Changing Insulin needs with Exercise

forestplay

One of my friends just asked me how I am adjusting my meds with my vigorous exercise. It's been a learning process as my exercise has gone from almost zero (weekend warrior about 2 weekends a month) to exercising an hour or more every day.

Please follow up on this thread with questions and suggestions on what has worked for you.

I started exercising regularly last fall. Previously it was just occasionally hikes and bike rides. Last Autumn I was challenged by some of my co-workers to join them in commuting by bike to work. As soon as I started, I began feeling great, having more energy, etc. All the stuff they till you will happen when someone start exercising regularly.

At first, I was getting low almost every time I exercised. This was because my basal and bolus rates we set for a more sedentary lifestyle. Both has to be adjusted to lower levels. I made multiple small adjustments on my own and with the advice of my doctor.

At the same time, I had to figure out how to adjust for the exercise at hand. I don't exercise at exactly the same time every day. Sometimes I run at lunch hour. Sometimes I bike commute to and from work (morning and afternoon exercise), sometimes I swim in the evening after dinner. Weekends are completely different than what I am doing during the week. It's crazy!

Here's what I've come to find is working for me:
Keep my basal rate constant regardless of exercise.
Eat a meal with at least 35 carbs and protein 20-30 minutes before exercise.
Bolus about 10% of normal.
Make sure I am >160 before starting exercise.

This works for vigorous exercise of an hour or less. Longer exercise means I have to test and possible eat a fast acting carb (glucose tabs, gel, or similar).

This -mostly- works. I still experience lows and always needs adjustments.

Any thoughts? What works for you?

-Bob

kimosabe1

I was on the pump but no longer am because my diabetic doctor adjusted my levels to where I experienced a diabetic coma from low blood sugar. That was hell..... I am now on shots and every afternoon before exercise and before that I eat a fiber one bar that has 30 carbohydrate grams. I am usually on the treadmill 60-70 minutes and test my glucose after getting off of the treadmill and most likely be at 120, which is perfect according to my endocrinologist.......

vickicutshall

Hi Bob,
Do I understand on your "Bolus about 10 percent of normal" that if you would usually use, say 3.0 units to cover a meal, you would only use 0.3 units to cover that pre-exercise food? Just curious if I understand. You also mentioned you don't change your basals and I'm wondering if yours are pretty low to begin with, so even adjusting it would be pretty tiny amounts. If I understand, sounds like you just exercise off of your snack and add carbs if needed for longer duration. Is that about right? Also, on blood glucose >160 mg/dl, could you be as high as, say 250 mg/dl, or do you try to stay under 200 mg/dl? What would be a good range for you? We've all gotten advice about whether and when to exercise if blood glucose is elevated, but we also know it has to be higher than our target or we crash. Sounds like you've got it figured!

You are my exercise hero, so learning through you as I prepare to head into the mountains. I'm just past the reduction in basals stage and have been reducing carbs while staying moderately active with daily walking in the morning. It's diabetes camp time of year so I'm packing and preparing supplies every evening and that seems to be burning calories too. But, in 2 weeks, it will be hiking, swimming, biking and I suspect that will be a huge catalyst to the next stage for me. We're also 5,000 feet higher than at home, so takes me a day or two to adjust to the elevation change! I've heard diabetes is affected by elevation, but still looking the physiology up on that one. Might just be extreme sports and heights.

I always wonder if we can adjust back our basal so we don't have to eat to exercise. But as you point out, you can eat whenever you want to, while adjusting the basal takes a good deal of planning and timing well in advance of the actual exercise--assuming it all happens as scheduled.

I was talking with some of my colleagues about "planned" versus "unplanned" exercise for Type 1 folks. It's tricky when friends all decide to hop on the bikes and I'm at the lowest BG of the day (late afternoon), so I'm thinking again that you've got the recipe by adding judicious carbs and protein and then just being prepared to keep topping that off if the activity is longer.

Am I getting that right?
Thanks for sharing!
Vicki

OhThatBlonde

Bump ... for follow up as I begin adding exercise back into my life after my late Type I diagnosis and "new to insulin" adjustments to my life.
thank you

Amber82479

Bump! Will respond tomorrow