# Issues with levels after excercise



## Greg (Feb 22, 2012)

Hi, first of all thanks for any advice! 

I've already been to see the diabetic team in my area and while they have offered some good advice its not quite there and I'm still annoyed/concerned that I cannot get it quite under control...

I do quite a lot of exercise, Mondays/Wednesdays at the gym for 90min, Tuesdays/Thursdays at the gym for about 45min, followed by 2 hours of rugby training. Saturday I have a rugby game, including warm-up is about 3 hours. I don't do much cardio at the gym as I rely on my rugby training for that, so it is mainly weights.

I'm 27, 6ft 2/3, 14 St (about 90kg) and am in pretty good shape with a healthy diet. Type 1 and I do carb counting, using Humalog insulation for fast acting and Lantus for my base. I try to keep my levels around 7 and have had diabetes for about 3 years (but not this level of exercise, thats only been past 6-12months)

Before exercise I aim to have my levels just a little bit higher, I normally aim for 9/10, I understand that exercise in general shouldn't be done if its above 13, however the problem I'm having is that my levels are around that before, during and straight after exercise, yet give it an hour and they rise into the 20's, this is without having a hypo. I then proceed to eat and take 75% of my normal dosage for the meal.

And this is where the problem begins, one of two things happens, either...

1) my levels (already in 20s) continues to rise with the food/after exercise effect and by the time i go to bed i'm in mid 20s, waking up in the morning they are still high. 

2) my levels drop but drop to far, leading to having an overnight hypo (full on cold sweats, which leads to high sugar in the morning) 

For me the the overnight hypos are horrible and I've been avoiding them by taking less insulin, but with my levels in the morning and overnight staying high this obviously isn't good.

I test my ketone's regularly and they are fine

Does anybody do similar level of sport/exercise as a type 1 and have any hints/tips of how to control that after exercise issue? When its falling rapidly I also have a small snack before bed (oatcakes for example) to keep it steady overnight, but its the massive increase in levels after exercise that confuses me.


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## Robster65 (Feb 22, 2012)

Hi Greg. Welcome 

Whilst I don't do that level of exercise anymore, I used to do rock climbing which is quite grunty and stop/start.

I bought "The Diabetic Athlete" by Sheri Colberg which explains the mechanisms at work when you exercise, both non-cardio and cardio, and suggests what to adjust for each sport.

I think that non-cardio stimulates the liver to output more glucose, thereby sending you high, but later on will replenish the stocks, sending you low in the night, as well as the increased insulin sensitivity from the exercise.

There's also a website, runsweet.com which goes into all the sports and explains what to adjust.

What insulins and regime are you on ?

Rob


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## Greg (Feb 22, 2012)

Hi Rob,

I'll have a look into that book as I would like to know more about it, thanks for that recommendation.

I've looked at runsweet and while there is a lot of good info there doesn't seem to be much feedback (in terms of the forums for example are pretty dead!) I didn't know that non-cardio stimulates the liver to produce glucose thats certainly interesting!

I'm on humalog fast acting for my meals which I self-regulate, in the evenings about 7pm I take Lantus for base insulin, is this what you mean by regime?

Thanks


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## Robster65 (Feb 22, 2012)

That's exactly what I meant Greg. 

I may have over-simplified the process, or got it completely wrong, but I know that the release of adrenalin and other stress hormones raise the BG (blood glucose) by suppressing the release (or action) of insulin and increasing release of glucagon which stimulates the liver to increase glucose output. There are some very complex processes at the time which I can't remember but the upshot is that grunty stuff (anaerobic) raises BG for a while before dropping it and cardio (aerobic) burns glucose as it goes.

It's all to do with the preferred fuel source for the muscles I think.

Hopefully a more qualified response will be posted soon!

I'm also on humalog and lantus. Have you been on a carb counting course at all ?

