# Time In Range vs Sport



## kakania (Nov 14, 2022)

Hello,

I have weeks, the most, when I am doing a lot of sport/activities with various degrees of intensity:

- football, swimming, weighlifting, HIIT training, yoga, ...and sit in front of the computer

 and others, quiet ones, from time to time, when I just walk and sit in front of the computer. Normally they are so because some type of minor injury in the back that stops me from doing the other things

In the quiet ones normally i manage to go over 90% 'time in range' (freestyle sensor 2), and even a couple of weeks i was 100%

being even over 50% is almost impossible in the hectic weeks

i don't know, the whole thing frustrates me. does the benefit of being very active overweights the fact of being "high" for so much more time? should i start to think on "retirement"? i am only 48 yo

maybe there is someone who mastered these, for me, opposites

thanks


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## rebrascora (Nov 14, 2022)

Hi and welcome.

Sorry to hear you are having difficulty balancing your levels during exercise....
Have you been diagnosed long?

Which basal insulin are you using and do you adjust it for the more active or less active days/weeks? I need to adjust my basal insulin (Levemir) on an almost daily basis sometimes because I have a very varied lifestyle. Some basal insulins don't allow you so much flexibility to adjust, so you might be better with Levemir than a longer acting basal like Tresiba etc provided you are confident to adjust it and if not, then I would recommend and intensive education course like DAFNE if you haven't done one.  
Have you discussed the problem you are having with your team and perhaps enquired about a pump? A pump is the ultimate solution because you can halt your basal insulin or set a reduced rate for the hour or two before you exercise, to help balance things.


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## kakania (Nov 15, 2022)

rebrascora said:


> Hi and welcome.
> 
> Sorry to hear you are having difficulty balancing your levels during exercise....
> Have you been diagnosed long?
> ...



thanks

i've been diagnosed in march 2020. 

I use lantus as basal, but i don't adjust it

I try to play with the bolus one (humalog) taking less if i am planning to do sports a couple of hours later. Or try to do the exercise after the 4 hours window that it is supposed to be active

taking less bolus obviously makes me spike more after eating

i gonna try to take the same bolus, but increasing the time till eating

and maybe start adjusting the basal one

i haven't done the  DAFNE course. in theory i don't need it as part of my team is a dietician, that's "even better"


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## Rob Oldfield (Nov 15, 2022)

Hi @kakania 

I posted a similar type topic a while ago and had some interesting responses https://forum.diabetes.org.uk/boards/threads/sugar-levels-plummeting-post-exercise.100227/

I also pinged an email to my DSN - who is very good.  She replied to say that their view was that best place to start was with advice pushed out by the extod site.  Specifically she attached these two documents:



			https://extod.org/downloads/Narendran-DTN-Exercise.pdf
		



			https://bathdiabetes.ruh.nhs.uk/documents/Type1/Exercise_Flowchart_for_Insulin_and_Carbohydrate_Adjustments.pdf
		


I do have to add that I've tried following the recommendations in those and they don't seem to work all that well for me, but think they will, at least, give you some more info on the types of things you need to be looking at as you find your best strategy.

Good luck!

(P.S.  I'd strongly suggest you push back on the idea of a DAFNE course.  Having greater awareness of the effect that the food you're eating is going to have on your sugar levels is key.  I'd suggest their advice is quite outdated.  Is your team from a GP or a hospital?)


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## rebrascora (Nov 15, 2022)

DAFNE is about so much more than just carb counting. I very nearly didn't do it because of the title (Dose Adjustment For *Normal* Eating) because I follow a low carb way of eating ie not normal eating.....and I am so pleased that I changed my mind because it provides you with a framework for assessing your insulin needs in all sorts of everyday life situations and learning when to adjust your basal and how to keep yourself safe during illness and with alcohol and sport or just increased activity. I don't strictly follow much of that framework anymore but what it gave me most of all was the confidence to adjust my basal insulin to suit my body's needs. It is also a huge benefit just spending time with other Type 1 diabetics and learning how different we can all be and how to problem solve for their situations as well as your own. 5 or 10 years down the line, you may end up facing the same challenges that they are. Diabetes is fickle and it changes and you have to change your approach to suit it, so having that understanding of other issues and a framework to go back to, to work through any problems is really helpful. 

With exercise it is important to understand that the effects of it last at least 24 hours possibly up to 48, so making adjustment to basal doses can really be necessary. For me, it is my overnight levels which drop dramatically after exercise so I always need to reduce my evening basal dose after exercise and if I exercise on consecutive days, I need to reduce it consecutive nights otherwise I will experience nocturnal hypos. Often my evening basal dose will end up being zero and if I keep exercising, I then have to start reducing my morning dose. Recognizing when my basal needs changing is key for managing my diabetes well and Levemir being a split dose and shorter acting basal insulin means I can make those changes more or less in real time. I absolutely love my Levemir for the flexibility that it gives me in managing my diabetes. When my basal doses are wrong my diabetes is really frustrating and I feel like I am battling and firefighting with my bolus insulin or eating JBs like they are going out of fashion! When I get my basal doses right, it is just so much smoother sailing, but I absolutely could not manage without adjusting them quite frequently. 

I think for me it helps that I regularly skip meals (eating LCHF/low carb, higher fat, means that I don't feel hungry and therefore don't want 3 meals a day) so I have a very clear view of how steady my basal insulin is holding me and it is therefore much easier for me to see when it needs tweaking. Eating low carb also means that I have protein and fat releasing glucose during exercise which provides me with a slow release source of energy (without having much or any bolus insulin in my system) whilst I exercise, rather than the spike and plummet that you get from carbs and QA insulin. Not saying I don't hypo, but the hypos I do have are mostly very mild and easy to treat. 

