Exercise causing problems (revisited)

[am1977]

Well, since it seems my post vanished into thin air, lol :laugh:, 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 :thumpdown (boo! :eviltongu )

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 :mad:

I've been trying several different things in efforts to solve this problem and so far, nothing is working :frown:. 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 :argh: ). 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 :idea:. 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 :o.

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. :D 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]

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]

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. :eviltongu 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]

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. :eviltongu 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 :top:. You all are the best :thumbsup:

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 :thumpdown. So now it's back to the drawing board :frown:. 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 :eviltongu. 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. :smile:

[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]

Really?

(if you could see the look on my face right now...)Really really. :D

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. :whistling :biggrin:

[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.:thumbsup: 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]

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.:thumbsup: 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. :thumbsup:

[am1977]

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. :whistling :biggrin:


Jen,

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

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 :eviltongu ).

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 :wink:...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 :eek:. I always prided myself for being a GOOD carb counter, but maybe not :dontknow:.


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 :idea: 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! :smile:

[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.asp?sku=30641382&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!

[KrisinNM]

WOW!!! Welcome to the Forum kidg:shakehand And you found the book,or at least a link, that Duck has been looking for. Great to have you aboard.
Have to say I agree with absolutely everything you said. Isn't this "experiment" in staying alive great?
Your post was very helpful and is sort of what I am leaning toward, except that even the cardio machines are causing a liver dump for me. Maybe because I haven't been to a gym since dx'd 21 years ago? I'm hoping my body will get used to the extra excercise and things will smooth out.

[am1977]

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.asp?sku=30641382&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!

Wow, I'm very impressed by your post :adore:... you make a lot of good points and what you wrote is very well stated. It really sounds like you are handling having this disease in a good manner. Being Diabetic, I guess we are bound to have issues managing and controlling our levels, but I think it's really how we cope with these things that is important.

I don't feel like I'm coping well with things at all... I'm constantly dealing with swings in my blood sugar. I know that's sort of the nature of this "beast", but I'm the wrong type of person to be "given" this type of thing. I'm an anxious person as it is w/o having to throw Diabetes into the mix.

I'm going to definitely look into finding that book. I'm not sure I consider myself an athlete, but I consider myself a pretty active person. If it can give me some pointers on how to deal with these exercise related issues, it's worth reading.

I know it's my body and my health, and I have to be the one to take the bull by the horns, so to speak. I guess in a way it's scary for me to take charge, maybe b/c I don't trust myself enough. I'm afraid I'm going to mess things up even more than they are already. Yes, I think the doctors try to help as much as they can, but it's definitely up to us to take care of ourselves and, I admit, maybe I'm not doing everything I can to take control.

I really want to control this disease, but unfortunately I feel like I am failing at the moment. I went through a lot of aggravation the last few days regarding my Diabetes (I won't go into it :rolleyes: ), but let's just say my numbers have been extremely high :eek:. So I definitely feel like something needs to change. I made an apt. with my endo for next week, so I am going to stress this when I talk to him. I don't think things can go on the way they have.

Anyway, I'll end this rather long post. But I want to thank you for posting your take on everything. It's nice to know that you understand and relate to what I've been going through and it inspires me to work harder to control my disease.

Thanks for your post :)

[kidg]

I'm glad my experiences could be of some help. Andrea and Kristen, you're both on the right track so don't get too discouraged. It's far too easy to get mad at yourself when your sugars get the best of you. But when you're able to step back for a moment, you'll realize that such frustration is the ideal motivation to take that control back. After all, we're much smarter than some stupid molecules, right?

While I don't claim to know more than my, or any other, doctor, I have begun to realize that the vast majority of her patients aren't too keen on physical fitness (to be fair, the general populous is pretty lazy, not just diabetics) As a result, I'm guessing that she is busy enough just holding the hands of people who "can't deal" with their condition, and doesn't have much time to spare for pushing exercise on them. She does have a handful of "diabetic atheletes" that are tentative about pursuing an athletic lifestyle AND dealing with diabetes. However, I find that by doing my own due dilligence, our visits have become as informative for her as they are for me. And she is able to pass my "findings" on to her patients that are struggling with the same things as I am.

I believe, the message that is not being communicated enough is that exercise isn't just good for you, it's GREAT for you! In my case, I've found that exercising correctly AND safely is that missing variable which makes managing your diabetes go from maddening to empowering. When I'm consistent about exercise, I literally find that I am able to decrease the amount of insulin that I need in a day. (My doctor was pretty impressed when I told her that one) Even doing less strenuous, yet persistent activities around the house, like painting a room or working in the yard will often allow me to forego my dose of Humalog entirely. (I had gotten tired of taking my prescribed dose, working in the yard, and having to run into the house every 20 minutes to eat a bunch of **** to avoid low after low).

Basically, I stopped chanting the mantra, "I am diabetic...need...insulin..." and figured that until a cure is found, I've got many months or years to "try stuff". I'm at a point now where I'm so tired of erring on the side of caution and constantly having to correct lows, that I figured I'd take some "risks" and, should I misjudge and go high, I'll just take the insulin that I held back earler...now. That may not be the "recommended" method, but you can't just sit around hoping that the treatment method your health care team feels "should" work but hasn't is going to magically kick in.

So Andrea, whle you're frustrated (and who among us doesn't experience that all too frequently), don't mistakenly assume that your treatment is correct and that you're simply "screwing it up". You've probably got the wrong combination of variables at work. Take a look at what you're doing, be logical...and change something. Then, take note of any discrepancies and use that info to make another change. Be prepared for even more frustration but, if you're motivated and patient, I promise the results will be pretty exciting. I can't promise that the frustrating days will be a thing of the past...that's just the price of being a "diabetic maverick".