Rob


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## Northerner (Feb 22, 2012)

Hi Greg, at what point before your exercise are you eating/injecting? If you don't have sufficient circulating insulin then your levels will climb. I aim to start exercising (I'm a runner) around 90-120 mins after eating/injecting. I then have a small snack (without injecting) immediately after my run - this provides glucose for the replenishment of muscle glycogen. After exercising you will be especially sensitive to insulin for up to 48 hours. You may need to reduce your lantus as well as your mealtime insulin if you are having night hypos.


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## Greg (Feb 22, 2012)

Interesting stuff Rob, thanks, problem with my diabetic ward is that they don't seem to have dealt with anybody doing the level of exercise i do before, and in 3 years nobodys really mentioned any of that! Definitely need to do some more reading on that. I've not been on a carb counting course other than an afternoon when i first got diagnosed, however, i've never really had any issues with the carb counting, during the day for example (after i take extra to reduce it in the morning) it stays pretty solid between 6-8 and i very rarely have hypos or high blood sugar, its just the excercise/overnight that i'm having issues with.

I go to gym/rugby training straight from work, so my pre exercise meal is generally a banana or cereal bar within an hour of starting to train, to close? Afterwards i often have a small snack also followed by a large meal which always has a good carb content.

I have already started to play with my lantus amounts, reducing them for days I exercise on as instructed by the diabetes nurse. One thing i was unsure about though i was told at one point that a change in your lantus can take several days to have an effect?


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## Northerner (Feb 22, 2012)

Greg said:


> ...I go to gym/rugby training straight from work, so my pre exercise meal is generally a banana or cereal bar within an hour of starting to train, to close? Afterwards i often have a small snack also followed by a large meal which always has a good carb content.
> 
> I have already started to play with my lantus amounts, reducing them for days I exercise on as instructed by the diabetes nurse. One thing i was unsure about though i was told at one point that a change in your lantus can take several days to have an effect?



So do you inject for the banana/cereal bar? If your levels are climbing so high during/after exercise then it is most likely due to the fact that your body can't utilise the glucose (whether from a food source or your liver) without sufficient insulin. Timing of insulin doses can also be important, depending on when it peaks for you - too early into your exercise and it's likely you will have a hypo, too late and your levels iwll likely rise before beginning to fall again. This is very difficult to get exactly right, unfortunately as there are many variables.

Lantus changes are supposed to take 2-3 days before you get to see the true effect, although I seem to react within a day - mind you, I am only on 1 unit!  I would have thought that, since you are exercising most days, once you can get the dose right (and it sounds like it needs to be lower) then you should stabilise and not have to keep chopping and changing unless you have a lazy few days, in which case your fasting levels will probably start to creep up again.


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## Greg (Feb 22, 2012)

Honestly no, i've not been taking insulin for pre exercise snack, would you take it at your normal ratio? i.e. for me 1 unit to 10 carbs, but that makes perfect sense, why don't the diabetes clinic say this kind of stuff!

I'll try changing lantus for a week then, seeing effect before changing it again, now its every 2 days or so, probably not enough time.


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## trophywench (Feb 22, 2012)

Greg

You can email Runsweet, I believe?


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## Northerner (Feb 22, 2012)

Greg said:


> Honestly no, i've not been taking insulin for pre exercise snack, would you take it at your normal ratio? i.e. for me 1 unit to 10 carbs, but that makes perfect sense, why don't the diabetes clinic say this kind of stuff!
> 
> I'll try changing lantus for a week then, seeing effect before changing it again, now its every 2 days or so, probably not enough time.



I would start with injecting for the snack at my normal ratio. You probably need to be prepared to do a test maybe half an hour into your session, so you can see if you are dropping low - somepeople find they need less insulin prior to exercise, but for me the reductions in dose always come afterwards - I'm afraid it's quite an individual thing! 

They suggest 3 days to see full effect of a lantus change, so probably don't need to wait as long as a week for each change. Good luck - let us know how it goes!


