FUDiabetes

Looking forward to insights from this group


#1

I have been a long distance runner since 1982. I raced Cross Country/Track in high school, won state titles in the 3200. I ran one year in college, but broke my leg in a sledding accident. I was out for the next season and began to pursue my talents as an artist. I was able to run again after 3 mths in a cast and transferred to an art school in Boston. I ran about 40-60 miles a week while in school. I was diagnosed with Type 1 in 1992 after college graduation.
I have never stopped running (a couple of injuries over the years) and added swimming to my weekly routine several years ago. Perhaps more swimming as I approach age 49. I currently run 30-40 miles a week (5-6 days) and swim for about 75 minutes 1 or 2 days.
I love running, have done some racing after college, but really don’t care to do that sort of thing. The beauty of running is it is on your time, your thoughts, your looking at the world with your own peace.
With Type 1, I have had to learn a lot about how to be prepared, how to manage lows or highs. Even after all of this time with Type 1, I can not always predict what happens after the runs, particularly the long runs, 10 -14 which I do every Sunday that I can.
So that is my long introduction. I will watch your posts and start to learn more tricks to have more predictable BS outcomes (LOL). Thank you.


#2

Hi Kjd,
Welcome to the place!

I am glad you joined us. FUD is becoming the premier place for diabetes and exercise.

Feel free to post specific questions about anything related to exercise or anything else.

There are a lot of wiki posts that are a good place to start. And we have a lot of conversations about this sort of stuff here.

You may already know a lot of this stuff, but some of it may be useful.


#3

Thank you, Eric! Since I had been long distance running for 10 yrs before diagnosis, I didn’t want to change my routine. I have taken action to protect my health of course, but I am stubborn. I appreciate the opportunity to hear suggestions and chime in if I can be helpful.
I appreciate Nicky’s suggestion I join!


#4

From that, I am guessing you are on a Medtronic pump maybe?

Do you do any basal adjustments for your runs?


#5

Hey, we are somewhat similar circumstances! I also ran distance events in high school and college around the same time. No state titles though, I was more like the sixth or seventh guy on the cross country team :slight_smile: In college I was running 60 miles/week and I’ve done a few marathons since but my knees can’t take the mileage anymore so a half is about as far as I’ll go. I do a few races but mostly enjoy trail running. I am coming back from tweaking my knee this summer so my long runs are only 7-8 miles right now.

Usually I will spike maybe 45 minutes after a long run so I’ll do a manual bolus after I’m done. Like you, it is a little unpredictable but if I start to dip low I’m usually pretty hungry after a long run anyway so I just eat to make it up. I use a minimed 630g and run with it using a temp basal of around 35%.


#6

Yup, New to 670…had Animas ping for 14 years. I make a call on whether to do a temp basal or not based on my blood sugar. I always run first thing (after walking the dog, stretch, bathroom) I usually don’t eat, sometimes the coffee is made and I will have some. Most of the time this system works fine. It is always a mistake to take correction bolus before running for me. I used to eat a banana and carry my meter and a gu on long runs with animas.
Now I rely on the sensor…


#7

Thanks. I like auto mode most of the time for running. After long runs I have to switch to manual mode in to get more insulin after being in low basal. Same thing after long swim, I suspend for about 90 minutes to swim and get changed. I look forward to seeing what each of us does to manage exercise and diabetes.


#8

How are your workouts going, @Kjd? I saw you over there talking about climbing on your long runs?? Do you use the Temp Target? Or do you suspend?


#9

Thanks for checking in, Nicky! 5-7 mile runs in auto (sometimes temp target if BS is in range before start, just regular if high-ish). I only suspend if I actually feel low and the sensor confirms low. I’ll eat fruit (figs, mulberries, blueberries) from neighbor’s yards to just keep running.
But the long runs…most of the time I have used auto, but today, after the discussion yesterday, I started in auto, but got the Alert on High at about 6 miles (I have it set at 150, because I found that if I let it get higher, it is so so hard to come down), so I switched to Manual with basal rate 0.475. And it did still get higher, 227 when I finished, but now what I think is that since I did not (and usually don’t) eat or bolus that perhaps that high is because of liver adding glucose for energy.
I then mowed the yard, and then ate my favorite egg and cheese and tomato panini sandwich and a salad, bolused etc.
The good news, is so far, unlike after AutoMode Long Runs…I am not getting high post run! Even after eating!
I hope you are doing well with your workouts too. How are you injured? I have had many, but so far, have been able to always get back to running. I do imagine swimming more each year…it is boring, but a good workout and less injury inducing! Peace!


