[karen]

When you are planning on a heavy exercise routine do you?:

Drop your basal prior to the exercise?

Test and if you are a bit high, just exercise to bring it down?

Test and if normal eat a certain amount of carbs to cover the length of the exercise? or?

Eat a normal meal and give less of a bolus and then exercise to return bgs to normal?

Karen

[seacomp]

Originally Posted by karen

When you are planning on a heavy exercise routine do you?:

My exercise, say a 2 mile walk, can better be described as moderate rather than heavy and I am on MDI rather than a pump, but what I do is the following.
I have an "exercise ratio", which for me, in this case, is 5 gm carb per half mile.
Unless, I've just eaten, I test and make sure I am at my target or a little above, if not I adjust. I then eat 5 gm of carb (a mini Chips Ahoy cookie) at the start of each half mile.
If I'm to walk right after a meal, I skip the test and the first cookie. Make sense?
And before I was on insulin, I followed about the same proceedure.

[Ronin]

Hi Karen!

From reading your public profile, I see that you are a fellow cyclist. I don't know how intense your cycling is, but I do know about "The Bonk" (which is what we cyclists call "going hypo") That condition is doubly dangerous for a Type 1.

Unfortunately, I really cannot respond to insulin questions because I am technically "Pre-Diabetic" although I do have the genetic inheritance that says I will probably have problems if I don't take care right now. I am also doing quite well at controling my BG with managing my eating and exercise.

I always carry something to eat on any ride (I've bonked once with some pretty nasty results -- just ask my wife and we ride a tandem so she gets the full effect of my hypo's) and I don't want to do that again. Oh yes, we are very intense cyclists for most rides because we enjoy the intense effort more than simply crusing. On those rides where I know I'm going to be on the road in excess of 1:30 I always eat somehting at the 1:00 mark. I've learned from experience that when I get past 1:30 of riding I tend to get a bit light headed (first warning sign).

Somebody who is using insulin is better prepared to respond to your specific questions. However, this is a learning process and you have to learn how to deal with your body and how it functions.

[HelenM]

Unfortunately I'm discovering that we're all very different - so you have to experiment and what works one time doesn't always work the next!
Heres what I've found so far.

Reducing insulin before pre run meal doesn't seem to work .. I go low after about 20 mins running (although I'm scared to cut too much and 170 is probably highest starting point)
Eating small amount of carbs at start of run helps.. although BS still reduces it doesn't go so low. ( otherwise it can go down dangerously low)
I need take a small amount of carbs regularly during exercise.
I need to reduce the insulin for the meal after exercise.

Yesterday, I ran (and walked) for 1.5 hours on a very hilly circuit.
I was 102 pre run so ate (as an experiment)an 'energy bar' 21.5 gm carb (normally I just take a dextrose 4gm)
at 20 min was 80 took 1 dextrose
didn't test afterwards but took 2 more dextrose during run.
was 110 at finish but 139 an hour later. Reduced insulin by 1 unit (not enough but 139 was high pre meal for me)
but was 61, 2 hours later.

The energy bar did seem to help me get over the first 20 mins without getting too low but I also had 'runners trots' towards the end of the run so I'm uncertain whether to repeat that!
Its been suggested that I reduce my basal for days when I run longer distances but I'm reluctant to try it as it means commiting to a long run the evening before.

[Cyborg]

It depends on what type of exercise you are going to be doing. Aerobic exercise tends to lower bg while anaerobic exercise (weight training) tends to raise bg. When I perform weight training, I will usually wait until afterward and then immediately eat and bolus with a slightly higher insulin to carb ratio. I suppose when I get back into the racquetball court or back on the treadmill I will eat something before exercising with a slightly lower insulin to carb ratio or no insulin at all, but I have not tried this yet. I just picked up a book someone recommended titled The Diabetic Athlete that is supposed to be very helpful.

[jen_slc]

Originally Posted by HelenM

Unfortunately I'm discovering that we're all very different

Yes indeed! I do none of the above, I have to bolus before all exercise, heavy or not. That's not any help to you if you're looking to minimize hypos, just a testament to the fact that we're all different.

[valc3]

Before a heavy workout, I eat a small amount of carbs, about 20-25gm. I test in the middle and at the end, usually don't have to treat for a low. After the workout, I eat a meal.

