FUDiabetes

New LADA- Long-time Runner Trying to Keep ON

Hi, I’m new to the Group, and newly diagnosed as LADA. October of last year fatique, weight loss and an inability to concentrate at school led me too my family doctor. BG was around 400, A1c 10.1. Diagnoses Type2. Given high Metformin and Invokana= vomiting and yeast infection. Lowered Metformin and stopped Invokana. Had victoza for 6 months couldn’t eat or drink some days due to complete non digestion, nausea. I thought I was dying as I continued to lose weight and muscle strength. Their were days I labored to walk up or down our 9 steps to our door.
Before last Autumn I was an active runner, putting in 25+ miles a week, for the past 20 years.
Once diagnosed correctly as LADA, I was removed from Metformin and Victoza and Put on Tresiba (long-acting) and Novolog (fast- acting) in March 2019.
I’m currently taking 3-5 shots of fast acting as I try to pick up trends and tweak to keep my BG below 200 and above 75. My BG trend on Dexcom looks like a somewhat zigzag line with mid afternoon stability and 5-9AM stabilty.
Ok backstory done…
I began to walk and jog around April or May and have been able to gain back the 15lbs I had lost and put my performance above the last two years. Whole food is an amazing fuel.
However, I still have high BG mornings when I’ve not taken enough insulin to accommodate carbs the night before. I’ve recently learned how to find my carb ratio and adjust for correction. Before I was given a baseline number (by endo) to give myself with each meal (3) and adjustments according to fasting BG. Somedays and meals that method worked fine but others left me high or dropped me to 40s. I’ve done alot of research and journaling to take control of my insulin needs. Now I count carbs, account for fasting BG and note effects with different foods.
As far as exercise, I’ve hit BG of 50s on the trail and not known it until I felt weak in my legs. So, as my endo saw I was hitting hypo over 10% of the time, he advised me to decrease bolus on run days. I do, and often head out with BG around 200 and return with it around 100-120 and dropping fast. I have to be diligent to refuel every 2-3 hours to prevent hypo for the next 12hrs or more. But, I also cant overeat and have increased BG that may zigzag it’s way down. My ratio is higher after runs, around 1:20 instead of my usual 1:14. Some mornings (fatty meal night before?) it is 1:10 or so.
Any advice on running and keeping BG steady is appreciated. I take energy gels with me now just in case, too.
Thanks!

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Wow! That is quite a story, and thank you for posting your background. Our membership really connects with people after they get to know them. First, congrats on taking control. If there is one thing our group advocates for, and perhaps the only thing we all have in common is the desire to control this disease. Once you get past that initial goal, i.e. everyone here is learning and in some stage of taking control and not letting a strict regimen define their treatments and their life. We have plenty of differences and opinion, which is of course the value of a site like this.

One strategy that I would definitely consider trying, is to start your run with 0 insulin on-board. However, in order to feel comfortable getting there, it is generally a process which you can see in @daisymae 's thread (Swimming) and @Nickyghaleb 's thread (running). In both cases @Eric coached both of them through the process and I am sure he will be by here shortly. His background is quite amazing, he runs marathon’s competitively, he has quite the running kit including lance and meter on his finger and wrist respectively, so he can test his bg while he is running.

Welcome to our community, sorry you ended up getting misdiagnosed, that sounds like it really sucked, and I look forward to getting to know you better.

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Hi.

We have a few things to go over. This takes a little time to get ironed out. You can run without problems, it just takes some work to get it all figured out.

To start with, can I call you by your first name? :grinning:

Are you still on Tresiba? Do you use a pump or pens or what is your insulin method? I see you mentioned NovoLog and Tresiba, but didn’t see a pump reference so I assume it is still Tresiba and injections…

What is your diet like? Are you low carb, normal carb, or anything special there?

Do you use a CGM? I personally don’t think it is very useful for running, but just for the nighttime issues you mentioned, like waking up high.

Do you think your endo is flexibile about giving you different/new things to try? Have you gauged that yet, meaning do you believe he or she is easy to work with?



