Getting back to exercise!

[The_Bowlii]

Any news on getting the Libre 2 yet @The_Bowlii ? That'll make a big difference in terms of keeping in touch with what your sugar level is doing.

Yep, fitted last Wednesday. It’s almost as if I have too much info now. I wouldn’t have known a fraction of this a week ago. Today post breakfast looks ok but just had big lunch and it’s barely moved. Confused!!

 

[trophywench]

Er, when you say 'big' lunch - exactly what about it was 'big' ? How much of it consisted of carbohydrate, did you eat that first before the protein, fats and vegetables, sauces, gravy etc and make sure you chewed it thoroughly before swallowing it?

Or what?

The thing about chewing the carb actually matters, esp when it's to treat a hypo for the simple reason the body commences its intake of food via the inside of the cheeks, before it is even swallowed - and precisely why full sugar Lucozade used to be an utterly wonderful hypo treatment! - but now nobody is allowed to even taste it. Full sugar squash, or even Robinsons Barley Water were equally brill and even they don't have as much as they used to - so even us flippin really old dogs have all had to learn new tricks, like it or not.

Although people go yada yada about jelly babies - I often think summat that needs chewing properly so it perforce stays in the mouth longer than a JB is better if its being eaten to stave off a low, rather than actually treat a hypo if you see what I mean. So - fruit gums, or I quite like an old fashioned humbug cos you know the soft bit you get to in the middle eventually - well they always take ages to get unstuck from the backs of teeth, don't they? Hence more than enough time to get absorbed! So OK, OK, NBG for the toothymegs Mr Dentist, Sir - but needs must when the Devil drives, is all! and I promise I'll use my trusty electric toothbrush asap after, honest .....

 

[The_Bowlii]

Er, when you say 'big' lunch - exactly what about it was 'big' ? How much of it consisted of carbohydrate, did you eat that first before the protein, fats and vegetables, sauces, gravy etc and make sure you chewed it thoroughly before swallowing it?

Or what?

The thing about chewing the carb actually matters, esp when it's to treat a hypo for the simple reason the body commences its intake of food via the inside of the cheeks, before it is even swallowed - and precisely why full sugar Lucozade used to be an utterly wonderful hypo treatment! - but now nobody is allowed to even taste it. Full sugar squash, or even Robinsons Barley Water were equally brill and even they don't have as much as they used to - so even us flippin really old dogs have all had to learn new tricks, like it or not.

Although people go yada yada about jelly babies - I often think summat that needs chewing properly so it perforce stays in the mouth longer than a JB is better if its being eaten to stave off a low, rather than actually treat a hypo if you see what I mean. So - fruit gums, or I quite like an old fashioned humbug cos you know the soft bit you get to in the middle eventually - well they always take ages to get unstuck from the backs of teeth, don't they? Hence more than enough time to get absorbed! So OK, OK, NBG for the toothymegs Mr Dentist, Sir - but needs must when the Devil drives, is all! and I promise I'll use my trusty electric toothbrush asap after, honest .....

I’ll not criticise your dental habits! 🙂 Big lunch was 200g cooked pasta bake with cheese, veg sauce and sausage (sounds terrible but delicious) plus yogurt, apple, carrot sticks, humous and nuts. Total 70g carbs. My wife says I rush my food so you reckon I should learn to chew more?

 

[SimonP]

@trophywench while I could swallow them whole, I do make sure I have a good (inner!) cheek covering with well chewed jelly babies/skittles before I swallow them, though this does mean I feel I have to go and brush my teeth if it's a night-time low!

@The_Bowlii you seem to have got your insulin spot on and presumably your pancreas is doing something useful to help too. Looks ideal!

Out of interest how much insulin did you take for your 70g carbs at lunchtime?

 

[helli]

while I could swallow them whole, I do make sure I have a good (inner!) cheek covering with well chewed jelly babies/skittles before I swallow them, though this does mean I feel I have to go and brush my teeth if it's a night-time low!

I used to feel that I must clean my teeth if I eat some sugar/dextrose/jb at night.
Then someone pointed out my teeth have no fillings from going a full daytime with 3 meals without cleaning until I go to bed and someone else suggested that teeth cleaning immediately after hypo treatment could "brush" the glucose into your teeth. The best advice seems to be to drink some water to dillute the glucose remaining in your mouth.

