Diabetes and exercise risk (ILM!)

K

Karky

2
Ok, I've heard that hypoglycemia is a risk with type 1 diabetes when you exercise. But why? But why? It says in my book that "hepatic glucose release does not keep pace with active muscle's increased glucose utilization"

What the hell is hepatic glucose release, and why does it not keep pace with glucose utilization in diabetics who exercise and not in people without diabetes?

And what about type 2?
 
I would guess hepatic glucose is liver glycogen that is converted back to glucose and released into the blood stream.

I would think with type 1 the problem would be restoring muscle glycogen not blood glucose. The lack of insulin would hinder the muscles ability to uptake more glucose.

Type 2 is essentially just insulin resistance taken to a whole new level, where insulin has very little effect causing a near constant state of hyperglycemia. I don't think type 2 diabetes would cause any problems with low blood glucose, but it would keep pace with type 1 in that I would think it would be difficult for muscles to uptake glucose effectively due to lack of stimulation by insulin.

I could be totally wrong though. I don't have diabetes nor does close family, nor do I know much about it, but that's my logical take on it
 
During exercise GLUT4 transporters (they usually need insulin to activate) are activated by muscle contractions, so no insulin needed for glucose transport into muscle cells. So I'm just wondering why the hepatic glucose release (whatever it is) can't keep up with glucose uptake in the cells..
 
I bonk easily when I work out, so I make sure my blood glucose is high before I go into the gym. I also take far less insulin than I normally would because insulin sensitivity is much higher when you work out. The quicker the insulin uptake, the faster the glucose gets sucked out of the bloodstream into the muscle tissue. When there isn't any "gas" left in the engine, you go hypo.

Of course, your body releases more glucose into your bloodstream when you exercise, so if you haven't taken enough insulin, your blood glucose levels will remain too high.

Type 1 diabetics also have to watch out for early post-exercise induced hypoglycemia and late onset hypoglycemia (which can happen anywhere from 24-48 hours after a good workout). That's why monitoring blood glucose is a must. Even then, it still happens. I've bonked many times in the gym over the years and passed out.

It's a balancing act. You really have to know how your body reacts to the exercise you're doing and how insulin is metabolized. A lot of trial and error goes into it. The other thing is if you inject insulin into your muscle instead of fatty tissue (or skin in my case), the absorption rate of the insulin is accelerated and you can go hypo within minutes.

I don't know much about Type 2 Diabetes. I think it would depend on whether they were on oral meds or were insulin-dependent.
 
ok, but can't going hypo be prevented by just eating fast acting carbs? I suppose that's not dangeoraus during and right after exercise since glucose uptake into cells is insulin independent. And why won't I get hypoglycemic, my muscles take up glucose as well.. or do diabetics go hypo when they exercise simply because they inject too much insulin, causing tissue to take up too much glucose, which lowers blood sugar faster than the body can release glucose into the blood from liver glycogen?
 
Insulin pretty much regulates just about every process in the body. It's probably the most important hormone we've got. When you lose a major player in the league, it's tough to win ;)

Sure, we can keep sucking back high GI carbs and keep injecting insulin to keep our BG at an optimal level, but only endurance athletes would have to do that.

Diabetics have to inject insulin to control how our bodies utilize glucose. But it's a very unnatural way to do it. I take slow acting and fast acting insulin to try to mimic how the body would do it if I still produced insulin. But it's just not very optimal. The Catch-22 is we need to inject enough insulin to get the glucose into the muscle tissue. And we can do that quite easily. But we do run out of gas quicker because the reality is there is no way for us to ascertain whether our glycogen stores are optimal or depleted. Since it can take anywhere from 4-24 hours to replace the glycogen we have lost, we just never know how much we have. If we happened to take too much insulin and worked out hard, we could be teetering on depleted. The only way we would know is we'd end up getting all the symptoms of hypoglycemia.

Tell me if this answers your question:

I don't know if that helps you or makes this even more convoluted :D
 
thanks for that file, I'll read it later. Yeah, I understand how hard it is to regulate (ok, really I don't, because I don't have diabetes, but you get the point :p), if you take too much insulin compared to how much glucose/glycogen you've got, then you to hypo.

But why do you take insulin when you exercise, I mean, the muscles can take up glucose anyway since exercise activates the GLUT4 transporter..

Started reading that PDF A bit and found this:
Moreover, there may
be deficiencies in the release of glucose counterregulatory
hormones that would normally help facilitate glucose production
and release by the liver.
Click to expand...

this I don't understand:
In the individual with type 1 diabetes, the pancreas does not
regulate insulin levels in response to exercise, making normal
fuel regulation nearly impossible.
Click to expand...

Normal people regulate down their insulin, type 1 diabetics always have low insulin, so what's the problem.. :s
 
Karky said:
thanks for that file, I'll read it later. Yeah, I understand how hard it is to regulate (ok, really I don't, because I don't have diabetes, but you get the point :p), if you take too much insulin compared to how much glucose/glycogen you've got, then you to hypo.

But why do you take insulin when you exercise, I mean, the muscles can take up glucose anyway since exercise activates the GLUT4 transporter..

