Insulin, Exercise, and Low Carb
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T1DCarnivoreRunner
Posts: 11,502 Member
I'm a type 1 diabetic (I also have type 2, so informally called "double diabetic") and turned to low carb a couple weeks ago to try to regulate BG. It has really helped with timing issues normally caused by carbs and chasing with insulin, plus with the variability of actual insulin needs, etc. So things are going well (except for the cravings - today it was banana bread and ice cream).
Anyway, I haven't had time to really exercise yet since starting low carb (I work FT and I'm a FT grad student). Prior to starting low carb, there was always a high risk of low BG when exercising and I would usually cut basal insulin (I'm on a pump, so it is convenient) to prevent lows as best as possible. As expected, BG's have become much more stable while eating low carb.
My question is: For others who are type 1 diabetics (sorry, not quite as interested in type 2's who still make insulin as it wouldn't compare the same way), do you run low when doing cardio? Are you able to prevent this with temp. basals? Does gluconeogenesis happen quickly enough to counteract lows from exercise? Or do you find yourself downing glucose tablets while you pass out?
Anyway, I haven't had time to really exercise yet since starting low carb (I work FT and I'm a FT grad student). Prior to starting low carb, there was always a high risk of low BG when exercising and I would usually cut basal insulin (I'm on a pump, so it is convenient) to prevent lows as best as possible. As expected, BG's have become much more stable while eating low carb.
My question is: For others who are type 1 diabetics (sorry, not quite as interested in type 2's who still make insulin as it wouldn't compare the same way), do you run low when doing cardio? Are you able to prevent this with temp. basals? Does gluconeogenesis happen quickly enough to counteract lows from exercise? Or do you find yourself downing glucose tablets while you pass out?
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We had another T1D member but I haven't seen her on the forum for a while, so I don't know how many others are actually members... If there are more, they're pretty quiet.
I'm not diabetic at all but my daughter is. She has just started back on the pump not long ago and is also eating Keto level carbs.
She hasn't done any exercise and right now that's not even a thought since she's developed neuropathy in her feet just recently.
The closest thing she has mentioned to the subject of your question for her is that sometimes at work she gets very busy and works alone for most of the day so she doesn't eat, while at the same time being on her feet moving around more than normal. Certainly not cardio.
She was having lows frequently at first (since starting pump), and just continued to adjust the basal rate to prevent it. She didn't use temp basal, but occasionally has suspended if bg was around 80 and she knew she would still be busy and not able to eat soon.
We did talk to the pump educator about what to do when exercising. She did say using a temp basal was the best course of action, but she immediately followed that up with "make sure to eat a carby snack"... This same nurse thinks my daughter will get DKA from low carb eating though... So, I don't have much confidence in her knowledge anymore.
Here's my thought though.
Since exercise is going to be a new thing and having time for exercise is clearly a factor, and being that you will clearly need to test before, during and after so that you can figure out the best course of action for you, I would suggest doing a 7-10 minute HIIT workout or start lifting because neither of those require the minimum 20 minutes that cardio does and I think it's common belief that you can make faster progress anyway with that type of exercise. HIIT is short enough that testing before and after, as well as keeping a close eye on things for a couple hours after should make blood sugar a little easier to manage. And lifting would allow you to test at any time between sets that you think you might need to. Plus, it doesn't have to take very long either. You'll probably need a temp basal no matter what. You'll have to figure out what's the right amount though. Trial and error is the only way I can think you'll do that. You will need to be prepared to treat a low. I doubt GNG would be able to react fast enough. My daughter has been able to treat mild lows,high 60's - 70's or so, with almonds and recovered quickly enough, but she has to use a candy or something for anything in low 60's or less. She's very careful not to over correct.0 -
I have T1D as well (27 years). I find that cardio doesn't really impact my blood sugars at all unless I have some insulin on board. I use a CGM so I can track it pretty reliably. I think prior to going LC it was an issue going low because of the difficulty matching up insulin peaks with blood sugar spikes. Once I went LC that was one less variable. Now if I lift weights or do a hiit workout my blood sugar spikes due to the adrenaline & cortisol being released. You may find that exercise reduces your insulin resistance a bit over time so you may need to reduce basals overall as you go. Good luck my friend. I know diabetes is a full time job!0
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I found time to go to the gym last night. Before leaving (the gym is about 30 min. drive away, add 10 min. for changing, filling water, headphones, etc.), I started a temp. basal of 30%. When I got started, I did the typical routine that I did when I had time to workout 2-3 times per week:
-Start with 20-30 min. of walking / running to raise HR.
