Anne had warned me of some crazy changes in my basal rates for the days following the Ironman. However, 4 days after Lake Placid my blood sugars were still pretty reasonable making me think my bs would be stable. Saturday as my blood sugar climbed into the 300s throughout the day I realized my blood sugars were anything but stable.
The human body requires two types of insulin regulation to maintain steady blood sugars. The basal rate is the hourly units of insulin a diabetic takes to keep their blood sugars flat with no food. The other type of insulin injection is a bolus; the bolus is a one-time spike of insulin taken to "cover" the amount of carbohydrates in the foods we eat. The bolus can be broken down into smaller sub-categories like high fat or high protein meals require a different allocation strategy than a whole-grain does but the two main categories of blood sugar maintenance are basal and bolus.
In the days following the Ironman I noticed that my blood sugars around 10pm were creeping past the 200 mark. I assumed that this was because of how unhealthy I was eating (the rewards of 13+ hours of exercise!) or the fact that I had been drinking a few beers each night. Then on Saturday I could barely get my blood sugars to drop below 200, on Sunday I hit the mid 300s a few times then Tuesday evening my blood sugars soared into the mid 400s! For a 4 day stretch my blood sugar tested below 200 only three times!!!
This morning I was thrilled to wake up to a blood sugar of 124 - the first time since Friday that I woke up to a stable bs. The day before the Ironman my basal rate was 6.8 units of insulin per day, today my basal rate is 11.4 units of insulin per day. The stress and recovery of the Ironman totally threw my system out of its normal metabolic rate forcing a heck of alot more maintenance than normal. The lessons for a diabetic athlete continue! The fun will really start as I begin to exercise again and am faced by low after low because of a basal rate that is too high for my new metabolic rate.
Showing posts with label Basal Rate. Show all posts
Showing posts with label Basal Rate. Show all posts
Thursday, July 31, 2008
Wednesday, May 7, 2008
Pre-Workout Basal Rates
Over the past month and a half a smaller percentage of my workouts have been cut short by exercise induced lows than the percentage of workouts cut short in my previous 10 months of training. In addition to using PBN's Ironman Cocktail and EFS I've experimented with my basal rates. This experimentation has led to much more stable blood sugars during exercise.
Under the advice of my previous endocrinologist I was reducing my basal rate to 5% or 10% of the hourly delivery 90 to 120 minutes prior to exercise. This effectively reduced the novolog in my body to zero, meaning I was exercising with no insulin in my system. After reading a few articles on sports medicine and nutrition it occurred to me that insulin was necessary to help move carbohydrates from your stomach and blood stream to your muscles. Without insulin the carbs I was ingesting sat in my digestive track and were not transferred to the body parts that required energy. I think this is why when I'd return my pump to normal settings after an exercise low my blood sugar would sky rocket.
After 6 weeks of experimentation I have settled on turning my pump down to 30% of an hour's full basal rate and maintain that delivery rate of insulin for the duration of exercise (except swimming when my pump is detached). This change has allowed me to maintain a blood sugar of 150 to 190 during exercise while more importantly transferring energy to my muscles. Granted my fitness improves weekly but over the past 6 weeks I have not had the fatigue, cramping or bonking issues I ran into over the winter. From both a diabetic and nutritional standpoint I'm in a much better place now.
All this experimentation does not solve the most annoying issue about insulin pump therapy however. Why doesn't the pump allow us to set an advanced rate reduction?!? If I plan on working out in the morning I need to change my basal rate pattern from pattern A to pattern B. Pattern B is a carbon copy of Pattern A except I manually calculate 30% of whatever basal rate I would have an hour before exercise (or in this case before I wake up). I'm constantly changing Pattern B's time intervals or basal rate. This extra step probably takes more calculation than any other I've had to make as a diabetic. It would be alot easier to program my pump in advance 5am rather than having to calculate the correct basal rate and time interval.
Under the advice of my previous endocrinologist I was reducing my basal rate to 5% or 10% of the hourly delivery 90 to 120 minutes prior to exercise. This effectively reduced the novolog in my body to zero, meaning I was exercising with no insulin in my system. After reading a few articles on sports medicine and nutrition it occurred to me that insulin was necessary to help move carbohydrates from your stomach and blood stream to your muscles. Without insulin the carbs I was ingesting sat in my digestive track and were not transferred to the body parts that required energy. I think this is why when I'd return my pump to normal settings after an exercise low my blood sugar would sky rocket.
After 6 weeks of experimentation I have settled on turning my pump down to 30% of an hour's full basal rate and maintain that delivery rate of insulin for the duration of exercise (except swimming when my pump is detached). This change has allowed me to maintain a blood sugar of 150 to 190 during exercise while more importantly transferring energy to my muscles. Granted my fitness improves weekly but over the past 6 weeks I have not had the fatigue, cramping or bonking issues I ran into over the winter. From both a diabetic and nutritional standpoint I'm in a much better place now.
All this experimentation does not solve the most annoying issue about insulin pump therapy however. Why doesn't the pump allow us to set an advanced rate reduction?!? If I plan on working out in the morning I need to change my basal rate pattern from pattern A to pattern B. Pattern B is a carbon copy of Pattern A except I manually calculate 30% of whatever basal rate I would have an hour before exercise (or in this case before I wake up). I'm constantly changing Pattern B's time intervals or basal rate. This extra step probably takes more calculation than any other I've had to make as a diabetic. It would be alot easier to program my pump in advance 5am rather than having to calculate the correct basal rate and time interval.
