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Re: [IPk] Stress, gym, basal levels and night-time blood sugar levels

Dear Graham,

Yes, stress raises blood sugar when you get an adrenaline rush. It's hard to 
know exactly how much your blood sugar will go up in every situation, so 
anticipating it is tough. Just the one day when you think you'll need 3 u. 
to prevent a rise and you give the bolus 10 mins. before the presentation, 
your blood sugar might 'decide' not to rise as much--and then you'll be 
stuck with a very inconvenient hypo! I have become discreet enough with my 
testing and bolusing that I've managed to do both whilst in meetings without 
anyone noticing anything except the beeping of my pump. Even that's been 
ignored when everyone has assumed it was someone else's watch alarm, mobile 
phone, or pager. When you're on just Humalog and you don't need to inject, 
programming a bolus on a pump is as antisocial as looking at your watch: no 
one cares in most situations. Bonus: when it would be rude to look at your 
watch, you can check your pump (a MiniMed, at least, displays the time on 
the screen). You can say, 'It's medical equipment', and, unlike looking at 
your watch, checking the time on your pump couldn't be construed as rude ;) 

As for gym sessions: if there's one thing that gets said every time the 
topic of exercise gets raised, it's 'your mileage may vary'. Bev, who runs 
considerable distances, needs more insulin when she exercises, but I tend to 
reduce my basal to 30% of normal, or 50%, or even to suspend my pump when I 
work out, depending upon a) my starting blood sugar, b) the activity I am 
doing, and c) how long I will be exercising. You will have to experiment to 
see what you need. The best way to get a start when exercising with a pump, 
I believe, is to start your workout (I mean every workout--starting a 
strenuous workout with a bg of 7 is like begging for a hypo) with a bg 
between 10 and 12. If you can plan it, reduce your basal rate an hour or so 
before your workout to let your bg rise naturally and you won't need much of 
a pre-workout snack. When you're trying to learn what your body specifically 
does, try keeping your pump at 50% of the basal you'd normally have at that 
time--if it would be 1.4, set a temporary basal for .7--for the duration of 
the workout. Then test when you're cooling down. You'll probably not have 
gone hypo, but if you've seen your bg rise drastically, you probably needed 
more insulin during the workout--reduce your basal by 30% next time in that 
case. I have found that sometimes my body burns a lot of glucose when I work 
out and sometimes it seems not to do, but the 8-hour delayed hypo (glucose 
going back into muscles) is a constant. I like to exercise in the late 
afternoons so I am still up when it starts--then I can reduce my basal rate 
(sometimes by a whole unit per hour!) for a couple of hours just when I go 
to sleep and wake up with a lovely bg.

About the night-time bgs: yes, it looks like you have a bit of the old dawn 
phenomenon going on. Brilliant reason to get a pump as glargine is clearly 
failing you at night. Determining different basal needs during the day is 
indeed a matter of delaying (not necessarily skipping completely!) meals to 
see what happens when you don't have any food or bolus insulin to obscure 
what is happening in the background. If you don't eat breakfast and you're 
quite high or hypo before lunch, you need a different basal; if you eat 
breakfast at 8, test at 11 a.m. and find you're fine, and then don't eat 
until 2 p.m., at which point your bg has gone very low, you probably need 
less basal insulin after 10 a.m. (point by which the dawn phenomenon 
hormones will have cleared out of your system for the day). Does that all 
make sense? Wish there were some on-line basal rate calculator for which I 
could send you a link, but we're all different and have varying 
requirements. We need to learn the strategies for finding the the right 
answers for us, not to collect simple, 'one-size-fits-most' solutions.

When you're feeling muddled about things, just thank your lucky stars you're 
not a woman with monthly AND yearly hormonal changes too!!!



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