T1D athlete - feeling weak and shaky hours after injection, affects sports performance, normal BGL

I typically have about 5 units of novorapid in the morning with 30 units of the NPH. Novorapid depends a bit, according to my blood sugars usually never more than 7-8.

I have none during lunch

My night time dosage is significantly lower as it’s not uncommon for me to drop over night. Fortunately it’s a case of me just waking up and having a couple jelly beans and going back to sleep.

I have somewhere between 0-5 units of novorapid, usually none and of the NPH, 5-15, I even had no insulin at all last week on one evening (and still woke up with low BG).

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For comparison I’ve been an autoimmune T1 since around 1972 and, when on MDI, I take 6IU of Lantus morning and evening and bolus an amount dependent entirely on what I eat, but it tends to end up at least 12IU. Here’s my 90 day history basal vs bolus, I sometimes use basal rates to cover carbs (these figures come from a pump):

Average daily basal: 17.6IU
Average daily bolus: 23.6IU
Average total carbs: 136.7g

I exercise moderately; not athletic, 1/2mile 100m of ascent every day or there abouts with additional spot exercise many days.

Basal usage is a choice, but higher basals need to be covered by continuous available carbs. It’s a choice because the basal lets us put on weight.

Newly diagnosed T1s and LADA both need to be careful. I don’t know your situation but complete loss of beta cells can take many years, or just a month or so… Certainly things can change so that’s a reason for talking to an endo and asking wtf is going on; C-peptide tests can detect insulin production, IMO they are important for all diabetics until the point where they return zero. Any insulin production massively complicates everything, though believe me it’s much better than zero.

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i felt very similar energy issues in the 1980’s when nph was my only option and anywhere from 2-6 hours later nph will peak depending on breakfast… i prefer tresiba(approved in au in 2018), but it looks like austrailian pharmacy companies don’t want to pay for it, so maybe obtaining levemir, splitting the levemir dose with experimental 35/65, 50/50, etc every 12 hours…a cgm with a pump is preferred, but can be costly. the knowledgeable endocrinologists/nurse practitioners usually tell me to aim for 6-7.1 mmol before activities, because you’ll usually drop if your basal is correct, and that sounds like what is happening…i also recommend trying a cgm, maybe a libre2 on the back of your arm with flexfit over it, or an arm sleeve, or shin guard sleeve, and aim for 6mmol prior to the game…sounds like lower bg levels are causing the fatigue which makes sense

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I might look into Levemir as an alternative. I know it sounds like I’m describing low BG, and the symptoms certainly are very similar. However, as I have previously stated, it is definitely not low blood sugar. These symptoms will occur regardless of BG levels. I am convinced it is a reaction to the insulin I am taking, a theory which was pretty well confirmed during my last game, when I skipped the NPH and only used the novorapid to cover breakfast. I have had a couple of weeks off because I’ve been away but will test this again in my next game.

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everyone knows cgms are a little delayed, as interstitial is a little slower than blood, but the directional arrows are why they are popular… novorapid only is similar to an insulin pump…so it is better in terms of predicted levels based on your insulin on board, however, if you have trouble obtaining levemir, you could try to test on your arm, then finger to see which direction your glucose is headed… probably the closest to a cgm

I am interested in hearing if you are able to get rid of this symptom if you start a different basal. NPH is totally different than any of the other basal insulins, so this is a very interesting thing to hear about.

It will take some experimentation to get a different basal tuned correctly. None of the other readily available basals like Levemir, Lantus (Basaglar), or Tresiba have the same pharmacokinetics as NPH. They aren’t even close!

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It’s fine to be philosophically against using a CGM ,but I don’t see how you can say that your blood sugar isn’t a problem when you don’t know what it is throughout an activity . Checking 3 times each match isn’t enough, after each scrimmage is. Have you been testing yourself for ketones?

Blood sugar IS a problem for every person who is insulin dependent, you are no exception. Having good A1Cs does not mean that you’re able to handle changes in activity, especially sports, without mastering a fine balancing act. It can be done pretty well most of the time, but only if you know how your body is responding, why you feel like you do, know specifically what to do, and have the tools to do something about it. Your question and comments makes it clear to me that you don’t. I hate seeing anyone suffer because of a lack of knowledge and tools. What I hate more is seeing anyone turn their back on what they need.

Eating before exercise is only helpful when its in balance with insulin and activity. Eat too much too soon and you can’t metabilize the food - you haven’t enough injected insulin. If you exercise hard enough to deplete the circulating glucose your liver will produce glucose and release ketones . Too much glucose doesn’t do the body any good because without insulin it can’t use it. You literally can’t burn the energy . .The immediate reaction to te ketones is you’ll start feeling tired even though there’s more than enough food in your system. If you stop excercising soon enough and you’ve taken enough insulin eventually you will either spill the surplus sugar or the insulin that becomes available will metabolize it, but in the meantime you’re “off” until the ketone level drops. Increased fatigue and decreased performance are symptoms of ketosis

I know what it’s like to run out of steam doing a physical job. I could sit at a desk for 4 hours at a time start and finish with beautiful blood sugars. But if I tried to do something physical that I used t be able to do, like a brake job on my car. a four hour job could turn into a two-day job. I’d crash half-way through. I was easily tired for no obvious (to me) reason but I didn’t want to change what had worked for me for years. It took several people a year to convince me to think about trying something different.

While I was still on MDI, I wore a professional model CGM for 2 weeks . I found out from studying its report more about my diet and activity thanI knew from years of observations. Wearing a personal sample CGM for 2 weeks let me see the effect of every friggin’ thing I did for two weeks. I had respectable A1Cs before that but my BG was all over the place between meal tests.
From those two experiences I was able to change from being a broken clock diabetic who felt lousy too much of the time when I should have been feeling good. I went from good numbers a few times a day to predictable good numbers any time I checked, from being a CGM skeptic who hated the unreliability of equipment and the inconvenience, to asking for one.

I’d rather put up with the problems and inconvenience of a CGM than feel the way I used to feel.

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I don’t really understand why you’re taking such an aggressive tone?

I know full well that a CGM will monitor BG more effectively. Personally, I don’t think I need one. I know when my blood sugar is dropping, even without the regular testing I do. I also know when it’s up. This isn’t some sort of boast, it just is. This feeling I get, while similar to low BG, is different.

If I test before a game, and two more times in the 80 minutes of game time, and then after… and my BGL is sitting between 7.0-10.5 mmo/l for the entire game… I don’t see how this can be the cause of my problem.

I will work a 8 hr day and then head to training for 2 hours. Sometimes I might have a low before or during training, which are easily identified and remedied before they become an issue. My energy levels aren’t an issue after the initial slump following insulin. Fortunately I am only injecting twice a day. By lunchtime and all the way through to dinner, I am feeling great. Even when the hypos come, I bounce back very quickly, with little impact to energy.

I’m not trying to be closeminded. It just doesn’t feel like a BG issue. Especially when I skipped my NPH insulin as an experiment before my last game, and felt significantly better, even though I over compensated with the novorapid and ended up having to correct a low at half time.

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