One thing that gives me a lot of trouble is participating in unplanned activities—like taking a walk or bike ride with a friend—when I still have meal-time insulin on board. There are times I though I’d compensated well only to go low midway through the activity. So generally I declined those kinds of invitations but I’d like to change that up and would sure appreciate any suggestions to help me meet my goal of having more FUN!
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Is it always going low?
I don’t mean you always go low. I mean, is it either low or no problem? As opposed to going high?
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I have the same issue. I can handle planned activities good, unplanned are problematic. Lunch and 8 units on board and then the “hey lets go for a walk” will be a disaster about 10 minutes in.
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If I were to go for an unplanned walk with a friend and have meal insulin on board, and have BG 120-160, then I’d go low. If my BG has spiked above 160 after a meal, a brisk walk will usually get me back in range but sometimes I can overshoot and need to take in some carbs.
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Yeah, this is one thing I’ve found it difficult-to-impossible to manage. If I have a decent sized meal I had better know exactly what’s planned afterwards. If I know how far I am going and what I am eating I can (probably) handle walking to and from a restaurant. But I’ve had many occasions where a spontaneous post-lunch walk on a nice day was proposed and I’ve had to decline. A bike ride would be out of the question, fun as it would be to cycle out for a burger some nights like in the pre-T1 days.
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When you have IOB and then start doing something, I think a zero basal helps for things like that. It does not make the problem go away completely, but it makes it a lot less worse.
(The phrase “less worse” sounds silly, but you know what I mean!)
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How willing would you be to monitor a little extra during an unplanned activity? I would try temporarily setting my CGM “low” alert way higher than usual (like 125). It looks like my Dexcom app will let me set my low alert as high as 150. Then if my CGM signals “low,” I should still have time to “pivot” and avoid a real low by eating something. When I’m having fun, I might not check my CGM as often, but I’ll always check it when it beeps!
I always carry at least 15 g. of carbs with me during any activity, but probably would do more like 45 in these cases. If the activity might last an hour or more, I’d bring 60-90 g. of carbs. (Hopefully I don’t need a whole meal after my meal – but better to be safe!) Just knowing I have it can bring a lot of peace of mind.
It might also help to just share status updates with the folks you’re out with. I go on a mile walk with a friend every day, sometimes broken into half a mile in the morning and half a mile after lunch. She knows that my BG is dropping if I pull out my fruit snacks. And if we need to slow down, or stop, she’s more than willing. We’re just happy to be spending time together – that’s the most fun part, not counting our steps or timing ourselves!
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My understanding metabolically, and from experience as a T1D, is that exercise shifts the body’s mode from digestion to muscle (movement) - hence “rest and digest”. Eating complex foods (to counter unanticipated exercise) that require digestion takes a back-seat during exercise. Duration and exertion dependent, returning to rest may bring on the post-exercise BG surge. In such spontaneous circumstances I tend towards small regular doses of simple sugars, eg glucose-barley sugars, to keep bumping the BG while exercising. The “micro-doses” would depend on IOB and exercise intensity, etc.
[edited for clarity and grammar]
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I definitely experience this. I’ve figured out what will and will not digest while walking.
Apple - No , Applesauce- Yes
Kind Bar - No, Cliff Bar - Yes
Glucose gel- always Yes but too many on a empty stomach 
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I expect an insulin dose to lower my blood sugar about twice the normal amount if I am exercising. And since digestion takes a back seat to muscle that makes normal snacks really slow to bring it back up. I get spikes after the bike ride ends because I stuffed too many carbs to overcome that. Like the others who are commenting I am surprised that even moderate effort like walking or raking leaves brings me crashing down if there is IOB.
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Yeah i have that problem too. Usually the short answer is more sugar. Can you carry around a bottle of juice or something?
The nice thing about exercise is if you go too high its easy to correct toward the end of your activity. But yeah I find it frustrating to focus so much on glucose levels during unplanned activity.
