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[IP] Exercise-basal rate changes-carbs

>When one exercises does one then go through the basal profile and replace
>each level with a lower one? Or does one decrease only some of the 24 hour
>profile? I don't mean the pre-exercise insulin but rather the post-exercise
>insulin. So far I've needed only to change my 9pm to 6am basal rates.
>Although I may be making up for daytime rates with more food/lower bolus?
I am very active and work out a lot, and I rarely change any basal rates when I'm spending a few days without a good workout.  If you're not working out at all and then start, your body will use insulin more efficiently for some time after that.  Since you're pumping Humilog, this is pretty easy to take care of.  I leave all basal rates the same at night whether I work out or not, but the daily patterns I change a lot.  1/2 hour before exercise, I drop my basal to 0.1, and keep it there till I'm done. The big thing to watch for is when you stop exercising and need to eat something.  I many times don't bolus enough to cover it; you have to remember that there isn't much insulin in your system.

>Then if I don't exercise for three days I have to bring the basal rate back
>up. I'm talking here about 0.3 to 0.5/hr. at night. Should I decrease all the
>basal rates the same amount or is night time especially affected by exercise?
>Also is that three days without exercise a predictable time span and/or could
>I expect the rate to creep back up even if exercise continues?
Again, I try to simulate what my pancreas would have done, which is drop insulin when you're working out, and bring it back up to cover what you're eating afterward.  I used to crash at night after a long workout (>2 hour hard bike ride) when I was using multiple injections of log and Nph.  Just a little Nph killed me because there was just too much insulin in there as my liver was trying to put glycogen back in my muscles.  Muscles are looking for glycogen for several hours after exercise, but not days afterward.  I don't think that your overall basal rate should change much with or without exercise.  Maybe I'm unusual, but I wake up with pretty similar BG whether I ride hard one day or not.  IMO, if you have lows at night after working out, you didn't eat enough after working out, assuming that you are on the pump and have had good control beforehand.  Because you are using insulin more efficiently after exercise, you may not need quite as big of a bolus for a meal that night.

>I've just read part of "The Glucose Revolution". It told me I should eat 2000
>grams of carbo to replenish the glucose in my muscles and liver. I guess I've
>been glucose starved with less than 500. It says to eat glucose within 1/2
>hour of exercising to stimulate insulin production as it is the insulin that
>stores the glucose in the muscles and liver.
I don't use anyone's carbs/day estimates. I eat what I need, and depending on how much fat and protein you eat, and when you eat it, 500 could be enough.  Also remember that fructose will go into reserves right away, while simple sugars will go right into your blood.  And your eating 1/2 hour after exercise should stimulate you to bolus.  Look on the packaging of Power Bars or Clif Bars and see how they mix the simple and more complex (e.g., corn syrup and dextrose) so that you get an energy boost right away and some that lasts longer.  This is a good example of how carbs come in different varieties.  Sweet bread or cookies will dump all kinds of glucose into your blood, but a banana will go in much more slowly and help you recover from a workout.

>I appreciate advice. Exercise is new to me as I found it unmanageable with
>shots and didn't need to gain weight. I never tried changing long acting
>insulin after exercise.
Now, I'm not a dietician, but this stuff has worked for me and should be taken as such.
Best of luck,

"We don't need a thinker, we need a doer: someone who will act first without considering the consequences."
-Homer Simpson

Derek Ryter
Ph.D. Candidate
University of Oregon