# Advice needed on Exercise, Insulin and BG



## 1oldgal (Sep 17, 2019)

Hi, When I was first diagnosed 2 years ago with T1 I had lost alot of weight and strength, I have managed to get my weight back up but I need to restore some physical strength. I have tried walking but that does not build much muscle. I am trying a system that is a cross between Pilates/ yoga but that has thrown my BG onto a rollercoster. I've tried reducing my breakfast Novo Rapid by 1 unit but that then allows my BG to soar to 23 - 24mmol, Is that acceptable?
I have tried drinking Oj just after the exercise and that seems to steady things a bit but then I get hit with Hypo's late evening or overnight.
One afternoon after I had exercised early in the morning, I walked to the shop (a 3mile round trip) and my BG just kept dropping even with a pack of Glucose tabs and a carton of OJ. that was scary.
So after all that waffle my question is How do I get to exercise and keep control of my BG without it being so traumatic?


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## Kaylz (Sep 17, 2019)

Unfortunately that's something you will have to test, test, test and determine for yourself, everybody has their individual needs before, during and after exercise, some are on a more flexible basal and have split doses so they may reduce their evening dose after exercise, I have a cross trainer/exercise bike in the house, I'm on Tresiba as basal so not the most flexible so I find I reduce my bolus by half a unit to avoid hypo's after a session, exercise can effect insulin sensitivity for 24+ hours so while everyone of us could tell you what we need to do, none of us could guarantee any of that would work for you unfortunately xx


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## 1oldgal (Sep 17, 2019)

Kaylz said:


> Unfortunately that's something you will have to test, test, test and determine for yourself, everybody has their individual needs before, during and after exercise, some are on a more flexible basal and have split doses so they may reduce their evening dose after exercise, I have a cross trainer/exercise bike in the house, I'm on Tresiba as basal so not the most flexible so I find I reduce my bolus by half a unit to avoid hypo's after a session, exercise can effect insulin sensitivity for 24+ hours so while everyone of us could tell you what we need to do, none of us could guarantee any of that would work for you unfortunately xx


Thank you for that, I sometimes feel that I'm diving into the unknown but I guess I'm not the only one doing that eh? I need to get this regime sorted on a regular basis and then maybe it will be a bit more predictable. thanks


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## Kaylz (Sep 17, 2019)

Think we all feel like that at times, even those that have been diagnosed 40+ years as diabetes always seems to find a way of throwing something new into the game 

If you start getting into a weekly regime of the same amount of exercise you may find that you'll need to alter your basal but as I cant set aside time each day etc to get a session done I find it by far easier to alter my bolus doses

Do you have a Libre?
xx


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## 1oldgal (Sep 17, 2019)

Hi, yes I do, I use it alot. if I have exercised I monitor my BG (every15 to 20 mins during and after) and if I see it start to go close to 6 with a down arrow then I have an oj or biscuit but even with that control its amazing how fast BG can drop down really low. I do think the libre has prevented me from totally crashing tho, thankfully. I guess I'm also fortunate that I am retired so that I can organise my time better. x


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## Kaylz (Sep 17, 2019)

1oldgal said:


> Hi, yes I do, I use it alot. if I have exercised I monitor my BG (every15 to 20 mins during and after) and if I see it start to go close to 6 with a down arrow then I have an oj or biscuit but even with that control its amazing how fast BG can drop down really low. I do think the libre has prevented me from totally crashing tho, thankfully. I guess I'm also fortunate that I am retired so that I can organise my time better. x


wow by saying you were retired it intrigued me so I just had a look at your information, well done on wanting to stay so active at that age, I can only hope I have the same attitude when I reach that! I'd definitely try and establish a pattern on your Libre as it may well be able to guide you in regards to what to do regarding insulin, what pens are you using for administering your insulin?
xx


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## 1oldgal (Sep 17, 2019)

lol, I have too much to do to sit down and you are only as old as you want to be    I have a NovoPen Echo which delivers 1/2 units. even a 1/2 unit can make a big difference sometimes


