Morning All,

[Eng1and]

Hi, I'm 51 year old male and was newly diagnosed on Christmas Eve as diabetic Everything was a whirlwind of new info and not the time to process all of it so I've been reading a lot on Learning Zone and the forums so thank you for that.

I had a HbA1C of 90'ish mmol/mol (Sorry can't remember exactly) They're still awaiting test results to confirm T1 or T2 I suspect T2 as I've put on 20kilos and my fitness level crashed during lock down due to working from home and the gym closing and me not going back when it re opened. Also my diet went from fresh lunches to anything quick and easy; I also drank more cans of fizzy pop. So no excuses I've only myself to blame.

I've been given insulin (Lantus 10m) to have every morning until they get the results back; And a meter to check my glucose levels.

With Changing my diet back to what it was and exercising again I managed to get my levels down from Christmas Eve being in the 16's to Average of 6.2 I had a call with my doctor a week after and she's didn't seem happy that my levels had dropped so quickly.

I managed to get back to the gym properly yesterday and after my first session my glucose levels drop off a cliff after only half hour of moderate exercise (from 7.0 to 4.1)

My question is If I stop the insulin will it not drop as fast? I don't want to change me diet by adding more carbs that I just don't need just to keeps glucose levels inflated.

Thanks

 

[Lily123]

Welcome to the forum @Eng1and

 

[SB2015]

Welcome to the forum @Eng1and

Sorry to hear about your diagnosis but pleased that you have found the forum.

If you are T1 you will definitely need to inject insulin, but the amounts vary for each of us. It takes time to work out what doses we each need and this changes as we go along. As a T1 I am able to eat what I want when I want, or not eat a meal as we are usually put on a basal/bolus regime and this is very flexible.

Try to be patient and stick with what they have asked you to do. They usually want to bring levels down slowly in order to limit any damage to our smaller blood vessels as a result of a rapid change.

Let us know how you get on.

 

[Eng1and]

Welcome to the forum @Eng1and

Sorry to hear about your diagnosis but pleased that you have found the forum.

If you are T1 you will definitely need to inject insulin, but the amounts vary for each of us. It takes time to work out what doses we each need and this changes as we go along. As a T1 I am able to eat what I want when I want, or not eat a meal as we are usually put on a basal/bolus regime and this is very flexible.

Try to be patient and stick with what they have asked you to do. They usually want to bring levels down slowly in order to limit any damage to our smaller blood vessels as a result of a rapid change.

Let us know how you get on.

Thank you for your kind reply.

Can you recommend how I can get my glucose levels up?

I've just been to the Gym this morning and had a large breakfast (2 eggs 3 toast chicken avocado & spinach) I managed to get my levels to 10.5 two hours after eating. 30 mins into my workout and I tested again and it was down to 4.3

Not sure what would happen if I did my full workout of an hour. Should I quite the working out as I don't want to go into Hypo range?

 

[Lily123]

Thank you for your kind reply.

Can you recommend how I can get my glucose levels up?

I've just been to the Gym this morning and had a large breakfast (2 eggs 3 toast chicken avocado & spinach) I managed to get my levels to 10.5 two hours after eating. 30 mins into my workout and I tested again and it was down to 4.3

Not sure what would happen if I did my full workout of an hour. Should I quite the working out as I don't want to go into Hypo range?

Are you afraid of going hypo? Because if so that’s an understandable fear. If not just take hypo treatments with you

 

[adrian1der]

Thank you for your kind reply.

Can you recommend how I can get my glucose levels up?

I've just been to the Gym this morning and had a large breakfast (2 eggs 3 toast chicken avocado & spinach) I managed to get my levels to 10.5 two hours after eating. 30 mins into my workout and I tested again and it was down to 4.3

Not sure what would happen if I did my full workout of an hour. Should I quite the working out as I don't want to go into Hypo range?

What do you do in the gym? The reason I ask is that I, and a number of other people, find that moderate aerobic exercise lowers blood glucose while more vigorous anaerobic exercise actually raises blood glucose. Your liver realises your body is under stress and helps out by dumping glucose into your blood stream. Longer term, anaerobic exercise will lower BG, often for several days

 

[Leadinglights]

Maybe as you are quite new to taking insulin and making some dietary changes you should go easy on the Gym workouts until you know how your body is reacting to such a new regime.
You don't want to put yourself at risk by having unexpected symptoms that you are not sure how to handle.

