So I went skiing in Tahoe over the holiday break. Whenever I do a new activity, there is a learning curve, but I was really challenged by diabetes last week. I'm going to outline the basics, and maybe some of you can weigh in on some suggestions or what you would have done differently...

(p.s. One Touch doesn't operate in freezing temperatures, so I used one of those "toe warmer" pouches to keep it warm in my backpack so I could check my sugar when I wanted. It worked great.)

(I'm on a pump)...depending on my sugars at the start of the day, I would lower my basal to approximately 80%-90% of normal. I decreased my bolus for my mid-day meals by about 30%. During the ski day, would stay relatively normal (ranging from 170-200 post meal and around 140-150 the rest of the time). I like to have a cushion like that when I'm exercising so a low doesn't strike me mid-exercise. During the ski day was not the problem...

It was the evening that killed me. Each evening after skiing my sugar would spike up to the upper 200's. One of the days when it hit 290, I figured it was because I had lowered my insulin all day and it was finally catching up to me. I bolused the 3.5 unit correction my pump suggested, and within 1 hour, and with 2.5+ units still left to go, I was 58. Another day, learning from the first, I didn't take the whole correction, still dosed normally for dinner, and was 90 at bedtime. I drank 2 small cans of juice, turned down my basal to 75%, and woke up at 140. (I've had horrible night-time lows so I'm always afraid of going low in my sleep after exercise. I cushioned that night a lot, and honestly thought I would be higher than that when I woke up).

Any ideas about the post exercise high sugars and the extreme response to the corrections? Should I have just ridden it out? Not corrected?

What do you guys do about bolusing for meals during and after exercise? I'm always challenged by whether or not to bolus the full amount when I've got my basal turned down...

Any suggestions or ideas are welcome! I'll include a pic of us at the summit - Lake Tahoe is in the background.

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i haven't experienced anything that high yet, but from what i've read on these forums many people have post exercise spikes. however, intense exercise makes me extremely insulin sensitive. if i'm a little high after exercise and try to correct with a mealtime bolus i'll be low in an hour as well. if i take a normal dose i'll be low in an hour and a half. after i play soccer i usually take half my bolus dose with dinner and have a bit more carbs (~50-60 grams). it was weird to try, especially if i was a little higher than i normally start a meal, and because i was eating more and taking less insulin, but if it works and you trust it then you actually get to eat something you normally wouldn't :) after a soccer match last year i had 2 slices of thin crust pizza with half my normal ICR and had a BS of 100 after :)
Rachel, I would suggest not reducing the basals quite as much for skiing. Even when I was racing and exerting a lot of energy, I was generally only reducing my "basal" (Lantus at the time) by about 30%. It was the boluses that I reduced a lot more. When I'm active, just about any extra spike of insulin triggers a low. I often will just bolus 20% of the regular amount and keep an eye on my numbers. Even with those small boluses, I will often have that over 0.5hr too so it doesn't hit all at once.

As for the meter, they are fairly useless in the cold. I would try to find a pocket as close to my body as possible, usually inside my coat where there's an inner pocket, but even there was still too cold. What ended up working was taking out the meter and putting it in my glove as I ride the chairlift. Then by the top, it was warm enough for a reading. In my experience (mostly using OneTouch meters then) a cold meter will give lower numbers - so don't be shocked if it says 50 and you feel more like 100.

Depending on how much exercise I do compared to my typical average, I'll adjust the night time basals and boluses. Skiing usually wasn't a huge effort, so maybe just -20% basals that night, and -30 or -50% for boluses. Other activities like hiking are a different story - usually -75% basals and boluses.
The thing that worries me about decreasing boluses vs. basal is that the food absorption can be so variable depending on the mix of the meal. I feel like I'll get all spiky at random times since the food can be so unpredictable, especially when eating out or in a ski resort cafeteria :)

I'll try it though, it seems like both you and Todd have had more success with meal time adjustments (food intake and bolus adjustments) rather than basal adjustments.

I want to start a Type 1 exercise group in my area so we can compare notes. This all helps me so much!

By the way - so funny that you mentioned the meter giving bad readings - I checked once and it said 51 - which would normally make me feel horrible, but I checked again 10 minutes later and I was 140. I had had some juice, but I think it was just a bad meter reading...

