Large increase after excercise

[JohnnyP]

I don't get it. My 10 yr old son has had T1 for 2 yrs and is on the pump. He has soccer practice from 5:30pm to 6:45 and works pretty hard. He comes home and we have a normal meal with a little less bolus than normal since he seems pretty sensitive to insulin right after soccer. This all takes place around 7:15pm - we live right next to the soccer field. I check his BG and active insulin at 10:15 and it looks like he is going to land right around 140 - which is where we like to have him before bed. At this point, he may only have 0.5 units of active insulin. Then I check him around 11:00 pm and he is 250. I can give him a full correction and check again at 2am and he will be 250 again. It seems like he is getting a large increase about 4 hours after excercise. Does this happen to others? What do you do about it? When he doesn't have soccer practice, the BG numbers work out pretty good. Any help is appreciated.

[kstreeter513]

Sometimes that happens to me too. Especially after intense exercise like soccer. Any kind of anaerobic exercise will do this to me. My only suggestion is to eat (and bolus for) something carby as soon as possible, (within 15 minutes of finishing practice) then have a meal once home. This seems to offset the hormones that raise BG too much. And don't be afraid to bolus a little more aggressively since you've noticed this pattern.

[Subby]

I'm in the middle of trying to sort this out with my own exercise at the moment. Bicycling in the evening, it seems pretty random as to whether my body reacts up or down. If it reacts down, it's pretty soon. If it reacts up, it's elevated sustained highs through the early morning, so maybe 6 or 7 hours on.

I've found that having 15g of glucose and bolusing at the start, does appear to help. Somebody here suggested it to me, I don't have the actual body mechanics as to why it helps, in my head. Maybe I should try some carbs afterwards, too?

Apart from trying these tactics, if a trend repeats, you have an effective tool in the pump. Taking the scenario you've outlined, an increased temp basal starting at maybe 9pm (usually an hour lead time, not a rule though) for maybe 4 hours (very rough: I can't comment on the details!) may well help really reduce the runaway BG. Keeping it contained should help the situation as far as corrections not being effective (often resistance to insulin mounts, the higher you go).

Temp basals are wonderful, but do require care and experimenting to get working, of course. Take care and start conservative, if you do try it.

[MJM]

the way it works for a lot of people is that moderate exercise can reduce your bg, whereas intense exercise can increase your bg. Soccer would generally be intense exercise, especially for a kid. Does he wear his pump while exercising? If not does he take insulin before starting to cover for lost basal?
What Subby suggests might solve the problem. i.e, taking something and bolusing for it and also having some snack and bolusing for it after the exercise.

[keeranx]

This would happen to me too..I asked my doctor about it and he said sometimes exercise can even cause blood sugar levels to jump (it has something to do with adrenaline levels in the blood going up..not sure exactly). It's a little strange how it keeps jumping though...is he sick with something? Last year the night before I was hospitalized for gastroparesis I could not control get my blood sugar under control and it was just because I was sick...

You'd definitely want to talk to your doctor about this. A nurse once told me that if your blood sugar is very high and won't go down it's unsafe to keep bolusing in an attempt to drastically reduce the sugar..she said it's safer to come to the emergency and have them bring it down gradually. To be honest this made no sense to me so do talk to your doctor about it and see what his advice is.

[shiftzor]

Do you drop his basal rates while he plays sport? Too little insulin (often accompanied by a low bg) can cause a spike in bg as the liver dumps glycogen into the blood stream. Try testing every hour after and during the sport to see if you can catch any lows. A low bg will increase the chances of receiving another low in the next 24hours. Alternatively if he always goes high without any lows you could work out how much insulin to bring him down and dose after every game (be careful doing this and test 2hours after dose to ensure no lows). I tend to go lower after intensive sessions of cycling, taking protein can help bg hours after the sport has taken place and eating a high carb meal with a reduced dose helps as well.

[REDLAN]

I get this effect alot!!!

The rise in BG after exercise is a piece of fairly well understood sports physiology.

The effect is caused by lactate recycling

Muscles are comprised of 2 types of muscle fibre - fast and slow twitch. Slow twitch are used for endurance. Fast twitch provide the power needed for sprinting and power.

typified by football.

The energy needs of the powerful contractions from fast twitch muscle fibers can easily outstrip their oxygen supply, so they are uniquely adapted. What they do is to derive energy from only the first part of glucose breakdown - namely the conversion of glucose to pyruvate. The buildup of pyruvate would eventually poison the muscle, and so they convert pyruvate to lactate, which is released into the bloodstream.

In the liver this lactate is converted back into pyruvate and then back into glucose, and released back into the blood stream.

As long as the intense activity continues the active muscles will reabsorb the glucose created from lactate - hence lactate cycling. To do this they need a sufficient supply of insulin.

- during very intense exercise I will take a carbohydrate snack and insulin to keep my BG down during exercise.

When the person stops. There will still be lactate in the bloodstream, which the liver busily converts back to glucose. However the muscles will no longer be active (there are changes in insulin resistance in muscles that occur with starting and stopping exercise, which also depend on fasting state)

If the muscles are unable to absorb the glucose from lactate cycling due to lack of insulin then it will build up in the bloodstream.

I counter this effect by taking a carbohydrate snack when finishing exercise, which I cover with insulin. If the exercise has been very intense then I will increase the carb:insulin ratio.

This effect takes place normally within an hour or so of exercise, but the BG high may last longer if not corrected. This appears to be the effect described by the other poster, and I don't believe the likely explanation for your sons high

questions

1) is the high ONLY happening after football. i.e. if he practices every night then how do you know that it is the football that is causing the high?

2) is the high after EVERY football session. Does it correlate with the level of intensity during practice - i.e. higher levels of intensity higher chance of a high. Does your son complain of soreness or stiffness in his legs?

2 things occur to me

1) it has nothing to do with football, but something else is going on, which is why checking to see if he gets highs on non-football nights is important to verify.

2) Is it possible that the high is related to injury? Lactate buildup in the muscle can cause muscle damage, and it is possible that the high is related to the inflammatory response.

[JohnnyP]

Redlan, Thank you for your lengthy and interesting reply. You are a diabetes stud. I am going to copy and paste your reply into my collection of worthy diabetes information folder.

My son plays soccer twice a week and I can say it (high blood sugars in late evening) happens almost every night he has practice and it usually doesn't happen on nights he does not have practice. It is highly correlated, but not 100%. My gut feel is that one is causing the other.

However, I can tell you that this usually happens quite a bit later than one hour later. Hmmm. I was wondering if he could be going low and rebounding, but he usually feels his lows, and I have not been able to document this occurring in him. Sometimes, it could be that he is going high an hour after excercise and I just don't see it until 3-4 hours later. I will look for that a little closer.

As far as injury? I doubt it. He usually let's everybody know when something is hurting :).

I will try the carb thing after soccer with a little insulin and see how it works. I will also keep my eye on a couple other items that you mentioned.

Thanks again for the advice.