Exercise Advice

[Spunky]

Hi. I have started going to the gym every other day to improve my fitness and movement following a stroke.
I have what some people on here describe as an odd insulin routine that the Diabetic Clinic set up for me at Addenbrookes hospital in Cambridge - which is two separate injections of Touejo - glargine in the AM and PM (72 and 63).

What I am finding is in the hours following my exercise my sugars keep dropping low - I expected them to fall during and shortly after but this is more long term - I sometimes find by the end of my exercise I need to top up my sugar - which I do - but then a couple of hours later it crashes again. I am tending to exercise in the morning so I am thinking I should lower the morning dose on days when I exercise.

I have a CGM that I self fund and so I am aware of the drops - but I am new to exercising so is delayed drop usual?

MY 90 day average (since my stoke) is 7.5mmol/L but since I joined a gym a week and a half ago I have dropped the last 14 day average to 6.9 but I have had occasions of sugars in the 3.2 - 3.9 range.

Your thoughts would be appreciated.

 

[Bruce Stephens]

but I am new to exercising so is delayed drop usual?

Yes, completely normal. Depending on the details some people find it's lower for that night or even the next day. (This is people with Type 1 but I don't think it's surprising you find it too.)

It's certainly worth mentioning it to your team and perhaps they can suggest some things to try.

 

[rebrascora]

Exercise can continue to lower your BG for up to 48hours afterwards. I find it is my night time levels which drop quite drastically after exercise and I need to reduce my evening Levemir dose, but I am not sure that Toujeo is as responsive as Levemir. If I do exercise consecutive days, I need to continue to reduce my evening Levemir. Once I get down to zero (I currently just need 4 or 5 units at night) I then need to start reducing my daytime dose if I continue with my exercise regime. That is just me though and how my body works, you need to figure out a strategy that works for your body, but I would be surprised if it didn't involve reducing your insulin dose(s).
Good that you have Libre to help keep you safe.

 

[Spunky]

Good that you have Libre to help keep you safe.

I actually have Dexcom - although a bit more expensive I find it more accurate and never have any issues with it coming loose / off.

 

[Spunky]

Continuing on from my post yesterday I decided to try a little experiment.....

After struggling yesterday evening to keep my sugar level up and probably then consuming too much sugar to compensate I woke this morning with a reading of 8.4. I didn't take my insulin (still took my 850mg Metformin) - had a small bowl of porridge for breakfast with a tea spoon of sugar (08:00) and went to the gym. I did 50 minutes of cardio and about 30 minutes of weights and motions to improve my left arm strength. At 11:00 when I had finished at the gym my BG was 4.9 so I decided to have an early lunch - had a ham and cheese toastie - waited till my BG was back over 5 before driving and went to the shops - by 12 my BG was back to 4.2. I took 2 glucose tablets and came home. Its now 17:50 and my sugar levels are still at 5 (have been between 4-5 since I've been home) despite me eating some chicken with satay dip, an apple with some peanut butter, a croissant and half a kinder beuno bar.

I'm kind of nervous that I don't want to repeat last night of taking my normal insulin dose and Metformin and then fighting all evening to keep my levels from dropping too low.

Exercise is a new thing for me - as is controlling my sugar levels as a result - I'm just interested in you thoughts and opinions - has this been similar for any one else?

 

[rebrascora]

For those of us Type 1s on insulin, it is hard to imagine not injecting our morning basal insulin and managing to keep our levels in single figures let alone below 5 and we would almost certainly still need some bolus insulin for the food you mention even with that level of exercise, but not injecting a dose of 72 units and achieving that plus eating the food that you have is mind boggling and just shows that you must have an incredibly high level of insulin resistance which the exercise overcame.
I honestly have no idea what to suggest other than to play it safe. There is little point in doing that exercise and then having to eat a whole load of sweet stuff to prevent a hypo so I would say that missing your night time dose or at least reducing it significantly would be a reasonable option.
The reason that I am so blown away is that a reduction of 2 units in my overnight basal insulin is usually enough to balance quite an extensive exercise session plus perhaps a 2 unit reduction for my evening meal and there might be 10-20g carbs involved during the exercise. Managing without 72 units and having to eat as a result of the exercise is just "Wow!"

 

[Bruce Stephens]

Managing without 72 units and having to eat as a result of the exercise is just "Wow!"

Yes, though I wonder how things'll look in a day or two? I don't have personal experience of Touejo but it looks like it's described as lasting 24-36 hours, so I wonder if a better way of handling exercise on a Thursday might be to reduce the insulin on Wednesday evening a little and then on Thursday morning (again, a little)?

Or maybe with an insulin acting for over 24 hours such changes aren't that practical? I've honestly no idea (and I'd be asking questions, and not ruling out changing to another one (Levemir being the obvious choice)).

 

[Spunky]

Had a break from the gym today - took my normal doses last night, this morning and tonight. Bloods have been stable between 5 and 8 all day even after eating out early this evening. Beginning to think that exercise has a big impact on my insulin resistance - going to keep experimenting on gym days.

Appreciate the comments and input.