-Lift weights, lower weights with high reps. (I have a routine with specific lifts for a specific purpose, and endurance is part of that - this is why high reps. and lower weights rather than lifting heavy with lower reps.) This takes about 1 hr., more or less.
By the time I got to the gym, got changed and everything ready and on the treadmill, my CGM was telling me I was running high (160's) and rising fast. So I walked for 10 min. and then ran for 10 min. Then I lifted for roughly 1 hr. When I left the gym, my CGM battery had died. I tested with a meter and I was down to 115, so a bit higher than target but pretty good still. I had ended the temp. basal shortly before finishing. I went to the store. Since I was really hungry, this was not a good idea. But I controlled my cravings for donuts and everything else that is high carb and delicious.
When I got home, I had some sugar free cider I had picked up from the store (8g carbs total) and rose to 140's (I took a bolus to cover that high, but should have been rising still) before going to bed. I put the CGM on the charger and didn't plan to replace it so I would not have to wake up to calibrate. That's where I ran into trouble.
As you probably know, exercise can continue to lower BG for hours afterward. I should have still been rising when I bolused to correct the 140 (instead of bolusing for 8g of carbs, which would not have had the same effect) and should have countered that. Well... not really. I woke up this morning at 41. So of course I had to eat to treat the low. Grrrr... the nemesis of losing weight.
Next time, I'll keep the temp. basal going for well after I finish working out.0 -
Oh man! I *hate* that! It's such a difficult balance. Most people don't get it. Good for you for getting back to exercising! I have a love/hate relationship with it. And I always forget the impact of my exercise on my numbers even several hours post exercise. Just gotta keep on keepin on though right?!0
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Either keep the temp basal or skip the bolus you did for the cider.
My daughter has gotten to the point that she rarely does a bolus anymore because meal and snack carbs are so low. The basal seems to take care of it. And she needs to reset a new ratio for bolus at this point because IR has gotten so much better that she over rides the recommended units anyway and only takes about half of it when a bolus is needed.0 -
I have a question though. Are either of you @midwesterner85 or @tkmelton at very low carbs, Keto level? And if so, have you actually tested and showed ketones at all?
Just curious because my daughter has not tested positive for ketones yet, though she hasn't checked very often. And I'm wondering if the basal prevents it and if muscle might be getting sacrificed...0 -
@Sunny_Bunny_ There was a time when I ate nothing but protein powder (and the occasional glucose tablet as needed) for a week or two to try to ramp up weight loss. During that time, I measured blood ketones daily and was staying around 1.2-1.8 mmol/L.
Recently, I haven't been testing blood ketones, but here are my charts (you can see where I started low carb. My goal is to try to stay under 100g / day net carbs (red line is 104g). I haven't been getting as much fiber as I should be, though.
Out of curiosity, I just tested and got 1.4 mmol/L blood ketones.0 -
Thanks for the info.
She has just checked urine ketones. We have one blood ketone strip left, maybe I'll have her check tonight.
She's probably just one of those people the urine strips don't work well for when well hydrated then. She drinks a lot of water. At least twice what I do in a day. Must be diluted enough to affect the strips.0 -
I almost ran out of blood ketone test strips when I was doing the protein shake diet. The urine strips are definitely less accurate, but if that is what you have... it's better than nothing. At least the urine strips are much cheaper.0
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Yes I do stay below 50grams of carbs and definitely test positive for ketones (urine only) but have verrrryyy slow weight loss results. Crazy how we're all the same yet so very different!0
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Yes I do stay below 50grams of carbs and definitely test positive for ketones (urine only) but have verrrryyy slow weight loss results. Crazy how we're all the same yet so very different!
I expect are can be very different on the inside. While I would like to lose another 25 on top of the 50 already lost as long as my health markers keep improving I know the weight will leave at some point in time. It took 40 years to work up to 250 pounds plus now I am 65 so things move more slowly.0 -
Sunny_Bunny_ wrote: »Either keep the temp basal or skip the bolus you did for the cider.