Of course Libre helps enormously too.


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## Spathiphyllum (Nov 15, 2022)

Dear Kakania-- Definitely don't give up on sport or exercise! You just need more information and guidance on how to manage it when you have Type 1.

I was only diagnosed 3 months ago (in my 50s), and at first was very worried about exercise; I do a lot of brisk walking and jogging. I have found this very helpful: https://link.springer.com/content/pdf/10.1007/s00125-020-05263-9.pdf . As you'll see, it's specifically for people with T1D, injecting insulin rather than having a pump, and with a Libre 2 or other CGM. It basically tells you what you need to do, depending on what your Libre is saying, before starting exercise, during exercise, and in the 90 minutes after exercise.

First, you decide which of three groups you belong to in terms of your exercise experience and your hypo risk: see the chart on page 2505. Then, when you're about to start exercising, you need to decide whether you expect your blood glucose will be rising or falling. And then you just read off the tables: Tables 1-3, pages 2506-2508.

For example: I'm group 'Ex 1'-- moderate exercise experience and moderate hypo risk. Let's say I've just had lunch half an hour ago, and I injected the usual amount of bolus insulin-- for me, that means I would expect my BG would be rising in the next half hour. I'm about to go out for a jog-- I jog so slowly that it is definitely 'AE', aerobic exercise, rather than 'HIT'!-- and my Libre is saying 6 with a horizontal arrow. According to Table 1, I should consume 10g fast-acting carbs, but then I can set off straightaway. If I'm exercising for more than half an hour, Table 2 tells me what to do in response to different readings during exercise. And then Table 3 tells me what to do in response to different readings in the 90 minutes after exercise.

Of course I don't carry these tables around with me and follow them exactly! The main thing for me has just been the reassurance that there are simple, practical steps I can take to keep good BG control, and keep myself safe, and still do all the exercise I want; and the tables have helped me develop my own guidelines for what I need to do. I started jogging again a month after I was diagnosed; my time in range since then has been 85% and in the 90s in recent weeks.

Finally: Are you aware that aerobic exercise, on the one hand, and weightlifting or HIT or sports, on the other, have very different effects? AE tends to lower BG, but resistance training or high-intensity training or sports tend to increase BG. So, when you say you're "taking less [insulin] if i am planning to do sports a couple of hours later"-- you may be doing the opposite of what you should be doing. For example: say my Libre reading is 11.5 with an upward arrow. If I was thinking of (my usual slow) jogging, Table 1 would say go ahead; but if I was about to do some HIT, Table 1 tells me to consider injecting some more insulin.

Anyway, best wishes, and let us know how you get on!


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## helli (Nov 15, 2022)

I second the idea of adjusting basal. Soon after my diagnosis, I was advised to reduce my basal by aout 20% the day after exercise. 
Like you, I was taking Lantus and found it very responsive to these changes. 
Typically, I would reduce it by 20% the evening after exercise and 10% less than usual the next night then, assuming I didn't exercise again, I would go back to my normal Lantus dose. 
Obviously, these are approximate because I could only adjust whole units and my normal dose was something like 16 units. If I remember correctly (it was more than 10 years ago), my first Lantus pen only went up in 2 unit increments so I had even less flexibility. 

Getting my dose correct before exercise I found most complex because some exercise decreased blood sugars (mostly cardio) and some exercise increased blood sugars (such as climbing). 
Unfortunately, most people focus on the hypo avoidance but trying to scale a climbing wall with a BG of 12 was near impossible so my climbing sessions were shorter until I worked out how to manage my diabetes better.


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## kakania (Nov 16, 2022)

wow, thanks for the responses. I gonna try to read in detail and response over the weekend

for the moment i gonna introduce a few things (from reading over the different posts and links).

- reducing the basal after doing a lot of exercise. initially just the night shot and the following morning one
- trying to keep at least 20 minutes between the bolus and the meal
- having a proper meal after  if exercising in the evening, with the matching bolus dose
- and correcting with bolus if i am very high before sport. yeasterday, for example, i was at 18, one hour before a footie game, and it was already outside the 4-hours window from the bolus. I took one unit of bolus, and could have a proper game. the week before i was the same, didn't take the bolus, and couldn't bother running, and even finished the game with 20

let's see how it goes, thanks again


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## rebrascora (Nov 16, 2022)

Woah! I would not consider exercising other than a gentle walk if my levels were 15 or above, let alone play football. You are putting your body, particularly your cardiovascular system, under a lot of strain in that situation. Do you know why you ended up so high? 
You do need to be careful with corrections before exercise though as the activity will make them much more effective, so be conservative with them.
Prebolusing is important regardless of exercise and the more of a habit you can make of it, the better your results, biut you do have to factor in the food you are about to eat and your starting BG and the time of day. So a fatty meal like pizza will need less prebolus time and probably a split bolus ie some just before the meal and some an hour or so later. On a morning I need about 45 mins prebolus time and I inject before i get out of bed to give me maximum time for it to work. If my level;s are low to mid 4s I will need less prebolus time than if I am 6 or above and if my levels are over 8 it can be more than an hour sometimes 2. I don't eat until my levels drop into range because otherwise I will be battling for the rest of the day and I won't fade away for waiting a couple of hours for one meal. 

Your meal after exercising will likely need a bolus reduction rather than the full amount in my experience, so do be careful with that or you may end up hypo.

Good luck with your experiments. They usually recommend just changing one thing at a time and see what effect that has.
Do let us know how you get on but do be careful about exertive exercise when your levels are really high.


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