Also Andrea, I too have the problem of going low after dinner, correcting, and rebounding high...so much fun. Trying to correct this has been my latest "experiment". Once I was willing to let go of my habits and stubborness, it seems quite simple (so far). If you're going low after dinner (and especially after an evening workout), then you have too many variable at work lowering your sugars. If you've already excercised, there's not much you can do to take that back (your workout from that evening will effectively contribute to lowering your sugars thoughout the night and into the next day). Therefore, the only logical option is to decrease the amount of insulin that you take (bolus) before dinner. Keep decreasing a little at a time and monitor your post-meal sugars until you arrive at a the "magic dose". I've decreased my dose so much, that there are some days that I wonder if it's even worth wasting a needle!

Kristen, what type of cardio are you doing? I'm sure that you've noticed all of the various modes on the machines. The level that is best for losing weight AND lowering sugars is the "fat burn" setting...or some equivalent. Don't try to mimic the way that others approach their workout. Most of them have vastly different goals or simply don't know what they're doing. Seriously, you don't have to be drenched with sweat and panting to get a beneficial workout. If you're on the machine thinking, "This isn't that difficult...I"m hardly breaking a sweat". Then, you're doing it correctly. Also, if you are just getting back in the gym after years of layoff then, yes, any exertion may cause your liver to dump its goodies. If that is happening to you, despite working at low-intensity, then you may want to consider taking a small amount of insulin before you workout. I know that sounds scary, but think about it. If you know that you're going to get the "liver dump" regardless, then you'll want to be prepared to counteract it. For me, taking 40% of my regular "non-workout day" dose, is the sweet spot. I also STRONGLY recommmend testing your blood frequently and having OJ or glucose tabs handy. You'll feel more confident if you're prepared for any occurance. I would also recommend that, if you need a pre-workout snack, instead of peanut butter and crackers, eat a banana instead. I know that the former are very tastey, but they create a lot more sugar over a longer period of time than a gool 'ol banana.

Also, if you're taking classes that are supposedly "low-impact", don't assume that your liver won't contribute. Any kind of sudden, dynamic movement (jumping, lunging, quick starts and stops) requires your body to replace sugars instantly, which tends to involve Mr Liver. Aerobic exercises (the "fat burn" kind) burn sugars at a lower, more stable rate and are replaced with a more leisurely method involving oxygen and current fat stores. Thus, bypassing the need for a glucose dump.

Whew! Sorry for the long-windedness. I've actually got to get to the gym now myself. Keep at it and best of luck!

[am1977]

I'm glad my experiences could be of some help. Andrea and Kristen, you're both on the right track so don't get too discouraged. It's far too easy to get mad at yourself when your sugars get the best of you. But when you're able to step back for a moment, you'll realize that such frustration is the ideal motivation to take that control back. After all, we're much smarter than some stupid molecules, right?

While I don't claim to know more than my, or any other, doctor, I have begun to realize that the vast majority of her patients aren't too keen on physical fitness (to be fair, the general populous is pretty lazy, not just diabetics) As a result, I'm guessing that she is busy enough just holding the hands of people who "can't deal" with their condition, and doesn't have much time to spare for pushing exercise on them. She does have a handful of "diabetic atheletes" that are tentative about pursuing an athletic lifestyle AND dealing with diabetes. However, I find that by doing my own due dilligence, our visits have become as informative for her as they are for me. And she is able to pass my "findings" on to her patients that are struggling with the same things as I am.

I believe, the message that is not being communicated enough is that exercise isn't just good for you, it's GREAT for you! In my case, I've found that exercising correctly AND safely is that missing variable which makes managing your diabetes go from maddening to empowering. When I'm consistent about exercise, I literally find that I am able to decrease the amount of insulin that I need in a day. (My doctor was pretty impressed when I told her that one) Even doing less strenuous, yet persistent activities around the house, like painting a room or working in the yard will often allow me to forego my dose of Humalog entirely. (I had gotten tired of taking my prescribed dose, working in the yard, and having to run into the house every 20 minutes to eat a bunch of **** to avoid low after low).

Basically, I stopped chanting the mantra, "I am diabetic...need...insulin..." and figured that until a cure is found, I've got many months or years to "try stuff". I'm at a point now where I'm so tired of erring on the side of caution and constantly having to correct lows, that I figured I'd take some "risks" and, should I misjudge and go high, I'll just take the insulin that I held back earler...now. That may not be the "recommended" method, but you can't just sit around hoping that the treatment method your health care team feels "should" work but hasn't is going to magically kick in.

So Andrea, whle you're frustrated (and who among us doesn't experience that all too frequently), don't mistakenly assume that your treatment is correct and that you're simply "screwing it up". You've probably got the wrong combination of variables at work. Take a look at what you're doing, be logical...and change something. Then, take note of any discrepancies and use that info to make another change. Be prepared for even more frustration but, if you're motivated and patient, I promise the results will be pretty exciting. I can't promise that the frustrating days will be a thing of the past...that's just the price of being a "diabetic maverick".

Also Andrea, I too have the problem of going low after dinner, correcting, and rebounding high...so much fun. Trying to correct this has been my latest "experiment". Once I was willing to let go of my habits and stubborness, it seems quite simple (so far). If you're going low after dinner (and especially after an evening workout), then you have too many variable at work lowering your sugars. If you've already excercised, there's not much you can do to take that back (your workout from that evening will effectively contribute to lowering your sugars thoughout the night and into the next day). Therefore, the only logical option is to decrease the amount of insulin that you take (bolus) before dinner. Keep decreasing a little at a time and monitor your post-meal sugars until you arrive at a the "magic dose". I've decreased my dose so much, that there are some days that I wonder if it's even worth wasting a needle!

Kristen, what type of cardio are you doing? I'm sure that you've noticed all of the various modes on the machines. The level that is best for losing weight AND lowering sugars is the "fat burn" setting...or some equivalent. Don't try to mimic the way that others approach their workout. Most of them have vastly different goals or simply don't know what they're doing. Seriously, you don't have to be drenched with sweat and panting to get a beneficial workout. If you're on the machine thinking, "This isn't that difficult...I"m hardly breaking a sweat". Then, you're doing it correctly. Also, if you are just getting back in the gym after years of layoff then, yes, any exertion may cause your liver to dump its goodies. If that is happening to you, despite working at low-intensity, then you may want to consider taking a small amount of insulin before you workout. I know that sounds scary, but think about it. If you know that you're going to get the "liver dump" regardless, then you'll want to be prepared to counteract it. For me, taking 40% of my regular "non-workout day" dose, is the sweet spot. I also STRONGLY recommmend testing your blood frequently and having OJ or glucose tabs handy. You'll feel more confident if you're prepared for any occurance. I would also recommend that, if you need a pre-workout snack, instead of peanut butter and crackers, eat a banana instead. I know that the former are very tastey, but they create a lot more sugar over a longer period of time than a gool 'ol banana.

