High BS from running hard

Radioactive Man wrote in message
<[email hidden]>...

Quoted message said:

I have type one diabetes and do a number of races every
year ranging from a 5k run up to sub-ironman triathlons. My
typical injection schedule is 5 per day - basal injections
at 9 am and 9 pm plus bolus injections at meals, and some
small snacks between meals to cover the slight excesses of
basal insulin. During training, I very seldom have troubles
with high blood sugars - if any problems, it is occasional
low blood sugars, especially when covering long distances
at an easy pace. For the last several 5k races I've done,
I've had problems with blood sugar spikes both before and
after the race. For me, a 5k is a short, high-intensity
race where I am on the verge of anaerobic failure much of
the time, as opposed to a half-marathon or olympic distance
triathlons.

Since these races are almost all done by 9 am, I haven't
been doing the morning basal injection until after the
race is done. I have tried varying combinations of novolog
boluses and small snacks before the races (almost always
resulting in a BS spike), but until today, I never tried
racing with an empty stomach and no injection before hand.
Only this morning did I try the no food / no shot, and
ended up with the highest post-race BS spike I've ever had
- 252 (it was 98 ~ an hour before the race). I had
initially suspected the spikes might be caused by dawn
effect or insulin pen error on my part, but now I am
almost certain it is due to adrenalin spikes caused by the
intensity of the race, and probably even thinking about it
before hand. I know it is not dawn effect because I never
get anything near these spikes on the occasional day I sit
around the house for several hours before eating
breakfast. My fasting BS seems to fall in the 60 - 95
range whether I get up at 4 am and eat immediately or
sleep till 7 and eat at 9.

Anyone else have similar experiences with this problem? At
this point, I see several possible solutions: (1) don't
eat, but inject a couple of units of novolog at some point
before the race. This would be suicide on a long race, but
for me, a 5k is over in less than 20 minutes, which is
about the same time it takes novolog to start acting. (2)
Inject my typical pre-breakfast novolog dose (9 units), but
don't eat as much and test a few minutes before the race.
(3) Don't eat before the race, but move my morning
injection of Lente to a time before the race.

These spikes have always been easy to bring down, but I
would like to figure out the most effective way to minimize
them in the first place. This morning at 9 am when I
discovered the 252 BS, I injected my usual lente dose + 5
units of novolog. By 10:30, it had dropped to 42, so I ate
a light breakfast and have had no more problems since.
Clearly, 5 units is overkill for the adrenalin-induced
spike. I'm thinking an extra 2 or 3 units at some point
before hand would prevent a severe spike from ever
happening in the first place. Any suggestions from others
with similar experiences appreciated.

My heavy exercise is Step Aerobics which corresponds
to about 50 minutes of 130 pulse rate. I find that the
only way I can pull it off is to have both carb in my
belly and Humalog in my fat before I start the class.
I never skip or modify a basal shot (3 x Ultralente)
for any transient reason.

I have miscalculated and seen the 250 mg/dL (Somoygi
during the exercise ? ? ?) and the 40 mg/dL (wrong insulin
to carb guess).

I have learned the carb/insulin balance/timing particulars
by trial and error. It's almost like a military campaign
now. Inject Humalog 70-90 minutes before the exercise, eat
carb-rich 60 minutes before the exercise. I imagine other
routines would work; the one I settled on is convenient
since the exercise classes are less than 15 minutes from
my kitchen.

Regards
Old Al

.

Radioactive Man said:

Only this morning did I try the no food / no shot, and
ended up with the highest post-race BS spike I've ever had
- 252 (it was 98 ~ an hour before the race).

I see post cycling BG highs. I try to exercise for an hour
and if I train hard my adrenaline raises BG to ~250 mg/dl
area. I wait an hour after exercise before corrrecting the
high with insulin.

My exercise days try to keep insulin at basal with an empty
stomach. I try to keep pre-exercise BG at 100-150 mg/dl. If
I'm below 100, I take some dried fruit snack to raise BG
above 100. If I start the session at 100 I usually stay
there. But if I start the session at 150 I usually rise into
the 250 mg/dl area. Since adrenaline has a very short half-
life, the liver and muscles should start to take up glucose
at basal insulinemia post-exercise. So I wait until the dust
settles before dosing and taking my next meal.

