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MyFitnessPal Community

Newbie to mfp

rmason12

Hey everyone,

Have found this group so thought i would introduce myself. I have had type 1 diabetes for 11 years and 2 months ago went onto a medtronic veo pump. Was really excited as thought it would mean better control overall, less highs and lows but I feel quite stuck with it really as my sugars are not in target so a bit disappointing. Finding it hard to get the right temp basal for exercise too, have been reducing it to 50% but then still having lows but then other days it seems a bit high afterwards! Anyway, feel free to add me, would be great to meet other type 1s.

Rachel

Replies

KristaTellier

Hi and welcome! I'm going to copy & paste a response (see below) that I offered to another poster. You may (or may not!) find some of the things I've listed helpful. Diabetes and exercise can be a real challenge - my biggest suggestion would be not to give up. It takes time, but I'm confident you'll be able to figure more things out the more time and effort you put into it (annoying, but well worth the restuls). Good luck!

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One of the things that I've learned is there is a direct link between my heart rate (HR) and my blood sugars. BRIEF EXAMPLE: Lets say I do a 30 min cardio workout, here is (very generally) what will happen depending on where my HR is at...

HR 120-140 = pretty quick fall in blood sugars
HR 140-155 = blood sugars will stay the same (maybe drop a little the closer I am to the lower HR of this range)
HR 155+ = blood sugars will rise

A couple of years ago I was able to get this down to a science for my body. It was really amazing. I was able to decrease a lot of lows and frustrations when it came to working out by figuring this out. However, it does take a lot of work (comparing HR's and blood sugars multiple times pre, during, and post workout... I was doing 15-20 blood sugar checks a day at the start ). Things have changed a little over the last couple of years (my weight, insulin requirements, age, etc.) and I haven't kept up with making adjustments as well as I could, so I don't know the *exact* correlations any more. But, I still am able to use general guidelines to help me. For example: If my blood sugars are lower at the start of a workout than I would like... I have the option of working extra-hard and making sure my HR is kept at a high level. If I do this, I know my chances of dropping too low are reduced. If my blood sugars are a bit higher than my ideal starting point, I have the option of doing a less-intense workout knowing it will help bring down my blood sugars faster - which means I may not need to take a correction bolus/shot. SIDE NOTE: When I was a kid I remember coming to the conclusion that different activities would impact my blood sugars differently. For example: When I swam I would go low during the activity, and then about 8 hours later. When I played basketball for fun I would drop during the activity. When I played basketball competitively, my blood sugars would rise. At the time I never considered HR, but looking back I'm thinking it was probably a big component of that equation.

The other thing I TRY and do (obviously doesn't always work out this way) is to plan meals/snacks around my activities (or vice versa). Starting a workout 30-45 mins after a meal or snack that I would have anyway has been helpful because I consume less calories overall. I won't take as much/any insulin for the food, and the exercise I do soon after seems to do the job of what the insulin would have. This means I don't need to eat any extra food just because I want to workout. But, this isn't always possible, as we all know!

The one other thing I have found (and am still learning) is that if I do take insulin directly before a workout, it seems to go about 3x's the distance! So... if I was to have a meal and then planned to workout, I might still want to take some insulin to cover the food since I know my exercise won't cover all of it. I then need to take some insulin. I learned that, for me, I need to cut the amount of insulin down quite a bit for it to cover the carbs that I want (and not more)... if I'm following it immediately by exercise (no matter what HR range my workout is in).

These are some things that have helped me. I don't know many T1s, so I'm not sure if the above strategies work for more than just me (diabetes is so fickle). But, they might be some strategies to consider if you haven't already.

Please continue to post anything else that works (or doesn't work) for you... I'm always looking for ways to improve (and decrease the Diabetes frustration

).

A little about me:
Diagnosed at age 10, have had T1 for 25 years
Have been on the pump for 15 years (or more maybe?)
A1c is usually in the 6's (not nearly this low in my teens & early 20's) - my goal is to hit a 5.something at some point in my life

Lauramcelroy

Krista, so interesting to see your post! I have discovered the same thing with HR, however mine is the opposite of yours! Perhaps because you sound like you're an athlete and I am re-entering fitness. When my HR won't recover I know my BS is low, but not as predictable as yours. I am "brittle" so I drop on a dime anyway... I was a 5 during all my pregnancies! During my teens I was usually an 11, I don't know how I survived high school

Welcome Rachel,

I'm new to MFP too! I have the same issues that you do with the pump and exercise. Has your doctor worked with you doing various testing of basal and bolus rates? This helped me quite a bit, but like you, dropping down to the temp of 50% I still have a low every time I workout. I agree with Krista to try and plan a meal around working out, this has helped occasionally for me. Are you giving yourself 3 hours of temp rate? One hour before, one hour of work out and one hour after? I have had success with this, but often don't know exactly what time I am working out, and to be able to plan out 3 hours doesn't happen very often for me. If you can, you should try it

MegRenzelmann

Hello There!

