Can I just exercise in peace?

Type 1 & LADA
1

I’ve had T1D for 15 years and I still cannot figure out how to maintain a straight line! I use the Tandem T Slim with Dexcom G6. My go to exercise in the spring, summer and fall is golf. Here’s my history:

  1. I undercount carbs because I had a scary low once and can’t get over it.
  2. I don’t exercise because the thought of going low is dreadful.
  3. I still don’t know what my actual basal rates should be and have no idea how to figure it out.
  4. I guess on my I:C rate because I feel like it changes all the time based on I’m a woman in perimenopause. Maybe I’m just being dramatic.
  5. My sugars are all over the place during the day but mostly wonderful while I sleep.

Where do I start?

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Welcome, @Cameedee! I’m pretty new here too, and definitely don’t have great answers to all these things… But here are a couple things that might help with your fear of lows! :crossed_fingers:

– If you have an endo, be honest with them about your fear. In the last couple years I was really scared of going low in my sleep, so I was constantly waking up high. I was reluctant to make the basal/I:C changes my endo wanted all at once, but she understood why I felt that way. As a compromise, she helped me take baby steps to change, observe, change, observe. It really helped to see that things weren’t changing as dramatically as I had worried.

– Speaking of observations… Sugar Surfing is a great book! Handy tips to use our CGMs to build confidence observing reactions and testing changes safely. Micro-carbing and micro-bolusing might change your life. I’m only halfway through but definitely think it’s essential CGM reading. (Thanks for the rec, FUDiabetes folks!)

Sugar Surfing also touches on some of the other things you mentioned, like the roller coaster days and the unpredictability of our bodies/hormones/activities every day (and learning how to deal with that unpredictability).

– When you’re worried about lows, you could try setting your CGM low alert at a higher threshold. I set mine between 80 and 100, so that on a trending downward graph, it’s alerting me when I’m actually 70 (instead of when I’m already in the middle of a “severe low”).

– Have low treatments everywhere. In your bedside table, in your car, in your purse. In your “special occasion” purse, in your cubicle at work, in your best friend’s cubicle at work… I also keep a Glucagon kit in my house and at work (with a big medical alert sign with instructions on when and how to use it).

I also hate constantly eating to treat a persistent low… But feeling over-prepared helps me feel safer – in the unavoidable event that a low happens!

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Watch what your BG does when you haven’t done anything to change it for a few hours (like eating, taking a bolus, or exercising.). A good basal rate will keep your BG pretty steady. If your BG is rising all by itself for no reason try a little more basal starting a couple hours before the rise. If your BG is falling all by itself then a little less basal should help. Keep making small adjustments until it generally stays steady. Skipping a meal or delaying the meal by 3 or 4 hours to see what happens without food and bolus during that time of day is useful, that’s called “basal testing.”

Basal is easier to get right with the help of a CGM (because you can see what’s happening without dozens of fingersticks), and it’s easier to get right with a pump because you can set different basal amounts for different times of the day.

I find my basal needs to be re-tested and adjusted 2 or 3 times per year. For women who are cycling, there may be a monthly adjustment before and after the period.

Getting the basal adjusted right is a good place to start. After that, it’s time to work on the carb ratio and the insulin sensitivity. Your new friends here at fudiabetes will help.

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I say the way to get over it is to learn the skill to recover before a low gets bad. First, set the low alert on the CGM so that it will give you plenty of time to respond before the low becomes a problem. I use 85, you could even use 90 or 95 if you want a bigger safety margin while learning how to manage it.

When the CGM alerts, eat some of the glucose tablets that you have with you. (I always have a roll of 10 with me.). How many? Different people have different responses, but for myself, I eat 1 glucose tab for every 10 points I want to rise. So if the CGM says I’m at 72, I might eat 3 to get to 102. Then check the CGM 10 or 15 minutes later to see if the curve is responding. If still dropping, I’ll take more glucose to solve the falling BG before it becomes a problem.

Back when I was on MDI I grabbed the wrong vial and took Novolog instead of Lantus. Soon my BG was plummeting. I saw it at 70, and because of how fast it was dropping I ate 4 glucose. 10 minutes later it was still plummeting and I was in the low 50s so I ate 8 more glucose to solve it with enough extra for safety since I was so low. That turned my BG back up. That’s when I learned that I can get myself out of falling BG before I get in trouble. So now I have no fear of lows anymore because I can always fix it promptly with a bunch of glucose. You can get there too.

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Hi @Cameedee,
The golf stuff can be fixed. We can get there. It may take some time, but it is certainly something you can do.

But first, before getting into any of that, you have to get to a place where your normal average non-exercise days are easy and manageable. And from that point, the golf is easy to figure out.

To start with, you have to get your basal amounts figured out. Once you have the right numbers, you can let Tandem make the adjustments to it, using either the Control-IQ or Basal-IQ algorithm, whichever one you have.

But if you don’t have the right basal numbers to start with, then the Tandem algorithms are making adjustments to the wrong basal numbers, which is not as good.

So that is job number 1, to get your basal amounts figured out.

I see @bkh did a post on that subject, so that’s really a good thing to start with. And I see he said the same thing I did. :+1:

Let me add this. If you are trying to figure out your basal numbers, you gotta turn off your Control-IQ or Basal-IQ, so that it leaves your basal alone. Then you know if it is too high or too low.

If you leave Control-IQ or Basal-IQ running, it will constantly be tinkering with your basal rates, and you can’t easily figure out if they are correct.

Does that all make sense so far?

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