Thursday, October 11, 2007
Bouncing Basal Rate
Last week after my 9 mintue run and a swim that I dropped to 60 during my coach gave me 4 days off to analyze my blood sugars without exercise. After two days one of the major culprits of all my lows caused by exercise was basal rates that were completely off!
On Thursday I had my typical turkey sandwich for lunch, about an hour later I was down to the 50s. On Friday the same thing happened - it dawned on me that within an hour after lunch I'd be stuffing my face with unbolused clif bars. Since I was adding so much unbolused food to my system in a desperate attempt to get my bs near 200 I failed to realize that the reason my unbolused clif bar was only getting my bs to 130 or so was because it was treating a low, not getting me high.
I reduced my basal rate and have had great results. On Monday I completed my 40 minute run without a problem, ending with a blood sugar of 100. Tuesday I had a blood sugar above 68 after a lift for the first time in a month. Yesterday was the biggest indicator of all - I tired to cram in a run about two hours before I normally go to the gym when my basal rate is at .25/ hour instead of .15/ hour - blood sugar crashed down to 85 within the first 10 minutes of running. So, I went back to the gym later that night when my basal rate was at .15/ hour for about 3 hours and had turned my pump down to 5% for 2 hours - I was able to complete both a swim and a run! I had to take 10 or 15 minutes off between the two to let the gatorade get into my system but after that I felt like I could have run all day.
This indicates a bigger problem however. For weeks I had been contacting various CDEs in addition to the ones I speak with at the Berrie Center. I asked in each e-mail, what am I doing wrong, why isn't my blood sugar high enough when I work out, why am I having to cut workouts short? I heard suggestions of having an unbolused bagel, turning my pump down to 5% 3 hours before I workout before 1 and 1/2 hours - NOT ONE OF THEM IDENTIFIED THAT MY BASAL RATE COULD HAVE BEEN A PROBLEM. As diabetics shouldn't we be able to trust our team of experts to identify problems before we do? Or is this a fight that we all have to live trusting ourselves and our bodies more than advice we hear based on a few excel spreadsheets?
I simply want to find doctors and CDEs as much as I trust the teams that performed my 4 orthopedic surgeries. The surgeons at the Hospital for Special Surgery have let me live my life as athletically as I wanted - I had reconstructive ankle surgery as a high school junior, I have half my rotator cuff in my right shoulder from surgery my sophomore year in college, post college I've had my left shoulder and right knee scoped. After each surgery I went through aggressive rehab, the doctor's warned of any possible problems but gave me the confidence to pursue my athletic career. Right now, I don't have alot of confidence in any of the diabetic professionals I want to trust that they'll identify the problem long before I do but I'm not close to there yet.
On Thursday I had my typical turkey sandwich for lunch, about an hour later I was down to the 50s. On Friday the same thing happened - it dawned on me that within an hour after lunch I'd be stuffing my face with unbolused clif bars. Since I was adding so much unbolused food to my system in a desperate attempt to get my bs near 200 I failed to realize that the reason my unbolused clif bar was only getting my bs to 130 or so was because it was treating a low, not getting me high.
I reduced my basal rate and have had great results. On Monday I completed my 40 minute run without a problem, ending with a blood sugar of 100. Tuesday I had a blood sugar above 68 after a lift for the first time in a month. Yesterday was the biggest indicator of all - I tired to cram in a run about two hours before I normally go to the gym when my basal rate is at .25/ hour instead of .15/ hour - blood sugar crashed down to 85 within the first 10 minutes of running. So, I went back to the gym later that night when my basal rate was at .15/ hour for about 3 hours and had turned my pump down to 5% for 2 hours - I was able to complete both a swim and a run! I had to take 10 or 15 minutes off between the two to let the gatorade get into my system but after that I felt like I could have run all day.
This indicates a bigger problem however. For weeks I had been contacting various CDEs in addition to the ones I speak with at the Berrie Center. I asked in each e-mail, what am I doing wrong, why isn't my blood sugar high enough when I work out, why am I having to cut workouts short? I heard suggestions of having an unbolused bagel, turning my pump down to 5% 3 hours before I workout before 1 and 1/2 hours - NOT ONE OF THEM IDENTIFIED THAT MY BASAL RATE COULD HAVE BEEN A PROBLEM. As diabetics shouldn't we be able to trust our team of experts to identify problems before we do? Or is this a fight that we all have to live trusting ourselves and our bodies more than advice we hear based on a few excel spreadsheets?
I simply want to find doctors and CDEs as much as I trust the teams that performed my 4 orthopedic surgeries. The surgeons at the Hospital for Special Surgery have let me live my life as athletically as I wanted - I had reconstructive ankle surgery as a high school junior, I have half my rotator cuff in my right shoulder from surgery my sophomore year in college, post college I've had my left shoulder and right knee scoped. After each surgery I went through aggressive rehab, the doctor's warned of any possible problems but gave me the confidence to pursue my athletic career. Right now, I don't have alot of confidence in any of the diabetic professionals I want to trust that they'll identify the problem long before I do but I'm not close to there yet.
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