T1 Diabetes and Running

[helli]

23 minutes is quite quick for my advanced age, so plenty of stress hormones which will always raise BG.

If you do this every weekend, I am surprised you are stressed regardless of your age.
You mentioned previously that you do not eat before running. Does your BG rise on a non-run day and have you tried a similar run later in the day to discount Dawn Phenomenon/Foot on the Floor as a contributor to the rise?
And have you tried pre-empting the rise with a pre-run bolus as suggested?

Running does not cause my BG to rise but other exercise such as climbing does. By pre-empting the rise with extra insulin, I have been able to improve my climbing endurance and grade. If you are able to manage your BG rise with the Park Run you may be able to improve upon your time.
I have assumed this is something you would want as your BG rise is something you have mentioned multiple times.
Forgive my badgering if you are just repeating an observation.

 

[SimonP]

I'm assuming that like me (when I ride) these stress hormones are not related to fear or excitement (like they might be when embarking on something you don't often do - I get these too, but not when riding to work 😉) but rather to do with what "zone" you're running/riding in, i.e. how hard the effort is.

It very much depends on how much/often aerobic exercise is undertaken as to whether aerobic adaptations continue to be accumulated. It's quite easy to get stuck on a plateau (cycling) unless much harder efforts are introduced and/or volume is increased. Even then at some point a limit will be reached beyond which it's not realistically possible to improve. If there's no upward movement of aerobic adaptations then achieving a given time (or other metric) will continue to be as hard as it was the last time.

And just to remind us all of the good news, as one gets older there's a general decrease in aerobic capacity. Though this is fine as I'm still only 21 (it has been quite a few years now though and my children are rapidly catching me up.... ))

 

[Inka]

As you’ve only recently been diagnosed I find it strange that they consider you too well for a pump in such a short space of time.
Curious that Runsweet say don’t use a pump. Is there a particular article you can link to on their site about that. There are many athletes who wear pumps.

This says to me your diabetes control is not well. Or were your diabetes team referring to your general health? How long had you eaten prior to the this run? If a while then it may be worth trying a unit of bolus insulin before running. Making sure you have easy access to some kind of glucose in case you get a sudden drop in BG either during the race or shortly afterwards. And that’s another question, as you finished at 13.2 did your BG start to drop after the run, stay fairly static or continue to rise? Or did you take more bolus?

Sorry about all this questions.

This thread seems to have got a bit muddled - well, it’s confused me anyway 🙂 The OP started it asking about running shortly after being diagnosed with Type 1 and having DKA, but then it seems to have morphed into the Parkrun thread or one of the other running ones from long-term Type 1s.

How are things going @ajr9393 ? I hope you’re slowly feeling more yourself now you’re on insulin.

 

[ajr9393]

This thread seems to have got a bit muddled - well, it’s confused me anyway 🙂 The OP started it asking about running shortly after being diagnosed with Type 1 and having DKA, but then it seems to have morphed into the Parkrun thread or one of the other running ones from long-term Type 1s.

How are things going @ajr9393 ? I hope you’re slowly feeling more yourself now you’re on insulin.

Morning @Inka

Being honest I am struggling - I am pushing to get a carb counting course asap as think this will really help.

At the moment I’m on a fixed protocol based on my blood glucose and that’s causing mayhem as if sugars are high over 16 then I give 7units novarapid and that is causing me to hypo around 1hr after the meal! I’m calling my diabetes team today as this has happened 2 days in a row after dinner and it’s unmanageable! I’m trying to put my boy to bed whilst treating a hypo!

I haven’t run since my first one mentioned in this post as the afternoon of the run I came down with norovirus that my 21month old son had… this was fun to say the least

Day to day I’m just trying to get myself stable for walking with my boy a lot!

Overall I’m feeling so much better now I have insulin, so can’t complain about that. Just need to get my rapid insulin amounts right.

They upped my lantus to 14 units and this has helped with rising overnight sugars

Guess I just need to give myself time, unfortunately I want to have solved it yesterday and the lack of control is driving me bonkers!

I will get running again, just maybe not just yet

 

[Inka]

Oh, no @ajr9393 ! Norovirus is an absolute pain with Type 1! I hope you recover quickly. Keep an eye on your ketones as stomach bugs can increase them.

Fixed doses of meal insulin (bolus) only work if a person eats the same amount of carbs for each meal and, of course, that’s not what most people do! It sounds like your Lantus (basal) dose is still being sorted. It’s important to get that right as that’s the foundation on which you build. If the basal dose is wrong, it’s harder to get your bolus/fast/meal doses right.

I wouldn’t wait for a carb counting course. You can do it without that (when you’re feeling well). Look at what you’re eating and start weighing and counting the carbs. Weigh things like cereal and check packaging for things like bread and pasta. Milk needs to be measured in a little jug. You’ll then start seeing how much insulin you need for different meals.

