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Gonzo 04-24-2017 03:50

Help with exercise and insulin
 
Hi guys,

So my last bloodwork came pretty bad. A1C was 8.7 :crying:

I started to change my eating habits (Less carbs, more fruit, vegetables and protein) and went back to exercising. I'm doing pretty well now. I lost the extra pounds that I had and my readings on most days are really good (at least compared to the ones that I was used to)

Exept for the exercise days. I really can't get it right. I either go too low and I have to eat a bunch of sugar for the rest of the day to compensate or go too high for the rest of the day.

I do Kickboxing for 1h30m and I think the main problem is that what we do on each class is highly variable and its effects on my glucose unpredictable. Some days we work on technique, some others conditioning, and some others a lot of sparring. I aim to start working out with 190-220 mg/dl to prevent getting too low (I know that it might be a little high, but the chances of detecting a hypo while being exhausted and being kicked are not high) and after working out some days I am on 120 and some others on 250 or higher.


I am talking to my doctor and trying to figure it out but I was wondering what do you guys do when you work out? Take less amount of basal insulin (if so. How much?)? Take less amount of fast insulin? Something else?

I am currently using Degludec Tresiba (basal) and Humalog (fast).

Any suggestions would be appreciated.

PS: My doctor suggests doing some other sport, more self paced and that doesn't vary that much but I'm really passionate about the sport and I want to do everything I can to keep doing it.

Daytona 04-24-2017 15:06

Hi Gonzo!

I enjoy playing tennis, which while not as action packed as kickboxing, also makes it hard to control my blood sugar. I still don't have it totally figured out but here are some things I do:

1. 2 hours before I begin, I set my insulin pump to a temporary basal rate of only 20% (trial and error helped me figure that out). So that's 80% less basal insulin for 2 hours before I play, during and then depending on how things look I'll continue that through the rest of the day. If I'm still high 2 hours after playing, I'll go back to my normal basal. Every day is different, I don't know why. :D

2. Just like you, I start higher before playing. I like to be around 140-160, that's just what I found from trial and error though. I don't like to drop below 80 at any time while playing.

3. I set my CGM to alarm at a different level than usual. Normally mine goes off at 70, but since things can move fast while playing I set it to 80. I keep a box of apple juice on the court, 21g carbs, so I can correct quickly. Much better than chewing 5 chalky tablets! I also set my high alarm to 200 instead of my usual 160.

4. After I workout, I test and just watch things for about 2 hours after. If I'm high, I don't eat but also don't correct. If I'm still high after 2 hours, I'll do a small correction (not at my usual ratio) and repeat if it's not where I want it 2 hours later. If I am low, .... well there's what I should do and what I do do. :D

I should take 15g of carbs or so and test again after 15 minutes. I like to get myself up to at least 110 or 120, as I find that I quickly drift back down and I hate dealing with lows twice. I should only take quick carbs, like tabs or juice. But when I'm low I've been known to go into black hole mode and not stop until the inner rage is satisfied, I won't even admit to what I'll eat when this happens. Let me know if you have a trick for avoiding that!

* I know you don't have an insulin pump. I love it for sports, being able to set it to a temp rate gives me enough control to play. Before I was pumping, I would try skipping my morning basal entirely (I'm T2 so I can do stuff like that, T1's should NOT DO THAT), or I would do a reduced basal. I never found something that worked so can't really give any advice.

Gonzo 04-25-2017 12:50

Quote:

Originally Posted by Daytona (Post 1208953)
Hi Gonzo!

I enjoy playing tennis, which while not as action packed as kickboxing, also makes it hard to control my blood sugar. I still don't have it totally figured out but here are some things I do:

1. 2 hours before I begin, I set my insulin pump to a temporary basal rate of only 20% (trial and error helped me figure that out). So that's 80% less basal insulin for 2 hours before I play, during and then depending on how things look I'll continue that through the rest of the day. If I'm still high 2 hours after playing, I'll go back to my normal basal. Every day is different, I don't know why. :D

2. Just like you, I start higher before playing. I like to be around 140-160, that's just what I found from trial and error though. I don't like to drop below 80 at any time while playing.

3. I set my CGM to alarm at a different level than usual. Normally mine goes off at 70, but since things can move fast while playing I set it to 80. I keep a box of apple juice on the court, 21g carbs, so I can correct quickly. Much better than chewing 5 chalky tablets! I also set my high alarm to 200 instead of my usual 160.

