Exercise

This is my diary for last 7 days or so. Loads of hypos - only change is daily a bit of cycling to local park or shops or bank. Seem to have delayed effect hours afterwards. Surely I should not have to reduce BI just for daily 30-50 minutes of cycling. Am I burning sugar at faster rate now. Any comments would be appreciated.

Updated Saturday: After increasing CPs from 1 to 2 before cycling the BG went sky high 2.5 hours later pre lunch. So this tells me that it probably needs to be reducing the BI - the morning dose probably especially since there is a delayed prolonged effect

Is this the right conclusion?

No lack of data! Well done!
I have not had time to analyse rigorously, so plse excuse me.
As a Type 1 diabetic of 45 years, exercise has always been a tad of a mystery. I was given an excellent suggestion on a very recent visit to my dafne centre: reduce QA bolus insulin dosage by between 30-50% if anticipating exercise.
I used to race a bike when much younger and I was staggered at how much sugar can be burnt during bike riding: 125g glucose supplement in a single shot in 20K (12.5 miles in old money) at around 36Kph (23 mph). So your fitness level, the weight of your bike, your speed and the weather conditions will all impact these kinds of numbers dramatically.
On top of this so will your general mental condition.
What do I mean?
Well, are you stressed by exams or do you find you find your levels of anxiety changing?
I have found that stress associated with activities I do not want to do (like going out or shopping (!) depress my blood sugar equally strongly just as if I were exercising.
So what am I trying to get at?
First, you will have the answers so look closely at your data and add stress factors and extra exercise-related info.
Second, my experience is derived from pump use and not MDI so please treat my observations with caution as I have not altered my basal rates during my most recent experiences.
I have only dealt with reduction of my bolus doses associated with meals.
Third, I have found that a 30% reduction is necessary for "normal" exercise like walking into town and/or mowing the lawn!
This recent change has made a dramatic effect on my perceived levels of anxiety and the numbers of hypos I have with the associated problems of hyperglycemic rebound and then later correction doses. A real see-saw and not helpful to anyone who is trying to gain control of their life.
I suspect that I will need to decrease my bolus insulin dosages by 50% if I take my bike out and seriously exercise. I would then still expect to require 60-90g of fairly fast acting carbohydrate per hour to be able to sustain my exercise level.

I hope this is helpful.

Hey SA2010,

Yeah, delayed hypos can be funny. Are you just getting back into cycling or have you been doing it regularly for a while and only just seeing delayed hypos?

Thank you Edward and Thank you Warwick

In answer to your points: My cycling and exercise is never planned and so cannot really address by QA bolus changes, I know that whilst the weather is good I would try to cycle to local shops or local park. My cycling is not intense. Leisurely and other cyclists do pass me !

But I seem to be very sensitive to little activity and also very touchy with minute adjustments to lantus dose.

I have not cycled for a while because I had a number of operations over the last three years - the last of which in June to fix an incisional hernia caused by the other ops. I got the bike out a week or so ago as the weather turned round.

I am adding a few more days to the BG diary with this post to show my failed attempts to deal with it. Because the impact was delayed I decided reducing Lantus was the answer but then had very high BG level I have not had before as you can see for the entry on the 6th May. It followed a hypo but surely a rebound would not go that high - 17.1. I repeated the test and got 14.9. It shows the accuracy of the meters ! Today I went back to the previous level of Lantus as 1u reduction seemed to make such a difference - I suppose with my low BI dose (3+6 reduced to 2+6, a 1u is significant percentage).

Today no cycling and no other activity and BG level back to normal levels. I do not know how to tackle this. Very sensitive to insulin - maybe without a pancreas my diabetes behaves different from others - or is just very touchy and sensitive to insulin levels? Exercise impact could be because I am not fit. I used to go the gym before the operations in 2010.

Personally speaking it takes me 3 days to see any impact of my Lantus BI dosage. Please take your time, particularly when changing this type of background insulin dose.
I'm insulin resistant and have QA ratios of 2 or 2.5:1...but rarely change more than + or - 2u BI and only when the need for change is firmly established in my mind.
Was your Friday 03/05 11:05 BI a typo?

Hypo rebound numbers seem to be a individual physiology thing, I've had 17s before.