Also, if you're taking classes that are supposedly "low-impact", don't assume that your liver won't contribute. Any kind of sudden, dynamic movement (jumping, lunging, quick starts and stops) requires your body to replace sugars instantly, which tends to involve Mr Liver. Aerobic exercises (the "fat burn" kind) burn sugars at a lower, more stable rate and are replaced with a more leisurely method involving oxygen and current fat stores. Thus, bypassing the need for a glucose dump.

Whew! Sorry for the long-windedness. I've actually got to get to the gym now myself. Keep at it and best of luck!

Thanks (again) for your inspiring and wise words :top:. I had to read it a few times, b/c I wanted to really process and comprehend what you are saying. I think I needed to hear this...these last few days have been, for lack of better words, HELLISH.

Yesterday, I woke up high and my blood sugars just seemed to climb from there. I tried everything to get my numbers down...changing the site (actually did that 3x out of sheer panic :eek: ), changing insulin vials, not eating carbs, and evern exercise, and nothing worked. Finally, after taking correction dose after correction dose, I came down. Actually, I bottomed out. Woke up and I was in the 40s. I was actually relieved to see that I had come down, but seems like I'm constantly bouncing from one extreme to the next. Actually, this wasn't just the case for yesterday. The last few days have been pretty much the same.

I know that I need to make more of an effort in getting this under control. I know I am not doing everything I can and should be doing...and then I wonder why things are the way they are :confused:. One thing in particular-keeping a good log of sugar levels, insulin bolused, exercise, and food. After reading that article about those 2 brothers who have lived so long with the disease, and hearing how meticulous they were with their logs, I think it would definitely benefit me to take better notes, so to speak.

Also, I agree. I need not to be afraid of making changes. It's definitely worth taking a risk if it helps to find something that works. I think this especially pertains to the issue of exercise. Seems like I have been having this issue for months and nothing has helped. Yes, it's discouraging and sometimes I do wonder if I am better off not exercising. However, like you and others have said, it's probably benefiting me more than doing harm- so I am not planning on giving up. I just wish I could get a better handle of things.

My current workouts are purely cardio...I will usually use the elliptical machine, treadmill, or arc trainer (mix between stepper and elliptical machine) for about an hour or so. I usually will work out moderately intensely. I like to get my heart rate up, b/c I know that it will help to burn fat and calories...and I like to feel like I have worked out. However the typical blood sugar response is for me to have a hypoglycemic episode immediately following exercise. Then I'll eat dinner, usually pretty low in carbs, and I'll test later in the evening and I'll be high, usually in the high 200s if not higher. I usually have a heck of a time trying to get it to come down...it will even carry over to the next morning often. Ugh, it's very frustrating :argh:.

I know there are a lot of variable at work. Yes, it's interesting in a way, but I think it makes it very difficult and aggravating at the same time. It makes it very hard to figure out what is going on and what I should do to improve things.

I'm going to try and hunt down a copy of that book. Maybe it will provide me with a little more insight into what's going on with me. I'm also going to make more of an effort to be more observant and conscious of my blood sugar and maybe, hopefully, I'll get somewhere.

Thanks again for your response- it's made me feel a lot better :)

[kidg]

Andrea,

I empathise with you're frustration regarding evening sugars. I struggle to keep those in line as well because, if I don't, I am usually starting off the next morning already "behind the eight ball".

Your penchant for going low immediately following a cardio-centric workout is normal. But, let me ask you, how do you treat this? I'm assuming that you don't drive home and prepare dinner "all woozy". What do you consume between your episode and your evening meal? Also, do you work cardio for 60 minutes continuously without stopping periodically to test your blood? If you do, I'd stronly recommend taking breaks every 20 minutes to test yourself and correct if necessary. If you can pre-empt a post-workout low, you should be able to decrease your chances of "ping-ponging" throughout the evening.

Also, I know that when you go to the gym you want to "feel like you've worked out". And, while there is nothing wrong with aiming for a higher level of intensity, you should know that this typically puts you in the "cardio-endurance" range rather than the "fat burning" range. And the "fat burning" range is the most effective means of both losing weight and lowering blood sugars. It'll seem almost too easy but, surprisingly, it is very effective. Both approaches should result in lower glucose levels post-workout, with the "higher intensity" workouts tending to cause a "spike" before levelling out.

Here are another couple of things to be aware of. First, be sure to always test your blood before you go the the gym and, if it's high (near 200), you should get that in check before going. If you start off a workout with high blood sugars, you're only asking for trouble. I'd recommend not working out until you've gotten your level somewhere in the 140-160 range, at least. Second, illness (virus, infection, etc.) will cause your sugars to be abnormally high in situations that you might otherwise maintain tight control. Since this is the time of year that many people come down with some sort of "cold", you'll want to keep an eye out for that as well. Sometimes its just a new variable in the diabetic equation that messes up the works rather than your own "failure".

Here is a direct link to the book that I recommended, should you have trouble locating it otherwise:

http://www.buy.com/retail/product.asp?sku=30641382&loc=106&sp=1&queryType=book

The first part contains a lot of information on how your body utilizes and replaces sugars during various levels of activity. While the second part breaks down specific exercises for people on different treatment plans. (for example, "I'm slightly overweight, use a pump, and want to climb a mountain...what can I expect?")

Let me know some of the specifics regarding how you approach your workout, resulting blood sugars, and subsequent treatment and I'll be happy to continue offering advice. I'm full of it...or, at least, I'm full of something...

