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[IP] re: how does the liver decide? - lows & exercise

Hi Jess....

	It does sound like your activity level (mild exercise) might be dropping
you low... and your highs are rebounds.  Perhaps you just aren't catching it
on a glucometer at the time.  Are you currently dropping your basal rate
(using a temp) during the activity?  Bolusing (by itself) before your walk
is definitely not the answer - more than likely you would only drop lower,
and then rebound higher thanks to your liver's attempt to save you!  The
drop in blood sugar is the mechanism which drives the liver's contribution
of glucagon (a hormone) - which releases glycogen (the stored form of
glucose).  High amounts of insulin, however, inhibits this process.  This is
often why we see the extreme rise in blood sugar *after* the blood sugar has
begun to come back up.  In your situation, my suggestion would be to start
by dropping your basal rate (or suspend if that works better for you) and/or
perhaps even eat a 10-15 gram CHO snack on your walk.  That should work....
but if it doesn't let us know.  You could try a few other things as well.

	And yes Gianna... I agree... it does get frustrating to have to add carbs
(& hence calories!) all the time, especially if you are trying to use
exercise for weight loss.  Pumps are easier for making spur of the moment
insulin dosage changes, in an attempt to avoid the need for additional
carbs.  People on insulin injections can have a more difficult time with
weight loss, thanks to lots more circulating insulin on board and no way to
acutely change that, except by eating more.  If your goal is weight loss,
the idea is to reduce your overall caloric consumption - this means you
could simply shift your pre-exercise carbs from a prior meal or snack,
without increasing your total caloric intake for the day.
	As for "fat-burning" theories.... we used to think that the best idea for
weight loss was "lower intensity" exercise which does burn a greater
*percentage* of fat than higher intensities, but not necessarily more
calories!  That "best idea for weight loss" theory has now been proven
wrong.  In fact, any exercise assists in burning both stored fat AND stored
carbohydrates (muscle & liver glycogen).  At rest, we actually burn about
50% carbohydrate & 50% fat!  But it doesn't really matter where the calories
come from in terms of weight loss - it is all about caloric expenditure.  :)
SO... if you must always ingest carbs prior to exercise to help keep your
blood sugar up, what good does can it possibly do??  LOTS!!  Sure, perhaps
if we had you exercising at the same intensity and the same duration as a
non-diabetic, and you had to ingest 15 grams of CHO to maintain your sugar
level, the non-d person might have burned more calories than you.  But I
couldn't put either one of you on a scale and see weight loss right then and
there!  And what you did for food intake earlier in the day certainly
matters.  Remember too that metabolism stays elevated for hours after
exercise, and training increases lean body mass overall.  Muscles burn more
calories over time, even at REST(!).... assisting in weight loss OVER TIME
without you even realizing it!  And yes, maybe the non-d person will lose
weight more quickly & have an easier time of it, in theory.  But we CAN do
it - we just have to think for our pancreases(!) and assist in the balancing
act... and perhaps be a little creative.  Makes you truly appreciate
metabolism!  Hope I didn't add to the confusion?  *grin*

~Delaine M. Wright, MS, CDE
Clinical Exercise Physiologist
MM507 11/97; Type 1 since '83

>Date: Tue, 23 Nov 1999 17:17:06 -0500 (EST)
>From: Jessica Marder <email @ redacted>
>so, what causes the liver to decide to dump glucose stores?  recently i
>seem to be having a lot of highs after walking around to and from classes
>and such...  is there anything i can do, besides trying to find a pattern
>by which to bolus when doing that kind of mild exercise?  it doesn't seem
>reliable enough to just bolus before going out for a walk...  (sometimes
>instead of ending up in the 200's i do end up in the 50-60 range...)  any
>thoughts?   Jess

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