Exercise and LADA

[Evergreen]

Hi!

I have been lurking on the forum for a couple weeks after being diagnosed with LADA recently. I’m still coming to terms with this and have so many questions! Feel stuck in a whirlwind with new components and information thrown at me every day…

About 6 weeks ago they started me on basal insulin (not yet mealtime insulin) and after a couple weeks of increasing the dosage I’m now on 14 units which has been keeping my levels down overnight.

I have had two hypos since, but think I can pinpoint why they happened (one in the awful heat when I was travelling and hadn’t eaten regularly enough and one on holiday after a glass of wine). I have noticed that if I don’t eat every 3-4 hours my levels slowly drop down, could this mean my basal insulin is too high?

Something else I really wanted to ask about is exercise. I love walking and walk to work. Yesterday I walked for about 30-45 mins (pretty steady, heart rate up but nothing major), I had some bread whilst walking which helped keep my levels up. However when I then had my dinner at home (lentil curry with brown rice), this made my levels go up to about 7.5 and then straight back down to the point where I had to eat another small portion, the same thing happened and I ended up eating toast and peanut butter before bed. Could this have been due to the walking? It wasn’t strenuous exercise and it’s made me scared of doing any more vigorous exercise!

Hope anyone has any wisdom!

 

[rebrascora]

Hi and welcome.

Yes, your basal is likely too high if you are hypoing if you don't eat regularly. This is the problem with starting people on basal only as it is having to cover both food and the glucose your liver trickles out.... the latter being it's primary role. Your own pancreas will also be chipping in which means that you don't get a clear picture of what is happening in this "honeymoon" phase which can make things more tricky for some people and smooth the edges off the highs and lows for others. Diabetes rarely affects two people the same, so there is a lot of experimenting to find out how your own body responds to food and insulin and exercise and alcohol and a whole host of other factors which affect BG levels.

As regards the exercise, a brisk walk will affect your BG levels for up to 48hrs afterwards. I did a 1.5 hour brisk walk yesterday and the way I deal with it is to reduce my evening basal dose, usually by about 2 units. Other people reduce their bolus at the following meal and sometimes the meal before the walk too. Obviously if you are not currently using meal time (bolus) insulin, then you don't have that option.
Some basal insulins are more amenable to being adjusted than others so this may not be a suitable strategy for you either and at this early stage in your diagnosis any basal changes should be discussed with your DSN so it may just be a case of eating more to keep your levels topped up.
The basal insulin I use which allows me to adjust it for exercise is Levemir but it usually requires 2 injections a day morning and evening instead of just one. The advantage of this is that you can fine tune it to your body's needs better than the longer acting once a day basal like Tresiba and Toujeo and Lantus to a lesser extent. Many people find Levemir is a much more flexible basal insulin and is particularly useful for people who don't have a regular routine.
I love my Levemir for enabling this adjustment but some prefer the stability of the longer acting basal insulins like Tresiba and set it to the minimum dose required to prevent them from hypoing during the night and then just use their bolus insulin to firefight rising levels during the day. We are all different so learning what is available and how it works can be helpful in making those decisions and asking to try different insulins, if you think they will work better for you than your current ones.
Personally I think it is better to start off on a full basal/bolus insulin regime from the start, even if you only need very small doses for meals and less basal. You can ask your DSN if you can do this. You might also want to ask for a half unit pen so that you can adjust doses more finely. In the early days of diagnosis, 1 whole unit can make a big difference. The half unit pens are also reuseable and you just replace the insulin cartridge so less plastic waste and therefore better for the environment.

 

[Inka]

@Evergreen You might very well be better off on a bolus insulin too. Basal is only supposed to control your blood sugar in the absence of food. If it’s used to try to mop up glucose rises from meals, you have to have more than you need, putting you at risk of hypos, as you’ve seen. It’s far better to have the right amount of basal, which will be less than you’re having now probably, and then use a bolus insulin for your meals. In addition, that will help with exercise as you can reduce your bolus before exercise.

 

[SB2015]

Hi @Evergreen, from another LADA (but tend to think of it as T1 since it is the same outcome)
I am glad that you have ‘unlurked’

Having hypos without eating is an indication that there is too much basal insulin. I would also recommend Levemir and splitting it to two doses, morning and evening. This allows you more flexibility to make adjustments to one without mucking up the other, but it does require an extra injection.

As @Inka and @rebrascora have said it would be far more flexible to use both basal and bolus insulin, since you can then adjust the basal to suit you without food, and then add in basal for meals even if it is a tiny amount needed. Well worth asking your DSN, and asking about half unit pens if you do not yet have that as it gives you access to finer adjustments.

Let us know how you get on.

 

[helli]

The way exercise effects your blood sugar is very personal which is why we are advised to test our blood sugars and learn how our body is affected.
For example @rebrascora mentions a walk of 1.5 hours will cause our levels to drop. This is her experience for how her body reacts.
For me, a 3 hour walk would not impact my blood sugars as it is something my body is comfortable with.
However, someone who does very little exercise could struggle with a 30 minute walk which would lead to their levels rising.

It is difficult to tell you how much exercise would cause your levels to rise or fall as we don't know your fitness levels and your body

 

[Evergreen]

Thank you all so much, this is really useful! Glad I ‘unlurked’!

Just to double check (my little brain is trying to comprehend all information, but I feel overwhelmed with it regularly!), in theory the basal insulin should not give me any hypos but theoretically level out again after a meal?