If BG is above 150 mg/dl before exercise, I will take a
small dose of Humalog then start the session. Once the skin
heats up and blood flow at the injection site increases from
exercise, the dose will be absorbed quickly. Even ultralente
will be absorbed quickly during exercise and cause a spike
in insulinemia during the exercise period. So I try not to
dose before heavy exercising.

I also lower my morning basal ultralente for the exercise
day. Then use variable bedtime NPH to control fasting
triglycerides as well as BG. This variable basal strategy is
still evolving but quite successful to date.

In any case, I see the same high BG post exercise. Goes
with the turf,
--
Jim Dumas T1 4/86, background retinopathy, rarely
hypoglycemic: <1/mo. lispro+R+U+NPH daily, moderate
exercise, typically <6% HbA1c

On Sat, 15 May 2004 22:08:15 -0400, "oldal4865" <[email hidden]>

Quoted message said:

Radioactive Man wrote in message
<[email hidden]>...

Quoted message said:

I have type one diabetes and do a number of races every
year ranging from a 5k run up to sub-ironman triathlons.
My typical injection schedule is 5 per day - basal
injections at 9 am and 9 pm plus bolus injections at
meals, and some small snacks between meals to cover the
slight excesses of basal insulin. During training, I very
seldom have troubles with high blood sugars - if any
problems, it is occasional low blood sugars, especially
when covering long distances at an easy pace. For the last
several 5k races I've done, I've had problems with blood
sugar spikes both before and after the race. For me, a 5k
is a short, high-intensity race where I am on the verge of
anaerobic failure much of the time, as opposed to a half-
marathon or olympic distance triathlons.

Since these races are almost all done by 9 am, I haven't
been doing the morning basal injection until after the
race is done. I have tried varying combinations of novolog
boluses and small snacks before the races (almost always
resulting in a BS spike), but until today, I never tried
racing with an empty stomach and no injection before hand.
Only this morning did I try the no food / no shot, and
ended up with the highest post-race BS spike I've ever had
- 252 (it was 98 ~ an hour before the race). I had
initially suspected the spikes might be caused by dawn
effect or insulin pen error on my part, but now I am
almost certain it is due to adrenalin spikes caused by the
intensity of the race, and probably even thinking about it
before hand. I know it is not dawn effect because I never
get anything near these spikes on the occasional day I sit
around the house for several hours before eating
breakfast. My fasting BS seems to fall in the 60 - 95
range whether I get up at 4 am and eat immediately or
sleep till 7 and eat at 9.

Anyone else have similar experiences with this problem? At
this point, I see several possible solutions: (1) don't
eat, but inject a couple of units of novolog at some point
before the race. This would be suicide on a long race, but
for me, a 5k is over in less than 20 minutes, which is
about the same time it takes novolog to start acting. (2)
Inject my typical pre-breakfast novolog dose (9 units),
but don't eat as much and test a few minutes before the
race. (3) Don't eat before the race, but move my morning
injection of Lente to a time before the race.

These spikes have always been easy to bring down, but I
would like to figure out the most effective way to
minimize them in the first place. This morning at 9 am
when I discovered the 252 BS, I injected my usual lente
dose + 5 units of novolog. By 10:30, it had dropped to 42,
so I ate a light breakfast and have had no more problems
since. Clearly, 5 units is overkill for the adrenalin-
induced spike. I'm thinking an extra 2 or 3 units at some
point before hand would prevent a severe spike from ever
happening in the first place. Any suggestions from others
with similar experiences appreciated.

My heavy exercise is Step Aerobics which corresponds
to about 50 minutes of 130 pulse rate. I find that
the only way I can pull it off is to have both carb
in my belly and Humalog in my fat before I start the
class. I never skip or modify a basal shot (3 x
Ultralente) for any transient reason.

I never adjust my evening Ultralente dose for transient
reasons either. But since I normally use a bit of excess
basal insulin (L, as long as its available) in the morning,
I have figured out that I can do better (fewer lows) by
reducing that dose by ~25% if I'm doing a very long bike
ride that day, or will be swimming in the morning, running
in the afternoon, etc.

Quoted message said:

I have miscalculated and seen the 250 mg/dL (Somoygi
during the exercise ? ? ?) and the 40 mg/dL (wrong insulin
to carb guess).