 

[Eng1and]

What do you do in the gym? The reason I ask is that I, and a number of other people, find that moderate aerobic exercise lowers blood glucose while more vigorous anaerobic exercise actually raises blood glucose. Your liver realises your body is under stress and helps out by dumping glucose into your blood stream. Longer term, anaerobic exercise will lower BG, often for several days

Hi, So far I've managed a 5 min warm up 10 min sprint/jog and 15/20 min weights. I would normally expect to do another 20 mins on the weights and finish with 10 mins sprint/jog and a warm down.

That was my normal work out (Pre Covid) I'm feeling good doing my workout and not seeing any Hypo signs (But to be truthful I'm not sure how I would react to one as I've never had one before)

I'm not doing or intend doing anymore than I used to do.

 

[Proud to be erratic]

Hello @Eng1and ,
I'm far from feeling knowledgeable about the effects of exercise on my BG. But I do have the Libre2 sensor and got the data coupled to an app called Diabox which gives me continuous glucose monitoring (CGM). So I do see the effects from my activity. I'm over 70 so my exercise is brisk walking rather than sprinting (!) and I try, when the weather allows, to spend a full day gardening or doing jobs - rather than sitting around. As a T3c from a total pancreatectomy I'm totally insulin dependent.

Like @adrian1der, I find vigorous anaerobic exercise pushes my BG up; but some 20+ mins after it starts to fall; how quickly and how far varies, depending on how much of my rapid (bolus) insulin is still residual in my system. I'm on Novarapid which seems to last no more than 5 hrs. I also find my BG will continue to fall even outside the 5hr bosul window, more slowly, presumably my basal Tresiba is doing its stuff.

I agree with @Lily123 about hypo precautions; I carry jelly babies with me whenever I leave the house, even in the garden. I have several small, slim containers with 10+ JBs inside and have one of these in most rooms in the house, most jackets, backpacks and both our cars. I've recently realised thanks to my 8yr old grandson that the little packets of Haribo sweets are also ideal, one pack is between 20-25 gm carbohydrate (CHO). One JB is c. 5gm CHO and I will take 2 as a precautionary response (enough for me to stop a steady fall, which I can see on my CGM) or up to 4JBs if I'm already below 4.0. Then wait 5+ mins, retest and repeat if necessary. You've possibly already been told that "4 is the floor". Don't panic at 3.9, but respond; and at low 3s I stop any activity. I don't even walk back to the house; just stay still for 5mins, sit if possible, try to stay calm and let the JBs do their thing. But I'm T3c, have no pancreas and so my liver doesn't get the instructions from my brain to open its glucose store! Curiously, when low the brain tells the pancreas to send a messenger (the hormone Glucagon) to the liver to open the glucose store - so that doesn't work for me. I sometimes take a sugary drink, like lucozade at 8.7 gm CHO per 100ml; this doesn't seem to be any faster acting than the JBs, and is fine while I'm static, but not so handy when walking or jobbing. There are drinks with higher CHO content and they might be good for you in the gym.

My hypo symptoms are feeling "strange", shivery, trembling. If the hypo is deeper then I get anxious, irritable and eventually less well co-ordinated. With my first testing meter I found the trembling and loss of dexterity made finger-pricking really challenging, adding to my angst. I have never been totally incapable when hypo, but felt close! My actual BG has been shown as 2.5 on a couple of occasions. I now have the (Roche) Accuchek Mobile meter, which has an inbuilt cassette rather then individual test strips, with lancing device attached (so all-in-one) and that has been a great help.

There are apparently 42 factors that can affect your BG. Dehydration is one of these and I would suggest you should be particularly aware of that risk while in the gym. Clearly you are getting benefit from working out, so I wouldn't stop; just be prepared to quickly respond. But I agree with an earlier comment to not overdo it and be aware that a prolonged spell of activity can, for me, take 3 or more days to dissipate; ie it shows in my poor BG control. I guess it's all about muscle memory and I don't have too much of that; my prior days of being super-fit have gone!

Hope some of this helps. With a preliminary diagnosis on Xmas Eve you are on a huge learning curve and it will all seem pretty confusing at first. As a T2 your treatment would normally be different to T1 or T3c, but since you are on insulin already you have the same risk as us of becoming hypo from an excess of insulin. This would be unlikely for a T2 on oral medication alone. The cause of your diabetes may be different, but the risk is not.

 

[SB2015]

Can you recommend how I can get my glucose levels up

Like others when I do anaerobic exercise my glucose levels will rise. For example I am on route to Pilates and I am a little low, counter intuitively I run a while and my levels will rise a while. Your sprints might do this for you.