Feel free to add me

I have had T1 since I was 9 years old - played sports all through high school and still work out, play vollyeball/softball (and coach high school volleyball) at least 5 times a week. I just recently switched to a Medtronic insulin pump about a year ago a love it! I do get occasional lows after/during working out, but what works for me is that I take my pump completely off during workouts and then usually set it to 70% for the entire night after I have a hard workout (for example, I try to run about 5 miles three times a week - this is considered a hard workout day). If I eat a low carb dinner that day as well sometimes I won't even take insulin with that dinner as the workouts seem to cover it.

Don't let it frustrate you - it takes a bit to figure what works best but once you get there you will love it! My last A1C was in the 6's - it has been FOREVER since I was at this level!

Good luck on your journey and welcome to MFP!

KristaTellier

Krista, so interesting to see your post! I have discovered the same thing with HR, however mine is the opposite of yours! Perhaps because you sound like you're an athlete and I am re-entering fitness. When my HR won't recover I know my BS is low, but not as predictable as yours. I am "brittle" so I drop on a dime anyway... I was a 5 during all my pregnancies! During my teens I was usually an 11, I don't know how I survived high school

Hi Lauramcelroy, you just made my day by saying it sounds like I'm an athlete!!

I'm not at all... but that is my secret (and now not so secret) dream goal (well, I have not desire to compete - but to have some of the physical capabilities of an athlete is a dream goal!). I think you did hit on something when talking about someone who has regular activity, vs. someone who is just starting out (or re-entering). If I need to take a few weeks off because I'm sick or something, and then I go back to the gym/running/etc... my blood sugars won't behave the same way they did before I took the break. It will take a few weeks for things to settle back to normal. And during that readjustment time, I tend to drop even more than usual. Welcome to MFP and I hope things go well!

Wolf843

Hey Guys,

I am also new to the group (but have been using MFP for some time). I have had type I diabetes since I was 18 months old and I am currently an Endocrinology fellow and thought I could add a little of the science behind some of the fluctuations in your blood glucose levels you have been describing.

Insulin receptors are stored within muscle and fat cells, so as we use our muscles when we exercise and use our intramuscular glycogen stores (stored glucose for quick energy) the cells move the insulin receptors to the surface to help move more glucose from the blood into the cell for use. Depending on how hard you use your muscles dictates how quickly you use up your glycogen stores. (Heart rate is a good indicator of how metabolically active your muscles are being-the harder your muscles work, the more oxygen and nutrients they need, the faster your heart rate is to help deliver them). The increase in surface insulin receptors is typically about 2 hours, however studies have shown the increase in insulin sensitivity can last up to 16 hours post exercise.

Of course itâ€™s not quite that simple, because the liver is the largest source of glycogen stores in the body, and also plays a huge role in blood glucose levels. So as blood glucose levels drop (from muscle cells using it up) glycogen is broken down into glucose in the liver and it is released back into the blood. Once you use up all your glycogen in your body you need to consume more sugar to raise your blood glucose levels. Which is why some people â€˜carbo loadâ€™ before a big athletic event to help maximally restore their glycogen stores.

Your resulting blood glucose level is a product of a complex interplay between several factors:

1. Amount active insulin in your body - which also depends on if you use different formulations of SubQ insulin injections or an insulin pump

2. Amount of exercise/activity you performed â€“ which can affect the amount of insulin receptors present and the amount of glycogen used.

3. How physically fit you are â€“ if you exercise frequently your body adapts and becomes more efficient in how it uses its resources such as glycogen/glucose and oxygen (which can help stabilize blood glucose levels)

4. Any other medical conditions â€“ such as liver dysfunction.

KristaTellier

Hi Wold843, thanks for adding to this discussion topic! I have a question regarding....