I believe in my case the high was caused by simply knowing
and thinking about how hard I was going to run and then by
actually going out and doing it. I start the 5k's with a
different mind set than longer races, knowing that I will
(or should) be huffing and on the verge of puking the whole
time. I believe my body simply reacts differently to this
stimulus than to the "save the best for the last few miles"
strategy I use in longer races.

As for the lows, I am quite a bit more experienced in
dealing with those without overshooting. For me, correcting
highs caused by exercise is tricky, since I have little
experience with correcting highs and I'm dealing with
tissues made more insulin-sensitive by the exercise, but
less so by the high blood sugar. Thus, I usually overshoot
and end up correcting the subsequent low before things get
back to normal.

Quoted message said:

I have learned the carb/insulin balance/timing particulars
by trial and error. It's almost like a military campaign
now. Inject Humalog 70-90 minutes before the exercise, eat
carb-rich 60 minutes before the exercise. I imagine other
routines would work; the one I settled on is convenient
since the exercise classes are less than 15 minutes from
my kitchen.

I believe it's mostly trial and error. My doctor gave me
these ratios of insulin to carbs and excess blood sugars
when I was diagnosed last year, but those are pretty much
obsolete now.

Might I ask if you do as I do and inject excess basal
insulin in the morning? (meaning that with a day of only
basal injections, you'd still have to eat a little to
avoid low blood sugars). If not, that might be a way to
eliminate the need for humalog before exercise. The main
reason I do this is to avoid highs when the novolog wears
off and also allow myself a few small snacks with no
additional shots. The downside of excess basal insulin is
that I must be very careful of lows during evening or
afternoon exercise. That is why I reduce the dose for big
events (like 50 mile bike rides).

Quoted message said:

Regards
Old Al

.

On Sun, 16 May 2004 12:15:01 GMT, Jim Dumas

[email protected]!mindspring.com said:

Radioactive Man said:

Only this morning did I try the no food / no shot, and
ended up with the highest post-race BS spike I've ever
had - 252 (it was 98 ~ an hour before the race).

I did another race this morning - a longer (8k), lower-
intensity trail race, but things went well this time. I woke
up at 5, had a fasting BS of 118 at 5:30 (a bit high, but
probably due to adrenaline), shot 9 units of novolog. Drank
a protein shake at 5:50 (~ 45 g of carbs), had a BS of 60 at
7:30 and ate a 13 g carb granola bar at that point. Ran the
race at 8 (didn't eat anything else before or during). At
8:50, the BS was 97 and injected 12 units of Lente, ran a
couple of more miles, ate a few snacks and have been OK
since. Normally, each unit of novolog would cover 10 or 11
g of carbs. Thus, I believe I'm using 2 - 4 units of
insulin to cover the adrenaline spike.

Quoted message said:

I see post cycling BG highs. I try to exercise for an hour
and if I train hard my adrenaline raises BG to ~250 mg/dl
area. I wait an hour after exercise before corrrecting the
high with insulin.

My exercise days try to keep insulin at basal with an empty
stomach. I try to keep pre-exercise BG at 100-150 mg/dl. If
I'm below 100, I take some dried fruit snack to raise BG
above 100. If I start the session at 100 I usually stay
there. But if I start the session at 150 I usually rise
into the 250 mg/dl area. Since adrenaline has a very short
half-life, the liver and muscles should start to take up
glucose at basal insulinemia post-exercise. So I wait until
the dust settles before dosing and taking my next meal.

If BG is above 150 mg/dl before exercise, I will take a
small dose of Humalog then start the session. Once the skin
heats up and blood flow at the injection site increases
from exercise, the dose will be absorbed quickly. Even
ultralente will be absorbed quickly during exercise and
cause a spike in insulinemia during the exercise period. So
I try not to dose before heavy exercising.

I also lower my morning basal ultralente for the exercise
day. Then use variable bedtime NPH to control fasting
triglycerides as well as BG. This variable basal strategy
is still evolving but quite successful to date.

That is a new one on me - using insulin to control
fasting triglicerides. Is that something you can check
regularly at home?

Quoted message said:

In any case, I see the same high BG post exercise. Goes
with the turf,

For me, that depends very much upon the intensity and
duration. Running 10 minute miles will not cause the
adrenaline spike like an all-out 5k race at near 6 minutes
per mile will. As long as I've had the basal injections on
time, I will become progessively more prone to lows as the
length of the training increases.