When exercising I have diluted juice with me so that I can top up my glucose if necessary. I also find that I sometimes need a top up after I have finished, depending on the nature of my exercise. I carry Jelly Babies everywhere with me and have a stash in a variety of places at home. These lift my levels very quickly.

I would still recommend patience, whilst they identify the type of diabetes, and work with you to lower your levels gradually. They will also work with you to adjust your insulin doses.

 

[Eng1and]

Hello @Eng1and ,
I'm far from feeling knowledgeable about the effects of exercise on my BG. But I do have the Libre2 sensor and got the data coupled to an app called Diabox which gives me continuous glucose monitoring (CGM). So I do see the effects from my activity. I'm over 70 so my exercise is brisk walking rather than sprinting (!) and I try, when the weather allows, to spend a full day gardening or doing jobs - rather than sitting around. As a T3c from a total pancreatectomy I'm totally insulin dependent.

Like @adrian1der, I find vigorous anaerobic exercise pushes my BG up; but some 20+ mins after it starts to fall; how quickly and how far varies, depending on how much of my rapid (bolus) insulin is still residual in my system. I'm on Novarapid which seems to last no more than 5 hrs. I also find my BG will continue to fall even outside the 5hr bosul window, more slowly, presumably my basal Tresiba is doing its stuff.

I agree with @Lily123 about hypo precautions; I carry jelly babies with me whenever I leave the house, even in the garden. I have several small, slim containers with 10+ JBs inside and have one of these in most rooms in the house, most jackets, backpacks and both our cars. I've recently realised thanks to my 8yr old grandson that the little packets of Haribo sweets are also ideal, one pack is between 20-25 gm carbohydrate (CHO). One JB is c. 5gm CHO and I will take 2 as a precautionary response (enough for me to stop a steady fall, which I can see on my CGM) or up to 4JBs if I'm already below 4.0. Then wait 5+ mins, retest and repeat if necessary. You've possibly already been told that "4 is the floor". Don't panic at 3.9, but respond; and at low 3s I stop any activity. I don't even walk back to the house; just stay still for 5mins, sit if possible, try to stay calm and let the JBs do their thing. But I'm T3c, have no pancreas and so my liver doesn't get the instructions from my brain to open its glucose store! Curiously, when low the brain tells the pancreas to send a messenger (the hormone Glucagon) to the liver to open the glucose store - so that doesn't work for me. I sometimes take a sugary drink, like lucozade at 8.7 gm CHO per 100ml; this doesn't seem to be any faster acting than the JBs, and is fine while I'm static, but not so handy when walking or jobbing. There are drinks with higher CHO content and they might be good for you in the gym.

My hypo symptoms are feeling "strange", shivery, trembling. If the hypo is deeper then I get anxious, irritable and eventually less well co-ordinated. With my first testing meter I found the trembling and loss of dexterity made finger-pricking really challenging, adding to my angst. I have never been totally incapable when hypo, but felt close! My actual BG has been shown as 2.5 on a couple of occasions. I now have the (Roche) Accuchek Mobile meter, which has an inbuilt cassette rather then individual test strips, with lancing device attached (so all-in-one) and that has been a great help.

There are apparently 42 factors that can affect your BG. Dehydration is one of these and I would suggest you should be particularly aware of that risk while in the gym. Clearly you are getting benefit from working out, so I wouldn't stop; just be prepared to quickly respond. But I agree with an earlier comment to not overdo it and be aware that a prolonged spell of activity can, for me, take 3 or more days to dissipate; ie it shows in my poor BG control. I guess it's all about muscle memory and I don't have too much of that; my prior days of being super-fit have gone!

Hope some of this helps. With a preliminary diagnosis on Xmas Eve you are on a huge learning curve and it will all seem pretty confusing at first. As a T2 your treatment would normally be different to T1 or T3c, but since you are on insulin already you have the same risk as us of becoming hypo from an excess of insulin. This would be unlikely for a T2 on oral medication alone. The cause of your diabetes may be different, but the risk is not.

Thank you for this.

This has given me a better understanding of what to look out for.

With regards to diagnosis on Xmas Eve it has been a big learning curve (Just getting my meds from the pharmacy was very interesting...arguing with the chemist that I do pay for meds and they insisted I didn't lol)

What I can't work out yet is why I need to use Insulin as it looks like I can keep my glucose levels down by diet and exercise alone and I wonder if using insulin is pushing the glucose levels lower?

Does insulin do anything else other than control glucose levels? What problem could I have by not using it?

