Exercise

Can anyone advise me as someone who has never used a gym before or done much exercise please. If I'm doing say an hour's exercise, DAFNE says to reduce insulin by 20-50% prior to the exercise. Does that mean short acting AND long acting? Do I also take extra cps? Or does that depend on my blood sugar? I also read that if you want to lose weight it is better to decrease the insulin. I am really nervious about going. I know I will have to work it out for myself as I go along but I wondered if anyone had any advice, thank you.

For an hour down the gym I wouldn't reduce background insulin. I reduce my background if I'm going to do a days paintball or something where I'm going to be much more active all day long. If I'm just going to do a hours running though then I just change the quick acting (QA).

If you took some insulin prior to exercise (QA generally last for 4 hours) and didn't reduce the dose in advance then you need to take on some carbs, if you're taking insulin after exercise though then you can just reduce your ratios for that meal. Do carry some quick carbs on you though should you get in distress and I'd advise testing your BG before exercise and apply the same rules you would do if you were going to drive, i.e. bring it up to 5.0 before starting.

You do need to be careful about being to high as well though as if your sugars are something mad like 15+ then that's not very good for you at the best of times, if you then start to put your body under physical stress it's only going to compound the problem.

Best advice is be progressive, it's good advice for anyone starting a new exercise regime but don't push yourself to far to fast. By easing in you'll see what impact a little exercise has and how increasing that load impacts you. Also if you're in a gym there are going to be other people around including staff, pick someone and tell them you're diabetic, show them how your test meter works, what hypo cures you have on you and what to do should you get in distress.

If you are still nervous about it though then test every 30 mins. That will give you a good idea of how your bloods are reacting to the exercise and after a while you won't need to do that any more because you'll be able to predict it from past experience.

You probably know this already but there is also a section on exercise in the DAFNE Course Handbook which is in the DAFNE tools on the right of the screen. Lots of advice in there too.

You will have to carry out a bit of trial and error testing for your own personal needs, but the general advice as detailed by Apollo, is that for short periods of medium to intense levels of activity you should consider reducing your previous meals QA dose, keeping in mind that you may need extra CPs during and after. Whether you need CPs during your activity will be determined after you have tested and analyzed your results.....

Longer period of low to medium intensity activity is usually catered for with a reduction in BI, basically due to the slower effects the activity will have.......

The DAFNE handbook has quite a good basic guide but you will need to make your own personal observations to fine tune your reductions......

OK thanks both of you, that's very helpful.

as I am intending to go in the morning I will reduce my QA at breakfast. If I go a couple of hours after breakfast, and I have reduced my dose, I have no idea what my reading will be when I test then, I mean if it is 5 or 6 I would panic a bit to be honest! If it was between 7 and say 10 I would feel ok. I know I am probably being over cautious and as long as I have glucose etc on me I will be ok.

QA insulin tends to last about 4-5 hours although generally it's done most of it's work 3 hours after you take it so 2 hours after your shot is not a bad time to go, it will show you that exercise will have an impact on your sugars without it being to drastic.

It's better to be overly cautious than not cautious enough, just do what your comfortable with, as you learn what works for you'll become more confident with it and will be equipped to make better judgement calls.

You may find that you need a little less insulin for the meal after your exercise too. If when you test for that meal you find your high I'd give no correction for it and use is as a sort of buffer zone. If you want to decrease your insulin a little for your lunch you can however so long as you have a hypo treatment to hand and have a reliable hypo sense there is no real harm in going that way and treating the onset of the hypo if it happens.

Don't let this scare you but one thing to be aware of is that when exercising hypo awareness can be slightly masked. Cold sweats are easily missed when your dripping with sweat and if you have really been pushing yourself you muscles may be tired and shakey as a result of the exercise so that slight tingle can be harder to spot. If you find yourself in any doubt just do a quick finger prick test, and if you do find you were low don't think you have lost your hypo awareness it's a little like being walking round the house at night with the lights off, you may not be able to see to well but it doesn't mean you have gone blind. Once you cool down from your workout your hypo sense will be just as it was before.