#10

That’s funny.

For me the urban version of this (for me that is only when I am traveling and run in a city) is to just stop at the local Kwik-E-Mart and buy something, and then keep going.


#11

We are not in the same category when it comes to the kind of runs we do. In fact, I almost feel like a fraud talking about running at all since I’m back jumping on the trampoline and talking up a big game over swimming (yet haven’t so much as put a toe in the pool), BUT I do know exercise, and I do know the 670G. So I’ll give you what I know about that combo, and maybe @Eric will have something to contribute…

First of all, whatever you’ve always DONE, like suspending only if you actually feel low, is not going to play out the same in auto mode necessarily. Be careful in thinking it will. Remember that auto mode is doing things in the background… So just because YOU haven’t suspended because, say, you’re eating fruit along the way, doesn’t mean auto hasn’t suspended you. Sometimes for that full 2.5 hours. So now you’ve eaten fruit AND been suspended. Of course, this will not always present the same way with auto’s “dynamic” delivery, making it even harder to identify. I never really used suspends before using the 670G, and I do think that was part of my difficulty with it. I just wasn’t used to it. Regardless, it took me a while to realize that my 300s and 350s after exercise were because I had done what I ALWAYS have done, but auto mode was in the background suspending my insulin for an extended period. Since coming here, Eric has taught me how to drop to zero basal for an hour prior to the workout and to leave that suspend on throughout. Medtronic has actually come out and encouraged people to suspend in auto mode with exercise so auto mode doesn’t misinterpret that drop in blood sugar as your needing less insulin in the days to come… if that makes sense. Since auto doesn’t know you’re exercising and only sees that drop, it might give you less insulin this time tomorrow in anticipation of a falling blood sugar, regardless of whether or not you need it. In order to not have a negative effect on the algorithm, Medtronic says just to suspend through your exercise. Maybe that hour before would work, too…

I didn’t know these things when I was in auto and would just be beside myself when I would see those climbs. I’m not sure how these things would work now but will keep them in mind if I ever venture back in…


#12

I never remember to bring money when I am out of my element. But I do always have Cliff Gu in my pocket when running away from home That sounds funny (out of context), but somehow, I always get back to home. Peace!


#13

So, Nicky Ghaleb and Eric, please weigh in, I have always had inconsistent results even on the Animas Ping, shots in the arm, lantus, pen needle…whatever. The sensor may help me actually see what is going on. What you said in the FuDiabetes Sports page is so helpful I will consider some of those options. Are you saying if one SUSPENDS? The pump in AM stops what it was planning to do, (give ridiculously low micro boluses while exercising) and then when you resume, it ramps up the MB’s? No one ever told me that before. But I totally believe it because after swimming for only one hour, suspend, back in AM everything works okay. More than an hour of swimming/suspend there is catch up but I am working on that.


#14

Hi Kjd! (may I call you Kjd for short? :grinning:)
I am not very familiar with the Medtronic algorithms. But from what I have gathered from our Darling Nicky, nobody is really very familiar with them.

All runs have different fuel systems they use from various sources. I hope you have had a chance to familiarize yourself with the general ideas behind exercise fueling on some of the posts here, if you were not already familiar with them.

Let’s look at a certain type of run, just as an example. If you were doing a pace that was easy-to-moderate, your fuel source might be close to 50% muscle glycogen and 50% fat metabolism. Suppose you were running for 1.5 to 2 hours.

You could possibly get by with zero basal during that time. During exercise, your body is better able to use the remnants of basal that you have turned off. During exercise your body is much more insulin sensitive. And also during exercise, your body has a process called “contraction mediated pathway” that is able to convert glucose without much insulin.

(Adenylate kinase (ADK) converts 2 adenosine diphosphate (ADP) molecules into 1 adenosine triphosphate (ATP) molecule and 1 adenosine monophosphate (AMP) molecule. The ATP is hydrolyzed for energy, and the AMP attracts 5’-adenosine monophosphate-activated protein kinase (AMPK). AMPK acts in a way similar to how protein kinase B (Akt) recruits TBC1D1), which releases GLUT4 to the cell surface and allows glucose uptake. Additionally, calcium ions released from the sarcoplasmic reticulum during muscle contraction also promotes GLUT4. Other pathways include ROS signaling, and nitric oxide signaling.)