There’s an online course you can do called BERTIE, which is similar to the carb counting course you’re doing:

Bertie Diabetes

.

 

[ajr9393]

Oh, no @ajr9393 ! Norovirus is an absolute pain with Type 1! I hope you recover quickly. Keep an eye on your ketones as stomach bugs can increase them.

Fixed doses of meal insulin (bolus) only work if a person eats the same amount of carbs for each meal and, of course, that’s not what most people do! It sounds like your Lantus (basal) dose is still being sorted. It’s important to get that right as that’s the foundation on which you build. If the basal dose is wrong, it’s harder to get your bolus/fast/meal doses right.

I wouldn’t wait for a carb counting course. You can do it without that (when you’re feeling well). Look at what you’re eating and start weighing and counting the carbs. Weigh things like cereal and check packaging for things like bread and pasta. Milk needs to be measured in a little jug. You’ll then start seeing how much insulin you need for different meals.

There’s an online course you can do called BERTIE, which is similar to the carb counting course you’re doing:

Bertie Diabetes

.

Luckily the norovirus has passed, was only a couple of days about a week ago! I was hyper alert to my ketones as having experienced DKA I wasn’t going back to that horrible dark place!

I have been looking at carbs and thinking about changing doses myself it’s just having the courage! But I do completely agree these set doses are not helping me! And the swing of high to low is mad - I have to remember this is still all so new as still only 4 weeks in!

I’ll take a look at that course

 

[counsellorneil]

At the moment I’m on a fixed protocol based on my blood glucose and that’s causing mayhem as if sugars are high over 16 then I give 7units novarapid and that is causing me to hypo around 1hr after the meal! I’m calling my diabetes team today as this has happened 2 days in a row after dinner and it’s unmanageable!

As @Inka has mentioned counting the carbs you’re eating will be a great help, in figuring out how much nova rapid to take. If you’re going low an hour after taking 7 units when over 16, it might be worth taking 6 units next time, to see what happens. Or maybe 6.5, if your pen has enough gradations.

Guess I just need to give myself time, unfortunately I want to have solved it yesterday and the lack of control is driving me bonkers!

I can vaguely remember the frustration after diagnosis and trying to get everything balanced. Over 44 years ago now. Unfortunately it can take time, but it is doable. Part of the frustration I remember is making a change in bolus or basal rates and then having to wait a couple of days to see the results and then perhaps needing to make further adjustments. In time it will mostly settle down and you’ll develop confidence in making small adjustments yourself without needing input from your diabetes team.

Do you have easy access to any members of your team? I’ve got the phone number and email address of mine, which I’ll use rather than waiting for my yearly appointment either to ask a question or update them about any changes I may have made.

I will get running again, just maybe not just yet

Yes, you will get running again. Keep us updated with your progress. Take care.

 

[JonathanGi]

First competitive run of the year on Sunday.
Only a 10k so lack of winter miles won't be an issue - I might be running in k's but my legs can only think in miles.
I expect to start low and finish high as usual.

 

[ajr9393]

First competitive run of the year on Sunday.
Only a 10k so lack of winter miles won't be an issue - I might be running in k's but my legs can only think in miles.
I expect to start low and finish high as usual.

I was meant to be doing Worthing RUNFEST 10km this weekend , but having only been diagnosed 6 weeks ago I’m still not sorted with my running yet.

I have dietician on 09/05, hoping that I’ll gain some confidence from them about exercise.

This week I did an online carb counting course and seem to have worked out my carb ratio and correction dose and things have been a lot less high/low rollercoaster but I just don’t want to speak to soon!

Good luck with your race!

 

[SimonP]

I have dietician on 09/05, hoping that I’ll gain some confidence from them about exercise.

Hmm..... I don't think I'd get your hopes up, there are very few in the medical profession who have much of an idea about exercise + diabetes. I guess for the majority of the population (including diabetics) there's not very much real exercise they do.

I would instead suggest you go to this (which I attended a couple of years back and thought was very interesting - both the course materials, and talking to other diabetics who do exercise to hear what approaches they take): https://www.diabetes-nnf.co.uk/events/extod-adults-with-type-1-diabetes-conference-0

 

[JonathanGi]

The thinking hasn't changed much - that is, exercise, of any description, will put your blood sugar down. But, for me it's far more complicated. Short, quick run will always put my blood sugar up.I would count a 10k as short and quick, as in less than 50 minutes. Even a half marathon I don't usually change the amount of insulin I have or need to eat anything.
However, anything more than 50 miles on the bike puts my blood sugar down. Long walk will do the same.
We are all very individual and you will learn what works for you.