4. After I workout, I test and just watch things for about 2 hours after. If I'm high, I don't eat but also don't correct. If I'm still high after 2 hours, I'll do a small correction (not at my usual ratio) and repeat if it's not where I want it 2 hours later. If I am low, .... well there's what I should do and what I do do. :D

I should take 15g of carbs or so and test again after 15 minutes. I like to get myself up to at least 110 or 120, as I find that I quickly drift back down and I hate dealing with lows twice. I should only take quick carbs, like tabs or juice. But when I'm low I've been known to go into black hole mode and not stop until the inner rage is satisfied, I won't even admit to what I'll eat when this happens. Let me know if you have a trick for avoiding that!

* I know you don't have an insulin pump. I love it for sports, being able to set it to a temp rate gives me enough control to play. Before I was pumping, I would try skipping my morning basal entirely (I'm T2 so I can do stuff like that, T1's should NOT DO THAT), or I would do a reduced basal. I never found something that worked so can't really give any advice.

Thanks for the reply Daytona :wink2:, even though I'm not on the pump, this is really useful since I have a meeting with the pump company in 2 days. I'm evaluating switching to it.

I actually worked out yesterday and it was perfect. I think my main problem is that I'm also loosing weight, and that means that I'm also changin my basal quantity constantly.

As regards to your hypo black mode. Did you try having everything pre-determined? (Before hand know that if you go low you need to have box of juice and a cereal bar and check 15m later). So have that snack handy and after you are done eating it actually set a 15m timer. Maybe that can help

Daytona 04-25-2017 15:38

Oh that's a good idea! I never have a plan and then when I'm low, just act on instinct. I like your idea to have it all planned out and ready to use.

Let me know how the pump infomercial goes! I have the t:slim X2, which one are you looking at?

Gonzo 04-26-2017 12:46

Quote:

Originally Posted by Daytona (Post 1209129)
Oh that's a good idea! I never have a plan and then when I'm low, just act on instinct. I like your idea to have it all planned out and ready to use.

Let me know how the pump infomercial goes! I have the t:slim X2, which one are you looking at?

Will do! I'm not really sure which one is it. My doctor organized the meeting with the guys that she works with. She told me that they just brought in the country one that is water proof so they'll show me that one.

Bunjee 04-26-2017 21:40

I assume that you have an instructor. They have a schedule typically already worked out (like a teacher plan). My suggestion is to tell the instructor that you are having some issues with your insulin so would like to know what is on the docket for which days next week or at least, what is on the docket for Tuesday (specific day). That way, you can plan what you need for each of the days.

Gonzo 04-27-2017 02:22

Quote:

Originally Posted by Bunjee (Post 1209321)
I assume that you have an instructor. They have a schedule typically already worked out (like a teacher plan). My suggestion is to tell the instructor that you are having some issues with your insulin so would like to know what is on the docket for which days next week or at least, what is on the docket for Tuesday (specific day). That way, you can plan what you need for each of the days.

That's a good idea. My instructor is actually a type 1 diabetic too. He doesn't have a schedule though since classes depend on the amount of people that showed up to training that particular day. I can still ask him before we start at least to know if i'll need some extra carbs or something like that.

knarfny 04-27-2017 13:12

@Gonzo

I think it might be a bit difficult to figure this out because you're injecting basal and can't "suspend" it. Once it's in, it's in. If you took 24-units daily at 7:00AM, that would be 1-unit hourly, in theory. With exercise, you can out-work that 1-unit and drop to low, forcing you to eat to recover.

If you exercise every day at the same exact time, eat exactly the same thing prior to exercise, it will be easier to work this out because you can forecast your numbers and make better predictions. Perhaps the answer is injecting your basal post-workout? Maybe your workouts should be at the tail-end of your basal delivery? I don't know, just thinking out-loud.

How about a workout BCAA "recovery" drink? Some have few carbohydrates and if you're dropping to low, sipping on a recovery drink during your workout might be enough to keep you stable. If it's not, you can purchase one higher in carbohydrates.

With an insulin pump, basal insulin is delivered in real-time. So if you were going to exercise at 11:00AM, you can start to prepare for it at around 9:00AM by adjusting your basal rate, or completely suspending it if necessary.

I am on an insulin pump myself and recently dropped from ~80-units daily to about ~10-units daily due to lifestyle changes. I started to change my lifestyle because I wanted to get off the pump. Turns out, the pump is the best thing for me because I can "turn it off" whenever I want and proceed with my activities.

If I injected 10-units basal to start my day and went to do some yard work and dropped to low, there is only one way to recover, which is to eat. But, with the insulin pump, I can suspend an hour prior to yard work and put the pump back on when completed.