Would stopping insulin and monitoring my glucose levels to see what/if any changes be OK?

 

[helli]

@Eng1and have you had any days since starting insulin when you have not been to the gym?
I ask because the problem may be that your insulin dose could be too high but, as exercise can affect our levels, it is difficult to know on a gym day.

I suggest having a couple of days away form the gym (the "gym affect" can last up to 48 hours) and check that your insulin dose is ok.

 

[Leadinglights]

I suspect they probably panicked when your level was 90mmol/mol which is high and rather than giving you other medication to bring down your levels which can take some time to have an effect they opted for insulin which will bring down levels more quickly.
That is maybe something you could ask of your diabetic team. Obviously depending on your eventual diagnosis that option may be reviewed but they should explain the whys and wherefores of your treatment regime.

 

[Eng1and]

@Eng1and have you had any days since starting insulin when you have not been to the gym?
I ask because the problem may be that your insulin dose could be too high but, as exercise can affect our levels, it is difficult to know on a gym day.

I suggest having a couple of days away form the gym (the "gym affect" can last up to 48 hours) and check that your insulin dose is ok.

Yesterday was my first day back in the gym and also been this morning.

I've only done 40 mins brisk walks from Christmas day to yesterday my levels dropped significantly just on this and diet changes.

My diet was really bad some days I would only drink fizzy vimto and no water, Breakfast would be bacon on toast and a coffee, lunch some sort of processed meat sandwich and a chocolate bar or two. evening meal would be cooked fresh as we all eat as a family so chicken, fish, red meat once a week with veg and potatoes or rice etc then I'd snack through the night on crisp chocolates.

I've completely cut all this out now and with low level exercise have been steady between 5 and 9

 

[Windy]

Hi @Eng1and you should be able to apply for an exemption certificate for free prescriptions. I think your GP surgery or the pharmacy have some of the forms, I got mine at the chemists. Fill it out and drop it off at the surgery and one of the staff there will sign it and send it on for you.
Cheers, Sarah

 

[Proud to be erratic]

Thank you for this.

This has given me a better understanding of what to look out for.

With regards to diagnosis on Xmas Eve it has been a big learning curve (Just getting my meds from the pharmacy was very interesting...arguing with the chemist that I do pay for meds and they insisted I didn't lol)

What I can't work out yet is why I need to use Insulin as it looks like I can keep my glucose levels down by diet and exercise alone and I wonder if using insulin is pushing the glucose levels lower?

Does insulin do anything else other than control glucose levels? What problem could I have by not using it?

Would stopping insulin and monitoring my glucose levels to see what/if any changes be OK?

Hi again @Eng1and ,
While I understand your desire to do something (anything?) and somehow get this resolved quickly there is not necessarily a rapid shortcut! Diabetes is complicated and your GP made a significant medical judgement in putting you on insulin straightaway. So stopping your insulin is, to my mind, not so wise. Certainly not without discussing it with your GP, who has shown a real commitment in giving you insulin.

I certainly understand the point you made in your first entry to this forum (your last para) about taking more carbs that you "just don't need to keep your glucose levels inflated". I've read this elsewhere as "feeding the insulin".

That said you could possibly try reducing, a bit, your once daily insulin. Lantus is a slow release basal insulin, intended to keep your body in a balanced state over the 24 hour day. If I were reducing my basal I would make only a small reduction, say 20% absolute maximum and go with that for at least 5 days - perhaps 7 days if that encompasses a normal exercise regime across the week; basal change needs time to settle and bring about metabolic change. Keeep in mind each time you exercise you are potentially moving goal posts and that exercise consequence can last for days rather than hours. Always do regular, repetitive tests. Then you can assess what has happened and adjust accordingly. I would keep a diary/log of what has been taken, insulin and carbs, when, exercise duration and intensity, what changes implemented and what changes seen. Review!

There is a recognised process for testing if your basal regime is correct, which involves testing, fasting, testing again then eating normally; but this process assumes one is also taking bosul insulin with each meal: and you aren't. The rationale behind the process is you can't truly assess if your bosul dosing for meals and interim corrections is correct, if the basal isn't correct first. If the basal is too large the bolus isn't doing what it was intended for and if the basal too small then the bosul is also trying to cover the shortfall in basal. But, since you are on a once daily basal only, your basal is doing everything. I assume your GP has put you into a "holding" position to alleviate your symptoms until your test results are back and a fuller plan can be developed.

