[am1977]

Well, since it seems my post vanished into thin air, lol , I thought I would repost this thread...especially since others seem to be experiencing similar issues and, personally speaking, my problem still dosen't seem like it is going away (boo! )

To refresh your memory, the issue is that I am having a hard time controlling my nighttime blood sugar levels. My concern is that my evening workouts, I go usually about 5 pm during the week, is the cause of my problem.

What usually happens is I'll go workout- usually purely cardio- for about an hour or so. Afterwards it's not uncommon for me to have a hypoglycemic episode. However, this is not where the problems end...no, that would be too easy. So I'll go about my business and have dinner and what have you...
Later in the evening I'll test again, and I'll be high. It's almost like a rebound effect. I go from one extreme to the other end of the spectrum- GRR...gets me so frustrated

I've been trying several different things in efforts to solve this problem and so far, nothing is working . Just seems like my blood sugars are very unpredictable. Let's see, I've tried eating a snack before working out (and often I'll still go low), eating a snack and setting a temp basal (usually end up high), not eating a snack and setting a temp basal (my latest thing I've tried-went low again ). Then, like I've mentioned, later after dinner, I'll spike and I have a heck of a time trying to get it down. So I'm running out of ideas . Oh and I've tried testing basals and that didn't help either

I guess what I'd like to do would be to have a good snack before the gym, do my workout, and have dinner. And since I seem to have these highs no matter what, I'd like to give Symlin a go. I think that might be what helps me. Not to mention, it may help me control my appetite...I tend to overdo it at night .

However, my Endo and CDE/dietician want me to really fine tune my rates before adding another thing into the mix. I guess this seems logical, but I think I'm running out of patience. I want it fixed now! I don't think that's too much to ask for considering this is an ongoing issue-it's been happening for months.

I'm not planning on stopping exercising, but I wish it was helpful to my blood sugar. So if anyone has any ideas, suggestions, or advice....please, PLEASE throw them out there. I need all the feedback I can get!

Thanks

[jen_slc]

Andrea, have you tried setting a higher basal around dinnertime, or around the time you start to see the spike, for a couple of hours? I don't know if that might help. How much do you change your rates? When I was on the pump I remember that even a change of 0.1 units in my basal would make a huge difference. If you're still going low during exercise or right afterwards, maybe just bump the rate down a teeny bit so you're not going to go high later on? and maybe supplement with a snack after the gym? I know, I tend to overdo it at dinner too, I lose a bit of control at the end of the day. Did you also try a larger dose for dinner? that might help offset the spike. It's really annoying but maybe just try out the different combinations of things to see if one of them works out? There are several variables that could be tweaked here - snack, basal, ratios.

[duck]

Have you tried consuming a "sport drink" (which really should be called a "nice, sugar-laden beverage") while working out?

[KrisinNM]

My problem is sort of the opposite: I go high while excersizing, do a correction, and then go low. Last week I went to excersize class in the morning, sugar went up, corrected, and then crashed 3 times before during and after dinner. That is just so discouraging because the point of the excersize/diet program I started is to lose weight, not have to eat more to correct lows!
I realize that light excersize lowers BS and heavier acticity causes a liver dump. So what should I be doing? Our fitness center has just about every machine there is, do I spend time on the elipticals? bike? walk laps in the gym?

[duck]

Originally Posted by KrisinNM

My problem is sort of the opposite: I go high while excersizing, do a correction, and then go low. Last week I went to excersize class in the morning, sugar went up, corrected, and then crashed 3 times before during and after dinner. That is just so discouraging because the point of the excersize/diet program I started is to lose weight, not have to eat more to correct lows!
I realize that light excersize lowers BS and heavier acticity causes a liver dump. So what should I be doing? Our fitness center has just about every machine there is, do I spend time on the elipticals? bike? walk laps in the gym?

What do you do now (exercise type and how long)? When you answer, try to gauge the "intensity" with which you exercise, with "1" being no intensity and "10" being the most intense. In my world, "1" is lying down on the couch, too lazy to lift a finger to use a remote to change a channel. "10" is I am working SO HARD that if someone put a gun to my head and threatened to shoot me if I did not work HARDER, I could not.

From my understanding of liver dumps, the closer you get to 10 on the intensity scale, the more likely your chances of creating a dump. I'd be curious to know if y'all's experiences play that out?

[jen_slc]

Originally Posted by duck

From my understanding of liver dumps, the closer you get to 10 on the intensity scale, the more likely your chances of creating a dump. I'd be curious to know if y'all's experiences play that out?