My daughter has gotten to the point that she rarely does a bolus anymore because meal and snack carbs are so low. The basal seems to take care of it. And she needs to reset a new ratio for bolus at this point because IR has gotten so much better that she over rides the recommended units anyway and only takes about half of it when a bolus is needed.
Hmmmm, I love this group, I learn something everyday. I was an insulin taking type 2 diabetic for over ten years. And I never heard of the term, "basal" or "bolus" (I just googled it, LOL!) I just called them long acting and fast acting insulin. I probably won't remember which is which (kinda like port and starboard)...
Oh well, I haven't taken insulin in over a year and half since being keto... But I still learned something!
Thank you,
Dan the Man from Michigan
Keto / The Recipe Water Fasting / E.A.S.Y. Exercise Program
How I Got Off of Diabetic Prescriptions Drugs Since I Started Keto
Blog #10 Keto: Abbreviations, Acronyms & Terminology Used on the LCD & Keto Updated
Blog #13 DittoDan's Milestone's, First's And Good Changes Since Starting the Ketogenic Diet Updated0 -
Sunny_Bunny_ wrote: »Either keep the temp basal or skip the bolus you did for the cider.
My daughter has gotten to the point that she rarely does a bolus anymore because meal and snack carbs are so low. The basal seems to take care of it. And she needs to reset a new ratio for bolus at this point because IR has gotten so much better that she over rides the recommended units anyway and only takes about half of it when a bolus is needed.
Hmmmm, I love this group, I learn something everyday. I was an insulin taking type 2 diabetic for over ten years. And I never heard of the term, "basal" or "bolus" (I just googled it, LOL!) I just called them long acting and fast acting insulin. I probably won't remember which is which (kinda like port and starboard)...
Oh well, I haven't taken insulin in over a year and half since being keto... But I still learned something!
Thank you,
Dan the Man from Michigan
Keto / The Recipe Water Fasting / E.A.S.Y. Exercise Program
How I Got Off of Diabetic Prescriptions Drugs Since I Started Keto
Blog #10 Keto: Abbreviations, Acronyms & Terminology Used on the LCD & Keto Updated
Blog #13 DittoDan's Milestone's, First's And Good Changes Since Starting the Ketogenic Diet Updated
Well, I'm going to confuse you even more then because when referencing basal and bolus for insulin pump use, it's all fast acting insulin.
The basal rate is set to deliver a certain amount every hour, drop by drop. And a bolus would be intended to deliver a greater amount to cover a meal, but it's all done with fast acting insulin.
But, when taking injections, the basal is the long acting and bolus is the fast.0 -
Sunny_Bunny_ wrote: »Sunny_Bunny_ wrote: »Either keep the temp basal or skip the bolus you did for the cider.
My daughter has gotten to the point that she rarely does a bolus anymore because meal and snack carbs are so low. The basal seems to take care of it. And she needs to reset a new ratio for bolus at this point because IR has gotten so much better that she over rides the recommended units anyway and only takes about half of it when a bolus is needed.
Hmmmm, I love this group, I learn something everyday. I was an insulin taking type 2 diabetic for over ten years. And I never heard of the term, "basal" or "bolus" (I just googled it, LOL!) I just called them long acting and fast acting insulin. I probably won't remember which is which (kinda like port and starboard)...
Oh well, I haven't taken insulin in over a year and half since being keto... But I still learned something!
Thank you,
Dan the Man from Michigan
Keto / The Recipe Water Fasting / E.A.S.Y. Exercise Program
How I Got Off of Diabetic Prescriptions Drugs Since I Started Keto
Blog #10 Keto: Abbreviations, Acronyms & Terminology Used on the LCD & Keto Updated
Blog #13 DittoDan's Milestone's, First's And Good Changes Since Starting the Ketogenic Diet Updated
Well, I'm going to confuse you even more then because when referencing basal and bolus for insulin pump use, it's all fast acting insulin.
The basal rate is set to deliver a certain amount every hour, drop by drop. And a bolus would be intended to deliver a greater amount to cover a meal, but it's all done with fast acting insulin.
But, when taking injections, the basal is the long acting and bolus is the fast.
Thanks Sunny, that wasn't confusing, different strokes for different folks....
Dan0
