Continued: (endo did not like my exercise routine, specifically the prep and why i have decided upon the way that i prep.)
he specifically disagreed with me regarding how long i turn my pump off for before i begin swimming. (he did NOT agree with Ericâs approach .)
he couldnât grasp the simple math of it. he did NOT think i should be off of my pump before i swim for more than 1 1/2 hours. i told him 2 1/2 was necessary or i would crash after an hour in the pool. anyway, that was the only disagreement we had. he made me an appt for 2 weeks from today and said that the sensor will monitor everything and that we will get a good look at how my swimming plan works (or doesnât) F- him. i tried his way, and his way DID NOT WORK. so i go to plan B. (EXPERIMENT : 17 )
I suspect that when he seeâs your bgâs around the exercise he will learn himself something. Your approach appears to be working wonders and allowing you to manage a very aggressive exercise routine in with your other activities, and doesnât appear to be putting you at risk of anything during that additional 1 hour, but what do I know, I didnât go to medical school
I think heâs concerned you could get ketotic with more than 3 hours off the pump. Many diabetics do. But insulin also has a duration of action anywhere from 4 to 6 hours, so you clearly have some circulating insulin. Maybe it would reassure him to do a quick blood ketone check before and after your swim to show youâre not getting ketotic with that time off the pump.
But in general I would agree with everyone elseâŚyou have to follow the plan that works, and in general I think the exercise insulin management routine is above the paygrade of most Endos.
i AM happy with the progress that i have made. unequivocally.
i am happy with the progress that i have made. it is slowly working, and from all of the notes that i keep, the proof is right there staring back at me; it is undeniable.
i told my endo that i did not want to be either defined by my D or limit my life and my goals b/c of my D, and he wasnât thrilled with my attitude ( which i have gotten from all of you guys and this particular website )
(anyway, Eric, i will PM you with more of the ridiculous details.)
my CDE believes that during my time off of the pump, my swimming is acting kind of like a basal would; the exercise is keeping my BGs steady. i donât go high when i am swimming, unless i eat to many of those sneaky little swedish fish .
its funny that they work in the same office and have such a repor with one another. but she is very strong willed and does not let his opinions scare her from expressing her own.
after all the many years that i have been with him, he still does not believe that i need to take insulin to eat protein. i MUST count 10gm carbs for any serving of any proteinâŚeven the ones you donât think i would need insulin for. (and heâs a T1D also. youâd think he would be more open-minded)
Swimming is not replacing insulin, but it is amplifying the small amount of insulin you still have in your system.
The other thing that is helping you is the increased carbs youâve been eating. It allows your body to use more stored carbs (muscle glycogen) instead of only relying on blood glucose for energy. That is reducing your drop!
Compared to the previous method - eating enough to start at 200, having much more insulin in your system, and then plummeting 100 or more points while you were swimming - your new method is way ahead.
Once you get the other things figured out - like the mini-bolus before you finish, and the post-swim bolus, and you get comfortable starting a little lower - watch out A1C!!!
BTW, do you think his change from 55 to 60 is right?
so, the way i think of it is like this: every different type of tissue in your body needs a different amount of insulin to function â your kidneys need some, your muscles need some, your fat needs some, your liver needs some.
Normally, the amount of insulin you need to keep your blood sugar steady exactly lines up with the amount that each of these tissues need to function properly. BUT when you are exercising, your muscle is able to take in more sugar from the blood with less insulin. That, however, doesnât mean your kidneys or your fat or your liver need any less insulin â they may even wind up needing more. So there can be this weird mismatch â your muscles are helping keep your blood sugar steady and level, but meanwhile your kidney or liver tissue could be cranking out ketones to compensate for what it perceives as a lack of insulin.
With our son weâve seen that he can develop HIGH ketones even with perfectly normal blood sugar over night â sticking close to 100 â when his pump was accidentally suspended. He was in the mountains at altitude, so what we think happened is that his muscles and his heart, etc. needed more blood sugar to function, but all the other organs still need some insulin, so he developed high ketones.
In fact, just last night dad forgot to plug his pump back into his site after bath time and he woke up with a blood sugar around 200. Thatâs for sure high but itâs technically âin rangeâ for him, and he was basically steady at that number or lower all night. But his blood ketone meter read 3.2, which is high. I reconnected and gave him his breakfast bolus without thinking, and then set a high temp basal. He actually went LOW after that but when I tested his ketones an hour and a half later, they were still 1.4, which is still high.
Anyways, all that is a long-winded way of saying that if you check your ketones you will have reassurance that youâre not developing ketones. Even if you are itâs something that can be managed of course. I donât think the answer to exercise is âswim at 200.â
just re-tested after 20 minutes; my bg was 130, so i am off to the pool.
please all say a prayer for me and wish me luck. i am fearless, but nervous at the same time. (eric, if you are reading this post, i am counting on you .
The trick to not spiking too much from eating a bit of sugar before you exercise is this - eat it RIGHT before you start swimming, not 30 minutes before.