 

[The_Bowlii]

@trophywench while I could swallow them whole, I do make sure I have a good (inner!) cheek covering with well chewed jelly babies/skittles before I swallow them, though this does mean I feel I have to go and brush my teeth if it's a night-time low!

@The_Bowlii you seem to have got your insulin spot on and presumably your pancreas is doing something useful to help too. Looks ideal!

Out of interest how much insulin did you take for your 70g carbs at lunchtime?

Morning @SimonP. I took 7 units of insulin for 70g carbs. I use 1:10 for all meals +/- 1 unit for any small correction. This morning however has been a bit concerning. 70g carbs, 8 units insulin, BG rising nicely post porridge and toast and then I went for a gentle 2 mile walk. My sensor stopped working on the walk but was showing just 3 mmol/l when it reconnected. I’ve eaten 5 jelly babies and it’s now stabilising.

Do you find that exercise has a big impact on insulin demand? Should I wait more than 10 mins before doing any exercise? So many questions…

 

[helli]

@Bowlii how do you feel?
I ask because it is possible that your sensor may be reporting incorrectly,
Unless you feel very hypo, it is recommended to always check high or low sensor readings before making a correction. And without knowing if this is a tempermental sensor, it is not possible to comment on what is happening.

 

[The_Bowlii]

@Bowlii how do you feel?
I ask because it is possible that your sensor may be reporting incorrectly,
Unless you feel very hypo, it is recommended to always check high or low sensor readings before making a correction. And without knowing if this is a tempermental sensor, it is not possible to comment on what is happening.

Hi @helli - I feel completely fine. I double checked with a finger prick and it was 3.8 so had definitely dropped from around 8 in the space of 30 mins. If I was still doing the 4 finger pricks a day, I wouldn’t have known I’d gone low and mentally I’d assure myself that I’d eaten a good breakfast so no chance of a hypo. I’m now thinking that I need to wait 30-60 mins for food to digest before exercise to avoid this happening. It’s all trial and error right now!

 

[SimonP]

@The_Bowlii yes, exercise makes insulin much more effective (shopping also does this to me, strange - I try to avoid it!). If I were doing something like that walk I'd halve my morning bolus or potentially take even less than that. It becomes tricky when you want to eat more than say 45min before exercising - you need some bolus to avoid going high, but not so much that you immediately go low when you start exercising - my bolus insulin, Novorapid, lasts somewhere between 3 and 5h, so it will affect BG during exercise for some time - this is why I've recently only been stopping briefly for food (lunch for example) while riding as I don't want to have to take any bolus dose and then go low once I start again - I reckon I can manage about 30min before I need to start riding again to stop the inevitable BG rise after a bacon sarnie.

The other thing to note, is that during exercise your digestion slows down, so you may find that a large breakfast has delayed absorption once you start exercising, which then compounds the problem of how much IoB you have.

70g carbs is probably too much to not bolus for, but I would happily eat a couple of slices of bread and butter for lunch (~40g carbs) and skip the bolus completely if I'm going for an hour's bike loop over my lunch break, and typically have a flat BG profile.

 

[The_Bowlii]

@The_Bowlii yes, exercise makes insulin much more effective (shopping also does this to me, strange - I try to avoid it!). If I were doing something like that walk I'd halve my morning bolus or potentially take even less than that. It becomes tricky when you want to eat more than say 45min before exercising - you need some bolus to avoid going high, but not so much that you immediately go low when you start exercising - my bolus insulin, Novorapid, lasts somewhere between 3 and 5h, so it will affect BG during exercise for some time - this is why I've recently only been stopping briefly for food (lunch for example) while riding as I don't want to have to take any bolus dose and then go low once I start again - I reckon I can manage about 30min before I need to start riding again to stop the inevitable BG rise after a bacon sarnie.

The other thing to note, is that during exercise your digestion slows down, so you may find that a large breakfast has delayed absorption once you start exercising, which then compounds the problem of how much IoB you have.

70g carbs is probably too much to not bolus for, but I would happily eat a couple of slices of bread and butter for lunch (~40g carbs) and skip the bolus completely if I'm going for an hour's bike loop over my lunch break, and typically have a flat BG profile.

