Help — exercise as part of job

Type 1 & LADA
1

As some of you know, I’ve started an internship where my exercise level is high but inconsistent. Despite eating very low carb for the most part, I’m having a great deal of difficulty controlling my blood sugar. My exercise varies from day to day and varies a lot in intensity, from slow walking to very fast walking. I don’t want to disclose my job in a public forum, but it involves teaching children and adults with disabilities where safety is a top priority. So I’m very paranoid about avoiding lows while teaching.

So far I’ve tried eating before lessons, suspending my pump by 30-60 minutes, and treating lows prior to them becoming lows. I end up with my blood sugar swinging from high to low constantly and can’t seem to get anything right stay consistently in range. To complicate things, my insulin needs have also doubled in the past two weeks, likely a result of hormones and weather changes (my insulin needs usually increase during the winter and decrease during the summer). Yet, due to my schedule being so variable and the fact that my insulin needs will probably drop again in a little while (but not sure by how much), I find testing settings near impossible. I also can’t necessarily stop in the middle of a lesson to adjust my pump or test, nor do I like pulling my Dexcom receiver out of my pocket to check constantly (hence my hope for Fitbit-Dexcom integration soon!).

Here is an example of the type of day I had for both my CGM and Fitbit (to give amides of my activity level). I was borderline low last night,ate some low-carb ice cream as a snack (no bolus), did a 1.5u correction at 11:30 PM which did nothing, did a 2.5u correction at 5:00 AM which dropped me too low, ate six glucose tablets at 6:00 AM to treat the low, suspended my pump for 30 minutes during the morning (slow walking around) to avoid a low, had a non-low-carb lunch at noon which I bloused for, suspended my pump for an hour at 1:30 PM as I knew I’d be walking a lot (and quickly) in the afternoon, and ate three glucose tablets when I saw I was dropping rapidly during a lesson at 3:00. The latter actions totally backfired as I’m now sitting at 15.6 mmol/L. Gave a 2.5u correction for my walk to the store and home.

I’m wondering if anyone has suggestions for keeping my blood sugar more stable. I’m also not blousing for protein and thinking I should be. I’m five weeks into my internship and have another eight weeks to go, so I’d like to sort this out. After this internship I’ll be going back to my old job but likely doing this type of work when I’m off from teaching during the summer.

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2

Your exercise variability is VERY high.

Are you still eating about 50 carbs per day? How do you refuel from exercise?

[EDIT] And the type of exercise, is it mostly walking fast/a lot, or more intense?

3

Just throwing this out.

What about intentionally using a higher than required basal and feeding it as you go?

4

I’m not tracking carbs, but I’d say I eat 20-40 grams most days.

My exercise is mostly walking. Not usually intense, although that depends on how fast students walk; this afternoon my HR hit 178 for the final 15 minutes, so that was more intense. My blood sugar doesn’t seem to respond to exercise consistently, possibly because of such variability.

Not really refuelling at all, though maybe I should be?

5

I am trying to be analytical. It seems to me that some of the problem is caused by:

  • the random exercise causing high insulin activation -> lows

  • the random exercise causing refueling after it occurs -> lows

  • bounce from glucose (for lows) or from low basal -> high

@MaryPat recently posted about walking and refueling: Walking and refueling on the go: no need to bolus. I wonder if you might be able to come up with some estimate for a refueling rule while you are walking, that takes care of the bulk of your upcoming lows, without having to bolus?

So, as you see yourself walk, say after 15 minutes you take one tab, or some such rule?

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6

I feel like my attention needs to be 100% on students, especially when teaching in high-risk places like around busy traffic. I feel like intentionally giving too high a basal would heighten my risk of lows should I misjudge, which is what I really want to avoid. It’s also quite hard to eat and teach simultaneously, regardless of the environment. I do it for oncoming lows, of course, but it would be a whole different challenge trying to eat every 15 minutes while teaching.

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7

I do think you are a lot more vulnerable to lows when on a low carb diet if you have a lot of random exercise daily. But what do I know? Maybe some people can reference research they are aware of that might confirm or infirm my thought.

8

It may not need to be more than a few skittles, jelly beans, or Swedish fish a couple of times per hour. But this may still be too much for you?

9

Just a few thoughts to throw in the mix.

I know you are lower carb, but I do think having a decent carb store is useful for maintaining level BG when active. Have you tried some slower carb / lower GI types of foods for BG stability? UCANN makes some slow carb products that might be worth trying. I can eat these with almost no insulin. I think it;s worth a try. You can get a sample pack from Amazon. I like the bars the best. I think the drink powder is kinda pasty.
https://www.generationucan.com/

Are you able to go all day without eating? For me, when I have to travel or have a schedule that is completely in someone else’s hands, having no IOB and simply going on basal all day is easy. The only thing I need to do is load up on food at night during dinner.

