Exercise and MDI
So I'm getting a bit frustrated trying to mix exercise with insulin injections.
Here's the deal:
- I like to work out first thing in the morning
- I wake up in the 7s and 8s (126- 144) although I'd like to be lower
- I'm hungry right when I get up
- When I exercise, my bgs drop as much as 5 mmols depending on what I do.
So if I have breakfast before I work out and don't take insulin, my blood sugar is high enough to prevent a low, but then I'm just burning off what I ate, so what's the point?
If I wait to have breakfast, I have lows. Maybe not the dangerous lows, but enough that I get shaky and frantic and light-headed.
I've tried eating a little bit, like a half a banana just to bring my sugar up enough to work out and have breakfast later, but then, same problem, I'm just eating to exercise.
Any thoughts on what I could do? I prefer working out in the morning because it fits into my routine the best.
Replies to This Discussion
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Permalink Reply by Brian (bsc) on -
For most people, Levemir does not last 24 hours, so to achieve a "flat" basal, you can split your total basal dose in half and take half in the morning and half in the evening (12 hours later). But many people find that their basal requirements are higher overnight, and that it helps to have a higher basal rate overnight so you can split the dose unevenly. You can do two things, you can make the evening dose higher (i.e. 60/40%) and you can stagger the timing.
But before we get into that, let me ask you an even more basic question. If you weren't taking a morning dose of Levemir, were you taking your Novorapid before workout and then not eating before workout? If you were, then everything becomes clear.
Your Novorapid is a bolus dose of insulin that "covers" your breakfast. Only take your bolus in preparation for eating. Taking that dose of insulin and not eating will likely give you a hypo even if you don't exercise.
If I am just off track, then just ignore whatever I said.
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Permalink Reply by Kelly on
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No, I did one of two things:
- no food, exercise, insulin, breakfast (went too low)
- little food, no insulin, exercise, insulin, the rest of breakfast
I've also tried
- no insulin, breakfast, exercise but I find that I'm hungry shortly after and then I end up eating two breakfasts.
I think splitting levemir doses may be good, but this regime I already have like 6 injections most days as it is.
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Permalink Reply by Brian (bsc) on
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ok, I'm sorry to be so boneheaded about this. After exercise, you are often insulin sensitive (often by a lot), you may need only a fraction your normal bolus to cover for carbs.
Again, in my view, you need enough glucose to fuel your exercise, that does not take away from the benefit of exercise. But if it really bothers you, then skip the insulin, eat no food and use an adjusted bolus after exercise with an insulin to carb ratio that works for you.
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Permalink Reply by nel on
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Only because of your dawn phenomenon would I suggest to take a low gi snack including protein at bed time and see where it takes you . I have read on TU , that lots of folks
are " creating " higher BG readings, if they do not eat breakfast .
And yes, when I do" my training " I eat without giving insulin .
I cannot answer your question about splitting doses,( no Levemir experience ) other than it makes sense , if the insulin does not last 24 hours ...you may want to read up at the TU Levemir users Group
On the side ..are you becoming insulin pump material ??
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Permalink Reply by Samantha on -
A few ideas on this, your morning numbers should be changed by your long acting insulin and not really exercise(At least that's how I try to do it) Also a low glycemic index diet has helped me with less lows and way less higher numbers. it's just even, which has been much, much easier on my day to day life. Basically eating low GI foods means that whether I exercise or not my bs isn't bouncing around like crazy, which means if i have a spontaneous workout it won't kill me. Or decide to be lazy my numbers don't skyrocket.
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Permalink Reply by Terry Keelan on -
The point is that exercise makes you healthy. You really should consult with a nutritionist about this.
Your exercise is not simply 'burning off what you ate'. Otherwise nobody would lose weight by exercising unless they also starved themselves. There is a distinction between foods that will keep your BG level during and after exercise and food that will add pounds. There has to be. I don't happen to know what they are, but there has to be.
That's why you should see a nutritionist!
Until then my short term advice is to eat before you exercise, probably some high fiber cereal or toast with peanut butter.
Since you can't change the time that you exercise, and since you're not going to give up exercising (we hope), the only other things to change are the food you take in, or the timing of your long-acting insulin.
"Eating to exercise" is not a bad thing, but that's not really what you're doing. You're eating to keep your BG up. You're exercising to stay healthy.
Terry
(not a nutritionist)
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Kelly ,
After all this interesting stuff here ...will I meet you at the Calgary Marathon finish line , May 30 ?? ...I will do the 10 K ( due to lack of training , no 1/2 M ;-( ) ...I start at 7.30 Am and wear a Team Diabetes flashy T-shirt .Don't know my bib number till I pick up the package on Sat.
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Permalink Reply by Kelly Rawlings on -
I echo Terry's words.
Exercise is sooooo good for us that even if you don't drop pounds, it's very much worth doing. I hate every second of it, but my numbers throughout the rest of the day are much better when I move my butt in the a.m.!
Here's what has worked for me: a low-cal but dextrose-rich treatment to fuel the exercise. I exercise before breakfast. Depending on starting number and how long/intensely I move, I pop one or more glucose tablets. The only calories in those is from the glucose, so there's no slowly digested fat, excess calories, etc., to haunt me later. Because I have a strong dawn phenomenon, a single tablet with 4 grams of dextrose can lift me a good 20-40 points. Later in the day and with more insulin on board, I might need more tablets for similar amounts of exercise.
After exercise, I check again, bolus for breakfast. Sometimes, again depending on numbers and exercise length/intensity, I use a lower temp basal rate until lunch. If I used MDI, I would probably take a little less breakfast bolus.
Best wishes as you figure your routine out. Let us know how it goes.
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Permalink Reply by Jag1 on -
Kelly, if a half a banana before exercising in the morning solves your low BG, then simply consider that part of your "pre-breakfast" and reduce your breakfast by that amount of carb/insulin as appropriate (assuming you're carb counting).
Here is a very good article that addresses timing of exercise CLICK HERE This was written by Sheri Colberg who has other great advice on her website, and who's written a book "Diabetic Athlete" - well worth buying if you want to know more. In essence, she recommends exercising before taking meal insulin since it is simpler - and when doing so supplementing with carb if needed (as you are doing with your half banana). To quote her: "Thus, if you often develop hypoglycemia during exercise, you might be better off exercising before taking any insulin to cover breakfast instead of afterward or later in the day". She also talks about adjusting meal insulin if you exercise after your meal, but that is more complex and depends on the type of exercise you're doing.
Personally I prefer exercising prior to dinner or late at night - I rowed crew in college and hated 6am morning workouts - but if morning is best for you I'm sure you can make it work - it sounds like you just need a little fine tuning.
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Permalink Reply by Kelly Rawlings on
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Sheri Colberg rocks!
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Yes Sheri does ROCK , I am going to refer her writings to a newly diagnosed type one, who wants to do a marathon ( with Team Diabetes Canada )
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