[am1977]

Andrea,

I empathise with you're frustration regarding evening sugars. I struggle to keep those in line as well because, if I don't, I am usually starting off the next morning already "behind the eight ball".

Your penchant for going low immediately following a cardio-centric workout is normal. But, let me ask you, how do you treat this? I'm assuming that you don't drive home and prepare dinner "all woozy". What do you consume between your episode and your evening meal? Also, do you work cardio for 60 minutes continuously without stopping periodically to test your blood? If you do, I'd stronly recommend taking breaks every 20 minutes to test yourself and correct if necessary. If you can pre-empt a post-workout low, you should be able to decrease your chances of "ping-ponging" throughout the evening.

Also, I know that when you go to the gym you want to "feel like you've worked out". And, while there is nothing wrong with aiming for a higher level of intensity, you should know that this typically puts you in the "cardio-endurance" range rather than the "fat burning" range. And the "fat burning" range is the most effective means of both losing weight and lowering blood sugars. It'll seem almost too easy but, surprisingly, it is very effective. Both approaches should result in lower glucose levels post-workout, with the "higher intensity" workouts tending to cause a "spike" before levelling out.

Here are another couple of things to be aware of. First, be sure to always test your blood before you go the the gym and, if it's high (near 200), you should get that in check before going. If you start off a workout with high blood sugars, you're only asking for trouble. I'd recommend not working out until you've gotten your level somewhere in the 140-160 range, at least. Second, illness (virus, infection, etc.) will cause your sugars to be abnormally high in situations that you might otherwise maintain tight control. Since this is the time of year that many people come down with some sort of "cold", you'll want to keep an eye out for that as well. Sometimes its just a new variable in the diabetic equation that messes up the works rather than your own "failure".

Here is a direct link to the book that I recommended, should you have trouble locating it otherwise:

http://www.buy.com/retail/product.asp?sku=30641382&loc=106&sp=1&queryType=book

The first part contains a lot of information on how your body utilizes and replaces sugars during various levels of activity. While the second part breaks down specific exercises for people on different treatment plans. (for example, "I'm slightly overweight, use a pump, and want to climb a mountain...what can I expect?")

Let me know some of the specifics regarding how you approach your workout, resulting blood sugars, and subsequent treatment and I'll be happy to continue offering advice. I'm full of it...or, at least, I'm full of something...


I have to admit, it's nice being heard. As much as my family tries, they don't really understand. They'll listen to what I'm saying and they'll hear my frustration, but I don't feel like they are really "hearing" what I am saying. From everything you have said, I can tell that you understand...and that's nice to know. Sounds like you have been there, so to speak. In a way, I think that's the only way people can really know what you are going through.

I know going low immediately after a workout is somewhat common and it's possible I'm not treating things right. For one thing, I don't stop during a workout and test. I know very well I could be dropping as I continue to exercise, but to get off my cardio machine (and possibly risk giving up my turn) test, and treat, is a little inconvenient, if I am being completely honest. Also, to constantly have to treat lows, seems to negate the whole purpose of working out. I'm there to become more fit, stay healthy, and, if possible, burn calories and fat. The idea of constantly having to stop and treat lows is very unappealing to me.

As for your question, I hate to admit this, but yes...there have been many times in the past where I have driven home woozy, almost zombie-like, and then I would try to make something to eat. Of course, the first thing I do when I step into my apartment, is hunt down food and then eat until I feel better. So, yeah, this probably isn't the best approach.

I know my approach needs to change. Like I said, to have to test and treat is inconvenient, but I may have to do that if it means improving my blood sugar control. I know testing really is key to controlling Diabetes, and this has been suggested to me in the past, but I've never followed through on trying it. Maybe it's time.

As for the intensity of my exercise, it's interesting what you bring up. I've heard something on a news magazine type of show, not sure if it was date line or 20/20, but they had someone, on the show, who studied myths about weight loss. One of which was about whether there are stages such as weightloss/fat burning stage and also cardo stage to exercise. What she uncovered was that those who exercise intensely in the cardio stage (higher intensity), still burn more fat and calories (which contributes to weight loss) than those who exercised at a lesser intensity (the "so-called" fat burning stage). I know you can't believe everything you hear, but I thought this was an interesting finding and it does make sense to me. I mean, the more intensely you work out, the more calories you are going to burn, etc. Also, the first year I joined the gym...I really didn't work out too intensely, I don't think I ever got my heartrate up enough, so I didn't see any results, in terms of weight loss. After working a little harder and a little more strenuously, I started seeing a change. So, at this point, it's hard to know what to believe... I'm not trying to discredit what you are saying, by any means, you seem like a very intelligent person, but I thought that I would let you address this matter (if you don't mind).

I often feel like I have to start over 200 before exercise. Otherwise, I have a fear of dropping suddenely. Honestly, that's happened to me way too frequently in the past. It seems if I start above 200, I'm ok and can manage to make it through my gym routine(though often I'll still drop anyways :rolleyes: ), but if I started lower, I'd probably be in even worse shape.

You're right about colds- seems like it has been passed around to everyone in my office. I did have my own little respiratory infection myself, but I think I've basically recovered. I know you "shouldn't" workout if youare sick, but it actually hasn't stopped me in the past :eek:. I know that's not smart, but I guess I didn't feel sick enough to skip it. It is something to be concerned about and I think it's very true that you want to take extra caution when you aren't feeling your best.

