Replies to This Discussion

Permalink Reply by Thomas on February 17, 2011 at 11:30am

Thanks Xanthasun,

I've tried what I think is every derivative of no bolus, small bolus, small bolus with small snack, and small bolus with larger snack with regard to exercise... Nothing seems to be predictable, although a few days ago I got bold and took 3 units 15 minutes before the gym...came home around 120 and no problems afterward with breakfast. I am just uncomfortable doing that and then "letting go" to work out. I should probably chill out about it all... I think you're on to something about the morning issue though. One time I went to the gym on a Sat afternoon with my wife ~150...didn't work out much harder than I usually do (probably less actually) and was a little dizzy for the last half. Tested in the car at a wonderful 95...held around there rest of the day. I have drops like that which don't affect me at all, so was surprised...probably just fatigue...CGMS should help.

How do you like the CGMS versus not having one? Has it been as informative and confidence-inspiring as you hoped? (That's what I'm counting on anyway)

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Permalink Reply by latvianchick on February 17, 2011 at 11:58pm

I would also like the CMG but when I went to a conference on Patient Choice for diabetes patients there was a discussion on it and they said that the CMG actually uses other bodily fluids, namely sweat, to measure glucose levels and that they are not accurate because it is not blood! Jury is out on that one.

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Permalink Reply by Xanthasun on February 22, 2011 at 7:03am

CGMS has been a great experience for me and in particular in regards to exercise because it shows where I am trending. That is going on a run at 89 and steady is different than 89 and dropping (where with the latter I would probably eat). It's also been really helpful because I have next to no awareness of being low so while it's not always 100%. In general it's been close enough to what I test (+-5 points beside the first day or so) that I don't worry about unexpected lows and also lets me better see what effects that different food and exercise has. In short, highly recommended.

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Permalink Reply by Thomas on February 22, 2011 at 7:23am

Thanks! Just about exactly what I'm hoping to get out of it...

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Permalink Reply by latvianchick on February 17, 2011 at 11:55pm

You sound like me! I do not exercise the same as you. I cannot. Physical problems. I just inject, know that I am going to go up, but also know that I am going to go down, so try not to worry about it.

If I am ill, namely a chest infection or something similar, am under stress for some reason (and I have been under terrible stress recently!) it will be higher too. I have to test every hour or so - if I remember - but I know that it will eventually go down.

As for the breakfast, you could try burritos, wraps, etc with bacon (well done and dried on kitchen paper). You do need some carbohydrate. However, like you, I am bored of breakfast!

I sometimes have porridge oats - but rather than fruit or jam, I prefer something savoury so will put in some chilli sauce or similar.

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Permalink Reply by Kristin on February 18, 2011 at 12:29am

Have you tried giving your Levemir dose before your workout? If you try it, certainly check your blood sugar DURING the workout in the beginning to watch for lows. This may ensure that you have enough insulin in your system during the workout to prevent these spikes, but you need to be sure that it will not cause lows.

If you are waking up between 110-140, then I guess that you do not need more basal insulin at night. We all have different basal needs depending on the time on day. On the pump, I know that I need a lot less basal at night, but then I need a lot more from 7-10am. What might be happening is that your exercise time is combined with your time of higher insulin resistance and the evening Levemir dose is not cutting it.

Exercising with insufficient insulin can be highly dangerous and lead to ketones quickly. You may be still producing a very small amount of insulin, which could prevent ketones, but you want to avoid those spikes during exercise not just because of the blood sugars, but also because in the future the spikes could become much worse if your body's insulin production decreases.

After my honeymoon was over, I once went from 100 to over 400 with almost no carbs during a 5k run simply because of having insufficient insulin in my system.

I can completely understand your desire to stay on injections. The pump is a wonderful tool, but if you are doing OK on MDI now, then good! One thing to consider for the future though is that the pump can allow you to adjust basal during exercise. It takes some trial and error, but I figured out a way to do 1 hour of intense rollerblading while keeping my blood sugar between 100 and 140 and almost never needing to consume extra carbs. Spontaneous exercise is not possible (I needed to turn my basal down at least 30 minutes before exercise began), but if you roughly know your exercise schedule, then the pump can be a great help in keeping stable numbers during exercise!

