The IOB Predicament... What do you do with a climbing blood sugar prior to starting exercise?

Ok, we can still be friends. You’ve got a nice delivery and an easy letdown.

Yes to all of it. And to the part about putting the stuff away (had to think about that a second longer).

I can.

They are.

I have NO idea why I have that. I was at the factory setting of 4 for years, and my most recent endo decided to shorten it. That’s as far as the loyalty to it goes. I’d be happy to try to change that… I test enough to catch it if it’s a problem.

I can, and I will. How long can I run? Does length make a difference?? It might take me up to a week to get this done though as those are like “when stars align” kind of conditions… but I’ll get it.

Thank you again, Eric. :smiling_face:

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Hang on, let’s take a step back.

When I am speaking of insulin duration, I am talking about how long it actually lasts for you. Changing the value in the pump only changes the numbers your pump shows you for IOB and for bolus suggestions. It doesn’t do a thing for how long insulin actually lasts.

Do you have a guess on how long insulin lasts for you? If your endo changed it to 3.5 hours, I suspect that was simply to help you get more insulin for meals or corrections or to remove you IOB faster, or some other idea he had. I am betting he didn’t actually calculate or test how long it lasts.

Let’s try to figure that out for real too!

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Would love to figure that out. Sorry. I passed out last night, but I’m back at it this morning, using JUST my contour and pump (and calibration factor because we didn’t specify, and because you’d have to pry that from my cold, dead hands).

And that’s pretty upbeat. I’m shooting for a late evening run but doubt I’ll be able to do what you mentioned last night. I’ve got a sick baby so it’ll be a seize the moment kind of thing. I will try to plan ahead as much as is possible and will keep to 20% if I need to do any kind of insulin…

But that’s a lot about me. How are you? :slightly_smiling_face:

I am fine, thanks!

Just try to look for some trends on your runs, depending on what your BG is doing. Start with big brush strokes and then work down to smaller ones.

Before run:
BG - high, medium, or low?
BG - flat, rising slowly, dropping slowly, spiking, or plummeting? (this is an important one)

And no IOB if possible.

It takes time to get it ironed out.

Ask @daisymae. She used to always start her swims at 200 because of fear of drops, and now she gets in the pool at 80. But she didn’t get there overnight. It takes time to get it figured out.

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@Nickyghaleb, I think this is a GREAT thread and I’m super proud of you for running repeatedly even with these swings and crashes and everything. True bravery.

One suggestion, and you won’t hurt my feelings if you don’t think it’s worth trying, but have you tracked your blood sugar with a monthly vision in mind? The reason I point that out is that assuming you experience cyclical insulin resistance and cyclical insulin sensitivity, the more acute tweaks for exercise MIGHT not address your exercise needs on a consistent basis. When I engage in high activity, if I don’t have my hormonally-induced insulin sensitivity or resistance ball-parked for the day, it’s going to be nothing but crashes or lingering highs for the whole activity and the whole day.

The biggest thing I’ve learned for my brand of diabetes is that if my basal is not correct +/- 5-10%, nothing else I do that day will get close to accounting for the incorrect basal. It’s amazing how much correction you need for a stuck flat-line of 210 or 220 that is progesterone-induced, when just an extra 5-10% basal an hour could manage it. The math on it is confounding and astounding, I promise.

Let me know if you have questions. Either way, I’m rooting for you!

One other thing…

I have two ways of tracking insulin resistance/sensitivity.

(1) I eat the same breakfast everyday. How the bolus performs day after day gives a good indication of when insulin resistance starts to ramp up and by how much.
(2) My overnight bg patterning. When it starts to consistently drift up and level somewhere overnight, it’s time to start cranking up temporary basals to deal with the hormone-induced resistance. When it starts drifting up to 160 and staying there overnight, that’s when I start adding it in 5-10% at a time. If it drifts up and levels at 190 like it did last night, I know I’m getting into the most resistant 4 days of the cycle with more rises to come.

I track my percentages of extra basal needed by day of cycle and compare notes to previous months for patterns. I’m lucky that it’s so consistent for me.

Anyway, if this is a factor for you like it is for me, it will help make the rest of your corrections for exercise/highs/etc start from a more level playing field.