So those are some initial questions. The next thing is some reading for you. :grinning:

Start with these posts. After that, I’d like to get you hooked up with a BG meter for running.

how-does-my-body-fuel-exercise

post-exercise-blood-sugar

the-3-energy-pathways

This is great. You have the foundation. You will get it right back!

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This is one of the many things that I greatly appreciate about this group…helping others live life how they want to live it!

Lisa

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Welcome! Glad you found your way here and I look forward to hearing how things progress.

Lisa

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Hi again. :grin:

So really, after reading your story, I feel like a very important thing to communicate is that much of what you’re doing is what you’ll be doing in your routine diabetes management. This is obviously just a personal opinion, and it’s not a dismal or demoralizing thought. Diabetes seems to be a condition that requires constant analysis and re-evaluation. This will be true in running, too. The great news is there also seems to be a limited amount of patterns (maybe an endless amount of conditions that can lead to them, but it’s less about why we have what we have and more about what we are going to do about it), so that helps. The part about limited patterns. I think you’ll find that certain combinations heading into a run often will lead to predictable needs during it. That’s so vague it actually hurt to say it, but it’s also true, and that’s nice. Because although diabetes can feel like a disease overflowing in mystery, it also isn’t. So it’s going to require some investigating, some exploring, and, at least in my case, making lots of mistakes. :grin:

My runs aren’t perfect, and I have to start with a renewed sense of dedication and commitment every morning because I also can’t piggyback off of recent success. Every day I have to do my best to get the right combination to set myself up for a good run. When I get lazy in that area, the runs are harder. For me, preparation is critical. And it’s in the preparation that I am able to start a run at a BG of 85 and not crash during it. If I mess with the prep, I’m a diabetic mess, and I can see both poles. @Eric has taught me everything in this department. I used to exercise in the 300 and even 400s because I didn’t know how not to. I can’t even do that even more. Exercising at a 200 sucks, and I now have the tools to have the choice.

Anyway. I get a little preachy around coffee time, but I just wanted to say I think you’re going to do great with all of this. I hope you even have a little fun with it. Weird as it may sound, I have. A lot actually. :grin:

Look forward to hearing of your journey. :heart:

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I do pen injections. Tresiba (long-acting) in AM and Novolog (fast-acting ) if I’m high in the mornings. I was fasting on AM runs but had quick BG drops. So I began to eat and take less insulin before. That leaves me staring out in 200-250 BG range. To be clear, is it the meal insulin you suggest I remove prior to my run?

Without a pump, removing all insulin is definitely more challenging, but I know Eric has run plenty while still using MDI, so he would have a better answer. If you were using a pump, I would aim for 0 insulin, then add it in after the exercise. On MDI there are other strategies.

Hi, call me Michele. Yes, I currently do injections. I am still taking Tresiba.
My diet fluctuates between 30-40 carbs per meal, 10 or so pet snack. Plant based diet but eat everything. High fiber. Certain 3 day stretches I consume 25% more carbs per meal.
I have CGM- Dexcom. It has been an awesome tool. Endo seems easygoing. I think he appreciates that I’m informed of my health and I’m determined to master it within.
I really enjoyed the posts. Especially " How do I control BG After Exercise." I’m particularly interested in changes with types of exercise. Ive noted that high intensity workouts have resulted in increased BG levels for me. HIIT stuff or hill sprints. But after 1-2 hours my BG drops. If I eat post workout, I usually take less I insulin and see what happens.

Yesterday AM I had high BG around 350. It was from eating BDay cake the night before. I took meal insulin with it that I thought was equivalent to the cake but maybe I was kidding myself about the frosting amount. I took more correction insulin in the morning. Still slow moving, high BG. I took another correction 3 hrs later, checked my ketones (all good) and ran for about hour on the trail. I run a mountain bike trail and parkour off the berms as I can. At beginning of run BG was 336 and at end 107. It dropped to about 90 over the next 20 min. and remained steady for a good hour. I then ate and took more meal insulin.
What are the dangers of exercising with high BG? What are your thoughts on fasting exercise vs. with food? I use to prefer AM fasting workouts. Now my energy is better used if I’ve eaten within 4 hours instead of 8.

