Working out/playing strenuous sports and avoiding lows

[KEVIN88GT]

So I'll be going to my first hockey game since I started on insulin. I dont want to go hypo so what do you guys suggest I do.

Hockey is from 7-8:30pm

My plan is to eat a hearty lunch and cover with a little less insulin.....so I end up in the 150's when I go to play.... That way if I drop...I wont get too low.... what do you guys think...

[Gangrel]

It depends. For me, the two times a week I play ice hockey, is when my basal insulin is starting to run out, so I find i don't need anything.

However, ball hockey is right after breakfast on Sundays, when i have fresh basal and Humalog (for breakfast) in me. In that case, I would take about 10 to 20% less Humlaog then normal.

Also, if you're worried, take a water bottle full of Gatorade and suck on that during the game. I'd rather end up high, then go low. Test soon afterwards, and you'll soon see what kind of pattern your body takes with activity......

good luck!

[REDLAN]

I assume you are on a basal-bolus regime. There are several things to consider

1) is to reduce your fast-acting for the meal before the game - I only do this however if I am within the 4 hour action period of the insulin - I'm not sure this is the case with what you are suggesting.

2) another option is to eat a fast-acting sugar before you start to play, you can then eat some more at half-time, and you may need some more at the end. How much will depend on how vigourously you play during the match.

3) reduce you basal - this is generally only necessary for prolonged strenuous activities - my 3 hour off-road journeys need this kind of measure.

4) It is very likely that you will need to reduce your basal and your carb ratios in the 24 hour period after the match, as your metabolism can be temporarily raised by strenuous exercise - your risk of hypos is greatest in the period AFTER exercise, not during.

you may need to use one or all of the above to achieve good control, and to reduce the risk of hypos.

make sure that you test - in your case I'd advise before you play, during half-time and at the end of the match.

generally though as long as you don't have any fast-acting insulin waiting to be absorbed, then hypos when you are playing will be very unlikely. Ensuring that you take sufficient glucose for the match will have one major benefit - not only will it prevent you going hypo, it will also reduce fatigue - I find taking sufficient glucose on my longer rides almost completely prevents fatigue

Ensure that if your match is strenuous, that you replenish your glycogen reserves, before you go to sleep - I assume that you will be eating your evening meal afterwards - make sure that it contains sufficient carbs - if you don't then you can risk getting a night time hypo, and if your glycogen is low, your liver won't be able to protect you.

[rocky]

If my BG is over 15mmol/L I go high when I do activity, and if it's under I'll run low by the 2 hour mark. What I usually do is mix a bit of gaterade with my water to avoid going low during the activity, and have a small snack (depending on the time of day and if a meal is near) after.

[Funnygrl]

I find that the longer I work out, the more my bs is effected. For an hour spinning class, I'm usually ok with just a snack before hand. If I'm skiing for 6 hours, it's nuts how hard I have to work to maintain my bs. When I was on shots I would have to eat literally every time going up the lift to maintain it. Now I set my basal at 0.05 to 0.1 units per hour, and I still had a range of 52 to 144 during the 6 hours I skiied yesterday, which most of my numbers in the 80s. I think it's harder to maintain when you're doing it for a long time because by the end you've depleted your body's stored sugars.

If I were you, the hearty lunch thing sounds like a good idea. Just keep some gatorade or something to sip on too around.

[am1977]

I think it really depends on the workout... I'm not sure how hockey would affect your blood sugar. My inital thought would be that it would be like most any cardio workout. Usually, for me, it would bring my sugars down pretty rapidly.

How soon after lunch are you playing hockey... If it's relatively soon, I would reduce your bolus by half... If you are playing later on, I would have a snack first. I would also suggest testing before, during, and after you play as well. That way you can really see how it affects you.

Good luck!

[KEVIN88GT]

ok guys so i went to play hockey last night...and this is what happened...help me analyze this and control better for next monday's game.

7:00p - 131 (right before game) I kept sipping gatorate between shifts totalling 1/2 of a 32oz bottle (i drank approx 30g of carbs)
7:45p - 236 Stopped drinkin the Gatorate (this is where it starts to go wrong...maybe I shouldnt have been drinking the gatorade?)
9:13p - 343 "ketones?" (took 9 units units of novolog and ate some soup and hot wings :) at UNO's. Mostly protein here so I took the 9 units to drop from such a high of 343 I havent had highs like that in months.