Tomorrow morning I’m going to try eating breakfast, dosing 2/3 bolus and then go for a walk. It’s another data point and I’ll carry some glucose tabs with me just in case!

 

[helli]

@The_Bowlii is it possible to eat AFTER exercise?
I find the increased insulin sensitivity due to exercise counteracts the dawn Phenomenon insulin resistance.

 

[The_Bowlii]

@The_Bowlii is it possible to eat AFTER exercise?
I find the increased insulin sensitivity due to exercise counteracts the dawn Phenomenon insulin resistance.

Hi. Yes, I could eat after exercise. Couple of times I’ve played squash in the evening after not having eaten or injected for 5 hours. That was fine and levels quite stable. Did the same with indoor cycling and only lasted 10 mins before levels plummeted. I had to eat quickly then!

If I’m heading out on a 100k bike ride (was my normal Sunday thing), I’m going to have to work that out as not eating isn’t really realistic.

I’ll try a walk with just basal, no food and no fast acting insulin on board as another data point. Tomorrow I’m going to eat as normal, 2/3 bolus and go for a walk to see if that makes any difference.

What’s the dawn phenomenon you mention?

 

[helli]

What’s the dawn phenomenon you mention?

At the start of the day (for some of this could be very early morning), our liver dumps glucose to give us energy to get moving.
This happens regardless of whether we have diabetes or not. But if you have a healthy pancreas, it would respond to the glucose dump with an insulin dump.
Unfortunately, we do not get that insulin so we see a a BG rise.
Some people find the rise is more dominant when they get up. This gets called foot on the floor.
I find my BG will rise until I eat something.

If you search for "Dawn Phenomenon" on the forum, you will see many threads on the topic.

 

[The_Bowlii]

At the start of the day (for some of this could be very early morning), our liver dumps glucose to give us energy to get moving.
This happens regardless of whether we have diabetes or not. But if you have a healthy pancreas, it would respond to the glucose dump with an insulin dump.
Unfortunately, we do not get that insulin so we see a a BG rise.
Some people find the rise is more dominant when they get up. This gets called foot on the floor.
I find my BG will rise until I eat something.

If you search for "Dawn Phenomenon" on the forum, you will see many threads on the topic.

Thanks - I didn’t know that! I always get up, inject (nowadays) and eat a big bowl of porridge within the first 30 minutes so any BG rise would be masked. Wow, another thing to look out for! 🙂

 

[Wendal]

Thanks - I didn’t know that! I always get up, inject (nowadays) and eat a big bowl of porridge within the first 30 minutes so any BG rise would be masked. Wow, another thing to look out for! 🙂

Hi. Yes, I could eat after exercise. Couple of times I’ve played squash in the evening after not having eaten or injected for 5 hours. That was fine and levels quite stable. Did the same with indoor cycling and only lasted 10 mins before levels plummeted. I had to eat quickly then!

If I’m heading out on a 100k bike ride (was my normal Sunday thing), I’m going to have to work that out as not eating isn’t really realistic.

I’ll try a walk with just basal, no food and no fast acting insulin on board as another data point. Tomorrow I’m going to eat as normal, 2/3 bolus and go for a walk to see if that makes any difference.

What’s the dawn phenomenon you mention?

Be very interested to see how you get on as was considering trying that as well.

My levels are very stable overnight although do have a slight DP rise but quite flat through to breakfast.I take my normal 2u of NR with a 30-40g carb breakfast and then as my level rises I go for a walk nothing strenuous and virtually always my level will drop back below 5 before I get back home.
So may try without any bolus and see if my BG stays above the 5/6 level,however I did have half a slice of toast this morning when I got up without bolus and my BG spiked as we are up early with the dogs and I lay back on the sofa for an hour before breakfast.
So moral of story if you are going to miss bolus and trying to control via walking make so sure you go out and not go back to bed

 

[The_Bowlii]

My levels are very stable overnight although do have a slight DP rise but quite flat through to breakfast.I take my normal 2u of NR with a 30-40g carb breakfast and then as my level rises I go for a walk nothing strenuous and virtually always my level will drop back below 5 before I get back home.
So may try without any bolus and see if my BG stays above the 5/6 level,however I did have half a slice of toast this morning when I got up without bolus and my BG spiked as we are up early with the dogs and I lay back on the sofa for an hour before breakfast.
So moral of story if you are going to miss bolus and trying to control via walking make so sure you go out and not go back to bed

