[Wolff]

Hey Everybody,

I just wanted to find out a couple of things about exercising and Insulin and how to counteract for sugar lows etc. I've made the desicion to take on an intense exercise regime in order to try and build a bit of muscle and get into shape. It's rather hectic on both cardio and weightlifting. Now I know that the more you exercise the more effective your insulin on board becomes so I'm a bit worried about sugar lows while I'm exercising. What is the best way to get around this? Do I go and exercise with high sugar?? I'v also heard that normal people won't burn fat if thier insulin production is too high and thats why they've gotta eat protien with their carbs to lower their insulin production. now how do we as diabetics do this without having high bg's?? I guess we just gotta eat right to minimise our insulin requirements?? Please can someone let me know if I'm right or off track. Any help would be greatly appreciated. Thanks

[JediSurfer]

hi,

I normally need an extra 20-40 grams of carbs for an hours exercise depending on how hard i workout. normally use Glucogel or a an energy drink to keep my numbers up.
Also its nessacary to replace the stored carbs the body uses during exercise otherwise lows can happen hours afterwards.

also dont exercise if bg is high. this can cause alot of damage to the body.

Its just a case of learning how you react to exercise and what you need to do to keep within designated parameters..

Rich

[ant hill]

Hello Wolff, I find that eating the stuff that will support your energy is impotant and also to have somthing that will get you out of a low within arms lengh like jelly beans. When I was dancing I had a small jar of these beans on a table beside the barre.

[HelenM]

I can only answer as to cardio, since I don't do weights though I have read that weightlifting may increase the BS so that may complicate things.
When long distance running I find I have to both reduce insulin before and keep topping up the glucose at regular intervals. I test regularly. I also find that I often go low several hours after a very long run, even after an intervening meal.
If you're exercising for a long time and/or frequently don't underestimate its overall effect on insulin needs. When I was in training for a marathon and ran further each week I also had to cut my basal insulin.

[REDLAN]

When you exercise, there are 3 basic responses to exercise you need to take account of

1) increased demand from the muscles will increase demand for glucose - this may cause hypos whilst exercising.

2) Muscle cells respond to the increased energy demands by becoming more sensitive to insulin. They suck up glucose to replenish depleted glycogen. This effect can last many hours, depending on the intensity of exercise can last up to 2-3 days. Typically it will cause you to go low later on - danger time is during the night when you may be low and your body has low glycogen stores.

3) once the lactate threshold (above 65% MHR) is reached the body responds by releasing catecholamines (the stress hormones). This causes the liver to convert glycogen into glucose - the more intense the exercise, the more glucose that is released by the liver. I personally find that this effect can last up to a couple of hours after exercise. And it is the cause of the BG rise following cessation of exercise.

each person will react differently to exercise. Also you will find that as you get fitter, your own body will respond differently to the exercise regime.

so you may find in the beginning that you don't need any glucose at all, but may have to give yourself extra insulin when you've finished, and you may find that the decreased insulin resistance of your muscles cause your BG to stay low for a full 3 days.

after a few weeks, as you get fitter, you might have to take glucose, and not need insulin when you finish, and only need to lower you basal for 24 hours.

You could however just as easily experience the reverse effect - it all depends on how your regime is configured.

On BG level when you begin exercising. I find that it is better to aim for a normal BG and take additional glucose, than it is have a raised BG as this can cause it's own problems.

If I am high, before exercising, then I will either run half dose corrections, or no correction at all if I am only a bit high - your muscles still need sufficient insulin to utillise glucose during exercise (and if you are high then there is insufficient insulin in your body)

The thing that concerns me about your program is not your control, but...

I've made the desicion to take on an intense exercise regime in order to try and build a bit of muscle and get into shape. It's rather hectic on both cardio and weightlifting.

starting an exercise regime with low levels of fitness, increases your risk of injury. The more intense the program, the greater the risk of injury.

If you are unfit, then I would suggest that you reconsider, starting an intense regime, and instead look to build your fitness more gradually.

The techniques I use to manage my regime and exercise is
as follows.

1) a longish x-country cycle ride - I will lower my basal before and after. Make sure I ride at least 2 hours after eating and taking my fast acting insulin. On the ride I ensure that I will consume between 30g and 60g of glucose per hour depending on the intensity.

2) for a short 30-45 min gym/weights session. Depending on the intensity - I will either take 10g of glucose (usually enough) or no glucose at all. After the session is over I will test and if my BG is higher than I expect (usually caused by effect number 3), then I will make sure I take insulin with my post exercise snack.

PS did we mention testing?

[JJM335]

Redlan:

GREAT POST!!! They should save it and trot it out anytime anyone asks a question on managing exercise!!!

A couple of points: You talk about lowering your basal before and after - are you on a pump? (that would be unusual in the UK). Lowering your basal temporarily is not really feasible on MDI. If I am exercising regularly (i.e. every day or at least nearly every day) I drop my Lantus by about 20%.

I prefer not to have ANY short acting on-board when I exercise (before lunch or early evening are the most convenient times). Less chance of a big unexpected drop in BG. I agree totally about aiming for a normal BG before starting. However, if I were beginning a new exercise regime I might aim at the high end of normal (?8) until I were confident about the effects.

Joel

[REDLAN]

You talk about lowering your basal before and after - are you on a pump?

no I'm on MDI - I've split my Levemir, I take it at 12 noon and 9pm. So if I'm riding the next day, and expect a long hard ride. I will slacken back the 9pm by a couple of units. I may wake a touch high, but that should sort itself once I get going. If it's been a hard ride I will also step back the 12noon injection. This helps lessen the impact of those nasty post exercise hypos.

hope this clarifies things.

