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Diabetic, Interrupted.

June 16, 2010

Over the last couple of weeks, I’ve been regularly going to the gym again. I would hardly call it going often, but I’ve consistently gone 3 days a week this month, which is more regular than where I was at earlier this year. Earlier this year I’d go three days a week, and then once, and then twice, and then maybe back to once. Most of this is because I was going in the evening and my evening schedule is so unpredictable, what with diabetes support group meetings, dinners with friends, running errands and seeing my fiance.

Because of my hectic evening schedule, I decided to start going to the gym in the morning. But I’m also finding that difficult as well. Because the time I test my blood sugar level before going to the gym is also the first test of the day, I don’t have much recourse if my blood sugar is low, or too low for going to the gym. This morning I woke up at my blood sugar was 130 mg/dl, which is a perfectly respectable fasting number, but it’s too low for a hardcore exercise session. On the flipside, on Monday I woke up at 230 mg/dl, which was a perfect reading to go for a run.

When I am able to run in the morning, it’s perfect. I get it out of the way, it makes me feel more awake and alert during the day, and in general I just feel better about myself. But it’s irritating to no end to have my plans interrupted by diabetes. I just want to go to the gym. I want to exercise and be healthy like everyone else, and yet again and again, diabetes throws a wrench in my plans. And I’m not sure what I should do about it, because it never seems to stay the same.

Despite the constant interruptions, I am on track to becoming a runner (hopefully). I decided that C25K was not the plan for me for a couple of reasons. First, I didn’t like their set up. The first few weeks of the run have you run for a very short period of time, and then rest for a short period of time, and since I work out on a treadmill at my gym, constantly ramping up and turning down my MPH speed was annoying. I also found that I did better when I was able to run for exactly as long as I was comfortable, and then slow down and walk for however long I was comfortable. At this point, I’m running at about 4.5 MPH for 2-3 minutes, and then I walk at 3.5 MPH for about a minute or two. Sometimes I’ll switch up my metrics, and I’ll run for .2 miles and then walk for .1 miles, and just do that for a mile. I’m using a training schedule I snagged from SELF magazine to help me, and it also incorporates other things like strength training and cross training in addition to running.

My only problem with keeping up with any kind of schedule is my diabetes. If my fasting blood sugar is 115 mg/dl, there is no way that I’m going anywhere fast. I am at the whim, I feel, of where my fasting blood sugar happens to land me. When I went back on Metformin, my blood sugars reacted strongly, and I was waking up with hypoglycemia several days in a row. Now that I’ve scaled down my basal rate, I’m facing a more unpredictable problem, where my blood sugar might be perfectly suitable for exercise, but it might also not be.

If you have diabetes and work out in the morning, what’s your management style? When do you test? How do you treat? Is there anything I can do to make my morning workouts more consistent?

  1. June 16, 2010 1:08 PM

    I’m a morning workout person. If my fasting BG is under 80mg/dl I’ll pop a few glucose tablets to bring it up. This usually keeps me from going low during a workout. The time of day when I exercise is also a factor for me — morning workouts tend to raise my BG, while afternoon/evening exercise tends to lower it, go figure. Maybe munching on something before you leave the house in the morning will have your BG in a good range by the time you get on the treadmill.

    • June 16, 2010 1:10 PM

      I’ve thought about doing that, but I hate eating before working out if I can help it. I might have to try that though. I did that once, though, and I still ended up going low because it hadn’t hit my system yet. I might just have to get up a little bit earlier.

  2. June 16, 2010 1:24 PM

    I agree, glucose tabs are good…I also eat a few crackers if I want to bump up my BG before working out.

    How much does running bring down your blood sugar? I find that my optimal pre-exercise is 150-200…..also, are you still connected to your pump when you run? On runs of less than an hour, I usually just leave it at home, and that works fine for me.

    I personally have never tried this, but you could also experiment with a lower basal rate from, say, 4-6 AM.

    When bad blood sugars keep me from exercising….the first thing I do is take a deep breath and remind myself that shit happens and this does NOT mean that I am lazy/unhealthy/cursed to be a slob/whatever. I usually try to find some replacement– going for a long walk instead of running, or strength training instead. (But that’s only usually….sometimes I just enjoy having a valid excuse not to exercise. :P)

  3. Meg permalink
    June 16, 2010 1:59 PM

    Long time reader, first time responder. 🙂 I struggle with this problem a lot too and, while I haven’t perfected it yet, a tip that a former dietician gave me has helped a lot. It’s sort of along the lines of what Caroline is talking about, I think. Most pumps allow you to select between one or two different basal programs (I’m talking like a full 24 hours of basal rate schedule). They advertise it as something you could tailor so that you would have a different basal rate, for example, on the weekend versus a weekday. What I do is program a basal program that is almost exactly like my normal program, except that it is toned down a bunch in the few hours right before I wake up (i.e. 4am-6am). This way, I’ve reduced my basal rate like I might do for exercise anyways, but I don’t have to set an alarm for 3 am to set a temporary rate. If I decide that I’m going to work out the next day, I put that basal rate on before I go to bed so that I wake up with pretty normal blood sugars and a little more resistance to hypoglycemia. Unless you’re planning on working out everyday, you do have to remember to switch back to your normal basal program by midnight of the next day, but that’s pretty easy to do. The upside for me is: 1) I don’t have to eat the equivalent of Thanksgiving dinner before my run and 2) I’ve made a commitment the night before that I will work out in the morning. Were it not for #2, I’d probably just roll over and go back to sleep most days 😉 Hope this helps!