For me, I don't think I see any correlation between intensity and how high my spike ends up being, it just seems to be any kind of movement. Most of my cardio workouts, whether it's machines, kickboxing, step, running or boot camp are pretty intense maybe an 8 or 9 on your scale duck. Most times yoga is 4-5, but sometimes 6-7, same as pilates. And after every single one of these, I will spike to the 200s, sometimes 300s, no matter the starting point. I physically feel the worst when I do a lame yoga workout and not really working, when my bg spikes really badly. It's a mystery.

[duck]

Originally Posted by jen_slc

For me, I don't think I see any correlation between intensity and how high my spike ends up being, it just seems to be any kind of movement. Most of my cardio workouts, whether it's machines, kickboxing, step, running or boot camp are pretty intense maybe an 8 or 9 on your scale duck. Most times yoga is 4-5, but sometimes 6-7, same as pilates. And after every single one of these, I will spike to the 200s, sometimes 300s, no matter the starting point. I physically feel the worst when I do a lame yoga workout and not really working, when my bg spikes really badly. It's a mystery.

Really?

(if you could see the look on my face right now...)

I think I have the "Diabetic Athlete" at home...Let me look something up. I am at a big loss right now...

Y'know, this data would make a very interesting study...

[am1977]

Hey All, thanks for your responses... it's nice knowing I'm not alone dealing with this problem and I so appreciate all the advice and feedback . You all are the best

Jen...I think I've tried just about everything to prevent this from happening. I aftualy just wen throught testing my nighttime basal a couple of weeks ago. Shockingly, my basal rates were right on the money for the most part. However, saying that, I tested them w/o exercising, due to the fact that I couldn't find a suitable night, where my sugars were in range, to actually do the test. I knew that everything would change when I went back to exerciseing as I normally do. And, unfortunately, I was right . So now it's back to the drawing board . My Endo and my CDE usually adjust my basal rate. To be honest, I wouldn't even know how to go about doing that, so I leave that to them (for the most part). I have contemplated increasing my bolus rate at dinner, but my CDE advised against it...I guess they both feel that if I get my basal rate set correctly, whether that's temp basal or regular basal rate, then I should be ok. Well, I have yet to see this...and like I said I'm losing my patience. Ah well, I'm doing the best I can, I guess that's all I can do.

Duck, No- I don't drink Sports drinks mainly for two reasons. One) I go to workout to burn calories and to drink these types of drinks would be kind of counterproductive (is that a word? lol :laugh). Two) I don't care for them.

Question for you...how is that book "the Diabetic Athlete" ? Could you do me a favor and look to see if there is anything noted about rebounding after exercise.... I'd really appreciate it!

It sucks that something that's supposed to be so good for you can cause this type of aggravation . I know that I am benefiting from my exercise, but I hate to see the numbers I have been seeing. It truly drives me crazy. Oh well. I'm trying to hold on to my sanity, but I'm going to truly lose it if I don't see a change soon. Ok, maybe I won't completely lose it, but I might just throw my hands up and give up working on it. I almost want to do that now, but then another part of me is so determined to work this out. Ugh.

I guess in the meantime, I'll keep doing what I'm doing....which is fooling around with temp basals, etc. Maybe I'll happen to stumble across something that works. Well, a girl can dream anyways.

[duck]

Meh, you also work out for the cardio-pulminary benefits for your heart and lungs, looking good/losing fat is a side-effect, right? LOL. If I were you I would consider the sport-drink thing during exercise as an option, but not one you have to embrace.

Now where is that book?

[jen_slc]

Originally Posted by duck

Really?

(if you could see the look on my face right now...)

Really really.

Originally Posted by am1977

Shockingly, my basal rates were right on the money for the most part. However, saying that, I tested them w/o exercising, due to the fact that I couldn't find a suitable night, where my sugars were in range, to actually do the test. I knew that everything would change when I went back to exerciseing as I normally do. And, unfortunately, I was right

Yeah, that's a problem when you do these basal tests. The same thing happened to me. You remove all variables and everything looks perfect. You add them back in and it goes nuts again. If your basal rate keeps you stable that's great, but that's in the absence of any exercise. To me, that says your basal rate post-exercise doesn't cut it, and I would think that a little increase in the basal rate post-exercise might help and then you may not have to compensate with a bigger dose at dinner.

So you've done the fasting basal test. But have you tried a higher basal rate later in the evenings when you see the spike on the days you actually exercise? If it were me, I'd play around with my basal rates for the time period that's troublesome. I used to do that a lot, without my doc knowing, I'd just tell him the new settings every time I went in and he was fine with it. It's your pump, it's your body, you know it best, I would tweak it to whatever rate covers you best imo. Even if you just try 0.1 units, and if that doesn't work try 0.2 units and so on. Just test a lot and make sure it's not dropping you too low. You'll never know unless you try. You could make every exercise day an experiment. And if you don't exercise every single day, you can make it a temp rate, right, if I remember correctly? Like if 1.0u/hr is what you normally have and you exercise 5-6pm, maybe you need to set a temp rate to 1.5u/hr 8-10pm, something like that? I'm just pulling numbers and times out of the air, but you know what I mean. You could even set a few different rates, couldn't you? So that your basal hourly dose matches your bg curve/spike as closely as possible? I can't remember how much work that takes on the pump or whether it's easy to program that kind of thing. It could take some work, you could plot everything and see how to match up your bg and doses - but I tend to forget that not everyone likes using themselves as a guinea pig or is willing to put that much effort into it.