Again, no pressure. Just my two cents.__

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And an impressive 2 cents it is… you are to hormones what Eric is to whatever he pretends to know everything about. :smiley: Seriously… you’ve got numbers, and numbers are something I can roll with. (And I will take a moment to say something very serious about Eric, which is that he’s awesome and knows some stuff, too, and I say that because I might be one joke away from dealing with it all on my own). :smiley:

I’m not exaggerating when I say I’ve never paid attention. And I’m not SURE any of it will apply, but you’ve got my attention now. I have something going on, and I don’t understand what it is. I have been really having a tough time for going on 4 days now?? 5?? And that was following a couple of days that things were too easy to be true. Last night my blood sugar went up and down all night… Literally, I’d clear an alarm letting me know I was dropping (now it would take me an hour to clear it, sure), and the next alarm would be to let me know I was on the rise at a fast rate. I even went back and looked at some of what you had to say, and although it would not fit my timing this month, it’s as good a possibility as anything I’ve got (which includes inflammation, recent change to high carb diet, or alien abduction).

So I’m on it. Please don’t hesitate running ideas by me if you’ve got any… and I would never offend you by telling you I don’t want to try, I’d just not try them and never admit it. :smiley:

I’m waiting for an evening run and half-expecting a disaster. So far I’ve got way too much insulin on board because my son didn’t finish his nasty BURNED gluten free buns… so I did. :roll_eyes:

I’ve got an hour and a half to go though, so hopefully some of it will disappear. I’ll probably crash just in time to have to jack everything up again and screw up my night… which is MORE positive thinking. Dripping with that today.

If time permits, i will try to slap a little organization into the hormone department and see if I can’t turn it all into something to track. I hope they have a meter for that. I could use another meter. :smiley:

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You’re hilarious and sincere. Love it. You go girl!

What?!? For what? For the 20g carbs I’m about to have??

Are you done or starting?

When you are finished, you should have carbs.

I have posts on that I can direct you to. The reasons you should have carbs after exercise.

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Done. :slight_smile:

Consider that shtuff ironed out…

Just kidding. But seriously… between you and me. What kind of witchcraft is this???

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I call it “The Force”.
:yoda: image
Ask @daisymae. She is now a believer!

But what do you mean now? Are you asking about what you should do after you run, as far as carbs are concerned and so forth?

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I’m doing this in pieces… but here’s my line. And what a fine one it is. I left the house just after 1, and that correction was when I got back…

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Can you provide these stats for me?

  • Length of run (in minutes)
  • Exercise intensity
  • Starting BG?
  • Any BG tests in the middle?
  • Finishing BG?
  • Basal adjustments - how much, when, and how long?
  • Any carbs before starting? (beside coffee, which I assume was unsweetened?)
  • Any carbs needed during the run?
  • Carbs needed after?

I know that some of these have been mentioned, but It’s easier for me to see it all in one place.

EDIT:
Seeing BG numbers are more valuable to me than CGM. Especially given how little confidence I have in the Medtronic CGM. And even my CGM when running is pointless. I often don’t even take it with me.

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Pointless to me, too… or at least until it’s too late. But it will show the trend anyway. And, yes, I’ll get you all of my info in a minute. It was great, and things have been a little rocky but still quite good since. I’ll be back…

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  1. 10 min walk then 30 minute run, followed by 20 minutes of alternating running and walking (more run than walk), followed by 20 minutes of walking
  2. High intensity
  3. Starting BG: 126
  4. No tests in the middle
  5. Finishing BG: 69
  6. Basal adjustments: I followed your recommendations and started a 0 basal 30 minutes before starting and didn’t turn it off until returning home… and something is wrong with my math because i was suspended a total of 2 hrs and 15 min. All I can think of is that it took me a little longer than I though getting out the door, I walked longer than I thought at the end of the workout, and I didn’t end the suspend right away (maybe 5 minutes late)
  7. No carbs before except one cup of coffee which of COURSE was sweetened with a little sugar free creamer (I count a cup as 8 g of carbs)
  8. I had one glucose tablet when I was about 15 minutes away from home.
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This looks promising. You did not end in the ditch. Finishing at 69 is decent.

That drop of about 50 points is what we want to improve.

Given that you needed a gtab toward the end, and had a 50 point drop, how about next time doing the exact same thing but doing a suspend of zero basal 60 minutes before, instead of 30 minutes.

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I’ll do that. I was actually thrilled with today… I’m usually WWL (walking while low) by the end, but today I had a bit of a swagger. :smiley:

In case I haven’t said thank you enough, thank you. :slight_smile:

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You are welcome. Let’s get some more trials in to see if it fits together.

Was the hard part significant? Pulse rate close to 85-95% of max? Enough to raise your BG?

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That’s kind of a hard question… I’ve never thought of my BG as rising during a workout unless I’ve started too high OR have done something to really make my BG rise… so I wouldn’t know. I used to wear a heart rate monitor with every workout. My heart rate was around a 190-210 with a good workout. I don’t wear a monitor anymore, but I know that when I’m working, I’m working hard…

Not much of an answer. Could’ve just said I don’t know…