So, I agree with @SB2015 in that first reply to you: try to be patient, stick with this as much as you possibly can and restore normality slowly to reduce possible other damage, particularly to the very small blood vessels.

 

[Eng1and]

Hi again @Eng1and ,
While I understand your desire to do something (anything?) and somehow get this resolved quickly there is not necessarily a rapid shortcut! Diabetes is complicated and your GP made a significant medical judgement in putting you on insulin straightaway. So stopping your insulin is, to my mind, not so wise. Certainly not without discussing it with your GP, who has shown a real commitment in giving you insulin.

I certainly understand the point you made in your first entry to this forum (your last para) about taking more carbs that you "just don't need to keep your glucose levels inflated". I've read this elsewhere as "feeding the insulin".

That said you could possibly try reducing, a bit, your once daily insulin. Lantus is a slow release basal insulin, intended to keep your body in a balanced state over the 24 hour day. If I were reducing my basal I would make only a small reduction, say 20% absolute maximum and go with that for at least 5 days - perhaps 7 days if that encompasses a normal exercise regime across the week; basal change needs time to settle and bring about metabolic change. Keeep in mind each time you exercise you are potentially moving goal posts and that exercise consequence can last for days rather than hours. Always do regular, repetitive tests. Then you can assess what has happened and adjust accordingly. I would keep a diary/log of what has been taken, insulin and carbs, when, exercise duration and intensity, what changes implemented and what changes seen. Review!

There is a recognised process for testing if your basal regime is correct, which involves testing, fasting, testing again then eating normally; but this process assumes one is also taking bosul insulin with each meal: and you aren't. The rationale behind the process is you can't truly assess if your bosul dosing for meals and interim corrections is correct, if the basal isn't correct first. If the basal is too large the bolus isn't doing what it was intended for and if the basal too small then the bosul is also trying to cover the shortfall in basal. But, since you are on a once daily basal only, your basal is doing everything. I assume your GP has put you into a "holding" position to alleviate your symptoms until your test results are back and a fuller plan can be developed.

So, I agree with @SB2015 in that first reply to you: try to be patient, stick with this as much as you possibly can and restore normality slowly to reduce possible other damage, particularly to the very small blood vessels.

Thank you for this I appreciate the time and effort typing such a detailed reply.

I currently log everything Meals Carbs Calories food types
I log bloods before and two hours after each meal plus morning and Bedtime
I also log what exercise I'm doing and the intensity
Starting Weight 107.6 24th Dec - down to 99.9 3rd Jan

I wasn't warned about make changes quickly and in my mind I didn't I've just gone back to how I ate and worked out. I think maybe I've already done some damage to small blood vessels.

I'm due to see the Nurse next Tuesday so I'll see how that goes.

 

[Proud to be erratic]

Thank you for this I appreciate the time and effort typing such a detailed reply.

I currently log everything Meals Carbs Calories food types
I log bloods before and two hours after each meal plus morning and Bedtime
I also log what exercise I'm doing and the intensity
Starting Weight 107.6 24th Dec - down to 99.9 3rd Jan

I wasn't warned about make changes quickly and in my mind I didn't I've just gone back to how I ate and worked out. I think maybe I've already done some damage to small blood vessels.

I'm due to see the Nurse next Tuesday so I'll see how that goes.

You are welcome. I was worried that I might be overloading you with stuff you don't need.

Anyway, well done with the "logging" and with the weight loss. It seems to me from this distance that you've responded to your wake-up call with enthusiasm and commitment; great start.

Good luck with the Nurse next Tuesday; I think most GP Surgeries have at least one member of the medical staff with a specific remit for helping patients manage diabetes: your Doctor was bold (good). Chances are the Nurse will be as good.

 

[SB2015]

Keeping your detailed log will help you work with the nurse to come up with an effective plan.

I dropped my levels very quickly once I was diagnosed as I wanted to get things sorted. I alos had not been told about taking things slowly. I haven’t suffered any long term damage. My eyesight did take a while to settle.

Let us know how you get on on Tuesday.

 

[Eng1and]

Keeping your detailed log will help you work with the nurse to come up with an effective plan.

I dropped my levels very quickly once I was diagnosed as I wanted to get things sorted. I alos had not been told about taking things slowly. I haven’t suffered any long term damage. My eyesight did take a while to settle.

Let us know how you get on on Tuesday.

Thanks,

I hope I've not done too much damage to my eyes (Need to wear glasses now for reading) They literally went from OK on the 28th and the following morning I couldn't see my phone.

I'll report back once I've seem the nurse.🙂