[KrisinNM]

Went to our monthly Cozmore pump group last night and for some reason I was the only one who showed up so I had 2 pump educator/CDEs and a local CDE all to myself. I posed the problem and here is what we did: We set 2 temporary basal rates to hopefully match my excersize pattern. The first one raises my basal 115% for 1/2 hour while I am brisk walking/warming up. Then I activate the second one which drops my basal to 40% for the next 6 hours.
We'll see how it works.
Yesterday I started class at around 200, was around 230 when class ended. I did not correct, just continued on with my regular day and meal boluses. By 5:00 I was back at 73 and at 1:00 in the morning I was 46. UGH!

[duck]

Originally Posted by KrisinNM

Went to our monthly Cozmore pump group last night and for some reason I was the only one who showed up so I had 2 pump educator/CDEs and a local CDE all to myself. I posed the problem and here is what we did: We set 2 temporary basal rates to hopefully match my excersize pattern. The first one raises my basal 115% for 1/2 hour while I am brisk walking/warming up. Then I activate the second one which drops my basal to 40% for the next 6 hours.
We'll see how it works.
Yesterday I started class at around 200, was around 230 when class ended. I did not correct, just continued on with my regular day and meal boluses. By 5:00 I was back at 73 and at 1:00 in the morning I was 46. UGH!

Ugh indeed. And I cannot find my book.

Anyway, at this point, I'd advise you do NOT correct for highs (obviously, correct for lows as needed), and let's monitor what happens to your sugars and when...Then we can fine tune your basals to what we see. It kinda sucks, but basically I'm saying put up with a week of torture so we can set you free for the rest of your life.

[am1977]

Originally Posted by jen_slc

Yeah, that's a problem when you do these basal tests. The same thing happened to me. You remove all variables and everything looks perfect. You add them back in and it goes nuts again. If your basal rate keeps you stable that's great, but that's in the absence of any exercise. To me, that says your basal rate post-exercise doesn't cut it, and I would think that a little increase in the basal rate post-exercise might help and then you may not have to compensate with a bigger dose at dinner.

So you've done the fasting basal test. But have you tried a higher basal rate later in the evenings when you see the spike on the days you actually exercise? If it were me, I'd play around with my basal rates for the time period that's troublesome. I used to do that a lot, without my doc knowing, I'd just tell him the new settings every time I went in and he was fine with it. It's your pump, it's your body, you know it best, I would tweak it to whatever rate covers you best imo. Even if you just try 0.1 units, and if that doesn't work try 0.2 units and so on. Just test a lot and make sure it's not dropping you too low. You'll never know unless you try. You could make every exercise day an experiment. And if you don't exercise every single day, you can make it a temp rate, right, if I remember correctly? Like if 1.0u/hr is what you normally have and you exercise 5-6pm, maybe you need to set a temp rate to 1.5u/hr 8-10pm, something like that? I'm just pulling numbers and times out of the air, but you know what I mean. You could even set a few different rates, couldn't you? So that your basal hourly dose matches your bg curve/spike as closely as possible? I can't remember how much work that takes on the pump or whether it's easy to program that kind of thing. It could take some work, you could plot everything and see how to match up your bg and doses - but I tend to forget that not everyone likes using themselves as a guinea pig or is willing to put that much effort into it.

Jen,

Thanks for your response once again. I truly appreciate your (and everyone's) advice. I'd lose it without you all .

I think you might be onto something here. Maybe I do need to start trying things myself. Quite honestly, I don't think there's anywhere to go from here, but in an upward, positive direction. After I read your response, I thought, you know what? Jen's right. I need to do more than what I'm doing and stop relying on my Endo and CDE to make changes.

I won't lie, in the past, I've adjusted things a bit here and there. But when it came to making significant changes, I would rely on my Doctor to take care of things like that. I guess because I thought that he and my CDE were experts in the field. However, I think that they really aren't certain of what is going to help. They just are trying to change up different variables to see if it makes a difference... It's trial and error for them too (how crappy ).

So I agree, I am going to start working on changing things myself. I think it's possible that I do need an increase in my Nighttime basal...I've already changed that ...we'll see if that helps. If not, then I guess I'll work on changing my carb to insulin ratio at dinner. The past few nights I have tried 1 to 8, instead of 1 to 10...and I don't see a difference. Guess that means that either I need to adjust it further or my carb counting is WAY off . I always prided myself for being a GOOD carb counter, but maybe not .