By dropping to low and eating to recover you'll fall into that never-ending vicious cycle of lows and rebounding highs. It sucks, I've been there. Just remember one thing, it doesn't take much to recover. When I used to drop low, I would panic and eat a bunch of junk to "recover". I think the general rule is your blood glucose will go up by three for every one gram of carbohydrates you eat. Sometimes it takes nothing more than ten grams of carbohydrates to recover, i.e., ten M&Ms; instead of the entire bag.

I'm curious to know how things work out for you and if you come up with a management plan that works out for you. I am still wanting to get off the pump at some point in my life but I am nervous about the forecasting with injections.

Good luck to you. There is definitely an answer, just a lot of trial-and-error as @Daytona suggested.

Gonzo 04-28-2017 00:57

Thanks for the reply Knarfny. Maybe you're right. It is really hard to make it work when you have a single basal and you have to make it work for the whole day.

I find it easier when I work out in the mornings. I would usually inject a unit and reduce the fast insulin during the day.

But when I work out at night is harder to make it work since you have to go through the whole day with a shortage of basal.

But anyway, I had my appoinment with the pump company today and I loved the concept. Specially the constant blood glucose monitoring and the hypo alarms. Ill probably have to adapt my sport to it but it's worth the try.

The pump is the medtronic 640, it just got in the country (yup, we are a little bit delayed in South America).

So why do you want to get off the pump @knarfny ?

knarfny 04-28-2017 09:47

@Gonzo

You should find out when the 670G will be available in South America. I believe it's rolling out now here in the U.S. during the spring of 2017.

The 670G is the first insulin pump that will adjust your basal rate based on your real-time blood glucose readings via the CGM.

In theory, you don't have to bolus. I am sure they don't recommend that, but, say you ate and forgot to bolus, your CGM would detect that your blood glucose is rising and the pump will adjust your basal rate to compensate for that rising blood glocose. It also predicts lows and will adjust your basal rate for that as well, not just "suspend" like the current model(s) do.

It's basically replicating your pancreas, which is pretty cool.

Don't quote me on this, but I think the 640G is no different than the older 530G. From what I can remember, the main differences between the two models is that the 640G is the new "body", which is the same as the 670G aesthetically, and it's also waterproof. Medtronic wanted me to upgrade a while ago but it wasn't worth it based on those two new features. So with the 640G, you get the new waterproof body and the new look of the GUI. I didn't care so much about the GUI because I used the Medtronic application on my iPhone with the little Bluetooth module they sell, which is the "Uploader". It sends the data from your pump to your mobile device via Bluetooth.

I want to get off the pump because I'm just tired of it being attached to me. It used to be more of an annoyance with the CGM. For example, the CGM has to remain nearby to the pump or it will disconnect and you have to go through the 2-hour warm-up process again. So, if I were to hop in the pool and take my pump off, I would have to try and leave the pump nearby so that it remained connected to the sensor. I would have to leave it on a chair and cover it with a towel. Then, one of my kids would take the towel off my pump and it would end up sitting in the sun. Once that happens, I'd have to replace the insulin reservoir. Also, being in the water for an excessive amount of time, the tape around the sensor would eventually fall off, which means I'd have to replace the sensor. Medtronic is good about replacing them, but, it requires a near 1-hour phone conversation with Medtronic support as they literally ask you a million questions before agreeing to replace the sensor.

Now, without the CGM and only the pump, it's not so bad. If I know I'm going out to do yard work or activities, I can simply suspend the pump or set a temporary basal, leave the pump in the house and go outside. While I still use the pump, I stopped using the CGM months ago. My numbers have been so stable for the past few months, the CGM was not necessary anymore.

I think it's also mental too. The pump makes the disease feel so permanent. When I was taking a shot or two daily, I wouldn't think about the disease for the remainder of the day. That's probably not such a great idea either though, I guess that's how one becomes complacent.

I hope things work out for you. I know that Medtronic has very affordable zero interest payment plans on the pump if your insurance doesn't cover it. I would assume they offer that outside of the U.S. as well; assuming you needed it.



Quote:

Originally Posted by Gonzo (Post 1209713)
Thanks for the reply Knarfny. Maybe you're right. It is really hard to make it work when you have a single basal and you have to make it work for the whole day.

I find it easier when I work out in the mornings. I would usually inject a unit and reduce the fast insulin during the day.

But when I work out at night is harder to make it work since you have to go through the whole day with a shortage of basal.

But anyway, I had my appoinment with the pump company today and I loved the concept. Specially the constant blood glucose monitoring and the hypo alarms. Ill probably have to adapt my sport to it but it's worth the try.

The pump is the medtronic 640, it just got in the country (yup, we are a little bit delayed in South America).

So why do you want to get off the pump @knarfny ?



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