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Couple of thoughts, too much IOB can have a significant impact and sometimes food is the best counter to bg drop. The type of food makes a difference a when the digestion slows it does present a challenge. Eating a known food going into the activity with fluids like water,
can help get that digestion started faster. If using a pump reducing basal pre activity can help minimize the IOB. During activity a food that can be absorbed in the mouth can be more effective, such as apple juice or glucose/dextrose mixed with water, can help keep bg up. On bike rides due to varying intensity of activity I use apple juice and water 50/50% has worked well for me as well as looking ahead and using the CGM to help predict bg impact and to help stay ahead of a drop. Not reducing basal during the entire activity helps post activity, or even a bolus to bring back up the lowered or missing basal insulin.
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Thanks, everyone, for your replies and suggestions. I will follow-up when I have a little more time. 
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I aways carry skittles or grapes or a small kids juice box with me. Never pass up activities. Engage a friend for some trial and error. You got this!
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This is one of the most frustrating things I experience as a Type 1! I go low if I go for a walk with IOB, which makes a spontaneous walk risky. I often do not WANT to eat more carbs (sugar) because it feels like I am negating the purpose of the walk (adding calories when I want to burn them). For planned exercise, I know what to do (lower bolus, exercise in the morning, etc), but even vacuuming will send me plummeting after a meal. So frustrating. I had heard about “low dose glucagon” usage on the TCOYD website. Apparently, if you can get a Gvoke “kit”, you can give yourself just a small amount (2-4 units) of glucagon before exercise of any type to bring you BS up or prevent it from dropping. I have not seen much about the kit online, and my search mostly brings up the Gvoke Pen, which would not work (it is for severe hypoglycemia and you cannot use only a small amount). I am getting a new endo in May, and will ask about this then, but wondering if anyone else has heard of it…
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I’m hesitant to chime in as a T2DM on a pump, but I have experienced exercise induced hypos over the years starting with Lantus.
When only on Lantus and on MDI I split the Lantus dose AM PM. I know the question is about spontaneous activity, but I would delay the second dose until after my bike ride.
This has been easier with the pump, but hypos can happen. I carry glucose tablets and peanut butter crackers. The glucose gives a rapid correction and eating the crackers after BG is better stabilizes BG.
This means that I carry a small kit in my jersey back pocket when on the bike and really when out and about. Been doing so for years.
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Hi @jsich,
Yes, you can micro-dose Gvoke.
You can do it with either the pen or the syringe, but it is easier with the syringe.
In either case, the trick is to first inject the Gvoke contents into an empty sterile vial. You can buy these easily. Amazon has them, as do other places.
You inject the entire contents of the Gvoke pen or syringe into your empty vial. It’s very easy with the Gvoke syringe, but it’s possible with the pen if you line it up correctly.
After you have the Gvoke contents in the vial, just use a regular syringe to do your micro-dosing. I’d recommend a 1/2 to 1 inch needle, because you want to inject it intramuscularly. Don’t use a short needle.
You pretty much have to use your own syringe with markings, because Gvoke is very concentrated, and the syringe they give you is not marked. The only way to know how much you are getting is to use your own syringe!
Gvoke is about 5 times more concentrated than the old Lilly glucagon kits. Since it is very concentrated, I’d suggest starting with only 1-2 units and see how that works for you.
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Thanks, Eric. This is very helpful. Did you have any difficulty getting your doctor to prescribe the Gvoke and syringes? And did he or she suggest this emptying of the pen into the vial or is that something you figured out on your own…
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Hi @jsich,
You can get syringes without a prescription in almost all states. (In a few states, you only need a prescription for larger quantities of syringes.) But for the most part, you can get them easily.
You can get them on some diabetes sites, like Diabetic Warehouse. For example, here are syringes with 1/2 inch needles, 100 of them for only $20.
As far as getting a prescription for the Gvoke, if your doctor gives you a hard time about it, or makes you work for it, it’s time to get another doctor!
Hey, my alpha cells don’t work either, Doc. Write it or I walk!
I figured this stuff out myself.
FUD is a great resource for learning little tricks like this.
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