I'll end this, before it really turns into a novel, but I want to THANK you again for your interest, concern, and advice. It means a lot :top:

[KrisinNM]

Yesterday, I woke up high and my blood sugars just seemed to climb from there. I tried everything to get my numbers down...changing the site (actually did that 3x out of sheer panic ), changing insulin vials, not eating carbs, and evern exercise, and nothing worked. Finally, after taking correction dose after correction dose, I came down. Actually, I bottomed out. Woke up and I was in the 40s. I was actually relieved to see that I had come down, but seems like I'm constantly bouncing from one extreme to the next. Actually, this wasn't just the case for yesterday. The last few days have been pretty much the same.
Sounds like I have a cyber double:smile: That was me last weekend, even to changing sites 3 times! Only difference is that I came out of it and this week has been almost perfect! It sounds like you are getting this figured out just by talking about it. See the next 2 quotes:
Also, to constantly have to treat lows, seems to negate the whole purpose of working out. I'm there to become more fit, stay healthy, and, if possible, burn calories and fat. The idea of constantly having to stop and treat lows is very unappealing to me.
Of course, the first thing I do when I step into my apartment, is hunt down food and then eat until I feel better. So, yeah, this probably isn't the best approach.
I think you just figured out part of the problem!!!

Kristen, what type of cardio are you doing? I'm sure that you've noticed all of the various modes on the machines. The level that is best for losing weight AND lowering sugars is the "fat burn" setting...or some equivalent. Don't try to mimic the way that others approach their workout. Most of them have vastly different goals or simply don't know what they're doing. Seriously, you don't have to be drenched with sweat and panting to get a beneficial workout. If you're on the machine thinking, "This isn't that difficult...I"m hardly breaking a sweat". Then, you're doing it correctly. Also, if you are just getting back in the gym after years of layoff then, yes, any exertion may cause your liver to dump its goodies. If that is happening to you, despite working at low-intensity, then you may want to consider taking a small amount of insulin before you workout. I know that sounds scary, but think about it. If you know that you're going to get the "liver dump" regardless, then you'll want to be prepared to counteract it. For me, taking 40% of my regular "non-workout day" dose, is the sweet spot. I also STRONGLY recommmend testing your blood frequently and having OJ or glucose tabs handy. You'll feel more confident if you're prepared for any occurance. I would also recommend that, if you need a pre-workout snack, instead of peanut butter and crackers, eat a banana instead. I know that the former are very tastey, but they create a lot more sugar over a longer period of time than a gool 'ol banana.
Music to my ears! I thought I had to really get my heart rate up and be drenched with sweat but you just enabled me to do what I have been doing without feeling quilty! Mon-Fri I am doing 15 min on the eliptical at the quick start setting. Then a couple weight machines for my back and arms (easy does it, trying to get more flexability from a frozen shoulder) then 20 minutes on the cardio bike set at the 2nd level. Tues and Thurs I am part of a seniors excersize class before the cardio.
I have figured out that the lower I am when I start (80-120) the better off I will be the rest of the day. Starting above 120 only makes me go higher and it is hard trying to get it back down. I test just before, during and after.
I love bananas but they spike my bs. The peanut butter and crackers I am talking about are the ones that come in a package. 3 of them after a workout usually hold my bs pretty level.
Kidg you are wonderful for helping Andrea and me (and all the other lurkers!) Hope you stick around!

[kidg]

Geez! Stubborn much, Andrea?

Luckily for you, Kristen, beat me to the punch before I was able to let loose with a full-on lecture. Listen, I completely understand your hesitancy to take on your condition. I’ve also spent many weeks rationalizing my laziness in regard my condition. No, it’s not fair that you have to factor your diabetes into the equation every hour of every day while everyone around you is oblivious to how “easy” they have it. Even if you keep PERFECT control for 365 straight days, guess what? You’re going to have to work just as hard on day 366 as you did on all the days prior. Personally, I would love to receive a “good diabetic” bonus (Keep tight control for 3 months…gets a week off from being diabetic).

Unfortunately…need I say more? That’s right. You’re diabetic…and you’re going to have to factor that in when you eat, when you sleep, when you’re driving, when you shop at the mall, and when you go to the gym. Sorry. I know it’s much easier not to test your sugars. That way, you’ll never know “for sure” that you’re not working hard enough. But, Andrea, you can’t expect much sympathy for your “hellish” weeks, if you haven’t put in the dedication necessary to control your condition. I don’t want this to sound like a reprimand (or maybe I do), but this business of staying healthy and living a long life is a very serious one. Brilliant medical minds sacrificed a lot to provide us with tools to help control diabetes. These tools are available to you and you need to use them.

In your last post you indicated that you “may have to” test and treat while you work out, even though it is “inconvenient”. I’m sure that you’ve already guessed that I’m going to tell you that testing and treating is NOT an option, but a necessity. Basically, there are three main variables at work…sugar, insulin, and activity. There is no way that you can change one of these without affecting the others. Insulin and activity are inversely related to sugars…when either insulin or activity is increased, sugars decrease, and vice versa. Ideally, we want our sugar levels to decrease as we increase our activity level and, the entire time, have our insulin level stay constant. However, if your sugars drop too low, you have either too much insulin in your system or need to decrease your level of activity (Note: I’m not talking about intense activities that trigger a “liver dump”, I’m only referencing aerobic activity) Therefore, if you don’t want to be “counter-productive” and consume more calories need to be burned off, you’re only other option is to decrease the amount of insulin in your system during a workout. By the way, you’re not only burning calories for the 60 minutes that you’re in contact with a cardio machine. You also benefit from an increased metabolic rate for hours afterward. So I wouldn’t worry too much about those “extra calories” that are necessary to treat a low…they won’t be around for long.

In response to your experiences reading or hearing experts on television discussing weight loss, I’ll say this. While much of the “facts” presented are probably fairly accurate for the “general population”, I doubt that many of these studies have taken diabetes into account. Unfortunately, not much on mainstream television does which is why it is so important to find out WHAT ELSE you need to do that non-diabetic persons don’t. I’m not saying that you should limit yourself to “low-intensity” workouts. But, since every type of activity affects sugar and insulin levels differently, you’ll need to know exactly how they’re being affected so you can be prepared. The only way to do this is to monitor your sugars regularly. It may seem daunting, but the more you test in the beginning, the less you’ll have to test in subsequent workouts because you’ll know what to expect. Also, I know I might be coming across as a “know-it-all”, but I’m far from perfect. Just because something works for me, doesn’t mean everyone should follow my lead. I’m just trying to point out some general tendencies that I’ve noticed from years of consistently trying to balance diabetes with athletics. While I may prefer to snack on bananas, Kristen likes the bite-sized goodness of delicious peanut-butter crackers. The bottom line is, if you’re experiencing positive results AND controlling your sugars, then keep doing what you’re doing.

