To all you hikers out there:
I did a mild (no elevation) hike yesterday, but it was somewhat fast-paced over 12 miles without stops. The hike wasn’t a problem for me, but I had to stave off a low most of the time with lots of snacks.
I could have lowered my 2x daily Tresiba dose, but I wouldn’t see a change until at least 12 hours after the dose. So I guess I could’ve lowered my Friday evening dose, but I really only needed it lower it for ~3.5 hours on Saturday. With Tresiba being so long lasting, I’d be compromising and adjusting so much time outside of the hike.
Saturday was an easy hike, but I think I want to do a shorter, more difficult one next weekend (1,600 ft elevation over 2.4 miles, then back 2.4 miles).
When you guys go on hikes, what types of carbs do you keep handy? Also, with a more intense hike, do you expect to have more issues with blood sugar going high? Or are lows more anticipated?
I enjoyed the hike so much yesterday, and I went with such a fun group of people. I think I want to do this more regularly, so I’d love any insight you all can provide . Thanks!
When we were using Lantus, we did not adjust basal at all for daily events such as exercise.
Check how much IOB we have at the start. This makes a big difference. I look at the IOB as suddenly becoming supercharged when you start exercise. We were not pumping at the time so we could not look at the pump for IOB but we certainly knew the last Bolus time. At that point, we were considering 2 hours to be the majority of the IOB with 3 hours taking care of the rest. I know some IOB would still be there after 3 hours but I never cared about what could be measured with an instrument - only what was of practical importance so as to impact our actions.
Which is not to say we would NOT exercise with IOB. We were going to do what we were going to do. But if we are dealing with IOB, the initial “carb up” would be more substantial. I pictured it as trying to soak up some of the IOB. Sounds stupid but sometimes visualizations like that (even though totally inaccurate) just help me think through something. If it works then it works.
So before Dexcom and Pump, we handled this entirely with properly timed carbs. Carb up about 30 minutes before the start. During the exercise, check BG every 20~30 minutes (again - no Dexcom) and consume smaller amounts of slower carbs during the exercise. (I would set a 20 or 30 minute alarm on my phone to make sure I would not forget or get distracted.) Carb up again at the end.
Smaller child so everything is reduced. But even small kids we can do extended exercise. Bike rides, walks, etc… The other difference is with a smaller child, we would do extended exercise but we would not do intense exercise. (Not saying no kids do intense - just that we did not.) Intense exercise as it relates to D is outside my experience.
Lantus is not Tresiba but I assume there are similarities.
Our approach with the Pump and the Dexcom changes things as we have more tools. We still use carbs as one of the tools but also have temp basal reduction as well. I do not consider a pump temp basal reduction to be a replacement for carbs during exercise but rather an additional element to take advantage of.
This is honestly one of the (few) major drawbacks I see to Tresiba. When I was on Lantus, I definitely adjusted my dose for events like this (same for days I’d be outside in the heat all day, which drives my blood sugars down); with Tresiba, I will see a response relatively quickly in my experience if I dramatically decrease your dose prior (and it must be more dramatic than seems appropriate because of the tail action from prior shots, which would be even more true with a 2x/day dosing schedule), but the issue is it will last longer than I likely need. It’s why if I both had regularly highly variable activity levels and wasn’t allergic to it, I would probably try switching to Levemir instead. So I think you have the option of either trying very dramatic dose adjustments to your dose prior to the hike (so maybe the night before), or you’ll just need to compensate by steadily eating carbs (which is what I do when I’m on vacation and walking 12+ miles/day around a city that’s full of delicious treats anyway). The carb thing isn’t great though if part of your aim with exercise is weight control.
For me, as I engage in any given physical activity more regularly, it has less effect on my bg… if I went for a long hike right now I’d probably have to snack… if I did it ten times in a month, I probably wouldn’t need to…
As I got more “in shape” I might see overall reductions in basal, but for me it wouldn’t be practical to reduce my tresiba every time I plan an activity
I set my Tresiba basal dose during active times, ended up a few units lower than it would have to be if I do nothing for a few days. That helps a lot with not having too much basal action on a hike, bike etc. On inactive days that low basal means I am using correction Humalog as needed to stay in range. I’ve tried adjusting my Tresiba basal dose and have not found any other workable way to do it.
So my suggestion is do basal tests the night after a long hike or bike ride and see if you can dial it in that way. For me, it takes several days for a changed Tresiba dose to do anything; it could take a few weeks to tweak it. Splitting the basal had no effect for me.
I hike a lot and do have lows that can drag on for a while. I eat raisins, low glycemic Clif bars, Kind bars, apples etc early (when I am trending towards a low but not there yet) and it seems to help. With raisins, they can be excessively chewed to speed things up or gulped down to keep them slow-ish. And glucose tablets or gels are easy to carry and eat without stopping when the lows hit during a hike.
To answer your other question, I have not had hiking cause a high. Overtreating a low, maybe that can happen.
Thanks @John58. It’s very helpful to know that you haven’t had a spike from hiking. I don’t think I’ll be going often enough to reduce my Tresiba dose regularly, but it’d helpful to only think about lows being caused by a hike (rather than highs as well). I’ll likely continue with the plan of snacking throughout the hike unless highs begin to pop up during intense hikes. Hopefully that doesn’t happen. Raisins are a good idea!
@Sam, yes, I’d expect to experience fewer lows over time. However, I don’t think I’ll be doing this regularly enough to not need an adjustment each time. Also, each hike tends to have different challenges. I agree that adjusting the Tresiba dose isn’t very practical. I’ll just continue on with the snacking.
@cardamom, yes, I think steadily eating carbs is the best bet. Luckily, the primary aim isn’t weight control. I truly enjoy hiking, and I’d also like to be in better shape. Being in better shape would likely include a little weight loss, but my aim is more for being healthy than losing pounds.
@Thomas, thanks for the suggestions. Smaller amounts of slower carbs is a good idea. Also setting an alarm could help considerably. Definitely something I’ll use on the next hike.
For me, any high during hiking would be self correcting, but I will need carbs, and it could be 30g per half hour. For a really high-intensity hike (like gaining 3000 feet in an hour) maybe there will be a rise from stress in the beginning, before the BG comes back down from the energy expenditure. I haven’t hiked in quite a while, but I’ve replicated the sensation of gaining altitude on a steep slope by climbing on a StairMaster, and at high exertion I can see my BG rise 50 mg/dL during the first 20 minutes, but then it turns down and I’m falling through the 80 mg/dL level at 45 minutes.