Replies to This Discussion

Permalink Reply by acidrock23 on April 19, 2012 at 4:24am

My plan is to try to eat at least 2 hours before I "blast off" so most of the insulin is "done" by "showtime". I don't eat anywhere near 100 carbs unless it's a festival of some sort, not more than once every 2-3 months. W/ a larger "dose" of food, the shot is, in turn, bigger. Dr. Bernstein mentions that the bigger the shot, the more uneven the absorption of the insulin so, w/ a bigger shot, you may be having some "leftover" insulin floating around as the larger ahot would be absorbed more slowly? In my experience, if there's insulin along with exercise, it will work more effectively and, in turn, lead to lows. The insulin "graphs" show "action" out to like 6 hours, it's tailed off, but it's still there. For 100G of carbs, I would think some insulin would still be in play and be what's hitting you.

I've been running for about 3 years and think that I don't get as much BG "bang for my buck" out of 5K as I used to so, a lot of times, I try to keep my BG flat around 100 before I run, have a glass of skim milk (8-10G of carbs...) and run. I also "cheat" w/ a CGM and pump so it is a bit easier to keep an eye on things but usually, by the time my BG starts to drop, I've finished the run as the milk starts to hit in about 15 minutes? I try to balance the exercise pretty precisely with the food and insulin and have just enough food. It seems to work out to about 10-15G for a 5K which is usually about 25 minutes for me these days. Longer runs, I take carbs along for the ride and try to have 8-10 every 3 miles or so. I haven't run out of carbs on a run for a while, although I've had a few "oops, I left the jelly beans on the counter" adventures.

It may be worth it to test your ratios and make sure that your carb/ insulin ratio is set correctly? I think that these numbers can change over time and that if you are off even a little bit, it make make a significant difference in your BG, 40-80 points, that can be fixed by determining the ratio precisely? For me, it's been worth it to get more organized (in my head, I still suck at writing anything down...) so that if my BG is running 20-50 points low or high for a couple of days at a particular time, I'll nudge the rate to fix it, assuming that there's no "festival food" situations skewing the numbers?

• ▶ Reply

Permalink Reply by timmy on April 19, 2012 at 5:47am

i wish i could start exercise at normal bsugar levels and maintain like yourself AR and Holger. I guess a pump is handy for this! Im always battling the basal drops and ingesting a fair wack of carbs in a session. The quick spikes before 'showtime' as you say are prob giving me higher a1c readings to. I wonder if these short term spikes an hour or so before training/racing effect me long term.

• ▶ Reply

Permalink Reply by eknight003 on April 19, 2012 at 11:28am

Guys, I appreciate all of your input and obviously vast knowledge about diabetes. But there are still a few misunderstandings that need to be cleared up for me before I get that "light bulb moment."

The way I understand it: 1)is that carbs are ingested. 2)they are absorbed into the blood stream and converted into glucose by insulin. 3)the glucose is stored in various cells for energy when needed.

What I don't understand is why does having low or high blood glucose levels make such a hugh difference in energy when you already have glucose previously stored in cells for later use?

Would it be better to not take insulin before exercising and keep a relatively high BG level, so that way your body will be forced to use already converted and stored glucose for energy?

I guess the bottom line is that when you have insulin floating around with glucose in your blood stream, that will be your body's first source of energy. And when there is no or very little insulin available your body will resort to energy that's already stored?

I'm sorry guys for the confusion and I don't even know if i'm asking the right questions.

I think this response by Holger may have answered my question directly but I'm not 100%.

"The glucose release of the liver is blocked as long as there is insulin in the blood stream. The healthy body will not release insulin if the blood glucose is going lower. The liver has not implemented a glucose detector because it just uses the presents if insulin as an indicator. Thus the "fail safe" mode of the liver is broken by design for us. This is why most researchers say that the symogi effect does not exist for insulin dependent diabetics. The symogi is often confused by the hormonally induced dawn phenomen that will increase with lower blood glucose. However this is just a hormonal reaction to provide glucose in the morning (for millions of years we had no breakfast). It might be possible that some people see a reaction of their liver with lows but it will be rare.

With theses tiny amounts it is difficult to get it right. I myself know the situation that 5 units of levemir at night might be too much but 4 units is not enough. You might feel terrible because you are actually missing insulin. Maybe you just get a fraction of the dosage you have dialed at these low dosages. Instead of reducing the dosage to 1 or 1.5 units you could just eat more. I think most very active people would prefer to fuel their body instead of restricting their needs."