All of that is well and good while you are running. But what happens when you stop? Your exercise has ended, so your body is no longer using the contraction mediated pathway. Plus you have been without basal for a few hours. So a spike after this type of run with extended zero basal is very common.

I combat this with a replacement bolus. When you are finished, you have to replace a portion of what you missed. Just resuming basal is probably not enough.

After every run, take in 4 things:

  • carbs
  • insulin
  • protein
  • water

Regardless or what your BG is, you need those 4 things.
what-should-i-consume-after-exercise

Of course, the amount of insulin you need will depend on your BG and how long you have been on zero basal.

Anyway, this is just a starting point. If you would like to work through some specific examples, let’s do that.


#15

First of all, I’d like to say that what Eric is sharing with you is the fundamentals of how it should all work. So when you say you’ve always had inconsistent results across all types of management styles, that’s where his information would be very useful—- in learning what your body is doing before trying to make appropriate accommodations. (And I say “fundamentals” like I had or still have a clue what he’s saying. I just smile and nod).

With that being said, auto mode is not going to be anything like any of your prior experiences because of the fact it’s actively administering, adjusting, and withholding your insulin. Because there’s not an easy way to see how much you’ve gotten, it can get a little tricky. When I was in auto mode, there was very little information available on how to handle exercise, so I was trying to do it the way I always had. Just go and deal with the numbers. In the background, however, auto mode was picking up that drop in blood sugar and often giving me 2.5 hours of no insulin, and sometimes that would even be on TOP of an additional couple of hours of a reduced rate. So when I’d have my glucose tab or 3 as I always would, it would seem like for some reason things were just different and those tabs were too much. After a while I learned to look for minimum delivery and to add up micro boluses on the graph screen and saw just how little insulin I was getting. Mystery solved. I tried using Temp Target, hated it, and finally found just staying in auto without messing with anything was a good way to get through the workout. Auto did pick up my drops, did stop my insulin, and I would just go back to manual with about 10 minutes left in the workout and add about 50% of what I had missed in my basal. (Eric! I just realized I was doing that before! :grinning:). In general that worked out. Again, after a couple of months of all of this, with all of this attention I had to being paying anyway without the comfort of knowing the decisions were mine alone (and not agreeing with MUCH of what auto wanted to do for me), it just became easier to do it in manual.

This is a long answer… but I’m trying to explain how I got to where I am now… because you’re on a similar path. The difference is, as I said, there was no guidance on how to handle exercise. Since that time, I have learned that suspending in auto might be JUST what you want to do. What I don’t know is how it will affect your micros immediately following, but the theory is that because auto mode is taking into account 6 days’ worth of your trends, if you are exercising and causing major drops in blood sugar, auto is going to observe that and decide in the days to come that you do not need as much insulin. I would LOVE to see what would happen to those micros after exercise if you’ve suspended— if you do try it, I hope you’ll let us know how that goes.

You also asked about how people are remaining in auto with success, and I mentioned the additional insulin… well, I’ll just say in here that it really does counter what Medtronic wanted us to do with our pumps. Auto was supposed to be able to study us and dynamically adjust our rates according to our patterns, assuming we were not making huge mistakes with carb counting (or running marathons). Every time we do a manual injection or a fake carb or a fill cannula, auto mode is only able to observe the effect on our blood sugar, therefore affecting the upcoming delivery rate. I do think this contributes to auto’s inability to perform consistently. I do think it’s why people say it’s great for a week and then crappy for two. It really IS trying to keep up with us, but it’s only working with half of the information.

And that’s about as opinionated as it gets. I’ll stop. I really would like to hear how suspending during exercise works for you and whether or not you see an improvement in those post-exercise micros. I’ll continue to try to learn the fundamentals :wink: in manual. At some point, with Eric’s help, I’ll try to do them in auto. If he’s up for it. :smiley:


#16

Eric,
Thank you! I am happy to see this website and group because there are ideas that I can work with and think about. I have a decent handle on my routine, and I am not going to change my daily activities, which actually all day long is pretty physical… work, exercise, whatever.
If I can ask you specific questions as they arise, you will be able to help me get a fix on consistent problem areas. Maybe…i am stubborn but a person who thinks and stews and massages content, usually while running or swimming.
I am here in hot and humid Durham, NC. Hope you are doing well! Peace!