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Hi Michele.
Let’s work through a few of these things.

First off, are you comfortable now in understanding the different fuel systems used during exercise? Fat metabolism, muscle glycogen, and blood glucose? And how your body uses a different combination depending on the type of exercise you are doing?

I think that running first thing in the morning without a meal is not the easiest thing to do for any kind of hard workout. It is fine for easy stuff, where you are primary using fat.

But for more intense workouts, first thing in the morning if you have not eaten, your liver glycogen is somewhat depleted and you don’t have any carbs to work with. And on top of that, for some people their BG spikes when they first wake up. And they may not have time to get their BG settled before they start.

If you always wake up at a perfect number, sure it may be easy. But having a few hours to eat and get your BG settled seems to make it easier.

One time I tried a marathon without eating breakfast. I won’t ever do that again. It was horrible. Felt like I had nothing by mile 10. Never again.

I think 4 hours is really a good time frame for normal workouts. I do 2 hours for races.

Doing it at 4 hours means you have some food, you have replenished your liver glycogen, and you have no (or minimal) IOB, and you have had time to get your BG settled.

With Tresiba, your basal rate is fairly flat all the time, and you can’t adjust it.

Ideally, you don’t want to start above 150. If you are committed to using MDI and Tresiba, you may have to feed your basal (option 1) as you go along to keep from dropping. That is one way to manage BG, without starting at a higher number.

Alternatively, you could look at a different basal insulin that lets you adjust your basal for different times of the day, so you would have less basal during your run (option 2). I am a big fan of Levemir for athletes that want to stick with MDI.

And a third alternative would be looking at getting a pump, where you could turn your basal off prior to exercise (option 3).

Yep!

The post below has it detailed pretty well. I could go through them again, but this post has several reasons numbered out and with detail. So take a look at this thread. :arrow_down:

(Make note that there are reasons pertaining to health, but also reasons to performance…)

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Hi Eric, thanks for your time!

Yes, I have a basic understanding of the 3 fuel systems and their use during exercise. My goal is too stay in the fat burning zone as much as possible. Most of my runs are done for long periods at a low to moderate pace.
I do throw in resistance training or a mix of both power and speed drills once or twice a week.

I’m not sure yet how my body and BG is affected. I’m keeping logs but my BG is unpredictable. I havent figured out how to account for carbs fully. Some days the same meal requires different dosages of bolus. Like today, I had BG above 250 when I woke, upped basal and took bolus insulin, but BG barely moved. Took more bolus and correction amount with meal. Still at 225 almost 2 hours later. New insulin, might just need more of it now? I’m afraid to go hypo, it happens at least once a week now, with no pattern or reason I can discern.

I’m getting ready to run and will tell you how it goes. I’m leary of taking more insulin before I head out but know I need to correct this!
Frustrating because I’ve had swelling from BG around 400 for past two days.

I will look into Levimere.

Sorry so scattered!

Carbs and insulin are only part of the story. There are a lot of things that affect BG. So really, you can’t just plug in insulin and carb numbers and have it balance perfectly every time every day. That’s a part of the challenge. There are always a lot of factors.

Sleep, hormones, illness, food intake from previous meals, seasonal changes - all kinds of things.

Continue running, but possibly the best thing to do would be to work on getting a good handle on your BG outside of running first.

There is always a reason. It’s just sometimes hard to figure out.

You are using a pen with NovoLog, right? I am personally not a big fan of Tresiba for anyone with variable basal needs. If you are not doing the same type of runs every day, you can have variable basal requirements. On top of that, you might have different needs for daytime and nighttime.

I think there are several threads around here that go over some of the factors that can affect BG.

Maybe some people here have suggestions for some helpful threads to read.

@Chris, any suggestions?

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Welcome, Michele (@ValidLADA)!