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## Robster65 (Feb 22, 2012)

Just as an aside, Levemir, which is the alternative basal insulin, is meant to show changes instantly but generally requires 12 hourly injections instead the Lantus (sometimes) 24 hourly.

I split my lantus anyway and it's not really a problem once the habit develops.

Rob


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## Julia (Feb 22, 2012)

Hi Greg. Welcome to the forum. I would agree with everything said so far and would definitely recommend the book by Sheri Colberg. 

I'm surprised that your team haven't dealt with anyone doing this amount of exercise before - there's a lot of active diabetics out there!

I'm not really sure what to suggest to you specifically, but I too struggle with BGs rising after exercise. This was one of the main reasons I switched to a pump, so maybe that is something to start thinking about. It is much easier to alter basal levels and typically I reduce my basal to 30-60% an hour before and during exericse, but then have to put a 200% basal immediately after exercise for an hour. Prior to doing this I would often rise by about 8mmol/l within an hour or so of finishing exercise.  
And then overnight, if it is a prolonged exercise session I will often reduce my basal to 90% to stop the middle of teh night hypos. Sorry if this sounds confusing, just trying to illustrate how a pump helps me, when I REALLY REALLY struggled with exercise on injections. 

My exercise is all aerobic and prolonged - cycling and running. To give you an idea of what sort of exercise I do, I am currently running over 30 miles a week, have completed 4 mountain marathons, cycled 965 miles in 9 days, taken part in 24 hour mountain bike races... There are quite a few active type 1s out there, but most (but not all) I come across use pumps. Sorry that doesn't help you right now, but you are not alone and BGs rising after exercise is a common problem!


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## Greg (Mar 1, 2012)

Hi all, 

Thanks for the further info and sorry i haven't replied been a bit busy as of late!

The injecting with snack before exercising has worked really well, if I'm just doing gym i can control my sugars well with it not going above 9/10, a massive difference from the 20s that i was getting before. 

The one thing that i am struggling with is when i do gym (which i take snack+insulin about 45min before now) followed by rugby training 30min after finish my gym, my levels start to increase i'm guessing because there is not enough insulin? Do you think it would be a good idea to either take more before initially training at the gym, or take some in the gap in between gym/rugby training? Thoughts appreciated!

Julia, a pump has been suggested to me before, unfortunately it won't work due to me playing rugby 3-4 times a week, and for obvious reasons I can't wear it during that, not sure how well it would cope at the gym either? Thanks for the thought though!


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## everydayupsanddowns (Mar 6, 2012)

Greg - I have a pump and just completely disconnect it at the gym (approx 1 hour sessions). There are some T1 American footballers who use pumps I think so they must have worked out a method for contact-type sports. You may need to completely remoce the set, but in general you are fine going 'offline' for an hour with a pump and either dose the basal after finishing or (as I do at the gym) treat it as a severe basal reduction for activity!

As to your other question - I would think more insulin early may lead to a hypo. My guess would be to try another snack/reduced injection between activities but as always you'll have to experiement for yourself I guess!


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## Northerner (Mar 6, 2012)

everydayupsanddowns said:


> As to your other question - I would think more insulin early may lead to a hypo. My guess would be to try another snack/reduced injection between activities but as always you'll have to experiement for yourself I guess!



It is such a tricky and individual thing. Some people (myself included) find that a small snack after a session of exercise will actually stop you from rising again, so you could try that after your gym session but before your rugby. I found that if I injected a small dose of insulin with a post-exercise snack then I would hypo fairly quickly. 

I suspect that part of your problem may be due to that break in exercise when your levels start to climb (this may be due to your liver releasing extra glucose to replenish your muscle glycogen). For continuous exercise this may not happen as the liver does not come into play, or its own supplies run low.

For example, if I run for 45 mins and stop, my levels will rise without a small snack, but if I run for 90 mins or more then I need to top up my levels with a jelly baby or two.

Flipping complicated, but once you have found what works for you it becomes much simpler (with the odd unexplained reaction, of course!).


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