There are some famous sports people out there with type 1 diabetes so while it's understandable that you would be scared by starting an exercise regime, diabetes it just a small obstical to overcome no an impassable barrier.

Hello Diane,

You may actually find that your BGs rise after exercise if it is anaerobic and that you need more insulin prior to exercise as Gari found in this thread:

http://dafneonline.co.uk/forums/1/topics/2128

It really is a question of trial and error. Personally I find that if I exercise for an hour, then I either need to do it shortly after a meal (with slightly reduced QA), or I need to take some carbs (about 30 g) before or during the exercise.

I also recommend regular and increased testing afterwards - hypos can occur for up to 48 hours after exercise depending on the intensity and duration of the exercise.

Despite all that, it is still definitely worth it to keep exercising.

In terms of losing weight, the best time to exercise is shortly after eating because you can reduce QA rather than needing to take extra carbs to avoid a hypo. If you experience dawn phenomenon, then another good time to exercise to lose weight is prior to breakfast when your BGs are high from the rush of hormones as you don't need to take carbs, AND your BGs will come down from their high levels.

I recently attended a conference on exercising with type 1 diabetes. The general advice from that was that there is no BG reading that is too high to exercise as long as your ketone levels are normal. Follow the DAFNE advice with regards to that - any BG reading above 13 prior to exercise should be accompanied by a ketone test. If ketones are present (0.5 or above), then do not exercise. Take some QA to bring the ketones down and exercise later, or another day when ketone levels are normal.

All the best,
Warwick.

I'm with Warwick, although I would say that your BG can be lower for upto 48 hours it doesn't necessarily equate to hypo's it just means be aware you may need less insulin than usual. In all the years I went to a gym I never once hypo-ed during exercise, it made my BG higher than normal a few times but never too low, so I wouldn't worry about hypo's or masked hypo awareness. As stated as well the DAFNE Handbook has a section on exercise that provides the basics.
I think the over-riding message is , don't worry ! enjoy the exercise it has loads of benefits and really is good for you. The benefits far out weight the negatives

Hope it is ok to continue with this thread for my scenario today.

I am wondering how long the impact of just a 40 minute cycling activity to the local park would last.

I have had 3 occurrences of BG below 4.0 (3.3, 3.4, 3.7) since then and it was a short bike ride before lunch which was 40 minutes and i thought 1 CP of mini flapjack taken before the ride would be adequate for it - it was just over an hour before lunch. Just in case, i reduced the QA after the ride with lunch QA reduced by 1/2 (10%) and for dinner i reduced it by 1u (13%). I did not expect impact of activity to have an effect so long after.

I will try to put a diary for a few days online tomorrow.

Insulin Regimen: Novorapid QA:CP 1.3:1 (Breakfast) @07:30-08:30am, 0.6:1 (Lunch) @13:00-14:00, 0.8:1 (Dinner) @19:00-20:00.
Split Lantus 3.0 @ 11:00am, 6.0 @ 23:00
Bedtime about 1am

Hello SA2010

I don't hypos during my 1 hour ride to work as it is too soon after breakfast, although I have occasional ones afterwards, but if I don't take carbs before my ride home, then I will hypo every time. I tend to need 3-4 CPs to keep the BGs steady on the way home.

If you have only just started cycling, then you may well find that you hypo more often until your body adjusts which can take 4-6 weeks. By that time you will have a very good idea of how exercise affects your insulin and carb needs.

That is very useful info Warwick. Thank you. Timing appears to be important. If it is soon after breakfast I would not take CPs either as my BG is probably at peak then. I will look at my diary for last week - I am cycling everyday. Spring is coming here at last. I just did not expect the delayed effect. A hypo 10 hours after the 40 minute cycling activity even with some reduction in QA after the activity.