Anyway, thanks for the info.

Radioactive Man wrote in message
<[email hidden]>...

Quoted message said:

oldal4865 said:

Radioactive Man wrote in message

Quoted message said:

Might I ask if you do as I do and inject excess basal
insulin in the morning? (meaning that with a day of only
basal injections, you'd still have to eat a little to
avoid low blood sugars). If not, that might be a way to
eliminate the need for humalog before exercise. The main
reason I do this is to avoid highs when the novolog wears
off and also allow myself a few small snacks with no
additional shots. The downside of excess basal insulin is
that I must be very careful of lows during evening or
afternoon exercise. That is why I reduce the dose for big
events (like 50 mile bike rides).

That's exactly what I do though for slightly different
reasons. I shoot an extra bit of cheap, OTC Ultralente
in the morning and assume that the extra Ultralente
cuts my need for expensive, prescription-only, 3 month-mail-
order only, Humalog (and defers the PITA which moving
from 1 vial of Humalog per month to 2 would entail).

Also, I am hypo-aware, function well when low, and carry
glucose with me at all times. Killing a low is trivial,
tweaking a high is burdensome.
. .and I can often (but not always) snack without shooting.

I believe that my Ultralente is a bit less peaky than Lente
which may be why I don't see problems with evening lows from
the extra basal. I also split my daily Ultralente into 3
shots which further reduces the effects of peaks. Thus, I
have not seen a need to adjust a basal to reflect my normal
day-to-day activities. I can hold it constant and adust the
Humalog, e.g. I shoot less Humalog on Step Aerobic days.

OTH, I Step 4 times a week and Nautilus 3 times a week so
my anti-Insulin Resistance exercise pattern is very
consistent. I have seen a need to adjust basal while out-of-
town or sick.

BTW. My fat layer seems to release basals rather quickly. I
would regard a 2 x Lente basal as "on the edge".

Regards
Old Al

wow! 9 units to cover 45 carbs and THEN you plan to run! I'd
be on the ground or in the ER if I tried that one. I take
1/2 of my regular bolus and cut my basal to about 2/3 of
normal when exercising. What is your carb/insulin ratio when
NOT exercising?

dave

Radioactive Man said:

On Sun, 16 May 2004 12:15:01 GMT, Jim Dumas <j-

[email protected]!mindspring.com said:

Radioactive Man said:

Only this morning did I try the no food / no shot, and
ended up with the highest post-race BS spike I've ever
had - 252 (it was 98 ~ an hour before the race).

I did another race this morning - a longer (8k), lower-
intensity trail race, but things went well this time. I
woke up at 5, had a fasting BS of 118 at 5:30 (a bit high,
but probably due to adrenaline), shot 9 units of novolog.
Drank a protein shake at 5:50 (~ 45 g of carbs), had a BS
of 60 at 7:30 and ate a 13 g carb granola bar at that
point. Ran the race at 8 (didn't eat anything else before
or during). At
8:50, the BS was 97 and injected 12 units of Lente, ran a
couple of more miles, ate a few snacks and have been OK
since. Normally, each unit of novolog would cover 10 or
11 g of carbs. Thus, I believe I'm using 2 - 4 units of
insulin to cover the adrenaline spike.

Quoted message said:

I see post cycling BG highs. I try to exercise for an hour
and if I train hard my adrenaline raises BG to ~250 mg/dl
area. I wait an hour after exercise before corrrecting the
high with insulin.

My exercise days try to keep insulin at basal with an
empty stomach. I try to keep pre-exercise BG at 100-150
mg/dl. If I'm below 100, I take some dried fruit snack to
raise BG above 100. If I start the session at 100 I
usually stay there. But if I start the session at 150 I
usually rise into the 250 mg/dl area. Since adrenaline has
a very short half-life, the liver and muscles should start
to take up glucose at basal insulinemia post-exercise. So
I wait until the dust settles before dosing and taking my
next meal.

If BG is above 150 mg/dl before exercise, I will take a
small dose of Humalog then start the session. Once the
skin heats up and blood flow at the injection site
increases from exercise, the dose will be absorbed
quickly. Even ultralente will be absorbed quickly during
exercise and cause a spike in insulinemia during the
exercise period. So I try not to dose before heavy
exercising.