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Permalink Reply by Thomas on February 20, 2011 at 11:25am

Thanks Kristin,

I've tried varying things including a small bolus before working out (this works but makes me nervous and is a big distraction from actually exercising)... I don't do anything relatively intense for more than 30 minutes at a time and agree that I am probably getting a little honeymoon help...

Appreciate the feedback. Have a nice day.

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Permalink Reply by acidrock23 on February 19, 2011 at 9:10am

re the AM spikes, it might be that the 160-175 afer lfiting in the AM could be combined w/ DP and that the "point" you measure may be on a line that isn't done going up? Have you tried testing in like 10 or 15 minute intervals? It will burn some test strips but it might give you a more accurate picture of what's going on?

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Permalink Reply by Thomas on February 20, 2011 at 11:21am

Yessir... I am pretty sure I am one of the most flagrant over-users of test strips ever... If I don't believe a number it's not uncommon for me to go ahead and test 2-3 more times on different fingers, new lancet, etc... I try all the "mapping" experiments...

It holds pretty steady under 180, although there was one time when I registered a 180 followed very shortly by some kind of nauseating 270! Big bolus in the bicep and I was back at 100 in about an hour and a half... I think the CGMS is going to solve a lot of things for me.

Thanks and have a great day.

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Permalink Reply by Holger Schmeken on February 22, 2011 at 7:33am

What about eating and bolusing before you workout? This way your body gets carbs and the liver does not have to inject additional glucose into the bloodstream (the liver has no idea you have no insulin production). In addition you will have insulin on board. Combined with physical activity this should help to reduce the spike.

I really question your Levemir routine. Basal is your background insulin. It has nothing to do with your eating pattern. It should keep you at normal levels if you are not eating anything. The only valid adjustments of basal insulins are: illness (increase of basal) and high physical activity (decrease of basal to prevent lows).

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Permalink Reply by Thomas on February 22, 2011 at 7:52am

I've tried that. Last time I took that route I spiked to well over 250...as I mentioned above...I ate a Balance Bar, bolused for it and a v small correction, worked out for 45min and bang! I never went low either... Bad JuJu. This morning I went with a 2 unit bolus before working out...125 before and 125 after...10 almonds before to try and shut off the dawn effect...45 min after got back, took my Levemir and 5 minutes later, right back at 160. 2 units in bicep, 5 in abdomen, and high protein breakfast and I was back to 110 heading toward a nice comfortable 85...

What do you find objectionable about my Levemir routine? It works doesn't it? I'm generally between 80 - 120 when not eating (other than the occasional waking up ~135ish....) I know what "basal" insulin means and what it should do...

Not all physical activity causes lows. Depending on the intensity and type, there is an adrenal response that causes BG to go higher. I also appreciate what you're suggesting re: "the only valid adjustments of insulins are:" BUT...I still have smallish, but wholly unpredictable levels of c-peptide and insulin production so frankly, I can't agree with you in my particular case. Once that c-peptide goes to zero and I have full confidence that my pancreas isn't going to "help out" at an inopportune time, I'll get more religion about consistent and reliable basal rates. I can always correct.

Good luck to you and I appreciate the commentary.

Thomas

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Permalink Reply by Holger Schmeken on February 22, 2011 at 12:10pm

Like you I think that what works is right. I just wanted to point out that sometimes we develop some strange strategies. These can make it hard for ourselves and our medical team to understand all the factors involved in our glucose management. Of course I understand your reasoning about the irrational behaviour your are sometimes confronted with as someone with LADA. It makes it difficult to identify the cause of fluctuations. I just mentioned the basal because sometimes a small gap in basal coverage can cause irrational numbers around the injection time of the next shot: an hour difference in injection times (9 instead of 8 hours), one unit more or less, unprimed pens (big problem of the NovoPen 4) etc.

Just out of curiosity: do you think that your liver is always dumping additional glucose for physical activity? Or is it the combination of dawn and physical activity that is the challenge here? What happens if you exercise after dinner?

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