In the month of January, 2016, I am fortunate to remain in good health with type 1 diabetes (T1D). I have continued my daily exercise and in fact on Jan. 2nd I intensified my weightlifting schedule which resulted in some unwanted changes in blood glucose (BG). A recurring pattern I have noticed since starting regular exercise in 2007 is that a new exercise usually results in hypoglycemia at first and then over the next few weeks as I adapt to it, the BG normalizes. Once adapted, intensification of the same exercise either has no effect or results in hyperglycemia presumably from release of stress hormones epinephrine, glucagon, growth hormone, and cortisol. These stress hormones are released in non-diabetics as well to help mobilize both glucose from the liver via glycogenolysis and gluconeogenesis and fatty acids from adipose tissue (fat cells) to provide energy to exercising muscles. However in the person with T1D, there are no beta-cells to produce insulin to counteract the increase in BG. This can result in significant increases in BG after exercise in persons with T1D. So in the month of January, my average fasting BG was 97 mg/dl, my average post-breakfast BG was 93 mg/dl, my average pre-dinner (after exercise) BG was 138 mg/dl, and post-dinner BG was 82 mg/dl. This post-exercise BG increase has been going on since Jan. 2nd (unusually long) and I hope that I adapt soon because I really don’t want to take rapid-acting insulin at the start of exercise to prevent the increase in BG. As you might guess, I do not get a text message telling me when stress hormones will be released or not on any given day. I worry that if I start taking insulin to prevent the increase in BG that eventually I will end up with hypoglycemia during exercise (definitely want to avoid that). So for now I’ve decided to stay the course. In Jan. 2016, I made no changes to my ketogenic low carbohydrate high fat (KLCHF) diet. Shown below is a summary table with my results for Jan. 2016 in the last row.
My mean (average) BG (103 mg/dl) increased due to the previously mentioned increase in BG after exercise. My insulin doses have not changed significantly (total = 31.4 IU/day, basal = 22.2 IU/day, mealtime = 9.2 IU/day), but the percentage of hypoglycemic values (8%) did decrease and none of these episodes were symptomatic. I attribute this to brain utilization of ketones from nutritional ketosis due to my ketogenic diet rather than to hypoglycemia unawareness, although as pointed out in blog post #12, I will never be able to prove my case. The table below shows my BG variability data for Jan. 2016 in the last row.
Most of the measures of BG variability were worse compared to the year 2015, but two were improved (interquartile range and Quintile 1). The meaning of these BG variability measures were defined in blog posts #5 and #10. The increased BG variability was due to the previously mentioned increase in BG with exercise and then the drop in BG after dinner due to mealtime insulin. The actual BG values and insulin doses are shown below.
Note that on Jan. 26th I did increase my basal insulin dose from 22 to 23 IU/day, but so far it hasn’t had much effect. If you are curious to see the exercise that I think is causing my BG to shoot up, I posted a video of my snatch and clean and jerk on YouTube. I have to say that even though I think my weightlifting is currently adversely affecting my BG results, I am really enjoying this challenging activity and how I feel physically as a result. My current exercise schedule is two weightlifting sessions per day for 2 days, followed by an easy day of swimming or cycling for about 30 mins, then repeat. If I lift weights for a third day in a row, my knees will be too sore. If I don’t do the aerobic exercise (i.e. if I take a rest day), my insulin sensitivity will change enough to result in hyperglycemia by the evening of the rest day. Basically, any significant change in my diet or exercise routine has an adverse effect on my BG results. That’s diabetes! But keeping my KLCHF diet the same is definitely easier. In fact, I do want to change my weightlifting, i.e. I want to improve my results.
That’s all for now….