Duck, I'm not totaly ruling out the sports drink...but I can't say it's something that appeals to me. Someone actually recommended having a snack that contains, not only carbs, but protein as well. So I'm trying to think of ideas that might work. Hopefully, I'll come across something.

I'll keep you updated with how things go...

Thanks for your support, advice, and concern! Much appreciated!

[KrisinNM]

Andrea, taking control for yourself is very important! If you don't have the book Pumping Insulin by John Walsh, get it! If you have it, read it again. Use input from your endo and CDE when you can't figure something out for yourself.
That said, a good protien/carb snack is peanut butter and crackers. I would try eating a couple before sarting your excersize to see if it keeps you from going low. It sounds to me like you are getting a spike from the initial low when you sart excersizing.
Maybe we can get this figured out....

[kidg]

Isn't diabetes both frustrating and fascinating at the same time? I feel like I'm my own science project...adding some of this, taking some of that away...logging the results.

Anyway, this is my first post at this forum. Since this thread addresses exactly what I've been "experimenting" with over the past year and a half, I thought that maybe my input might be of interest or, at least, help me organinize my thoughts. So, if you'll indulge me...

I'm 36 years old and I've had Type-1 diabetes for 15 years. Unlike many of you, I have not yet made the jump to pumping so my experiences are based on the archaic guesswork of multiple daily injections I've been committed to keeping fit for much longer than I've been diabetic (gymnactics, tennis, biking, hiking, sailing, kayaking, etc.) I go to the gym about 3-4 times a week and workout for about 60-90 minutes involving some combination of free weights, cardio machines, yoga, etc. Up until a year and half ago, my workouts almost always took place in the evening and, I'll admit, weren't always accompanied with diligent monitoring of my sugars. I guess that I just figured, "Working out ALWAYS lowers blood sugars, so why not just save on test strips". Well, once I decided to try working out in the mornings (7am), I began feeling "odd" and started to check my blood more often. I noticed that after workouts that involved a lot of heavy weights for intense stretches of time, my sugars would be at all-time highs (300-400). After leaving many panicked messages for my doctor that went unreturned, I began doing some research which included picking up a copy of "The Diabetic Athelete" (as many of you have mentioned and I HIGHLY recommend...http://www.buy.com/retail/product.as...&loc=106&sp=1). I hadn't realized that "working out" had so many sub-variables that affected sugars (In my case, time of day and type of exercise being the most notable).

It was that annoying "liver dump" that occurs when lifting heavy weights that got me started really managing my own condition without "the ok" from my doctor. I initially thought that a snack before my morning workout would decrease the need for my liver to "help out". It turns out that my liver doesn't care and just dumps glucose as soon as I begin lifting. What worked for me was actually taking a small shot of Humalog (bolus) before my morning workout. This was something that I would have never even comtemplated before an evening workout due to the risk of going low. However, this seemed to do the trick (as long as my sugars weren't already at very low levels). I've also found that on mornings that I'm primarily doing cardio that a pre-workout snack in place of additional insulin does the trick. Now each morning before I workout I test my blood to see what type of "preparation" is necessary. I always take my Lantus (big glut of basal for the day) and either have a snack or a small shot of Humalog, depending on what I will be doing at the gym. During workouts, I make periodic stops in the locker room to check my levels (about every 20-30 minutes). I also, keep a small bottle of orange juice in my locker along with the standard glucose tabs "just in case". Since making these changes, I rarely have any "unexpected" readings and, the best thing, is that I find it much easier to keep my sugars at "normal" levels throughout the rest of the day. I can eat more and even take less insulin a lot of the time. And, to address the original post, I find that I can take less Humalog before dinner (especially when eating a high-protein meal) and actually maintain good control until bedtime (overnight readings are an entirely different animal)

I apologize for rambling but, I guess that what I'm trying to convey is that nobody knows you, your body, or your lifestyle better than you do...not even your doctor. I realized that waiting for my doctor to tell me that it was okay before I made ANY radical changes...and then never deviating from the that schedule for the 3 months until my next visit...only drove me to new levels of frustration and anger. Don't be afraid to make little "tweaks" or even big ones, monitor your blood, and use what you've learned to improve your control.

Although I still experience times of immense frustration with my lack of control (like when I'm sleeping and can't do a **** thing), I am overall much more confident in my ability to manage my condition in nearly any situation that comes my way since I'm no longer afraid to "manage on the fly". (SCUBA is next) I'm not sure if any of that is helpful to anyone but me but, man, do I feel better!

Thanks for indulging me and good luck with your workouts!