My experiments with my meter results taught me how the numbers generated were hugely affected by hand cleanliness and have in a past thread reported big variations in results pre- and post-washing. Even having damp hands had a big effect.
Meter manufacturers will tell you that their meter is precise......what they mean is that the results have statistical precision, or repeatability to a dope like me. Somewhat different to accurate, which is what we all imagine they mean.
Regards
Garry

God what happened to my original post.

Sorry Diane - the subject of the thread was too good to keep the thread untouched. It was the obvious post/thread to add to ! So whenever anyone want to find out about exercise and BG and QA/BI etc... they can come to your thread !!

Hi Garry. Well spotted - it was a typo. Corrected it in the diary and now showing the correct dose of 3u BI at 11:05 on 3rd may.

I am now getting my BG levels almost right after regressing the BI morning dose to 3u from 2u which I only tried for 2 days and also did not cycle yesterday. Today I cycled to the supermarket - round trip with bit of shopping was 30 minutes, Took 1,5CPs of mini flapjack before cycling, BG was then 5,5. Was 9.0 pre dinner two hours later and now 6.2 3 hours after dinner. Might need a tiny bit of CP topup at bedtime as a fresh BI lantus dose coming in an hour.

Might stick with the extra CPs pre activity but would probably need a BG test to determine need and how much, Annoying to have to do that.

I too found the difference in BG test results after cleaning hands. Some months back I felt my BG was on the low side (I tend to feel it when it is about 5,0 or below) but when I tested it showed a reading of over 8.0 ! I did not believe it and repeated the test after washing hands and it was 4.9 ! I did not know wet or dry hands gave a difference too. I will bear it in mind. When you complain to manufacturers about false readings they send you the test kit but then the range for correct answers is quite wide for low and for high - range stretching 5.0 at the high end and 2.5 at the low end on my current strips (aviva). Similar ranges for freestyle. Just need to make sure dry clean hands every time.

Looked back through old posts and copied content of some old threads: -

.....May I ask - Do you always wash your hands before blood testing?
Most BG kits now use such a small blood sample that any contamination error has a really dramatic effect.
BG 16 to 5.6 in 45 minutes is very unusual.

I say this from experience with a Medisense Abbott Optium Xceed meter which on 5 second Optium Plus test strips uses a tiny blood sample - 0.6 μL.
They did a 3 second strip for a time which used an even smaller blood sample. But not sure whether they are available now.
Anyway I proved contamination error to self by repeated trials of unwashed hands v washed hands - washed immediately after - and saw errors of up to 8 BG. My conclusion was that I had to always accept the need for lack of contamination and to stick with washed hands at testing time.

Another one -
....where he mentions Optium Exceed meter test solutions, as far as I remember!! the acceptable meter result range using the high solution is around 13 to 21 mmol/L so that gives us a good idea of the error bound...which reminds me that I have not checked my meter for some time!
Which reminds me now.... that I have not checked my meter for some time again Test solutions at home are probably out of date now.

Regards
Garry

Thanks Garry, I do not always wash hands before a test.

When I suspect a BG reading, i.e. when I am not aware of any reason why the BG reading should be what it is, I do repeat it often switching to the other hand. The hypos and low readings were real. It is only the high's that could be suspect sometimes for me.

With so low Lantus dose for me (only 9u = 3u+6u] it appears that a 1u change has a big impact = so probably have to leave the BI dose as it is, Tamper with Lantus dose at your peril !! It could me months to stabilize and get the timings and the dose right after splitting the daily dose from 10u a day.

The issue then is how to address delayed hypos after some exercise. Because it appears to be delayed changes to QA dose would not be appropriate. This then tells me it has to now be extra CPs for extra activity. The trick is to work out when it is necessary and how much. If exercise is within 1 hour of meal then extra CPs at that time would not be appropriate,

I will try from now to always wash hands and dry them before every BG test

Going back...early mornings I could wake with a BG of 13 and think I'll go for a belt around the park on my bike and down to the seafront as quick exercise before insulin and breakfast.. to come back and do my blood and find I was BG 14....what's going on... I've just come back with a good elevated heart rate following exercise and blood has gone up!
Vic explained it best to me though...fight or flight.. as created by aerobic(?) exercise...releases adrenalin - which makes us insulin resistant + releases liver glucose...and bumps our blood up.
So then I would not start exercise without insulin and food first.
Can't offer you any good guidance however......as I'm still learning after 34 years.
Willing to progress and read some of the literature on exercise, that others have faith in and are promoting on here, to see whether it can help me sort out some mysteries of diabetic life for me.

Regards
Garry