Same. Halloween 2005 for me.

Same.

Same ballpark for me.

Same.

Same.

YES! The day I started insulin…after surviving on Metformin, cottage cheese and egg whites for six months…my now-husband came with me to my “here’s how you take shots” appointment and then straight to Panera. My first real food after diagnosis was a Frontega Chicken Panini. My husband said that between every single bite I was saying, “Oh my gawd. This is SO good. Oh my gawd. I’ve missed food.” It wasn’t too far off from “When Harry Met Sally” in the diner. Lol.

I’m reaching out to welcome you, encourage you, and throw in my two cents based on my experience so far with T1D. Feel free to take what seems useful to you and leave the rest. We all have to tinker for ourselves, but FUD is fantastic for collaboration on tinkering.

  1. Having a collaborative endo is a great starting point. Eventually, I think the majority of FUDders take the reins and control day-to-day on their own and we end up informing our endo what really works for us. It’s a process.
  2. MDI has a lot of benefits. I stayed on MDI for seven years with good results. It is also a great way to learn the disease when everything is new. If I personally could maintain good control on MDI now, I would choose MDI over pumping. But it is not tenable for me anymore for a few reasons.
  3. Dexcom will be a huge help to you in learning the disease way faster than maybe the rest of us did on fingersticks (or urine tests, which were before I joined this club). I did my first pregnancy on fingersticks alone and that feels crazy now.
  4. Exercise is great for health and happiness. Exercise with new T1D is admittedly a lot of variables at once. I think getting your overall dosing dialed in (basal and meals) independent of exercise will help you get to where you want to be as a T1D athlete faster. Exercise affects everything in the T1D realm. My personal strategy would be to get used to what “everything” is first (how long insulin lasts in my system after a meal, how much of a head start my insulin needs before meals, overnight control. morning control, etc).
  5. Continue with your method of learning everything you need to know about your T1D and your factors which affect it. We have a fantastic Women’s Health category here on FUD. It has threads covering all kinds of things specific to female endocrinology. I have yet to meet an endocrinologist who has ever acknowledged or understood the fluctuating sensitivity to insulin in female T1Ds (I’m not saying these endocrinologists don’t exist, but I have never had one ever mention it or speak credibly on it when asked…and there are no books that deal with this topic in any depth). It is not well studied nor understood, but I’ve been following it for over a decade in myself and more recently here on FUD. These factors have to be considered by me on a daily basis (you may or may not see the same effects as you get dialed in). The revolving hormone factor for me is the difference between tanking through the 50’s all day long vs. being stuck in the 250’s all day long. For me it is a very real routine that I have to consider with or without exercise…especially for how I’m going to dose and treat before/during/after exercise.

I think you are doing great! I hope FUD can help you get to where you want to be and it looks like you’re already on your way! I’m always willing to bounce ideas if it is thought to be helpful.

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Thank you, Eric!
I’ve got some reading to do in the forum. When I catch up a bit, I’ll have plenty to say!

BTW, went running and did hills and drills. BG hovered at 250 all day, took insulin a few times just for correction. Took it 30 min before run. Maybe not enough time before exercise so it could work. BG still 230ish at start of workout. After 40 min workout at moderate to intense pace, BG was 120s. It didn’t bottom out but slowly declined to about 90 before I ate, post exercise.
My insulin needs were less after exercise and my BG dropped into 50s about 3hrs later. That’s the hardest tinkering. When I need more and when I need less meal insulin. I know after exercise I need less but that 50 drop led me to eat and this AM I’m back at 220 BG.