[Wolff]

Why do they say. 'If normal people have elevated insulin levels they will not burn fat' and how does this apply to us as diabetics??

[REDLAN]

Why do they say. 'If normal people have elevated insulin levels they will not burn fat' and how does this apply to us as diabetics??

This is a rather complicated question, and to be truthful I do not completely understand completely the action of insulin (but then I believe there is still significantly large holes in this knowledge in the scientific community as a whole)

However insulin's main action is not to lower glucose levels - it does this as a side effect almost of it's other actions.

it's real function is to preserve fat stores, by forcing the body to use glucose when glucose supply is plentiful. So after you eat the beta cells respond to the rapidly rising glucose by secreting insulin - this has 2 main effects

1) It allows glucose uptake by the peripheral tissues, in particular muscle cells where it is converted to glycogen.

2) it forces the liver turn glucose into glycogen, and store it.

3) As maximum glycogen capacity of the liver is reached, insulin causes the liver to begin converting glucose into fat.

4) the high insulin levels prevent fat cells from mobilising fat and releasing it into the blood stream.

This is the simplified version of my understanding of what happens.

insulin makes your body use glucose instead of fat as an energy source. So high levels of insulin will prevent you from utilising fat.

The statement is really a simplification normal people do not have high levels of insulin. People with type 2 have high levels of insulin, but this occurs due to insulin resistance - and yes the high circulating insulin levels can make it very difficult for these individuals to lose weight.

what actually matters is overall energy balance. The body also appears to have several compensatory mechanisms to prevent weight loss, but these are very poorly understood.

[Wolff]

Exellent posts REDLAN. Very helpful and informative. Could you maybe tell me about the following. What different effect do Carbs listed as sugars and carbs listed as Complex Carbs have on BG levels??

[REDLAN]

well....

I have to try very hard not to get on my high horse, but my personal view is that there isn't a great deal of difference between a simple sugar and complex carbohydrate.

it's one of those diet advice things when everyone believed that glycemic index of foods was important. The idea is that by eating complex carbohydrates instead of sugars, you would slow down the rate at which glucose would enter the blood stream, would need less of an insulin peak, and therefore would be healthier. And this is all fine and dandy, except that this model is far far too simple to represent what actually occurs during digestion.

First off you need to know what a complex carbohydrate is. There are plenty of them, but really the only complex carbohydrate that is relevant is starch.

starch and glycogen are almost identical in chemical structure, they just differ in shape. Starch is composed of long chains of glucose molecules known as amylose, which is bound to blobs of glucose known as amylopectin.

rest assured that free starch is broken down extremely quickly by the body - astonishingly the starch from a boiled russet burbank potato can enter the blood stream faster, than glucose dissolved in water.

simple sugars are just that - there are only 3 molecules worth worrying about - glucose, fructose, and galactose - simple sugars are made by combining them together in short chains -usually bimolecular structures.

so you have sucrose - simple table sugar is a composed of glucose bound to fructose., maltose is 2 glucose molecules bound together and lactose is glucose and galactose bound together.

fructose (of which there is much angst) is turned into either glucose or fat. What it gets turned into depends largely on available glucose in the liver.

the point is when you eat carbs be they complex or simple, then their ultimate fate is to get turned into glucose. Any excess is turned into fat.

my personal view is that the distinction is purely artificial. what actually matters most to you is how fast they get there. so...

fat slows down the absorption of carbs including simple ones - which is why ice cream typically has a medium GI (it's significantly less than mashed potato)

Another handy guide is the degree of processing the food has undergone - the more processing then the more easily nutrients are absorbed - apples have a lower GI, than juice for example.

[kstreeter513]

I'll just tell ya what I do. I am in the process of training for a marathon and find being able to control my blood sugar has become key to gaining fitness. Are you on a pump?

What you said was true...and if our insulin levels are too high, we cannot metabolize lipid stores in our body either. So what I do to prepare for a run is this:
--Three to four hours before a run I eat something high in carbs (like 50 grams) with some protein and low in fat and bolus as normal.
--After the bolus is finished, I reduce basal down to 20-25% of the normal and wait three to four hours without eating, then go exercise.
-- Immediately after my workout I eat around 50 CHO and take a normal bolus. Most people say they don't need as much insulin after exercise, but I do, you my not.

By the time I go exercise my bolus insulin is gone for the most part and sufficient time has gone by so that my circulating insulin is low enough to go exercise. Before I exercise I always check BG. It is usually 140-160. Thats about where I like to be before a long run. About every four or five miles I need to suck down an energy gel (about 25 grams CHO).

When I get back my BG has consistently been in the 100-115 range. As for weight lifting, I find that no reduction in my insulin is needed. I still go low if I have eaten a large meal within an hour of going. I think all the active insulin from the meal tends to lower BG. But a light snack is no problem for me.

This is just what seems to be working for me right know. As we all know, everybody's body uses insulin differently. It took me a long time to find this works best. I would suggest not trying to train too hard too fast without first knowing, what active insulin will do to you during exercise.

But hey good luck with whatever you do. Enjoy the endorphins .

[kstreeter513]

I also have a question that pertains to this. If high insulin levels demote fat loss. Do our bodies produce hormones that trigger fat to be released (glucagon, epinephrine)?

[Wolff]

Originally Posted by kstreeter513

I also have a question that pertains to this. If high insulin levels demote fat loss. Do our bodies produce hormones that trigger fat to be released (glucagon, epinephrine)?

what i thought was that if isulin levels in the body were high then your muscles would just use glucose from the bloodstream and it wouldn't need to do that

[BlueSky]

Fat is the the default source of energy. When insulin is high, the body stopps using it and utilises glucose in the bloodstream. It is much easier to get energy from glucose than from fat.