I’ll bear that in mind - if I’m going for a walk, make sure I do!! 🙂

 

[The_Bowlii]

I’ll bear that in mind - if I’m going for a walk, make sure I do!! 🙂

Turns out it worked a treat! Reduced bolus by 1/3, swapped berries for a banana and BG spiked within 10 mins but fell very quickly when I started walking. BG been stable all morning, risen post lunch but I’m off to play squash shortly so that gives me some headroom. Every day is a learning day…

 

[The_Bowlii]

Squash this afternoon, not eaten for 4 hours, no IoB so all set. BG at 10 (little high) but down to 6 within 20 mins. Took @helli advice and drank diluted orange juice during the match and remained stable between 5 and 6.

Bizarrely, however, had a large dinner of homemade lamb curry, 1/3 of a naan and rice, about 80g carbs. Took 8 units of insulin as 1:10 ratio as normal but had two low level alarms within an hour of eating.

What have I learnt?
1. Keep up glucose levels through the match with water / OJ mix (thanks @helli)
2. Reduce insulin dose post exercise.

It’s only 10 days since I started exercise again but that’s 4 squash matches, one cycle ride outside and 2 indoor turbo sessions. Not a massive amount but learnt so much. More importantly, the T1D diagnosis isn’t the end of the world and I’m confident I’ll get back to where I want to be.

Thanks all for following the thread and for the encouragement.

 

[SimonP]

I've doubtless said all this before elsewhere, but specifically re your comment about your Sunday ride:

If I’m heading out on a 100k bike ride (was my normal Sunday thing), I’m going to have to work that out as not eating isn’t really realistic.

For a non-stop 100k ride these days I'd knock a couple of units off my morning basal (taking 6 or 7U vs normal 9U), for an 200 (with a stop!) I'd knock it down further (to ~3U). I would probably survive without reducing my basal, but I'd need to eat more in the latter part of the ride for sure - at least 100km is short enough (time-wise) that I could live with that, I think a century or 200 would be pushing my gut's desire to keep eating so much for so long.

For a 100km I don't tend to stop (for proper food/cake/etc), but I do stop on the longer rides to eat proper food part way. If you are stopping I'm sure you'll be fine trying without changing your basal even if you do start to run low on either leg (as you can fix things and eat during the stop).

If I don't stop, I tend to eat ~30g carbs an hour from ~2h onwards (I eat something uncovered when I leave, which tides me over for a couple of hours alongside my liver being helpful), if I do stop and eat something a bit more substantial for lunch (I don't bolus for this at all) I can get away with eating very little on the way back as the uncovered food tends to drive me up into the low teens for a little while - interestingly if I can time it right I don't go too high, but also don't drop away - presumably digestion is matching carb requirements. It's still a work in progress!

I did once try taking some bolus to cover lunch (1/3 normal in this case) on a century ride, I still went high as I was hanging around, and then I needed to eat much more than 60g of carbs an hour on the way back all the while bumping along just above being hypo. I don't see a useful way to take any bolus - I happily burn off my lunch glucose and still usually need to eat eventually even just running on reduced basal, so short stops it is for the time being!

When I first started riding and was upping my distance, I was still taking full basal and my experience of riding ~80km (without a stop as this was during lockdown, aside from me trying to recover from the hills that is), was that I would need to eat incessantly (well that's a bit of an exaggeration, but I'd probably need at least >60g/h - which I now realise is around the "recommended" rate), which meant taking loads of food with me. This was in the early days of my cycling career, so I hadn't got a very good (high density) set of food stuffs to take with me (so it took up lots of space); I wasn't used to eating while exercising for that length of time (so the combo of eating + exercise would eventually make me feel fairly nauseous); and I wasn't as fit/efficient in general. Nowadays I'd not be too bothered about riding 80km with full basal (especially when I'm riding to work so I'm stopping half way and can fix BG if needed) - so you may find you don't suffer too badly as you've obviously been cycling for some time.

