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[IP] Exercise Lows/Highs

"What a complicated disease this is!" Nancy Morgan

Nancy's right of course, diabetes is a complicated disease and so is 
figuring out an appropriate plan to maintain Bg during exercise. Of course 
the best way for me to manage my Bg before, during, and after exercise is to 
check my Bg often, even during the exercise. I have done countless hours of 
many different levels of exercise, and how my Bg responds always varies. I'm 
very careful about exercising too close to a bolus. Ideally, I need a window 
of two to three hours. I also depend greatly on adjusting my pump with temp. 
rates to make the appropriate changes in delivery. I wear a disetronic pump 
and I sometimes use my 2nd pump for exercise, which has the bolus increment 
set at 0.1 instead of the default 0.5(MiniMed increments in 0.1). I would 
caution against a large bolus before or during any exercise. I sometimes use 
a combination of a small bolus and significant temp. basil increase to 
"chase" a high Bg. With a temp. basil, every three minutes you get a tiny 
pulse of insulin; that's much closer to the normal pancreases release of 
insulin. I have never had success with "padding" my Bg prior to exercise. 
Padding is a technique that disables your athletic ability.  We aren't 
camels and we can't just overdose on glucose and expect to burn it off. To 
optimize my athletic performance and better plan a great workout, I always 
look at how much insulin is in my system and where my Bg is then I can 
adjust the insulin or glucose appropriately. I like the 20 minute rule for 
fueling the exercise, and I also like to eat 15 grams of carbs prior to the 
exercise. The 20 minute rule also works well with children with diabetes 
because it is a rule that keeps them safe from lows and we all know how 
children like to follow rules!(ha) On long workouts, I like to check every 
20 minutes, but if it's not possible to check I try to eat some glucose 
every 20 minutes. I use a complex carb for the 1st 2/3's of the workout such 
as PowerBar or PowerGel, Then I lean more towards simple carbs like gatorade 
or glucose tabs. Hey, nobody said it was easy! The type of exercise will 
certainly effect my Bg as will how long it has been since I last exercised. 
For example, if I take several days off then go for a run, I will be much 
more likely to see a rise in my Bg throughout the workout and also after the 
workout. If I exercise on consecutive days, I'm running tired and depleted 
and I am much more likely to run with a low Bg throughout and after the 
workout. If I perform at a competitive level or intense level, my Bg will 
spike high because of the adrenaline and anaerobic nature of the exercise. 
Also, as exercise stops, what tells the liver to stop? The liver continues 
to process and the carbs that are in the system. Heat has a significant 
effect on Bg. When the blood temperature goes up then the blood get thin and 
the metabolism goes higher. I try to stay hydrated, and drink enough water 
as well as check often, carry glucose for the 20 minute rule, and carry 
glucose for an emergency.

Happy Trails,

Bill King

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