much information in that video, I watched it 3 times and I still haven’t captured it all so I will bookmark it so I can revisit it later again


I like that vid too! very good and yes I've watched it a few times also.
I've got to say how amazing it is how all the type 1's who have done (or still do) exercise in the past (pre-libre or cgm) have done. Without the libre or a cgm the risk of hypo's with starting exercise are dramatically increased. Even with a libre it would take some practice to get to a point where exercise becomes safe and easy. There are only a few options at the moment for T1 exercise on m.d.i. Keep the basal (long acting insulin) dose the same each day for exercise days as for non exercise days and eat extra carbs (without any bolus insulin or with reduced bolus insulin) for and during exercise and then reduce bolus doses by 50% of the usual meal time doses for up to 48hrs after an exercise session. This is the option I use as my basal is not adjustable. I did a walk up Snowden this year and I got up by eating ginger biscuits, about 2 every 20 minutes without any bolus insulin and then reducing my boluses for next 48hrs for all my meals due to increased insulin sensitivity.
I am aware that some basal doses can be changed from day to day like lantus. This can be reduced (by maybe only a couple of units or more trial and error) on the day of exercise and upto 48hrs after to avoid having to reduce mealtime boluses so much.
If you want to try the burn method, by doing a short burst of really intense sprint or heavy weight lifts to spike up blood sugars, this will draw on the livers resources, however this will require the liver re-uptaking extra glucose later on from meals.
I would speak with a consultant or, if you can find one with the right knowledge and good attitude a DSN to get me started on exercise, esp if it's something you'd be doing on a regular basis. It's all quite personal with lots of trial and error. most of the time the DSN and consultant can only give starting points, it's down the individual to work it all out for themselves.


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## Bruce Stephens (Dec 31, 2019)

Amity Island said:


> I did a walk up Snowden this year and I got up by eating ginger biscuits, about 2 every 20 minutes without any bolus insulin and then reducing my boluses for next 48hrs for all my meals due to increased insulin sensitivity.



Back in the last millennium (a bit before 1990) I walked up Snowdon with a group of post-grads. I don't remember eating quite that much, but of course I ate now and again. I suspect I was just almost always higher than I try to be now, and during this kind of activity the relevant thing was too eat when I felt I was going low.


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## RayMathers (Jan 9, 2020)

Hi, I'm male 57, diagnosed with T1 last March. I was doing regular gym and 50-80 mile cycle on a Sunday. I stopped as well and now I'm starting serious exercise again. Currently I take 8 units Lantus in the morning and don't need NovaRapid during the day.  I've been doing 35-45 minutes intense bike spinning in the garage, buckets of sweat, but my BG does not change much during that time an over the next hour or so. I'm going to start longer 2-4 hour bike rides over the next few weeks . What food would anyone recommend. I usually just take energy gels and bananas. Some mention short term and long term fuel, I'd welcome any suggestions. I could make my own flapjacks. 

My goal is the 100 mile Velo Birmingham in June 2020, probably 8-9 hours total ride. Any suggestions in fuelling for this


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## everydayupsanddowns (Jan 10, 2020)

RayMathers said:


> Hi, I'm male 57, diagnosed with T1 last March. I was doing regular gym and 50-80 mile cycle on a Sunday. I stopped as well and now I'm starting serious exercise again. Currently I take 8 units Lantus in the morning and don't need NovaRapid during the day.  I've been doing 35-45 minutes intense bike spinning in the garage, buckets of sweat, but my BG does not change much during that time an over the next hour or so. I'm going to start longer 2-4 hour bike rides over the next few weeks . What food would anyone recommend. I usually just take energy gels and bananas. Some mention short term and long term fuel, I'd welcome any suggestions. I could make my own flapjacks.
> 
> My goal is the 100 mile Velo Birmingham in June 2020, probably 8-9 hours total ride. Any suggestions in fuelling for this



My experience in terms of needing to fuel exercise seems quite different to yours, but for me rapid acting high glucose drinks seem a good way of keeping BG up during distance running. I am only really talking 10k or (a while back) a half marathon, so not 2-4 hours. 

For a longer walk/hike I might take Lucozade and/or Skittles for rapid, and some plain-ish biscuits (Digestives say?) for something longer acting. 

I would also reduce my basal insulin and meal doses prior to starting to have less circulating insulin.


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## Carlos (Jan 10, 2020)

RayMathers said:


> Hi, I'm male 57, diagnosed with T1 last March. I was doing regular gym and 50-80 mile cycle on a Sunday. I stopped as well and now I'm starting serious exercise again. Currently I take 8 units Lantus in the morning and don't need NovaRapid during the day.  I've been doing 35-45 minutes intense bike spinning in the garage, buckets of sweat, but my BG does not change much during that time an over the next hour or so. I'm going to start longer 2-4 hour bike rides over the next few weeks . What food would anyone recommend. I usually just take energy gels and bananas. Some mention short term and long term fuel, I'd welcome any suggestions. I could make my own flapjacks.
> 
> My goal is the 100 mile Velo Birmingham in June 2020, probably 8-9 hours total ride. Any suggestions in fuelling for this


I wouldn't worry too much if you are only taking basal insulin, perhaps look at reducing that a bit before the ride, and for peace of mind test a couple of times in the first few rides to see what your levels are doing.

For a fifty km ride (about three hours for me, I am quite slow) I reduce two units on the bolus before setting off, and have a fruit/nut bar every hour or so, I only use a gel if I go hypo.

As I said, it may feel daunting now, but you will soon get the hang of it.

Edited to add. It is also likely that you will need less insulin on the days following a long ride.


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