  4. June 16, 2010 2:17 PM

    What Meg & Caroline said – great advice! I’ve used both strategies – reduced pre-wakeup basal rate and eating some quick carbs before I head out. If I’m not wearing my CGM, I also test 15-20 minutes after I start to work out to see if I can tell where things are headed. If I’m heading south, I eat a gel or two, or a few glucose tabs and that will often keep me from having to totally scrap a workout, and only cancels out a few of the calories I’m burning. Lately, I eat a light breakfast and boluse for 1/3 to 1/2 of what I normally would. Works well most days, but today it left me gulping down 7 glucose tabs throughout the course of my workout. Early testing or watching my CGM, and always being willing to change things up if they aren’t working are the keys for me. And a good cry of frustration when all else fails!

  5. Christina H permalink
    June 16, 2010 3:48 PM

    I have this problem sometimes, girl. But then I have a quick snack before I leave to work out… 15 to 30 carbs, depending on the intensity of what I predict my workout will be (some are more intense than others)… and I turn down my basal rate (usually to 50 percent). Consider drinking a cup of juice, even milk, or having some animal crackers or toast before your workout when your blood sugar is normal/not elevated. You really can make it work, I promise!

  6. June 16, 2010 4:05 PM

    Take a look at your morning basals. Most people have a dawn phenomenon basal — mine is rather complex, starts at 4:30am and tapers down all the way through 9am. Going for a run when I wakeup at 6am (my peak basal rate) would be just like having a ton of IOB without having any carbs in my system. Does not matter if you put a temp basal on — since you ideally have had hours of higher basal already. Typical reccomendations call for setting a temp basal 30 minutes prior to a short workout — but if you just woke up — that is not going to happen.

    Starting a ride at 5am is always interesting, because even if I use a temp basal of 50%, I am going to be using way too much insulin right off the bat.

    Whenever you are having a problem — looking back in 3 hour segments is really helpful to understand why you are where you are.

    • June 16, 2010 5:30 PM

      I actually don’t have the dawn phenomenon! I kinda feel left out… My basal rate is the lowest of the day between 5-8 a.m. It’s the highest in the late morning. Odd huh? I’m really trying to get my basals to land me right around 170 mg/dl every morning… so far, not working the best.

  7. June 16, 2010 7:32 PM

    I have absolutely no advice on the diabetes thing but just wanted to say great job with your workouts and keep it up 🙂

    • June 16, 2010 10:49 PM

      I gotta say, even if you don’t have any D advice, the fact you and Emily and the other twentysomething bloggers still read my blog even when I blather on about an illness means a lot. 🙂

  8. June 16, 2010 8:00 PM

    I was using that Self training thing too!! I’m doing my first 5k run on Saturday.

    Great job on the exercising!! It’s SOOOO hard to find time to do it, so kudos to you!

  9. June 16, 2010 8:40 PM

    I usually eat some toast or fruit and yogurt when I wake up and only take half of the insulin using a lower carb/insulin ratio, for what I eat, then I can do my exercise videos (45 min cardio) or walk/jog 3 miles. It took a while of tweaking but I figured out the right amount that allows me to exercise after breakfast and finish with a normal number without going low. I don’t usually experiment with my basal rates but I hear this is a great way to do longer workouts that expend a lot of energy. I plan on experimenting more with this for afternoon exercise! (Like, Caroline, I also enjoy the excuse not to exercise when my BS does not cooperate!) Love your blog!

    • June 16, 2010 10:51 PM

      I have been thinking that eating before working out might not be such a bad idea as far as performance goes (the whole working out longer you mentioned). I could think of it as just because a normal morning blood sugar and adjusting through my food rather than foregoing the exercise all together. I’ve been so hesitant about eating though! I should give it a whirl though before completely giving up hope!

  10. June 17, 2010 7:06 PM

    I have very different workout experiences. Before I got my basals “fixed” I would sometimes drop a fair amount at the gym. Now, I’m happy to start a workout around 100 mg/dl (I don’t like to wake up higher than that anyway) without much fear. I am not a competitive athlete by any stretch, but I can usually keep up 20-30 minutes of 80-90% heart rate (around 150-160) and then do another 20-30 minutes of weights without dipping much. Because I eat pretty low carb, I often find my BG goes up a bit during a workout, because I’m getting my energy converting protein to glucose, instead of carbs (I still carry glucose tabs, and check my CGM frequently).

    The short answer, of course, is that it’s all trial and error, and different for everyone. Still, I think you’re much better off taking some glucose tablets to get into a range you’re comfortable with than scrapping the workout all together. You’ll definitely burn those calories and more, and of course you further the cause of getting in shape to burn even more next time as your endurance/strength improves. I also find that I feel stronger when I have some food in my system before a workout.

    Good luck getting it all balanced.

  11. casey permalink
    June 18, 2010 10:45 AM

    it takes a bit of time to figure out your body’s routine. I run in the mornings and don’t temp basal or anything. If I wake up at 90 mg/dl, I usually finish my run at 120. Causes me to go up. I take my insulin for breakfast before my shower (30 mins before I eat) and have no problems…. most of the time! If I wake up low, I drink a bit of juice and eat 1 piece of light bread. Keeps me steady 🙂 If I work out in the afternoon, I have to temp basal it and eat before hand because I drop with later day workouts. I don’t exercise if I am over 200. I figure if I can get it done in the morning, thats awesome. If for whatever reason, I can’t…I can do it in the afternoon. 🙂 I hate that I have to food I am not hungry for just to work out… but the activity is good for your body even if you don’t counterbalance the extra calories.

    I hope you get your routine figured out! 🙂

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