Or, if your activity is later in the day, could you just eat breakfast, skip lunch, and wait until dinner to eat again?

What is your advance notice on the times of activity? Do you have enough time to adjust your basal before it starts? Like an hour of advance notice?

Are you able to sense drops enough without looking at your CGM or BG meter?

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10

I agree with your post

We are kind of saying the same thing here. I posted mine without even seeing yours.

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11

Part of why I haven’t been “refuelling” is that a) I felt it was only for athletes and b) people in the low-carb groups seem able to exercise and remain perfectly flat while eating a low-carb diet (and these are T1s). But it’s something I’m willing to experiment with, though I know nothing about it.

I’m not strictly against carbs, it’s just that ever since my thyroid went crazy, I can’t seem to bolus for them without creating a spike (unless I later create a low). Pre-bolusing and all that doesn’t seem to work for me, even though it did work for me before my thyroid went off the rails.

I can try the UCAN bars if I can find them in Canada, or if I can find a similar bar. They look like they have 25-30 grams of carbs, though, which I can’t imagine eating without requiring a bolus.

My schedule is pretty much 8:00 AM until 4:00 AM, Monday to Friday. I’ve been reading about intermittent fasting and wonder if that would work. But from what I’ve read, it sounds like that in and of itself may cause highs or lows. I typically don’t take insulin for breakfast except to correct highs, because I eat just eggs and bacon every morning. Lunch is typically ten grams of carbs, and dinner is maybe five or ten grams. Snacks are ten to twenty grams, which I might have once or twice a day. Today was an exception in that I did eat a fairly high-carb lunch.

I do have advanced notice, but my problem is that my response to exercise isn’t always consistent, and I don’t always know exactly how much exercise is involved. It’s teaching, so although I have a lesson plan that may go exactly as planned, it may end up being a completely different lesson than the one I planned if the student is in a bad mood or there’s construction in the place I intended to teach that wasn’t there a few days earlier when I planned the lesson, or the student may be sick (happened this morning with a young student who wasn’t at school when I showed up). And the student I was with this afternoon is a fast walker and typically causes me to drop low, which is why I was so aggressive in trying to avoid lows (turned off pump for an hour and treated the drop when I was still only at 5.6 mmol/L with 12 grams of carbs, which backfired and shot me up to 15.6). Yet when I walked to the store after work, which was less intense exercise and only took about 20 minutes, I dropped from 13.6 mmol/L to 3.0 mmol/L over a 45 minute period because I didn’t eat anything. Since I’m on an internship, I’m working with students I haven’t necessarily met before, so may not know if they’re really active or not until I know them better (my students literally range from Paralympians to those who use walkers and from preschool students to senior citizens, and cover all speeds those categories include). Hopefully in future when I have an actual job I’ll have more steady students, but that may not be the case if I’m doing it on a contract basis as is likely (since I don’t think I want to switch to this career full-time, but part-time or contract I’m interested in).

Yes, I can usually (but not always) sense rapid drops (single or double down arrows on my CGM), which prompts me to look at my CGM. Usually by the time I sense them I’ve dropped a substantial amount (like 5 mmol/L) and so I often can’t stop a low even if I treat it before I’ve reached a low level. I also have my CGM low alert set to 4.5 mmol/L, so even if I don’t feel it, I’ll be alerted before I’m actually low.

12

When my son is walking around at a sustained pace, he is taking only a few carbs at a time, maybe 3-4 every 20-30 minutes depending upon the pace. The effect, for him, is invisible on his track while he is walking. But, on the other hand, he uses pure candy (very cost effective btw).

13

Is this with the increased basal as @Thomas mentioned, or just with regular basal, or decreased? Eating every 30 minutes is probably something I could try. Lessons are usually one or two hours. I could set my Fitbit to alarm every 30 minutes and, if the carbs are only a few Rockets (US Smarties) or something like that, that would be doable, I think, especially if it doesn’t involve the increased basal, which I think would be a serious risk of lows.

14

Just with regular basal. Because we stop and go a lot, when visiting a place, we are not ready to decrease the regular basal. He only eats when he walks for a while. For a full day of walking around + museums, he uses about 35-40 carbs eaten while we walk, in 3-4 at a time mostly, although occasionally he will take more at one go.