• ▶ Reply

Permalink Reply by acidrock23 on April 19, 2012 at 3:12pm

I was always a fan of big syringes but a buddy of mine gave me her "leftovers" when she recovered from Type G. They included some very small syringes that were like 1U w/ very small increments. I don't recall exactly what the increments were but I have run into that problem too. I used to fill a syringe and jiggle it a little bit more when I thought it needed an extra whiff?

• ▶ Reply

Permalink Reply by FHS on April 19, 2012 at 4:29pm

The way I understand it: 1)is that carbs are ingested. 2)they are absorbed into the blood stream and converted into glucose by insulin. 3)the glucose is stored in various cells for energy when needed.

Carbohydrates are chopped into glucose (and other simple sugars) by different enzymes in the saliva and small intestine. As mentioned, one of insulin's functions is to act like a key that opens the doorway for glucose to get into most cells so that it can be utilized once glucose becomes availabe in the bloodstream through digestion. Insulin also signals muscle and liver cells to store glucose as glycogen, our own storage form of carbohydrate.

So, insulin's overall action is to remove glucose from the blood.

What I don't understand is why does having low or high blood glucose levels make such a hugh difference in energy when you already have glucose previously stored in cells for later use?

Muscles do not work very well without enough glucose. They can burn other fuels like fat an protein, but they are limited by the amount of glucose available to them. The only "storage" form of glucose you have is glycogen. Glucose is not floating around free in a cell just waiting to be used. Once inside of a cell, something happens to it, either use for energy or converted to storage form.

The thing to remember is that glucose will not enter a cell in large quantities unless there is a higher concentration of glucose in the bloodstrem than inside the cell.Also, muscle cells convert their glycogen to glucose when needed, but that glucose is never released into the bloodsteram to affect BG levels. So,really, a low blood glucose level indicates a shortage of glucose, which will negatively affect muscle activity and teh activity of a lot of other cells as well. As Holger says, normally, your liver would convert glycogen to glucose and release that into the bloodsteam, raise your BG level back to normal, and preserve muscle function. Holger explains why this does not happen for diabetics and we just go hypo and hit a wall instead

• ▶ Reply

Permalink Reply by eknight003 on April 21, 2012 at 11:10am

Holger, thanks for clearing up my misunderstandings. I finally have the light bulb moment! :)

First off, I was very misinformed to believe that insulin literally converted carbs to glucose and that cells stored glucose for "later usage." OMG was I way off!! I also literally thought that insulin converted carbs into glucose.

Now that I understand the relationship between the liver functions and glucose as you explained. Are you saying your energy pretty much comes from the glucose floating around in your bloodstream and that this whole "storing of carbs." concept is a bit exaggerated?

I decided to conduct a little experiment:
Last night at around 10p my BG was 331(on purpose). I took two units of Novolog. at 3am my BG was 245. I took 1.5 unit of insulin and ran 2.5 miles 15 minutes later. Towards the end of my run, I started to feel myself becoming weak( not out of breath but literally weak). Immediately after completing my run my BG was 109.

What I gathered from this experiment is that I probably should not have taken that 1.5 unit of insulin before my run because I dropped too fast and way too soon. For the most part, I felt pretty good during the run. But I'm starting to think that contrary to what people say about 100-130 being the ideal BG range, I tend to think that it depends on the individual and the level of activity. Quite frankly because I'm so active, I function better when my BG runs kind of high. Is that strange or unusual?

Oh, and I take 10 units of Levemir once everyday at 1pm.

• ▶ Reply

Permalink Reply by FHS on April 21, 2012 at 11:53am

Now that I understand the relationship between the liver functions and glucose as you explained. Are you saying your energy pretty much comes from the glucose floating around in your bloodstream and that this whole "storing of carbs." concept is a bit exaggerated?

Think about it this way.

Although BG levels generally remain constant under normal circumstances, there will always be some amount of glucose moving into the cells because cells will always be using some amount of glucose. So, the system is like a bucket with a hole in it. You will always be replacing some the glucose being used in order to keep BGs at a constant level. Depending upon the type of workout you do, as you work out more, you lose glucose faster, so you will have to replace glucose faster to keep levels constant.