 

[SimonP]

The thinking hasn't changed much - that is, exercise, of any description, will put your blood sugar down. But, for me it's far more complicated. Short, quick run will always put my blood sugar up.I would count a 10k as short and quick, as in less than 50 minutes. Even a half marathon I don't usually change the amount of insulin I have or need to eat anything.
However, anything more than 50 miles on the bike puts my blood sugar down. Long walk will do the same.
We are all very individual and you will learn what works for you.

Yes, and I think that's a reasonable assumption (if we're boiling things down to the simplest possible message, which appears to be the general approach in comms from the medical profession), and it probably works for the majority who don't do anything more intense than walking somewhere.

However, the EXTOD training for clinicians (and the bit for diabetics - they run courses for both) does completely accept that "hard"/stressful exercise will raise blood glucose. In fact they explicitly say that if you're doing something "easy" and start going low, doing something harder can be used to raise BG temporarily. e.g. walking, do a sprint. I imagine worrying about the fact you're going low also helps on the hepatic front there too!

While I agree that we are all individual and different, the underlying processes are IMO the same:

"Hard" exercise will put blood sugar up, as will nerves, for as long as the liver has glycogen available. Both are due to the liver converting glycogen to glucose due to stress hormones. What is "hard" depends on the person (and changes as they adapt to exercise), as does how much one suffers from "pre-match/event" nerves/excitement. Even when maintaining "hard" exercise, the liver eventually dials back how much glucose it produces (which may be to do with how much glycogen it has left, or it may be that the body adapts to the stress hormones, or it may be that we produce fewer stress hormones after the initial hour or so - I don't know, it would be interesting to see if anyone has published on this) and then you start to go low assuming you have enough (i.e. usual) basal insulin on board.

If you start with low intensity exercise you don't get much/any help from the liver (low stress hormone release), so you skip the initial part and start to go low immediately. How low you go (or rather how fast you go low) depends on the person, and is probably due to muscle adaptation to a given activity and fat burning ability as well as how much energy the activity requires.

Going back to the point about doing something "hard" to raise BG, this only works if you've not already depleted your liver - i.e. it doesn't seem to have much of an effect after 8h (same questions as above though - is this due to insufficient glycogen, fewer stress hormones being produced for a given level of "hard", or the liver moving to a higher stress hormone threshold requirement before it will produce glucose, I don't know.)

I'm quite confident that despite the reported wide differences in BG response to exercise, we all operate along this continuum, it's just a question of working out where and therefore what needs to be done to make exercise as easy as possible.

 

[JonathanGi]

As predicted, BG started at 5.6 and I finished 46.01 later at 12.8. After finishing I had 2 further units of NovoRapid. Usual basal of 6.5 with 2 units of bolus. 1 Weetabix for breakfast. Nothing else to eat until lunch.

 

[helli]

As predicted, BG started at 5.6 and I finished 46.01 later at 12.8.

If you know running PREDICTABLY causes a liver dump, why don’t you pre-empt it with a bolus for the rise?

 

[JonathanGi]

I do.

 

[helli]

I do.

Sounds like you need a higher pre-emotive bolus if you are “predictably” hitting 12.8 during a run.

By the way, when responding to a comment, it helps to use the Reply button. Then your response is in context (especially, if someone else adds a comment in between), and the person posing the question is more likely to see it.

 

[silver minion]

@ajr9393 as others have said I would give yourself a few weeks of rest.

As with most things with diabetes it is trial and error. It is best to keep trying and giving it ago until you work it out.

It will be still possible to have an active life with exercise as you did before it will just take some time to work out how it works for your body now. You will find our what works for you.

It's been a few years since I ran but I did do it 3/4 times a week at one point. One thing I learnt is for me it is about what level I start at when I go out. If lower than 5.5 I would need some glucose / a snack otherwise I would go low.

I would say have a few weeks rest, speak with your medical team, and then give it another go. Eat what is a steady meal for you that you know keeps you level and then go out. I always found morning the worst time personally for a run due to the old liver dump. Even now I prefer after breakfast with some carbs and fast acting insulin.

Give yourself time, patience and some space for learning. You can do this, will just take some tweaking.

I always thought I had been told don't exercise at 13 or over, but actually DAFNE advise is 15, based on the below, from a recent DAFNE course I attended in Dec 2024. It also then talks about reducing background insulin for the type and duration of exercise.

When to delay your exercise

• If you have had a severe hypo in the last 24 hours (your liver and muscle stores of glucose will be reduced).
• If your Glucose is more than 15.0 mmol/L before the exercise and your blood ketones are 1.5 mmol/L. Follow illness and sick day rules if you have a positive ketone check.

Note: The presence of ketones indicates that the amount of insulin you have on board is low; exercising in this condition will increase your risk of developing diabetic ketoacidosis (DKA). Wait until your Glucose is less than 15.0 mmol/L and your ketones are negative before exercising.

Really good advice. I have done a screenshot of the chart. I take gliclazide rather than insulin but the information is really helpful as I am increasing my exercise levels .Thank you @PhoebeC