Andrea, if I was your doctor, I’d order you to check your sugars every 20 minutes the next time that you go to the gym (and I wouldn’t care if you lost your place on your machine). I realize that I’m not your doctor, but, It seriously sounds to me that you’ve got too much insulin in your system during your workout. Check with your doctor first, but a simple reduction in your basal rate (or, more likely, a series of reductions…WHILE TESTING YOUR SUGARS) could make a world of difference. If you work out in the evenings, you might want to think about switching to mornings when your amount of circulating insulin is lower and your insulin-resistance is higher (and any snack that you consume can be burned off over the course of a full day)

Whether or not you want to follow my suggestions let me finish this manifesto by posting the “ADA and ACSM General Exercise Guidelines for Athletes with Type I Diabetes”

Metabolic control before exercise:
- Avoid exercising if fasting glucose levels are >250 mg/dl and ketosis is present, and use caution if glucose levels are >300 md/dl and no ketosis is present.
- Ingest carbohydrates if glucose levels are <100 mg/dl

Blood glucose monitoring before and after exercise:
- Identify when changes in insulin or food intake are necessary.
- Learn the glycemic response to different exercise conditions

Food Intake:
- Consume carbohydrate as needed to avoid hypoglycemia.
- Keep carbohydrate-based foods readily available during and after exercise.

See…and those guys are even smarter than me!

Keep at it, Andrea. It’s not easy, but it’s worth it. And Kristen, it sounds like you’ve been having some success lately. Congratulations.

[am1977]

Geez! Stubborn much, Andrea?

Unfortunately…need I say more? That’s right. You’re diabetic…and you’re going to have to factor that in when you eat, when you sleep, when you’re driving, when you shop at the mall, and when you go to the gym. Sorry. I know it’s much easier not to test your sugars. That way, you’ll never know “for sure” that you’re not working hard enough. But, Andrea, you can’t expect much sympathy for your “hellish” weeks, if you haven’t put in the dedication necessary to control your condition. I don’t want this to sound like a reprimand (or maybe I do), but this business of staying healthy and living a long life is a very serious one. Brilliant medical minds sacrificed a lot to provide us with tools to help control diabetes. These tools are available to you and you need to use them.

In your last post you indicated that you “may have to” test and treat while you work out, even though it is “inconvenient”. I’m sure that you’ve already guessed that I’m going to tell you that testing and treating is NOT an option, but a necessity. Basically, there are three main variables at work…sugar, insulin, and activity. There is no way that you can change one of these without affecting the others. Insulin and activity are inversely related to sugars…when either insulin or activity is increased, sugars decrease, and vice versa. Ideally, we want our sugar levels to decrease as we increase our activity level and, the entire time, have our insulin level stay constant. However, if your sugars drop too low, you have either too much insulin in your system or need to decrease your level of activity (Note: I’m not talking about intense activities that trigger a “liver dump”, I’m only referencing aerobic activity) Therefore, if you don’t want to be “counter-productive” and consume more calories need to be burned off, you’re only other option is to decrease the amount of insulin in your system during a workout. By the way, you’re not only burning calories for the 60 minutes that you’re in contact with a cardio machine. You also benefit from an increased metabolic rate for hours afterward. So I wouldn’t worry too much about those “extra calories” that are necessary to treat a low…they won’t be around for long.

In response to your experiences reading or hearing experts on television discussing weight loss, I’ll say this. While much of the “facts” presented are probably fairly accurate for the “general population”, I doubt that many of these studies have taken diabetes into account. Unfortunately, not much on mainstream television does which is why it is so important to find out WHAT ELSE you need to do that non-diabetic persons don’t. I’m not saying that you should limit yourself to “low-intensity” workouts. But, since every type of activity affects sugar and insulin levels differently, you’ll need to know exactly how they’re being affected so you can be prepared. The only way to do this is to monitor your sugars regularly. It may seem daunting, but the more you test in the beginning, the less you’ll have to test in subsequent workouts because you’ll know what to expect. Also, I know I might be coming across as a “know-it-all”, but I’m far from perfect. Just because something works for me, doesn’t mean everyone should follow my lead. I’m just trying to point out some general tendencies that I’ve noticed from years of consistently trying to balance diabetes with athletics. While I may prefer to snack on bananas, Kristen likes the bite-sized goodness of delicious peanut-butter crackers. The bottom line is, if you’re experiencing positive results AND controlling your sugars, then keep doing what you’re doing.

Andrea, if I was your doctor, I’d order you to check your sugars every 20 minutes the next time that you go to the gym (and I wouldn’t care if you lost your place on your machine). I realize that I’m not your doctor, but, It seriously sounds to me that you’ve got too much insulin in your system during your workout. Check with your doctor first, but a simple reduction in your basal rate (or, more likely, a series of reductions…WHILE TESTING YOUR SUGARS) could make a world of difference. If you work out in the evenings, you might want to think about switching to mornings when your amount of circulating insulin is lower and your insulin-resistance is higher (and any snack that you consume can be burned off over the course of a full day)

Whether or not you want to follow my suggestions let me finish this manifesto by posting the “ADA and ACSM General Exercise Guidelines for Athletes with Type I Diabetes”

Metabolic control before exercise:
- Avoid exercising if fasting glucose levels are >250 mg/dl and ketosis is present, and use caution if glucose levels are >300 md/dl and no ketosis is present.
- Ingest carbohydrates if glucose levels are <100 mg/dl

Blood glucose monitoring before and after exercise:
- Identify when changes in insulin or food intake are necessary.
- Learn the glycemic response to different exercise conditions

Food Intake:
- Consume carbohydrate as needed to avoid hypoglycemia.
- Keep carbohydrate-based foods readily available during and after exercise.

See…and those guys are even smarter than me!