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## Kaylz (Sep 17, 2019)

1oldgal said:


> lol, I have too much to do to sit down and you are only as old as you want to be    I have a NovoPen Echo which delivers 1/2 units. even a 1/2 unit can make a big difference sometimes


the same as my grandad, he's 86, had a hip replacement a few years ago and walks with a stick but still tries to do what he used to when he really should be chilling for a while lol, yeah I know what you mean, 1 unit correction made me hypo so I was prescribed the echo for the convenience of half unit dosing, as I say try and let your Libre guide you  xx


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## 1oldgal (Sep 17, 2019)

Thanks for all your help, I appreciate it, onwards and upwards eh? thanks xx


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## TheClockworkDodo (Sep 17, 2019)

1oldgal said:


> I've tried reducing my breakfast Novo Rapid by 1 unit but that then allows my BG to soar to 23 - 24mmol, Is that acceptable?


The short answer to that question is no!  You're really aiming to keep it below 9 - the occasional 12 isn't going to matter much, but you don't want it to go into the high teens, let alone the 20s, that could be really bad for you.

Other than that, as Kaylz says it's just a question of testing and experimenting - with different doses, timings of doses, and extra carbs.  I was told by a DSN that if I knew I was going to be getting exercise I should reduce the preceeding bolus by half, but I told her that there's no way that would work for me - for one thing, I'll never know for sure in advance if I'm going to be up to any kind of exercise.  She then said I should eat a biscuit before the exercise, and that does help - if I wait until after the exercise I'm guaranteed a hypo, but if I have the carbs just before the exercise I've a better chance of staving off the hypos.


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## Bruce Stephens (Sep 17, 2019)

1oldgal said:


> if I have exercised I monitor my BG (every15 to 20 mins during and after) and if I see it start to go close to 6 with a down arrow then I have an oj or biscuit but even with that control its amazing how fast BG can drop down really low.



Yes, and it's really telling you what was happening about 10 minutes ago (and anything you eat will take 10 minutes or so to have any effect), so even with the Libre there's a strong element of trial and error. If you haven't seen them, you may find the videos https://abcd.care/dtn/education helpful (especially the one on exercise).


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## 1oldgal (Sep 18, 2019)

TheClockworkDodo said:


> The short answer to that question is no!  You're really aiming to keep it below 9 - the occasional 12 isn't going to matter much, but you don't want it to go into the high teens, let alone the 20s, that could be really bad for you.
> 
> Other than that, as Kaylz says it's just a question of testing and experimenting - with different doses, timings of doses, and extra carbs.  I was told by a DSN that if I knew I was going to be getting exercise I should reduce the preceeding bolus by half, but I told her that there's no way that would work for me - for one thing, I'll never know for sure in advance if I'm going to be up to any kind of exercise.  She then said I should eat a biscuit before the exercise, and that does help - if I wait until after the exercise I'm guaranteed a hypo, but if I have the carbs just before the exercise I've a better chance of staving off the hypos.


Thanks for your info, it looks like I'm going to have to do much more experimenting than I first thought just to avoid the extreme highs and Lows. Its all very exhausting but hopefully persistence will win in the end.


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## 1oldgal (Sep 18, 2019)

Bruce Stephens said:


> Yes, and it's really telling you what was happening about 10 minutes ago (and anything you eat will take 10 minutes or so to have any effect), so even with the Libre there's a strong element of trial and error. If you haven't seen them, you may find the videos https://abcd.care/dtn/education helpful (especially the one on exercise).


Brill, thanks so much for the link I will have a look, hopefully I will get there in the end.  All this just to start to get fit! I hope it gets easier


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## Bruce Stephens (Sep 19, 2019)

In case you didn't receive it, Abbott just sent me an email about a webinar on Tuesday titled "Understanding exercise using the FreeStyle Libre system". Judging by https://freestylediabetes.co.uk/webinar you could register for it there. (And/or view what was presumably an older one (with a rugby player, whereas Tuesday's is "*Melanie Stephenson* Professional sprint athlete with type 1 diabetes").)