9:55p - 251 (novolog is working)
11:36 - 52 (working so well in fact that maybe 9 units was too much...funny thing was...I has no symptoms of hypoglycemia......drank 1 small cup of OJ and ate one tangerine)
12:00a - 100
12:30a - 102
went to sleep
7:53a -116 (today before breakfast)

So my only logical conclusion is that Glycogen was being broken down by the liver (Glycogenolysis) during me playing....I was affraid of going hypo and kept sipping the sweet stuff..and the additive effects of both got me so high .what do you guys think?

Oh yeh...I had a few assists and scored 1 goal :) I'm also really sore one one side after I tripped over the goalies stick on a breakaway and ended up crashing into the boards

[SugarLESSlie]

So, it was said that the basal might need to be reduced after strenous excercise.

For me, I do the gym 50 min a day 7 days a week. every single day is a struggle. i get my sugar up to 240 to start and after 15 minutes on eliptical it is down to 130ish

Any recomednations on keeping it more stable?

Also, after gym, it shoots sky high so i put it on 200% temp basal till bedtime to keep it normal:(

[KEVIN88GT]

bump....what do u guys think...?

[Gangrel]

During strenous exercise, you are probably release adrenaline, which will make you run high. I know when I play ice hockey, it does this most times. I've stopped drinking Gatorade during the games. For example, I was 11.2 before my last game, played an hour, no Gatorade, and was 11.2 after.

The exercise increases your metabolism too, so that probably explains why you went so low afterwards too. If I am really high after playing and I take Humalog, I have to be careful or I sometimes have the same problem of crashing.......

I would try drinking less Gatorade, or none even, next week and see what happens.

[BriOnH]

You drank too much gatorade, then you corrected too much.

Drink less gaterade if you follow the same routine.

[KEVIN88GT]

I will repeat with proper modifications next week...will report as soon as I can...wish me luck.

[rocky]

I would suggest the same as everyone else. Less sugar during play... and less insulin after. When I work out it usually works well into the night. Sometimes stays in my system for 48hrs. Good luck for your next game, HOCKEY RULES!!! And congrats on the goal and assists!:D

[REDLAN]

7:00p - 131 (right before game) I kept sipping gatorate between shifts totalling 1/2 of a 32oz bottle (i drank approx 30g of carbs)
7:45p - 236 Stopped drinkin the Gatorate (this is where it starts to go wrong...maybe I shouldnt have been drinking the gatorade?)
9:13p - 343 "ketones?" (took 9 units units of novolog and ate some soup and hot wings at UNO's. Mostly protein here so I took the 9 units to drop from such a high of 343 I havent had highs like that in months.

what time is your basal?

I guess you had your lunch as normal say 12-1pm - insulin action for this would be pretty much over by 4pm, and definitely gone by 6pm.

do you take your basal at night b4 bed? Because if you do you may be sitting in a big black insulin hole...

this may be why your BG are rising after exercise and not dropping as I would expect - you're relying on the long acting and it's stopped working.

if this is so, then...

I would suggest that you actually need to take no sugar at all before the match, and that you eat something as soon as poss after and take some insulin - you will probably need to reduce this dose as well.

[BriOnH]

what time is your basal?

I guess you had your lunch as normal say 12-1pm - insulin action for this would be pretty much over by 4pm, and definitely gone by 6pm.

do you take your basal at night b4 bed? Because if you do you may be sitting in a big black insulin hole...

this may be why your BG are rising after exercise and not dropping as I would expect - you're relying on the long acting and it's stopped working.

if this is so, then...

I would suggest that you actually need to take no sugar at all before the match, and that you eat something as soon as poss after and take some insulin - you will probably need to reduce this dose as well.

If he is in a 'big black insulin hole', why would he need to eat as soon possible after exercise. If that's the case he would need insulin right after before food.

Either way, Occam's razor Redlan. Occam's razor.

[REDLAN]

Well what would you suggest?

seems to me that to run from 7.3 to 10.1, and then up to 19.1 (sorry can't think in mg/dl) - I find it hard to believe that 30g of sugar would do this - I would expect a 10mmol to drop pretty quickly after exercise without needing a correction dose, not carry on soaring to 19 - seems to me that the most reasonable explanation is a shortage of insulin

seems to me that the most reasonable explanation is that the basal has run out - if KEVIN88GT takes his basal at night as most people do (he hasn't actually said so I'm just guessing)

If this is the cause he needs insulin pretty quickly - most natural for me would be to eat and take my fast acting, rather than injecting fast acting on it's own - especially with a 10 and after exercise as a correction dose - you risk nasty hypos doing this - my correction ratios get shot to pieces after exercise - I usually correct with food - it's safer.

the other solution would be to have a snack a couple of hours prior to the match with some insulin with it - that way he would have cover over the match.

gotta be guys out there with some better ideas?