Glucose stored in the form of glycogen in the liver and muscles acts like a reserve tank of glucose. As you work out, you rely on those stores to replace the glucose you are losing. Those stores are very important because once that supply of stored glucose is depleted, you BG will drop and you will hit the wall. How fast you deplete those stores depends on how much you have stored and how fast you use it.

When you finish working out, there is a window of time where your liver and muscles will work to store glucose to previous levels at an optimal rate. This is usually within a couple of hours after your workout. Carbs consumed at this time will preferentially be stored as glycogen to rplace lost stores.

What I gathered from this experiment is that I probably should not have taken that 1.5 unit of insulin before my run because I dropped too fast and way too soon. For the most part, I felt pretty good during the run. But I'm starting to think that contrary to what people say about 100-130 being the ideal BG range, I tend to think that it depends on the individual and the level of activity. Quite frankly because I'm so active, I function better when my BG runs kind of high. Is that strange or unusual?

In diabetics, this system is all broken to hell. First, no matter how hard you workout, without insulin, your muscles cannot use glucose. So, even while you are working out, you have to have some insulin working to allow muscles to use glucose. As you found out, if you use too much, your glucose levels drop too fast and outsrip your cellular capacity to convert glycogen to glucose, which depends on a competely different set of hormones than insulin.

So, you have to find a balance between insulin on board, BG levels at the start of your workout, and how hard/long you will be working out.

Most of us do end up starting our workouts at a higher than normal BG. I would say that starting in the 300s is too high and the recommendation is to not even extercise if your levels ar that high. At those levels, you start to worry about diabetic ketosis. If we are working out for an extended pwriod of time, most of us will consume carbs as we work out to maintain our BG levels rather than spike our BGs to extremely high levels at the start.

I'd definitely cut back on the pre-workout insulin dosage if you are falling from 300s to 100s during your workout. I'm like you. It's not just the BG level that affects my workout, it's how fast my BG is dropping. If my BGs are stable, I can workout comfortably in the 60s and even the 50s. If I'm dropping, 70 becomes uncomfortable.

Since you are on MDI, this is a difficult thing to do. On a pump, I just dial down my basal does and adjust my bolus as needed.

You have the right idea though. It's just a matter of finding the balance between starting BG, insulin dose, workout level, and how many carbs to supplement with as you work out.

Good luck!!

• ▶ Reply

Permalink Reply by eknight003 on April 21, 2012 at 3:19pm

FHS, thank you.

I have one more question though in refereence to levemir. Being that it's a long acting insulin, could i pretty much let that once a day dosage control my BG levels during my run? I really don't know if Levemir is meant for something like that.

• ▶ Reply

Permalink Reply by acidrock23 on April 21, 2012 at 7:16pm

Levemir should be present for approximately 24 hours after you shoot it, but is supposed to act in a low, flat curve.

shows the different curves. "Think Like a Pancreas" and "Using Insulin" have a chart that suggests that for pre-exercise fueling, you bolus and "cut" the dose by a %age, taking a part of of the regular bolus for an hour of moderate exercise. I haven't found the chart online but took a pic of the one from the book:

If my BG runs too high during a race for whatever reason, I'll enter the BG into the pump, like 200, and it'll figure out a 'correction bolus' and then reduce it to 1/3 of the regular bolus. Same thing pre-run. I kind of "cheat" as I have a CGM and pump but they have informed my approach and it usually works decent.

• ▶ Reply

Permalink Reply by FHS on April 22, 2012 at 5:01pm

I don't know the answer to that.

When I was on Lantus, if I worked out prior to a meal, usually before dinner, I never bolused. I never had a particular problem going high during a workout, so I'm assuming that the Lantus was covering my needs.

• ▶ Reply

Permalink Reply by acidrock23 on April 22, 2012 at 5:00am

In the "Blogs" section, MeganJ, who posted here, also wrote a great account of a race she just did, going through some of the details and approaches that she used and how she "just did it" in a triathlon!

http://www.tudiabetes.org/profiles/blogs/first-tri-of-the-season

• ▶ Reply

Permalink Reply by eknight003 on April 29, 2012 at 10:48pm

Tell me more about this CGM sir. How hard are they to aquire? I have pretty good insurance, I'm type 1, I'm law enforcement(which is to say that my job is very dynamic) and I exercise on a regular basis. Will my insurance cover the costs of a CGM based on these factors? I have a doc appt w/ my endo in a couple of days, so lemme know.

thanks

• ▶ Reply

• ‹ Previous
• 1
• 2
• 3
• Next ›
• Page