Any STers w/ Diabetes? Need some advice

Triathlon Forum
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I am looking for advice for a friend of mine who has recently decided to start running and attending yoga class. She has been having a hard time figuring out how to manage her blood sugar when she exercises. I asked if she knew any athletes w/ diabetes who had figured things out and she did not- I thought given how many of you there are perhaps there would be someone who can offer some advice.
So far, her problem has been crazy high sugars. Last week she went out for a 2-3 mile run and wound up almost passing out as a result of high blood sugar. Yesterday, she was off to a bad start since her sugar had been in the 200s-300s all day (we are nurses and her patient coded this AM- so that was the start of the problem). We went to an hour long yoga class together and then we went out to whole foods and ate a pretty carb- free salad and some cantalope. When she checked her sugar after dinner it was 500! So, if you have DM or know someone who does that can offer some insight on what might work to keep a stable blood sugar that would be very helpful. Also, I should probably add that she is using a pump just in case that makes a difference.

Thanks!
KJ

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  1. Some individuals have post exercise hypergycemia, if that is the case, suggest increasing basal for 3-4 hours.
  2. 500bg, sounds more like a problem with the infusion site, I bet anything the infusion isn’t working right or pulled out. Once you get in the mid-3’s, take a shot to play it safe.
  3. Consider using a continuous bg monitor, all diabetes specialists have them and of course you can buy it from medtronics. These are far from accurate, but do work trends so she can see what is happening.
  4. I bet the patient code, (if infusion is ok), caused cortisol release thus everything goes haywire.
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I’m assuming she’s type 1. My best advice is to check your sugar often. If I’m doing some type of new activity or workout. I usually end up checking my sugar at least 10x that day because I’ll check it during the activity and after the activity a couple times to keep an eye on things.

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First of all, keep in mind that everyone’s body reacts differently, so the safest thing is for your friend to check her blood sugars very often. Everyday stresses can wreak havoc on blood sugars, so when combining that with her workouts, she just has to start building a knowledge base. It can definitely be done 100%, but unfortunately, it sometimes just needs to be done with a bit of trial and error. Ask away with any specific questions, I know there are more than a few Type 1 Diabetics on the forum, so one of us should be able to offer a little insight. I’ve been racing triathlons for many years and the last 19 of those years have been after my diagnosis, so fitness can be had!
Kevin Powell
Team Type 1 Triathlon & Running Team member

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http://www.triabetes.org/
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  1. She needs to make sure that her blood sugar is not high before she goes out for a run or starts Yoga. I normally make sure mine is below 160. For some (or most) people, if you start with high blood sugar, it will only rise while exercising (don’t ask me why, but I’m sure someone else on the forum knows why).
  2. 500? That’s super high and, as other have suggested, it seems that there might be some other underlying issue with the pump. I’m not a pump user, but is it possible the thing isn’t calibrate correctly (can any other pump users weigh in on this… is calibration an issue?). How has her control been before she increased her workouts? I’d venture to say it hasn’t been the greatest, because I just can’t see a 2-3 mile run spiking her sugars THAT high on its own.
  3. As others have suggested… check sugars, check sugars, and check sugars. Everyone reacts differently, and the only way to learn about one’s personal reaction is diligently check your sugars around your workouts.
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I am a pump user and I have had similar issues. I have found a couple of things that have really helped.

  1. Continuous Glucose monitor. I use Dexcom. This was covered by my insurance so the cost to me wasn’t too bad. I look at this all of the time during my workouts. While the exact numbers are sometimes off, the direction of the reading is usually accurate. So for example the monitor may read 160 vs. a sugar that is really 140, but when I see it hit 150 then I know that it is headed down. Dexcom (and probably others) allow you to set up alerts for both high and low sugars. The monitor then notifies me that my sugar is over 200 and I can counter act it with some insulin if necessary before it gets way out of hand. The low sugar notification is especially helpful while working out. I set it at 100 but I rarely let it get that low during a workout.

  2. Have appropriate sugars with you. I use various gels (lately Accel with no caffeine). You are probably going to get low at some point so be prepared to take a gel and walk for a while. I find that a gel really increases my sugars but not necessarily right away.

  3. Take some insulin right after you finish your workout. I don’t know why, but my sugars are often around 80-120 when I finish and a half hour later are hitting 200 quickly. I found that if I take 3-4 units of insulin right after I finish my workout that I minimize these increases.

Basically it is different for everybody so she will have to figure a lot of this stuff out for herself. I strongly encourage her to get a Continuous Glucose Monitor. Not just for working out but for everyday life. I would say that other than pump malfunctions it has stopped me from being over 300 more than a couple of times in the last 3 months whereas I was probably crossing the 300 threshold at least once a week before.

Feel free to PM me if you have any other additional questions or just want to chat. My email is rsfrech@ yahoo.com.

Good luck to your friend.

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Another Type 1 here.

I’ve never gone high from exercise, but I also make sure to never start if I’m much over 200 (very rare). I guess my question would be: how was her control before she started exercising?

Also, someone posted the Triabetes link already. The whole Insulindependence group is great.

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I’m a marathoner and somewhat of a cyclist with Type 1. I was diagnosed 5 years ago and have been on an insulin pump for 3 years now.

First of all, I’m going to take a stab in the dark and say that the 500 was a fluke unrelated to exercise. I’m better that the infusion site was bad, the insulin was bad, or your friend did not take enough insulin to cover for her meal. I’ve never heard of anybody having calibration issues with their insulin pumps, but if the trend of really high blood sugars continues for more than a week, I would call both the doctor and her pump manufacturer.

Type 1 is different for everybody, but generally 2 things can happen when we work out:
Sugars go low- This is typical for endurance exercise and lower intensity workouts like lifting weights, using the elliptical, etc.
Sugars go high- This is typical for high intensity or high stress situations. Think of doing a time trial on a bike or sprinting.

However, as may be the case for your friends, sugars just freak out no matter what. Most Type 1s that I know prefer to start exercise with a blood sugar between 120 and 180. I usually try and aim for 180. This is because I commonly go low during exercise. However, there is a point at which blood sugars are really too high to exercise- I believe the medical standard is anything over 240 mg/dL.

Is she wearing her pump while she exercises? She should, and if her current trend is to have high blood sugars after workouts, she should considering using a higher temporary basal rate while exercising or taking a set bolus of 1 or 2 units at the end of a workout.

I know nurses are busy, busy, busy. Hopefully, she is checking her blood sugar at least pre-meal and 2 hours post-meal. On days I exercise I also test 30 minutes before exercise, right before exercise, during exercise (if it’s a long workout), and immediately post-exercise.

Blood sugars for Type 1s tend to be like a roller coaster, but testing blood sugars more often (or getting a continuous glucose meter to see trends) helps to reign it in.

If your friend wants to talk more, PM me for my email address.

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Great responses by many folks already. The only thing I’ll add is that it is hard and some days… even dangerous… but (BUT!!!) the benefits of exercising/running/doing tris as a T1 diabetic far out weight the challenges. My blood sugar is much more manageable on the days I’m working out and when I have workouts coming up, I make sure my numbers are where they need to be. On my off days or if I take a small break, I find it very easy to let things slide.

So… my point is while it is difficult, especially in the beginning, it is worth it and keep after it!!

I’ll second triabetes.org and throw in glucomotive.org for runners. I happen to be closely involved with this organization. There are many regional events around the country to check out!!