Keep at it, Andrea. It’s not easy, but it’s worth it. And Kristen, it sounds like you’ve been having some success lately. Congratulations.

Moi? Stubborn? LOL :laugh:. Ok, I guess that's pretty apparant, huh? However, I'm trying to be as open and willing to make changes, as I can be. Seriously, you've been so helpful, Kidj. You're saying things, I think I do need to hear and that are, for the most part, true.

As I've said, I know that things could definitely be improved, but I think part of me is resistant, for some reason :dontknow:. I don't know if it's because I haven't completely accepted this disease or what. I think, for the most part, I do accept it, but then there are times when I have my doubts.

I'm not against testing...I actually don't mind it at all. It's just that when I'm in a place, like a gym, or something like that, it's awkward and, yes, I'm going to say it, inconvenient to do. Part of me thinks, I shouldn't have to- I mean, I'm not exercising for hours- only for about 1. So I guess I'm not seeing it as a necessity at the moment. I generally test before and after, but I guess I'm not willing to stop and test during exercise. Maybe this is why I'm having problems, but I think there has to be other ways around it. I know you said it really isn't a choice, but I think I'm going to try other things first and, perhaps, try it at a later point if need be.

As I have posted, I have been fooling around with temp basals and snack vs. no snack pre-workout, recently. No, nothing has worked so far, but I'm thinking, ok, hoping, I'll eventually find something that works in time. You're right, maybe I"ll have to go workout in the morning instead or find a better snack, so I'm going to explore those options and hope for the best.

Well, I hope I'm not boring anyone with my posts, but I feel like I need to voice this and this forum is a good place to do that. I don't know how long you've dealt with Diabetes yourself, but it does seem like you know what you ard talking about. And, no, I don't think you sound like a "know it all " at all...just someone who's very educated and informed about this disease. I truly appreciate you sharing what you know with me and us all.

Thank-you :)

[Cyborg]

I've had similiar problems from exercising and have unfortunately put exercising on hold for now until I feet I understand the process a little better. I'm glad to see other's experiences posted here as it will surely prove helpful when I reincorporate exercise into my routine.

Being on MDI for several years, I have migrated to a very low carb diet as a means to help control my diabetes. I have to be careful not to go into ketosis and when I do, I need to not stay there very long and use enough insulin to account for it (do not want DKA - been there, done that).

I start pumping in 2 days. I'm looking at this as an opportunity to completely change my metabolism and the way I eat and hopefully exercise. Currently my diet is high protein, medium fats, and low carbs where my new diet will probably be high carbs, medium proteins and low fats. I will go from practically no excercise to a medium to moderate excercise routine initially.

The way I see it (and I'm no doctor) I should have an almost constant supply of carbs in my body. As long as I do not exceed my calorie goals and as long as I get my basal rates set correctly (the hard part) and take the correct bolus for each thing I eat, I hope to lose weight and change my metabolism to become a carb burning machine rather than a protein processing plant and give my kidneys a break. I'm also hoping the high carb intake will give my body what it needs to avoid those dreaded night time lows.

Ideally, I'd want to eventually step the exercise up into something much more strenuous like racquetball or running. I've had enough night time lows just from sitting on the couch. But then again, I've never been on a high carb diabetic diet and an insulin pump. It's a real drag that something so good for combatting our disease induces such aweful lows. Has anyone found a way around this? Has anyone tried the high carb approach to diabetic eating while exercising?

Here is a link I found to calculating the number of carbs you should be eating based on your desired body weight: http://www.diabetic-lifestyle.com/articles/may03_whats_1.htm The article was written for diabetics. I don't endorse it as I have not tried it. But it sure seems interesting...

[am1977]

Hello...and welcome (not sure I welcomed you yet-there's a lot of newbies ;) )

First, Congratulations on starting pumping. A lot of people are very successful pumpers- I'm sure you must be pretty excited about starting :top:. I prefer pumping to MDI, hate shots :thumpdown. It allows so much more flexibility and freedom. However, my experience has been somewhat bumpy. I've had pump "issues", unfortunately. But saying that, I haven't returned to shots, so that has to tell you something.

I think the ADA and AMA does recommend a diet higher in whole grains, fruits and vegetables. Yes, these food groups are carbs, but I think that this is pretty much right on. To eat so much protein and fat, as many opt to do, seems very hard on your kidneys. Not to mention that we need carbs- our brain functions on mostly sugar and it's also a very important energy source.
Saying that, I think it's important to keep in mind that you do not want to overdo any food group. Because that will only lead to weight gain.

I'm definitely going to be checking that link out you posted, I am now curious about my carb intake. I definitely am not a low carb-er. I'm leaning to the other side probably moderate to moderate-high intake. And I still run into lows (esp after exercise) too often.

It really is easier said than done. Like Kidg suggested, there's so many variables involved- that even if we have one thing correct, there's very likely something else goiong on that can screw things up. In my case, it's exercise. Yeah, it doesn't seem right that doing something that is so good for us, can cause such blood sugar problems. It's very frustrating :mad: and there are times I want to throw in the towel. I haven't yet, but I am tempted to at times.

This disease is not easy, by any means. However, I do think it's possible to achieve good to great control with some work and effort. My control isn't bad right now (last A1c was 6.9), but I'd like to improve it further. So I continue to work on it and be conscious of the decisions I make regarding it.

I wish you luck with your move to the pump and your return to exercise. It sounds like you already have thought about it a lot and I think it's good to plan ahead.

Keep us updated :)

[Cyborg]

Thanks... Getting anxious as the count down approaches. I got my Pumping Insulin book today and while skimming through it found the same info on page 63. It talks about how to calculate your daily carb requirements.

As far as the exercise goes, has anyone tried experimenting with various factors. Things such as time of day, duration, intensity level, etc. I did read people were varying snacking behaviour such as before, during or after workouts. How about basal rate adjustments or work-out boluses? Does anyone check for ketosis before a workout and bolus for this if present before the workout? I would assume working out while already in ketosis would only raise your bg more since you would be burning more fat for fuel.