[kidg]

Karen,

Based on the options that you are considering, I"m assuming that your "heavy exericise" is the "endurance" type of aerobic activity rather than the "strength" type that involves heavy weights. Believe it or not, each of the pre-workout scenarios that you've mentioned could be appropriate depending on your pre-workout sugars. The key is, as you state, to test prior to choosing how to prepare for your workout. In my case, when planning an aerobic-type workout, I tend to use the following guidelines. (note: these are not hard and fast rules, but tend to work for ME "most of the time")

I test my sugars in the morning before heading to the gym (or track, or ocean, or wherever...). I prefer mornings because it helps to eliminate many variables. So, instead of trying to workout after a full meal and a regular dose of insulin, I avoid all of the "extras" and focus on the needs relating to the workout.

Before an aerobic workout I always take a full dose of Lantus (I'm on MDI) and, based on the level of my sugars:

IF BS is less than 100 (but not too low) - I have a snack at home (banana) and bring additional carbs (orange juice, dextrose tabs) to the gym.

IF BS is between 100 and 140 - I eat a banana onece I get to the gym and have additional carbs on hand.

IF BS is greater than 140 (but not too high) - I head to the gym and get movin'. (I prefer sugars in this range because I have more flexibility with my pre-prep and also more room for error)

In each instance I always have extra carbs on hand and test 1-2 times per hour.

If, however, my workout involves strength training, I will usually treat pre-workout with a shot of Humalog (usualy 40% of a full dose in addition to my full dose of Lantus) I do this because anaerobic exercise almost always raises my BS. (I lift extremely heavy, so those of you doing the "high rep" brand of weight program may not have as dramatic of a reaction as I do).

Whichever type of workout I do, I always test and always have carbs nearby. Then, after a workout, I have my morning meal and a full shot of Humalog. (This is helpful because it allows my body to replenish its stores of muscle glycogen immediately after the workout and reduces the risk of severe post-workout lows resulting from the consumption of glucose as it becomes available).

Like Cyborg mentioned, "The Diabetic Athlete" is an excellent resource and a book that any diabetic who is committed to fitness should own.

In my case, I've been involved in athletics most of my life and have been diabetic for the past 15 years of it. I honestly didn't think that balancing the two was such a big deal until I shifted my workouts to mornings. Doing that brought all kinds of new and peculiar problems to light (increased insulin resistance, liver dumps, the fact that I was a "lazy diabetic").

Over the past two years I've probably tested more times in more situations involving more variables that in the previous thirteen years combined. It's extremely hard work and sometimes becomes maddeningly obsessive. However, the results are definately worth it and the confidence gained makes it a whole lot less frightening to "get off the couch".

[kidg]

In case anyone is interested, I ran across a couple nice articles dealing with Type 1 and exercise. (They are in PDF format, so you'll need Adobe Acrobat Reader to view them).

Type 1 Diabetes and Vigorous Exercise: Applications of Exercise Physiology to Patient Management.
http://www.diabetes.ca/files/Riddell--Final.pdf

Type 1 Diabetes and Exercise: Using the Insulin Pump to Maximum Advantage.
http://www.diabetes.ca/files/Perkins--FINAL.pdf

They're a bit clinical, but contain a lot of excellent information.

[Cyborg]

Originally Posted by kidg

In case anyone is interested, I ran across a couple nice articles dealing with Type 1 and exercise. (They are in PDF format, so you'll need Adobe Acrobat Reader to view them).

Type 1 Diabetes and Vigorous Exercise: Applications of Exercise Physiology to Patient Management.
http://www.diabetes.ca/files/Riddell--Final.pdf

Type 1 Diabetes and Exercise: Using the Insulin Pump to Maximum Advantage.
http://www.diabetes.ca/files/Perkins--FINAL.pdf

They're a bit clinical, but contain a lot of excellent information.

Looks like great material. I'll have to put my thinking cap on before attempting to digest it!

[jen_slc]

Originally Posted by kidg

In case anyone is interested, I ran across a couple nice articles dealing with Type 1 and exercise. (They are in PDF format, so you'll need Adobe Acrobat Reader to view them).

Type 1 Diabetes and Vigorous Exercise: Applications of Exercise Physiology to Patient Management.
http://www.diabetes.ca/files/Riddell--Final.pdf

Type 1 Diabetes and Exercise: Using the Insulin Pump to Maximum Advantage.
http://www.diabetes.ca/files/Perkins--FINAL.pdf

They're a bit clinical, but contain a lot of excellent information.

That Riddell article is great, thanks kidg! Now my theory for my exercise-induced spikes is that I must reach the "lactate threshold"/anaerobic threshold pretty easily regardless of exercise type (~175 bpm for me). When I next go to yoga, I'm going to pay more attention to my heart rate. I know my breathing slows down a ton, but I do feel my heart pound.