3. How physically fit you are â€“ if you exercise frequently your body adapts and becomes more efficient in how it uses its resources such as glycogen/glucose and oxygen (which can help stabilize blood glucose levels)

Do you know how long it takes a typical person to adjust to changes? This may be way too detailed of a question and really depend on each person (as so much of diabetes seems to), but figured I'd ask just in case! An example: I do some kind of physical activity every day, and although it might be different activities to me, it is probably pretty typical for my body (i.e. 30 - 60 mins of cardio in a specific HR range is seen as expected and typical for my body, even though the actual cardio activity I'm doing might differ). How many days in a row would I need to NOT do this, for my body then to need to re-adapt when I go back to doing this regular routine again? Obviously I'm looking for an approx. guess or range - I wouldn't expect anyone to know an exact number for my specific body

. If I was to take up to 3 days off should things approx. be the same? up to 5 days? up to 7 days? If this was something we had some guidelines on, I know I'd find it helpful. I haven't really evaluated this with myself before. I know if I skip a day from what I would usually do, everything works typically the same with my blood sugars the following day when I go back into my routine. BUT... if I've been off for a "little while" beause I've been sick, once I go back to the exercise, I'll be extra sensitive and seem to drop faster/further. I just have never thought to take a closer look at where the threshold is (1 day off is ok? 2 days? 3 days? After what point is my body no longer use to the set activity and needs to have a readjustment period back into it?).

Very interesting! Any additional insights you might be able to provide related to this point would be helpful (either from a medical standpoint, or your own personal exerpeinces). In the meantime, when I take breaks from exercise routines moving forward this is something I'm going to try and pay a lot closer attention to. Thank-you! Helpful!

Wolf843

Hey, Krista!

That is for sure a tough question! Most of the studies looking at this found the changes occurred between 3-6 weeks of training(that is they could measure changes in the muscle proteins and signaling pathways that aid in increased insulin sensitivity). However, it appears that these changes usually only last for about 48hours. So, while taking 1-2 days off shouldn't make any noticeable difference, you may start to see some of that extra sensitivity after 3 days off. But of course, like you said, everyone is a little different

KristaTellier

Hey, Krista!

That is for sure a tough question! Most of the studies looking at this found the changes occurred between 3-6 weeks of training(that is they could measure changes in the muscle proteins and signaling pathways that aid in increased insulin sensitivity). However, it appears that these changes usually only last for about 48hours. So, while taking 1-2 days off shouldn't make any noticeable difference, you may start to see some of that extra sensitivity after 3 days off. But of course, like you said, everyone is a little different

Interesting! Thank-you. This is absolutely something I'm going to keep an eye on with myself...

lizzielou67

Hi Rachel

I'm a Type 1 and have been for 38 years. I went on an Animas pump about 3 or 4 years ago due to my constant way too low blood sugars and no sense of them happening. I'm an odd ball for my endo and she actually wants me to keep my blood sugar a bit higher than normal (like 130 or so at fasting) and my A1c no lower than 7. I've been in the 6 range for the last couple of years and she's trying to get me up higher! Not the usual for most diabetics.

One thing I can tell you is that a pump takes a lot of work to get "right." You've been on for 2 months right? I hope that you and your diabetes team are working constantly at readjusting and testing your settings. You'll get to the "sweet spot" eventually but it takes a ton of work at the start. I was lucky that my endo and the nurse I work with are both pump wearing diabetics. We got my setting spot on in less than 2 weeks. Again, I'm the unusual one!! HA!

As for exercise . . . we are all so different. My endo suggested to me when I started by "healthy" life in January that I should lower my basal 50% for 2 hours before, during, and 2 hours after exercise (so basically 5 or 6 hours depending on the length of the workout). This did NOT work for me!! I had all sorts of highs when I did that. So, I just leave my pump on and leave all the settings as is when I work out. I just make darn sure that I do NOT exercise when my sugar is below 100 and when it's around 200 or higher. I still get strange lows here and there and an occasional strange high (for me that's around 150 or so). I don't worry too much about the 150s but the lows are a major problem. I have discovered however that I need a lot less insulin. I've lowered my basal rates quite a bit since January and my insulin to carb ratios as well. I like that. It will me lose weight as I'm taking less of a fat storing hormone. :-)

I do test right before a workout, right after, at dinner (we always eat after a workout), and then again before bed. Aslo occasionally in between if I'm not sure what's going on.

Welcome to MFP!!