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Thank you Allison for your insight and encouragement. I’m sorry you suffered as well! I appreciate this group and the the wealth of experience and expertise. I will do some reading and comment fully soon!
I also need to get to my PC for commenting instead of phone! I’m not a great texter…

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Welcome! I agree with Eric on the levemir suggestion, and it does sound like a basal adjustment is needed. Levemir seems to peak every 6 hours, and is usually depleted after 12, at least for me. You would probably take a little more in the evening, and less In The morning depending on your planned activities…but that’s why tresiba is tough for athletes…I also highly recommend a watch that will display your glucose as a watchface… Android or ios, just make sure you can look at it and see your Dexcom BG and arrow…

.I can’t imagine running without one…I do apologize in advance if you already have one…I also recommend an app like bitesnap(android) where you can take a picture of your meal or birthday cake and it will estimate the carbs…you have to tell it if its large, med, 3 servings of waffles, etc, but I think it helps a lot

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One more thing…My company tends to shop for health insurance providers yearly(small company), and I recently had to switch from lantus to levemir…then I saw my endocrinologist, and she recommended tresiba…i thought I might have to wait, but they treated it as a different medication…just thought it might help if you decide to try levemir…you will most likely be able to refill it immediately

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Hi Michele,
There are a few tricks that people here use for running and for general BG management. Here are some very general thoughts.

  • Start your workout with minimum IOB. Meaning, don’t run after a big meal, or soon after a meal. Trying to wait a few hours after running allows the insulin to finish working through your body. For example, you have more insulin an hour after a meal than 3 hours after, so just try to run at a time when you do not have as much IOB.

  • Cutting basal a short time before a run is helpful. On MDI this comes down to timing shots and using a different basal insulin.

  • Try to start a run in a good BG zone, like 80-120, and take carbs or insulin during those runs, as needed to prevent drops or spikes. Test frequently!

  • A few carbs right before you start will be helpful if you are on the lower side of your BG. It depends on the individual, but your body will instantly use any glucose it has in the blood when you start. Even before your body can start metabolizing fat, blood glucose is a much faster fuel, so a few carbs right at the beginning can be helpful. This can help prevent an early drop. Carbs you take at the beginning of exercise are used for glycolysis and gives you instant energy instead of glycogenesis for future use.

  • Exercise amplifies your insulin. The carb:insulin ratios will not be the same as when you are resting! And exercise can also reduce your basal needs, just like lack of exercise can increase it.

  • After workouts - carbs, insulin, protein, fluids! You need insulin to replenish as well as carbs. If you are high after a workout, any carbs you take in are wasted. Please make sure to take the right amount of insulin and carbs when you are done.

  • Different workouts have a different effect on your BG. Long slow runs will drop your BG. Faster and more intense runs can spike you. The intermediate runs, like tempo pace, will probably drop you faster, depending on your fitness level. But having a good flat starting point lets you see the affect your workout had, rather than trying to figure out all the other stuff that was going on - like if it was a meal, etc.

  • After exercise, your insulin will be much more powerful. Adjust carb ratios for meals following long or intense runs. And adjust basal too (if you start using a shorter acting basal insulin).

But one of the most important things will be to get a good handle on your BG when you are not running.

If you can have good BG when not running, the running part of it becomes very easy.

In addition to reading threads, hang around a bit with some of the women warriors here who exercise. They are inspirational. There are a lot of them, but here are just a few of them who have posted frequently on their workouts.
@T1Allison
@Nickyghaleb
@daisymae
@Trying

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Hi Michele, considered the short amount of time being a T1 you are already engaging in levels of control that a lot of T1’s will never ever experience.

One of the hardest things as a T1 and an athlete is the understanding of your own “glucose reserves”, how fast they replenish and where you might actually use them in your work-outs or even at sleep when you are not aware that you actually do.

If insulin dosage is a bit too high and you use up energy during work-outs those reserves can be a true lifesaver. Using them up for work-outs as in going into them without eating depletes that lifesaver until you have a new one onboard.

Do not worry as much about those highs, rather do not do a bolus to fight them before a workout but eat something. Your workout will bring that high down eventually. But it also will lead to a somewhat inverted learning curve since you will experience those work-outs that will shoot your levels skyhigh instead of lowering your glucose levels. Meaning is that you just used those reserves without noticing. Now be extra careful countering that high with a shot, you do not have that lifesaver reserve on board for about another 12 hours.

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