It’s All About Timing

exerciseI feel like this is the secret to diabetes that no one mentions and no one can really figure out: timing.

How long does insulin take to start working? How long will it take for my food to digest? How long will it take before my physical activity ramps up my sensitivity?

It’s all about taking the various pieces of our diabetes management and laying them out properly so that everything lands at just the right time. I remember my childhood endocrinologist drawing graphs of when NPH and regular peaked and the idea was that we would have everything timed to my meals. Of course, the timing of my meals and the peaks of insulin were never the same, and that’s the point. We rarely live in a space where timing can be exact, and that’s what makes diabetes so incredibly mind-numbingly impossible to understand and manage.

Lessons in timing have been readily apparent in the last couple of weeks as I get a better grip on my exercise regime. For a long time, I only exercised at night, which worked well because I’m not a morning person, except I found that I went low with any on-board insulin from dinner. No matter how little I took, I always seemed to drop halfway through my run. So I switched it to the morning, and now I don’t go low, but sometimes I will go high from the insulin resistance. I also need to eat something before I exercise. I’m not an empty stomach exerciser or I feel very fatigued. I need to have some fuel in my system, and that fuel is usually carbs. But carbs = insulin which = lows. Fun stuff, huh?

I’ve been playing around with various tactics and I think I’ve found a couple that work. It was actually something Gary Scheiner said at the Insulindependence conference that I attended last month. He said that occasionally he will eat dinner and then exercise and then bolus for his meal, because the exercise delays the digestion of a meal because all the blood is being diverted from the stomach to the muscles. I thought for sure I would skyrocket if I tried something like that. But this week I decided I wanted to take a couple evening classes at the gym — a cardio kickboxing class and a Zumba class — and both of them would be after dinner. So I had dinner and then almost immediately after dinner (within half an hour) went to the gym and worked out. I held steady in the 90s the first night, and then the second night I actually went all the way up to 250 before coming back down by the end of the class.

After the first class, I bolused the full amount and the second night I bolused half the amount, but neither one seems to be the sweet spot. The full amount is too much, and half is too little. Three-quarters? That’ll be fun math to do in my head! But I loved that I was able to take a class regardless of the time of day and enjoy it and not go low. I also still had the benefit of taking less insulin, which is a key in losing weight.

In the morning, I typically wake up and have a GU gel. They are 25 grams of carbs and 100 calories, but so far I haven’t been bolusing for it and paying the price later with a high blood sugar. I plan to experiment by taking a partial bolus of the GU after a run, and then in addition take a partial bolus of my actual breakfast. I’ll have to tweak the percentages a bit, because it’s not likely that every day will be exactly the same! But it’s nice to have a base to work from and a strategy that — for now! — seems to be working pretty well.

I know a lot of people struggle with exercise, so I wanted to share in case anyone else thinks this might be useful (although it’s obviously not medical advice!). Do you have any exercise / blood sugar strategies to share?

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2 Responses to It’s All About Timing

  1. seejendance says:

    This is kind of a struggle that makes my doc and I scratch our heads. I can only dance at night because that’s when the studio is open/my instructor is available/blah blah blah. (Ballroom teachers are nocturnal, y’know.) I’ve noticed that when I have a later lesson, usually post dinner, I’m low half way through or by the end. But if I go in early, before dinner, I have less of a chance of dropping during or after the lesson because I don’t have this huge amount insulin on board. However, if I’ve corrected from lunch or overshot a 3 pm snack, I have a chance of dropping before the lesson begins. I think my ratios need to be dropped across the board, but I’m waiting for my CDE to get back to me. But that’s something I’ve noticed.

  2. StephenS says:

    Allison, I find the idea of eating, then working out, then bolusing intriguing. Might have to try it.

    The hard part for me is when I reach the two week mark after starting a particular training regimen. That’s when I seem to be most vulnerable to lows, because my body is starting to use insulin more efficiently, and because I haven’t quite dialed in the temp basals/carb needs for that exercise yet. Like you said though, it’s always a work in progress. Good luck!

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