[Gangrel]

You're right, it depends on many things, including when he takes his basal.

I personally think, the reason he shot up to 19 was a combo of the Gatorade, AND whatever adrenaline gets kicked off in very streneous, short, repative exercise. Ice hockey is usually a few mintues of hard skating, followed by sitting, then more skating, etc.

I ALWAYS run high after ice hockey, so I don't bother eating before if I'm at a reasonable level, and have laid off the Gatorade (tho I'd bring some just in case)

Other exercise I do (playing goalie in Ball Hockey for example) doesn't cause my body to go as haywire, so in those cases I would probably drink Gatorade to keep me going......

[BriOnH]

From the data we have, 1 day, all he needs to do is drink less or no gatorade and maybe take a unit or two after. It's really that simple.

[KEVIN88GT]

I take my Levemir 18 units (long acting) @ 10:30pm every night.... it's supposed to act for 23 hours (might be a little less) so @ 7:30-8pm it should be still working...not wearing off/hence causing my hyperglycemia...... I've looked @ previous day's readings @ around 7-8pm and they have been good 80-130.

[REDLAN]

when do you normally eat your evening meal?

levemir typically lasts around 20 hours - with some people it can last as little as 16 hours - however everybody is different.

What happens with the 4 hour hole is that most people cover this by eating their evening meal - the lack of basal is covered by their evening meal insulin - someone I met recently had soaring BG's following exercise after work, coupled with eating her evening meal later than normal - when she didn't exercise everything was fine.

I guess if you typically eat around 8/9pm anyway, and you're getting good readings, then your levemir is lasting into the 22nd/23rd hour.

if you choose to follow BriOnH's advice just be aware that taking your fast acting after exercise can produce really big drops - for me 1 unit of insulin will correct about 3mmol (55 mg/dl) - after strenuous exercise I have had as much as 7mmol (125 mg/dl) from a single unit - everyone is different though...

[KEVIN88GT]

I'll keep all the good advice in mind guys...thank you all and I'll report next week trying to keep the conditions the same...

[KEVIN88GT]

ok guys.... played again last night (1 goal :) )

here are my results

6:08p - 100 (Ate 15g worth of carbs.without covering with insulin..didnt want to get to the game low...just in case...but in retrospect I probably shoulnt have done this)
6:42p - 149 (Right before the game which started @ 7pm)
8:22p - 232 (uhm.....Finished playing @ approx 8:50pm)
9:20p - 184 (going down by itself without insulin)
10:30p - 117 (still going down by itself took some carbs without covering not to bottom out)
11:32p - 163
7:52a - 62 ( I see it still kept going down over the course of the night..so I ate some cottage cheese and few strawberries without covering to rebound from the low)
9:00a - 101
10:26a - 52 (wow still dropping by itself... just ate two bannanas and a sip of OJ)

so what do you guys think.... Does the exersice spike the BGL levels by breaking down glycogen stores(and then having them plummet down shortly thereafter? Is a BGL of 232 "normal" during highly strenuous activity?

[Tyler]

so what do you guys think.... Does the exersice spike the BGL levels by breaking down glycogen stores(and then having them plummet down shortly thereafter? Is a BGL of 232 "normal" during highly strenuous activity?

Were you highly excited during the game? Lots of adrenalin? It's pretty normal under those circumstances.

[KEVIN88GT]

very hyped... A LOT of adrenaline....I can see the arteries in my wrists pulsating :)

[Tyler]

very hyped... A LOT of adrenaline....I can see the arteries in my wrists pulsating :)

In weightlifting meets I often have a hard time keeping my blood sugar below 300 with no other changes other than the heightened emotional arousal.

[KEVIN88GT]

I wonder if these type of activity induced increases happen in non-diabetics? any studies out there?

[Tyler]

I wonder if these type of activity induced increases happen in non-diabetics? any studies out there?

I'm sure mildly but the working human body can correct it incredibly fast.

[KEVIN88GT]

see thats why i'm looking forward to the continuous BGL monitor and pump from bio med... i'd know it was getting high right away and be able to correct....also would know if I was low......cant wait..