He had to learn what amount of effort corresponds to the carbs he takes - it did not take him long. He keeps Skittles in a glucose tab tube (the Skittles are a lot more cost-effective, and he does not like glucose tabs anyway), so he just grabs a Skittles tube from his pocket or his sling bag, opens it, brings it to his mouth and slides 3-4 into his mouth (so as to keep his fingers clean of sugar), then closes the tube back and puts it in his pocket.

It takes maybe 20 seconds while we walk. It’s two-handed because he needs to take the top off with one hand while holding the tube in the other.

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15

I may try this. I can’t picture myself putting the entire tube to my mouth while in the middle of teaching (not very discreet), but I could keep a bag of them in my pocket in an open Ziploc bag and easily just get two or four at a time.

16

@Eric, do you have any good posts on refuelling that you can link me to? When and how much do you eat? Is this partly what contributes to hypoglycemia that happens for hours post-exercise?

17

Yes, let me put together a few things. I have some thoughts to share on this subject.

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18

Here are a few to start with:
how-does-my-body-fuel-exercise
the-3-energy-pathways

Replacing muscle glycogen (the stored carbs in your muscles) is best done right after exercise. But that is usually only necessary when you are burning a lot. If you are only eating to keep from going low after activity, you don’t have to do it right away.

How much you need really depends on the level of activity, the amount you burned. For something like walking 30 minutes, you can just eat a normal balanced meal and you’d be fine because you have enough muscle glycogen to last you for several days at that level.

But, your body will take the food you eat and use it to restore your muscle glycogen. So the problem with going low is because your body pulls the glucose out and uses it to restore. That is another reason eating after exercise is important. Otherwise your body uses your blood glucose to restore your muscle glycogen. That would usually translate into a nighttime low BG.

You can get them from Amazon, right?

The UCAN carbs are different. You can eat it with minimal insulin. It’s different than normal carbs!

It’s kind of like the way basal insulin works. It’s almost like basal carbs.

Rather than thinking of it as 30 grams of carbs, think of it as 2 grams every 15 minutes. It just trickles in, like the way basal works.

Try it first on a weekend of course. It is a nice slow carb release. I like them.

The idea I had about skipping breakfast was just to eliminate IOB. If you are able to have breakfast without IOB, that is certainly helpful.

There is a lot of stuff about carbs versus low fat that is worth discussing. At some point I want to have some threads specifically for that topic.

There are advantages to both. When I talk of the value of higher carbs, that is geared more toward performance sports and training. Someone could certainly have a successful time with lower carbs and still do daily walking or lower intensity activities. The higher carbs become more important when you are draining your body every day.

Your body will use whatever is available and works most efficiently for the situation. It will use muscle glycogen (stored carbs) fat metabolism, or carbs you are currently digesting.

But one thing that is often overlooked, in order for your body to metabolize fat for energy, it needs the Krebs cycle, also known as the tricarboxylic acid (TCA) cycle. And in order for the Krebs cycle to occurs, it needs a background of carbohydrate metabolism.

Think of it as a candle. The fat is the candle which fuels the flame, but it needs the wick which is like the background carb metabolism. Without the wick, the candle can’t burn. And without a small background of carb metabolism, your body can’t metabolize fat for fuel.

So going completely without any carbs is going to make your body pull other sources for fuel. If your blood has any glucose in it, your body will suck that out and there is your BG drop.

While you are waiting on your CGM watch stuff, I am guessing you have a Dexcom receiver, because they are always sold as part of the package.

Tallygear makes a receiver holder. You can wear it like a watch. A single button push displays your BG. Much easier than a phone. Until you get your CGM watch, this is a decent option.

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One thing that will happen as you walk more, your body will become more used to it. It will become less of an impact on your BG because it will become more normal, easier. If you aren’t already doing it, one of the best things to do would be to incorporate walking as a daily activity. If you are used to walking 30 or 45 or 60 minutes every day, then when you do it for work, physically it will cause less of an impact on your BG.

Everything will become easier with practice. All of the variables, the different times of day and different levels of activity, all of them will start to become easier to negotiate with practice. Basal adjustments and carb adjustments and all of those things.

Sorry, my reply is a bit scattered. Please let me know if there are things I missed.

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19

We have used these bars from Amazon:
Maybe slowly snacking on one might help?

Gluten free of course.
:slight_smile:

Amazon code: B0034KN28U
(In case the link breaks - again)

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20

Thanks! Unfortunately, the Extend Bar contain milk and possibly potato (maltodextrin and natural flavours I always check into). So they are out for me. :frowning:

It ddn’t look like the UCAN bars had wheat/gluten in them, but maybe I need to re-reading the ingredients.