I have an appointment next week so will ask about the different insulins, half unit pens and the basal/bolus regime.

I’ve reduced insulin this morning with one unit, so will see over the coming days and see whether that will help. Levels are pretty stable overnight so I think that’s what’s confused me!

I have so many questions, so might be back soon! Learning new things every day! Thank you again!

 

[Evergreen]

The way exercise effects your blood sugar is very personal which is why we are advised to test our blood sugars and learn how our body is affected.
For example @rebrascora mentions a walk of 1.5 hours will cause our levels to drop. This is her experience for how her body reacts.
For me, a 3 hour walk would not impact my blood sugars as it is something my body is comfortable with.
However, someone who does very little exercise could struggle with a 30 minute walk which would lead to their levels rising.

It is difficult to tell you how much exercise would cause your levels to rise or fall as we don't know your fitness levels and your body

This makes sense. Thank you. I’m pretty active (I don’t run marathons but hit my 10000 steps probably about 4 days a week) and not overweight or anything, which is why this confused me. My heart rate is up slightly but not actually very much but there we go. I suppose as you say it’s just learning about my body and what is ok and what is not.

Thank you again 🙂

 

[everydayupsanddowns]

Thank you all so much, this is really useful! Glad I ‘unlurked’!

That’s great to hear! Lurking is good, but there’s nothing quite like having a conversation around the question you have asked 🙂

Just to double check (my little brain is trying to comprehend all information, but I feel overwhelmed with it regularly!), in theory the basal insulin should not give me any hypos but theoretically level out again after a meal?

Well… in theory your basal insulin should only be dealing with the glucose that is trickled out by the liver 24/7 - so shouldn’t be interacting with food carbs at all!

However you are in a bit of a different situation, because you still have a degree of ‘home grown’ insulin production, as you still have some beta cells in play.

I have an appointment next week so will ask about the different insulins, half unit pens and the basal/bolus regime.

Those sound like very helpful additions to your diabetes toolkit!

I’ve reduced insulin this morning with one unit, so will see over the coming days and see whether that will help. Levels are pretty stable overnight so I think that’s what’s confused me!

I have so many questions, so might be back soon! Learning new things every day! Thank you again!

Haha! Don’t worry. Fire away with any questions as they crop up. Don’t worry, no questions will be considered too obvious or ‘silly’ 🙂

 

[Evergreen]

Thank you, I really appreciate it!

I actually just had a bit of a curveball again today! So here we go with question nr 2! I had some dark rye bread this morning which spiked my blood sugar to about 12 (which is pretty normal for me atm), and then came down fairly slowly. This was all as I expected as I’ve had this bread before and this seems to be the trend. I had it again at lunch with some salad, mackerel and houmous and it pretty much did nothing to my blood glucose level in terms of spiking it, but it did drop (albeit slowly) after. I haven’t done any exercise today. Is this just how it is some days?

And if so, how do you manage this on a basal/bolus regime when carb counting. It seems that if I had counted the carbs and injected insulin I would have had a hypo?!

Hope anyone has any further wisdom (and possible advice) on this 🙂

 

[rebrascora]

Most people are more insulin resistant in the morning than they are later in the day so they may have different carb:insulin ratios for breakfast and lunch, which means if they ate the same thing for breakfast and lunch they might need two different doses of insulin for it, usually more for breakfast. Add to that the fat from the mackerel and hummus may have slowed the release of the carbs from the bread at lunchtime enabling your own failing insulin production to cope better with the glucose release from the bread. Then there is your basal insulin which doesn't always totally match what your body needs.... Again most of us need more in the morning, but the basal insulin we inject once or twice a day is a fairly crude tool balance our needs so there may be a bit of surplus basal in the afternoon which is helping out your own insulin with lunch.

Biological systems are very complex and messy compared to physics and maths so x+y doesn't always = z because you can't isolate any one equation. It is always linked to some other process or reaction and BG levels are affected by so many other things, it is all much more of an approximation which is why we look for trends to give us information rather than individual results.

 

[Evergreen]

Hmm yes that makes sense and was a bit what I was worried about haha. There seem to be so many components and variables, hard to get to grips with it!

I suppose I had a little hope that x + y would equal z as it would things just that little bit easier! Oh well…

 

[rebrascora]

I think in some respects it helps to know that it doesn't equate as cleanly as we would like because it helps us to understand that no matter how hard we try, we can't get perfect results and I think that eases the pressure a bit.... for me anyway. Just knowing that I can't really control all the elements involved helps to to accept that I can only manage it to the best of my ability whilst still living my life and that is a balance that we all need to find. I can never fully control it even if I give it 150%, so it's OK not to be perfect because it is impossible to manage it perfectly. Good enough is good enough!

After 3.5 years I find there is as much intuition as calculation goes into my diabetes management and the more experience I get the better my intuition becomes, but I have to accept that some days I will still get it wrong, sometimes badly wrong 😳, but other days I will have real triumphs! 😎

 

[Evergreen]

I like that way of looking at it! Will try and do this too. Thank you again for all the support, it’s a massive rollercoaster and knowing people are there on the other side of the screen helps

 

[everydayupsanddowns]

After 3.5 years I find there is as much intuition as calculation goes into my diabetes management and the more experience I get the better my intuition becomes, but I have to accept that some days I will still get it wrong, sometimes badly wrong 😳, but other days I will have real triumphs! 😎

+1. Except 30+ years