In the early days I'd also run low overnight after a ride like that. Once I realised that reducing basal was an option and started doing it, I'd taper my basal back up to normal over a few days to avoid going low overnight. I don't get this effect very much these days (and I now always take my full evening dose after a ride) unless it's a century or longer, and then I just have a bedtime snack and it's flat all night and my dawn phenomenon has vanished the next day (yay, though perhaps a quite extreme method of achieving this result! 🙂)

If it's a long ride I will eat something uncovered as I leave - If it's leaving first thing in the morning then it's anyone's guess whether the (reduced) bolus I take for my dawn phenomenon will adequately cover that or not (usually not, though my last long ride was much improved, and my dawn phenomenon seems to be abating somewhat in general, so the jury is still out). If leaving a bit later in the day (without any/much active bolus IoB left over from breakfast) then I'd probably have 20-30g uncovered as I head out the door depending on BG level.

Sorry for all the repetition.

I trust we'll get a report as to your progress on Sunday evening 🙂

 

[The_Bowlii]

I've doubtless said all this before elsewhere, but specifically re your comment about your Sunday ride:

For a non-stop 100k ride these days I'd knock a couple of units off my morning basal (taking 6 or 7U vs normal 9U), for an 200 (with a stop!) I'd knock it down further (to ~3U). I would probably survive without reducing my basal, but I'd need to eat more in the latter part of the ride for sure - at least 100km is short enough (time-wise) that I could live with that, I think a century or 200 would be pushing my gut's desire to keep eating so much for so long.

For a 100km I don't tend to stop (for proper food/cake/etc), but I do stop on the longer rides to eat proper food part way. If you are stopping I'm sure you'll be fine trying without changing your basal even if you do start to run low on either leg (as you can fix things and eat during the stop).

If I don't stop, I tend to eat ~30g carbs an hour from ~2h onwards (I eat something uncovered when I leave, which tides me over for a couple of hours alongside my liver being helpful), if I do stop and eat something a bit more substantial for lunch (I don't bolus for this at all) I can get away with eating very little on the way back as the uncovered food tends to drive me up into the low teens for a little while - interestingly if I can time it right I don't go too high, but also don't drop away - presumably digestion is matching carb requirements. It's still a work in progress!

I did once try taking some bolus to cover lunch (1/3 normal in this case) on a century ride, I still went high as I was hanging around, and then I needed to eat much more than 60g of carbs an hour on the way back all the while bumping along just above being hypo. I don't see a useful way to take any bolus - I happily burn off my lunch glucose and still usually need to eat eventually even just running on reduced basal, so short stops it is for the time being!

When I first started riding and was upping my distance, I was still taking full basal and my experience of riding ~80km (without a stop as this was during lockdown, aside from me trying to recover from the hills that is), was that I would need to eat incessantly (well that's a bit of an exaggeration, but I'd probably need at least >60g/h - which I now realise is around the "recommended" rate), which meant taking loads of food with me. This was in the early days of my cycling career, so I hadn't got a very good (high density) set of food stuffs to take with me (so it took up lots of space); I wasn't used to eating while exercising for that length of time (so the combo of eating + exercise would eventually make me feel fairly nauseous); and I wasn't as fit/efficient in general. Nowadays I'd not be too bothered about riding 80km with full basal (especially when I'm riding to work so I'm stopping half way and can fix BG if needed) - so you may find you don't suffer too badly as you've obviously been cycling for some time.

In the early days I'd also run low overnight after a ride like that. Once I realised that reducing basal was an option and started doing it, I'd taper my basal back up to normal over a few days to avoid going low overnight. I don't get this effect very much these days (and I now always take my full evening dose after a ride) unless it's a century or longer, and then I just have a bedtime snack and it's flat all night and my dawn phenomenon has vanished the next day (yay, though perhaps a quite extreme method of achieving this result! 🙂)

If it's a long ride I will eat something uncovered as I leave - If it's leaving first thing in the morning then it's anyone's guess whether the (reduced) bolus I take for my dawn phenomenon will adequately cover that or not (usually not, though my last long ride was much improved, and my dawn phenomenon seems to be abating somewhat in general, so the jury is still out). If leaving a bit later in the day (without any/much active bolus IoB left over from breakfast) then I'd probably have 20-30g uncovered as I head out the door depending on BG level.

Sorry for all the repetition.

I trust we'll get a report as to your progress on Sunday evening 🙂

Looking at the weather, it might be an indoor turbo session! Will keep you posted.