Post exercise lows -- anything we can do better?

My son has sports practices most every day. Most of them cause lost-exercise lows. This is exactly our routine:

  • 20 minutes before exercise, bring BG up to 130-150 by eating a complex carb

  • eat as much carb as you can during exercise while keeping BG steady

  • immediately after exercise, take 6-12 oz of milk

  • immediately after exercise, dose for a large carb meal (between 70 and 120 carbs depending upon the sport). We typically underdose the meal up to 50% because we know we won’t need all the insulin.

  • eat the post-exercise carb meal as soon as you turn the corner, i.e. typically 40 minutes after exercise and dosing.

What else could we do to force more glycogen into the muscles/ liver/kidneys faster? Despite our routine, we frequently have to endure post-exercise lows hours after the post-exercise carb meal.

I guess one option would be to inject insulin 20 minutes before the end of the exercise session, to further accelerate the glycogen reload. I can’t say I like the idea of having large IOB while exercising.

12 oz of milk only has about 16 grams of carbs. Use chocolate milk right after exercise. Otherwise he is not getting sufficient carbs soon enough after the exercise for it to be most efficient at restoring muscle glycogen.

If you wait 40 minutes before he is getting any substantial carbs, you are starting to lose the window of ideal time for replacing.

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I wouldn’t recommend that, especially when practice may go longer than expected.

What happens if you reduce the post-exercise bolus even more than 50%? Also, maybe try with a shorter than 40 minute wait after bolusing. When I’m through exercising I bolus and eat right away and haven’t noticed any serious BG peak from not pre-bolusing.

Finally, its fine to keep grazing on carb to keep BG up, assuming he isn’t exercising so late that he goes to bed while BG is still falling. I don’t believe it is true that the body can instantly acquire all the carb it needs immediately - I think it is normal for it to take some time. If he was on a pump he could reduce basal rate, but those of us who inject basal kind of just need to deal with it.

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We tried giving him more but he went to the 150s for 30-40 minutes. We’ll try again and see what happens.

We’ll try that too. Do you bolus for 100% of your carbs or for a % of them? What kind of exercise sessions do you run?

Post exercise - carbs and insulin. You need sufficient insulin to be able to use the carbs. The insulin you take after the workout will also help with the post-workout dinner.

This is advice given to non-diabetics. You just need to make it fit into the diabetes.

As soon as possible post workout, get carbs and protein immediately into your body. This gives your muscles the ability to replenish the glycogen they just lost through training and helps your tired muscles rebuild and repair with the available protein and amino acids. Try to eat within 15 minutes of completing an intense workout.

Since you are trying to eat within 40 minutes of exercise, part of the insulin you take right after would be used for the dinner, and part of it would be used for the post-workout carbs. Then you might need to add a bit more right when dinner starts. Just a little experimenting with the timing and amounts.

Four things I have immediately after every single run, no matter what my BG is:

  1. insulin
  2. carbs
  3. protein
  4. fluids

I exercise three or more times per week, and normally exercise for only about 20 minutes - 5K rowing machine or 5K running. But lately I’ve been doing a fair number of 10K exercise runs since the weather is so nice. I take Levemir insulin twice a day, plus Humalog bolus. I try to exercise with no bolus insulin on board, but will always have normal basal on board. BG will usually go up 20 or 30 points during the first 5K, then go down by the same amount plus another 20 to 40 points in the last 5K. Eating some fruit immediately after the run is useful to turn around my falling BG (and feels good), and I bolus for my meal and eat within 10-20 minutes or so.

I do underbolus for the carb I’m going to eat post-exercise, but only for my longer runs. 5K exercise stints seem to be pretty neutral for my carb needs. For 10K runs I will actually take my normal nightly insulin bolus, but eat extra carb, probably 50g or so that I haven’t bolused extra for - though that will change depending on what I seem to need. From what I’ve read, you have a couple hours to eat carb and protein for peak glycogen building so personally I don’t worry about the first 15 minutes being critical. And I will keep grazing on food post-meal if needed - some nights more than others.

When I was in college I rowed on the varsity crew team, seriously working out (rowing, running, stadiums, weights) every day, and that is probably closer to what your son is doing now. Unfortunately that was in the days of one injection a day of NPH, no bolus insulin, and urine-testing only, so I have no data points at all from that time - not even A1c tests which hadn’t been invented yet. Management back then really consisted of simply eating carb when you felt low - period. (Only once did my bag of jelly beans open up while in a boat and rattle around in the back of the boat, leading to much confusion on the part of the seven other oarsmen about where the hell this candy was coming from). But I also believe that the exercise I did during that time was crucial to my overall health to this day, and I’m really glad I did it, and I think its great that your son is doing it too.

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Is he staying hydrated before, during, and after exercise? I know proper hydration plays a crucial role on most systems within the body so it only makes sense that he should be staying very hydrated in order for things to work within the body as they need to be working.

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