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## Bruce Stephens (Sep 19, 2019)

Having given that link, I now don't see any place to register for the webinar. But the last exercise one seems excellent and seems like it addresses the things you're asking about. (The ABCDiab one's also very good, and I'm not sure that the Abbott webinar one contains much more information, though it's several times as long. But that may just be my interests: I'm just briskly walking, really (in the form of dancing, as well as walking to and from work), so just moderate aerobic exercise.)


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## 1oldgal (Sep 20, 2019)

Bruce Stephens said:


> Having given that link, I now don't see any place to register for the webinar. But the last exercise one seems excellent and seems like it addresses the things you're asking about. (The ABCDiab one's also very good, and I'm not sure that the Abbott webinar one contains much more information, though it's several times as long. But that may just be my interests: I'm just briskly walking, really (in the form of dancing, as well as walking to and from work), so just moderate aerobic exercise.)


Thanks for the heads up on the webinar. I found a link on an email from them. I must admit i did one of theirs before and It was a waste of time but maybe they have improved them now. Anyhoo i've registered and I will have a watch so fingers crossed it is useful.


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## Bruce Stephens (Sep 20, 2019)

1oldgal said:


> I found a link on an email from them. I must admit i did one of theirs before and It was a waste of time but maybe they have improved them now.



I watched the recorded one (with the professional rugby player) and thought it was pretty good. The various flowcharts and things didn't seem readable (and if they're not available somewhere, they ought to be).


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## rebrascora (Sep 20, 2019)

I'm no expert on balancing BG, insulin and exercise but what strikes me is that you say that your BG soars to 23 if you reduce your morning bolus by 1 unit of NR. That does not seem right unless your BG is already running much too high. What do you have for breakfast and have you considered going lower carb and using less bolus insulin and experimenting with the timing of your bolus injection, particularly on a morning? It takes at least an hour for my NR to get going at breakfast time, so I wait at least that long before I eat. I appreciate that this does not address the problem you are having with exercise but the less bolus insulin you use the less risk of a hypo and the more likely it is to respond very easily to treatment without dropping again. I find breakfast is the trickiest time to eat carbs, so I keep it at or below 20g carbs in the morning. Either an omelette with salad or a Nature Valley Protein bar (10g carbs) are my normal options for breakfast.

The other possibility is that you are still in the honeymoon phase where your pancreas is squeezing out a little insulin here and there when you least expect it and catching you unawares, causing hypos when you really wouldn't expect to have them. Unfortunately no amount of tweaking will really help this and it is just a question of riding it out until your natural insulin production completely dries up and you get to play on a more level playing field..... at least that is my experience.


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## 1oldgal (Sep 20, 2019)

Bruce Stephens said:


> I watched the recorded one (with the professional rugby player) and thought it was pretty good. The various flowcharts and things didn't seem readable (and if they're not available somewhere, they ought to be).


Thanks, I'll definitely check it out next week


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## 1oldgal (Sep 20, 2019)

rebrascora said:


> I'm no expert on balancing BG, insulin and exercise but what strikes me is that you say that your BG soars to 23 if you reduce your morning bolus by 1 unit of NR. That does not seem right unless your BG is already running much too high. What do you have for breakfast and have you considered going lower carb and using less bolus insulin and experimenting with the timing of your bolus injection, particularly on a morning? It takes at least an hour for my NR to get going at breakfast time, so I wait at least that long before I eat. I appreciate that this does not address the problem you are having with exercise but the less bolus insulin you use the less risk of a hypo and the more likely it is to respond very easily to treatment without dropping again. I find breakfast is the trickiest time to eat carbs, so I keep it at or below 20g carbs in the morning. Either an omelette with salad or a Nature Valley Protein bar (10g carbs) are my normal options for breakfast.
> 
> The other possibility is that you are still in the honeymoon phase where your pancreas is squeezing out a little insulin here and there when you least expect it and catching you unawares, causing hypos when you really wouldn't expect to have them. Unfortunately no amount of tweaking will really help this and it is just a question of riding it out until your natural insulin production completely dries up and you get to play on a more level playing field..... at least that is my experience.