Thanks Andy!
It really all depends on your exertion too. If skiing is a leisurely thing for you, than I don't think big basal adjustments are necessary, and might be contributing to you post-skiing highs. On the other hand, if skiing is a thigh-burning workout all day, then those basal adjustments might be perfect.
It's average - I definitely got the thigh burn, but took breaks and such. My basal wasn't down much (depending on your basal-speak, I was at 80-90% of normal, or a decrease of 10-20%)...
I only have one ski trip under my belt as a Type 1, but I do have a lot of long triathlon workouts. I'm on the Pod and have a Dex as well. For long workouts I normally decrease basal 35% and then eat/drink carbs throughout the entire workout without any bolus. I'll have drinks with 20-40g per bottle, faster carbs (Gu, Shot blocks, etc) and some slow carbs (clif bars, etc) and basically work on getting in 30-40 carbs an hour. That usually keeps my levels right around 90-110 the entire workouts/race. I admit, the Dex really, really, really helps so I can adjust on the fly as needed. Definitely recommend a CGM. Post workout I can definitely be sensitive. If I start to go up I'll correct, but maybe 50% or less depending on the spike. Once again, the CGM will show you if you are going up fast or crazy fast (or down) so you can adjust quickly. Like Dan, I can splurge sometimes and I don't see the normal spike as a result of the linger effect from the earlier exercise. Nice! :)
I love the splurge... that might be why I'm so active. A full day cycling and I can eat everything in the house and still stay within range!
Wow Todd! That seems like so much food to me! I guess in the form of Gu and shot blocks it doesn't make you feel full at all. I'm surprised at how much carb you can consume and stay within such a good range. - I'm jealous actually - maybe I'll try less of a decrease during exercise (when I cycle I drop it down to 40% of my normal basal but I don't do the long triathlon type workouts) and more carb to balance it...
Yea, it really depends on the workouts so I was just giving an example. Normally I'll have oatmeal or something similar before a workout (covered completely), lower basal and for the first hour I'll be "riding" the carbs from breakfast. About 45 mins in or so I'll start adding liquid carbs (Accerlade, Endurox, etc), but just normal drinking. In the 2nd hour and beyond is when I'm really into 30-40 carbs per hour as I'll be regularly rotating between drink (carbs), long carbs (clif, etc) and an occasional fast carb (Gu, Shotblocks, etc). If the ride is really more of a casual one I'll dial it back a lot since I won't need it as much, but if the pace is higher, lots of hills, etc I'll need the carbs to stay in alignment. BTW, the carb consumption I'm talking about is actually similar to a non-Type 1. Once again, the CGM is the key for me. In my workouts before the CGM I was pretty consistent still, but when I tested mid-workout I didn't know if I was dropping or rising so couldn't really react.

I'm going skiing in early Feb so we'll see if I'm as consistent again as I am on the tri workouts. :)
Hey Rachel - after reading your post i have couple of questions/suggestions for you to think about.
You say you took your normal bolus with dinner (was this inclusive of a reduction??)
How long after exercise is your basal reduced for?? exercise can affect blood sugars even 24hrs post (freaky hey) i found and feel corrections following exercise can be managed one of two ways - either - as you say ride it out.... or with a correction minus 50%.

Another thing is that you could have still gone hypo through the night and had a "rebound" - where your liver will throw out a big heap of sugar to counteract the hypo (a body's natural response).

As we say down here - suck it and see!! every single time you do exercise you may have different hormones kicking around and different stresses so nothing can ever be set in stone!!

happy slope time (its summer here - biking rather than skining!!)

dan
Hi Danny,

Yes, I bolused normally for dinner. I considered doing less, but I was so high before dinner and had taken only a portion of the correction that night, so I thought I would need it to bring myself down. Apparently it was too much. I have the hardest time not dosing and correcting when I'm high. I know the exercise will hit, it's just counterintuitive to sit there with high sugar and not take my regular amounts of insulin.

The bummer is that I feel like part of the reason I'm exercising (outside of just plain loving it) is to better my health, and yet it's followed by erratic blood sugars and risky overnight lows...

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