I also lower my morning basal ultralente for the exercise
day. Then use variable bedtime NPH to control fasting
triglycerides as well as BG. This variable basal strategy
is still evolving but quite successful to date.

That is a new one on me - using insulin to control fasting
triglicerides. Is that something you can check regularly
at home?

Quoted message said:

In any case, I see the same high BG post exercise. Goes
with the turf,

For me, that depends very much upon the intensity and
duration. Running 10 minute miles will not cause the
adrenaline spike like an all-out 5k race at near 6 minutes
per mile will. As long as I've had the basal injections on
time, I will become progessively more prone to lows as the
length of the training increases.

Anyway, thanks for the info.

On Mon, 17 May 2004 00:10:14 GMT, Bay Area Dave <[email hidden]>

Quoted message said:

wow! 9 units to cover 45 carbs and THEN you plan to run!
I'd be on the ground or in the ER if I tried that one. I
take 1/2 of my regular bolus and cut my basal to about 2/3
of normal when exercising. What is your carb/insulin ratio
when NOT exercising?

Normally, I do about 11 to 1 carb to insulin in the
mornings. The extra insulin this morning was only to cover
the adrenaline-induced BS spike and it worked pretty well
this morning. My experience yesterday (BS spike to 252 after
the 5k race) pretty much demonstrated that.

For my normal training runs (or swims) I do in the
morning, I don't need to inject and eat first. When I eat
breakfast afterwards, I can actually reduce the insulin to
carb ratio a bit.

Quoted message said:

dave

Radioactive Man said:

On Sun, 16 May 2004 12:15:01 GMT, Jim Dumas <j-

[email protected]!mindspring.com said:

Radioactive Man wrote:

>Only this morning did I try the no food / no shot, and
>ended up with the highest post-race BS spike I've ever
>had - 252 (it was 98 ~ an hour before the race).

I did another race this morning - a longer (8k), lower-
intensity trail race, but things went well this time. I
woke up at 5, had a fasting BS of 118 at 5:30 (a bit
high, but probably due to adrenaline), shot 9 units of
novolog. Drank a protein shake at 5:50 (~ 45 g of carbs),
had a BS of 60 at 7:30 and ate a 13 g carb granola bar at
that point. Ran the race at 8 (didn't eat anything else
before or during). At
8:50, the BS was 97 and injected 12 units of Lente, ran a
couple of more miles, ate a few snacks and have been OK
since. Normally, each unit of novolog would cover 10 or
11 g of carbs. Thus, I believe I'm using 2 - 4 units of
insulin to cover the adrenaline spike.

Quoted message said:

I see post cycling BG highs. I try to exercise for an
hour and if I train hard my adrenaline raises BG to ~250
mg/dl area. I wait an hour after exercise before
corrrecting the high with insulin.

My exercise days try to keep insulin at basal with an
empty stomach. I try to keep pre-exercise BG at 100-150
mg/dl. If I'm below 100, I take some dried fruit snack to
raise BG above 100. If I start the session at 100 I
usually stay there. But if I start the session at 150 I
usually rise into the 250 mg/dl area. Since adrenaline
has a very short half-life, the liver and muscles should
start to take up glucose at basal insulinemia post-
exercise. So I wait until the dust settles before dosing
and taking my next meal.

If BG is above 150 mg/dl before exercise, I will take a
small dose of Humalog then start the session. Once the
skin heats up and blood flow at the injection site
increases from exercise, the dose will be absorbed
quickly. Even ultralente will be absorbed quickly during
exercise and cause a spike in insulinemia during the
exercise period. So I try not to dose before heavy
exercising.

I also lower my morning basal ultralente for the exercise
day. Then use variable bedtime NPH to control fasting
triglycerides as well as BG. This variable basal strategy
is still evolving but quite successful to date.

That is a new one on me - using insulin to control
fasting triglicerides. Is that something you can check
regularly at home?

Quoted message said:

In any case, I see the same high BG post exercise. Goes
with the turf,

For me, that depends very much upon the intensity and
duration. Running 10 minute miles will not cause the
adrenaline spike like an all-out 5k race at near 6
minutes per mile will. As long as I've had the basal
injections on time, I will become progessively more prone
to lows as the length of the training increases.

Anyway, thanks for the info.