Hi, thanks for your reply, I have to agree with just about everything you have said, I do believe i am still in the honeymoon phase as I can sometimes mooch along with ok BG and then suddenly it plummets and I end up fighting to bring my sugar levels back up, its scary and exhausting.  You are also right and make such sense about breakfast. I have been reluctant to change it as I love my morning porridge but I know I will have to  as this is the time of least control over my BG after food. I also have recently started to wait an hour for my morning insulin to kick in before i eat. My BG is usually good overnight but then it climbs steadily from the moment I wake up to the moment the insulin kicks in. You talk a lot of sense and have caused me to re-evaluate my reluctance to do a simple thing like change my breakfast. I guess I just wanted to hold on to a little bit of my life before T1. Thank you, its amazing how easy it is to go around in circles with some things when a little bit of common sense can identify a new way forward. Appreciate your time and common sense


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## rebrascora (Sep 20, 2019)

I so understand how you feel! I came into my diagnosis via an assumed Type 2 label due to my age, so I learned to eat low carb before I was confirmed Type 1. My morning porridge was the last thing I gave up, carbs wise, before I started to get my BG readings into the normal range and it took me 5 weeks to let go of it. Oats are a doubly tricky carb to manage with diabetes because they are slower release, so balancing them with NR is difficult and your own pancreas producing insulin adds in another level of difficulty. Maybe it would help to think that breakfast porridge needs to be put on the back burner for now, but you can perhaps come back to it when you get better control.... or try it in the evening instead. If it is any consolation, I don't really miss it now as I have discovered a load of other low carb breakfast options that I enjoy, but coming out of the honeymoon period certainly helps, even if that in itself takes a bit of getting your head around..... there was a point 7 weeks ago when there was a notable rise in my BG levels and they remained stubbornly and much more stable than before but in the 8-10 range, sometimes a little above or below. I have increased my basal insulin 3x since then and at last I think I am starting to get there. I used to joke that there were a lot of numbers between 3 and 8 and I would like to stop off at a few of them in between the highs and lows but the last few days I am getting more 5s and 6s and 7s and less silly numbers. It is sad to think my pancreas has run dry but it makes trying to manage my levels manually a lot less frustrating!.


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## 1oldgal (Sep 20, 2019)

Thank you, Its nice(?) to hear of other peoples journeys, I don't feel quite so pathetic about it knowing I'm not the only one to feel this way. I'm sure its the reason it has taken me nearly 2 years to get my HbA1c down to an aceptable level. I am going to have to grit my teeth and just get on with it. I really do appreciate your time and advice. 
thank you 
June


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## rebrascora (Sep 20, 2019)

We are all in this together June. I have learned so much from this forum, it is good to be able to pay a bit forwards.
I am actually having a bad day today with an anxiety attack (after an absolutely great day yesterday, I should add), so composing my thoughts to try to help you has also helped me in the process.... along with a few glasses of rum and coke.... win/win situation. Hope you have a lovely weekend and the Diabetes Fairy is kind to you.


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## 1oldgal (Sep 20, 2019)

rebrascora said:


> We are all in this together June. I have learned so much from this forum, it is good to be able to pay a bit forwards.
> I am actually having a bad day today with an anxiety attack (after an absolutely great day yesterday, I should add), so composing my thoughts to try to help you has also helped me in the process.... along with a few glasses of rum and coke.... win/win situation. Hope you have a lovely weekend and the Diabetes Fairy is kind to you.


This rollercoaster ride we are all on is not as much fun as the ones i remember when i was a kid. I've had a couple of days in tears but with your help I have come out the other side. So thanks and have a drink for me. I hope you also have a great weekend I have no doubt we will speak again, take care 
June


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