So right before you start, check and take more if you need it. And also check while swimming and take more sugar if you need it then.
11am bg 91 ; turned off my pump and gave myself .4 units bolus
12pm bg 86
1pm bg 114 (ate 2 swedish fish to bring my bg up pre-swim)
1:30 bg 129 walk to the pool (15 minute brisk walk)
1:50 bg 153 ( oh those pesky fish; next time i will only eat 1, not 2)
in the pool; start swim
2:30 bg 137
3pm bg 114
3:30 bg 125 (why up rather than stable or lower?)
out of the pool, 1.5 hour swim (short one today) took .8 manual units by pump
walked home (another 15 minutes) briskly (almost a jog )
home now. at 4pm bg 99. seemed to be very insulin sensitive to have responded that quickly to the modest .8 bolus post swim.
about my swim today:
started out at a medium pace. long stroke and glide; 2nd half hour swam at a faster pace, shorter stroke, upping the anti to feel the burn in my arms and legs, last 1/2 hour, faster pace, pushing myself, b/c i knew it was going to be a short swim today and wanted to make the most of it.
its funny that now a 1.5 hour swim seems short to me. very easy to accomplish. i remember when i began this exercise journey, 1 hour was a challenge. now, the 1st 1/2 hour seems more like a warm-up to me. isnât that nice .
btw: my pump has been set for a TB of 120% 24/7 for the past 3 weeks. i seemed a bit insulin resistant. then, for whatever D reason, it was too much, and now i am back to 100% basal. this is a crazy disease . must be on top of it constantly. thank God for all the notes i take and keep (for reference) ; they are a very useful tool for me. (also, i can whip them out at my endoâs and show him how crazy and misunderstanding he is .)
You ask â3:30 bg 125 (why up rather than stable or lower?)â
Because at that point, you had been unhooked for 4 1/2 hours! There is no way you would keep dropping.
So this is useful for this reason:
Suppose you are unhooked for 4 1/2 hours. If you were to drop down to 80, but itâs been 4 1/2 hours, would you need to worry about dropping much lower? Probably not! You eventually bottom out and start to go back up.
This is great. You only dropped 40 points today, and then started to climb.
Imagine if you had not had the fish. You might have started at 120, bottomed out at 80, and started to climbâŚ
Get the confidence that you will eventually stop dropping. At some point - maybe itâs 4 1/2 hours - you will not drop anymore, right?
yes; it makes complete sense. i totally understand now. you showed me your graph from your run the other morning where you started out lower than you ended. i was confused, but now it makes sense to me. thanks for that.
PS: overnight i did NOT reduce my basal, and i went low twice; then when i woke up this morning, my bg was back down to 50. took over an hour to get it back into target range (82) i am sooooo hungry for bfast .
its Thursday, and i am taking the day off b/c of family obligations, so i plan on resting up, recovery day, etc. eating/fueling up.
i plan on swimming tomorrow and since fridays have been my harder workouts, i hope to swim for the full 2 hours. if my bgs are lower than my starting target range, i will bring my swedish fish with me and hold off to eating 1 before i jump into the pool rather than taking one at home before that. hopefully, that should do the trick. also, i only plan on taking 1 fish, as 2 seems to really have a bit too much elevationâŚthose fish really pack a surgar surge.
also, i keep having lows, so i have turned my pump down to 80% TB. i remember you telling me that exercise has a cumulative effect, and i swam 3 days in a row, twice for 2 hours and then 1.5 hours yesterday. as i already mentioned, my overnight BGs were low (50s) and i just tested 2.5 hours after bfast and i was 47. had some juice and hope that my pre-lunch is elevated enough to eat. if i need more juice, then i will have some and just bolus modestly.
do you think all of this IS is what has been effecting me? perhaps i need to lower my basal profile now that i am swimming regularly. i will see how i do on the 80% TB and see what adjustments i need to make after the day goes by.
everyone, not just eric , please feel free to chime in with your experiences with the insulin sensitivity (both basal and bolus, although i think that this is really a basal problem)
prep same as usual, so i wonât take up space and bore you with the details.
today was an incredible swim. the best ever. i believe that with all of your help and support that i am getting close to having it be right on the money. i know that i will most likely NEVER catch up to the achievements of Ericâs, but i will deff have a good handle on my BGs. here are the stats:
2pm : bg 156
2:30 : bg 147
3pm : bg 151
3:30 : bg 128
4:pm bg 132
a little on the high side, but pretty close to a flatline . it was a daring hard swim; much faster than i have ever swam before. i have moved from the âSlowâ lane, into the âMediumâ lane, and today i was able to swim in the âFastâ lane. (and i knew while i was pumping away that my body was going to kill me tonight. a deff ADVIL evening .) my arms and my legs were searing and i was breathing hard.
.)
.
.
.)
.
. it was a daring hard swim; much faster than i have ever swam before. i have moved from the âSlowâ lane, into the âMediumâ lane, and today i was able to swim in the âFastâ lane. (and i knew while i was pumping away that my body was going to kill me tonight. a deff ADVIL evening