[rea]

When I excersize, I have a similar issue. the only way I can go for a 45-60 minute run, etc is to have a high sugar intake ahead of time, usually what I do is eat lunch without bolusing, then run, which will do it for me.

About 45 min later I run, when I get back, my blood sugars go on a constant drop and I take my fast acting insulin again with the next meal. On really intense workouts, or after evening excersize, I'll take a small drink of juice, or eat a small apple when I get back, which helps me from dropping so fast.

[Cyborg]

Here's another variable to throw into the loop.

How about the type of food. In that I mean food that has a high glycemic index vs food with a low glycemic index.

Take for example a situation where someone is going low at night due to a morning workout (my scenario actually), perhaps a high carb dinner of low-glycemic foods would do the trick.

[jen_slc]

As far as the exercise goes, has anyone tried experimenting with various factors. Things such as time of day, duration, intensity level, etc. I did read people were varying snacking behaviour such as before, during or after workouts. How about basal rate adjustments or work-out boluses? Does anyone check for ketosis before a workout and bolus for this if present before the workout? I would assume working out while already in ketosis would only raise your bg more since you would be burning more fat for fuel.Yes, yes and yes. Time of day, duration and intensity really make no difference for me, but then I'm the weirdo who has to bolus pre-gym every single time. If I have ketones, no way am I going to work out until my levels are down and/or ketones are gone. I have to be as low as possible before working out. I usually feel like dying when I show ketones so I'm not going to want to work out anyway. A couple times I have worked out in that situation (felt ok though), and it did shoot my levels super high. As I'm not pumping anymore, I can only suggest what I would have done years ago if I were experiencing Andrea's probs - lower temp basals during, snacks before/during/after, higher evening basals, higher dinner doses, and I think she's been doing that without much luck. :hmpf:

[kidg]

I generally test before and after, but I guess I'm not willing to stop and test during exercise. Maybe this is why I'm having problems, but I think there has to be other ways around it. I know you said it really isn't a choice, but I think I'm going to try other things first and, perhaps, try it at a later point if need be.

Well Andrea, if you're able to discover a means to keep your diabetes under control while exercising that the ADA, the ASCM, and countless health professionals have overlooked, I say, more power to you. Just promise me that I'll get a personal invitation to the ceremony when they award you the Nobel prize for medicine.

Since there have been a few new posters to enter the fray, since Andrea and I have started our back-and-forth, I won't repeat everything I've written already (it would take all day) All of what I've discovered regarding diabetes and exercise has been learned through personal experience so, of course, what works for me won't necessarily work for everyone.

In general, people that are new to exercise (and diabetics especially) need to know that, during exercise, your body is constantly striving to maintain glucose levels and glycogen storage levels in the muscles and liver. Low-intensity exercise, since it depletes glucose at a low rate will usually avoid the need to tap into glycogen storage, and instead break down fats and proteins for energy. On the other hand, moderate to intense exercise requires greater amounts of energy which your body needs right away. As a result, your body releases stores of glycogen into your blood that reside in your muscles and liver. This makes large amounts of glucose available for energy production. (and is also why your sugars may be unexpectedly high during a workout...even though they were normal before you started and you haven't consumed a "snack")

Regardless of how intensly you exercise, it's important to realize that your body requires glucose during AND after you exercise (usually for many hours after) Hence, the high risk of hypoglycemia as a result of working out. Just be sure to monitor yourself frequently, at least at first, so you can begin to recognize situations when it might hit. (Andrea will argue with me on this point...but, then, that's what she does...) The most important thing that you gain from testing during and after a workout, is the information necessary to identify when you are ABOUT TO GO LOW and treating yourself then...rather than waiting until you actually go low, "panic-eat", and send your sugars on a roller-coaster ride for the rest of the evening...and into the morning (c'mon, you know you do it)

In response, to the "various factors" that oopdeveloper had listed:

- I hope that some of this has helped to provide insight on the "intensity" and "duration" of a workout.

- jen_slc is correct about working out when ketones are present...don't.

- In the morning, circulating insulin levels are low and insulin-resistance is high, so "time of day", could absolutely factor into your results.

- Type of snack (high-glycemic are best during a workout) and when or if you need it depends on many of the factors already discussed. Personally, when I work out in the morning, I tend to take extra insulin if I"m planning a high-intensity workout (or if my sugars are running high) If I'm planning a lower-intensity workout, I may or may not, ingest carbs depending on my pre-workout glucose levels. Evening workouts don't tend to effect my levels as dramtically as morning workouts. In any case, I make sure to monitor, treat, and change insulin doses as needed thoughout the day.

I hope this has be helpful.

[Cyborg]

So you're saying that your body needs glucose when you exercise either low or medium-high intensity. And your body makes it one of two ways, by breaking down fat and protein or by releasing stores of glycogen from the muscles and/or liver. Does the hypoglycemia com into play when the body needs more glucose than the body itself is producing while perhaps you are not supplementing by eating enough carbs? Say after a workout...

[kidg]

I couldn't have said it better myself, oopdeveloper.

I've been recommending the book, "The Diabetic Athlete" by Sheri Colberg, PhD to anyone who will listen. And now I"m recommending it to you. The first part of the book (particularly the first 3 chapters) goes into detail about the physiology behind why our blood sugars respond the way that they do during exercise and detail the factors you've mentioned. (type of exercise, intensity, duration, frequency, and progression of training) The latter part of the book then breaks down just about every athletic activity you can imagine, giving examples of different types of diabetics and recommendations for approaching each activity.

Personally, this book has been extremely valuable in helping me to gain tight control of my sugars throughout my workout days and confidence when approaching a new sport. Don't worry, it's a much simpler and enjoyable read than any biology textbook.

Here is a link: http://www.buy.com/retail/product.asp?sku=30641382&loc=106&sp=1

(I'm sure that you can find it at many other locations...this is simply where I purchased it)

[Cyborg1]

Thanks for the link. I'll pick up a copy. As exercise has been one of the most frustrating, but most needed things in my life as a diabetic.

Thanks

Cyborg
(f.k.a. oopdeveloper)