Started reading that PDF A bit and found this:


this I don't understand:


Normal people regulate down their insulin, type 1 diabetics always have low insulin, so what's the problem.. :s
Click to expand...

Type 1 Diabetics have ZERO insulin. We don't produce it. We have to inject it. And it is extremely difficult to regulate blood glucose. We're up, we're down, we're all over the map. The ability for diabetics to have continuous fuel stores when working out is virtually impossible. That's why we can go hypoglycemic.

And that's why most diabetics don't exercise. It's far easier to maintain stable BG readings when you aren't doing anything to disrupt your body's homeostasis.

I don't inject insulin before a workout for the reason you gave. Once you start to exercise, reactions occur in the body to deliver fuel (glucose) to the body parts that are being taxed. Insulin sensitivity is much higher when this happens, which is why diabetics who are on an insulin pump have to disconnect them and why I don't inject before working out. I rely on my long acting insulin and cross my fingers in the hope it's enough to get me through the workout, although I have injected insulin half way through a workout and I've also eaten prunes, gummy bears or chugged back grape juice to get sugar into me.

To put it in a nutshell, diabetics don't have the ability to adjust insulin levels in the bloodstream from second to second like a functioning pancreas would. We have to rely on injecting insulin for that, but instead of delivering insulin when we actually need it like a normally functioning pancreas would do, we have to rely on our body absorbing the insulin we've just injected and then delivering it to the bloodstream.

Since that doesn't happen the way it would in a normal person, we're NEVER in a euglycemic state. We are in a perpetual state of being overinsulinized and underinsulinized.

The other problem is actually getting the hepatic glycogen to be released from the liver. Diabetics often don't have proper glucose counterregulatory hormone function as a result of the insulin issue, therefore, even if we did have glycogen stores in the liver, we may not have biochemical access to them.

That is also why I have a glucagon kit: if I'm so hypo I can't stand up, or I've passed out, the glucagon injection will release the hepatic glycogen, and I'll be good to go (although it's a given I'll vomit from the injection and feel like crap for a day).

Does that help?

EDIT: Here's one of those Google book excerpts:
 
Last edited:
yeah that helps. If the hormones that counter insulins effect (like glucagon) aren't optimaly functioning, then you'd go hypo from exercise. that's probably what the book meant by hepatic glucose release can't keep up with glucose use.
 
Karky said:
yeah that helps. If the hormones that counter insulins effect (like glucagon) aren't optimaly functioning, then you'd go hypo from exercise. that's probably what the book meant by hepatic glucose release can't keep up with glucose use.
Click to expand...

Yep. That's what they meant ;) You catch on quickly!

Insulin pumps allegedly alleviate some of those problems. I'm waiting for the Omnipod to be approved in Canada because I'd really like to try that puppy out. They're wireless. You just inject the insulin into a pod, stick it on your tricep, and away you go. Obviously you program the unit that tells the pod when to administer the bolus doses, but you get a steady stream of basal dose. That's pretty sweet. You're in far more control of what's going on with your body.

There are also insulin pumps that have continuous glucose monitoring as well. One of my girlfriends is going to get one of those because she's doing an Ironman next year and she said it would be impossible for her to regulate her BG. She did a Half Ironman in the summer and found it quite difficult. She felt horrible the whole way through because her BG was either way too high or too low. When BG is too high, you feel really sluggish and it's hard to move. When BG is too low, you just feel like the world is closing in on you because everything in your body is shutting down.

I believe most endurance athletes are switching to insulin pumps because although it takes about 3-4 months to get the hang of them (because you have to factor in working out), in the long run, they mimic the functioning of a real pancreas much more effectively than injections (as long as they don't malfunction, which happens from time to time).
 
Oh.......my god. Say what???? jk

Sorry to bud into your convo but u two are knowledgeable in this area. You might have answered these Q's but about half way down my eyes glazed over.

1. If you are a type 1 diabetic and you work out, meaning your blood glucose will be doing a roller coaster all work out? Thats why they usually dont exercise??
2. And if so, How do you counter that, keep injecting insulin or stop and take a breather???

This is one confusing area to learn about
 
Excder said:
Oh.......my god. Say what???? jk

Sorry to bud into your convo but u two are knowledgeable in this area. You might have answered these Q's but about half way down my eyes glazed over.

1. If you are a type 1 diabetic and you work out, meaning your blood glucose will be doing a roller coaster all work out? Thats why they usually dont exercise??
2. And if so, How do you counter that, keep injecting insulin or stop and take a breather???

This is one confusing area to learn about
Click to expand...

Diabetics are accustomed to feeling like sh1t when they work out :D Seriously, you just have to pay attention to what's happening in your body. Sometimes it works; sometimes it doesn't. A lot of diabetics don't exercise because it's just a real pain in the butt to adjust insulin doses.

1. Yeah, my blood glucose can sometimes roller coaster pretty badly, depending on the day. If I'm feeling weak, dizzy, having cold sweats, getting tunnel vision, or things start sounding like I've just stuck my head in the water, that usually means I'm close to running out of gas and I need sugar ASAP, hence the gummy bear stash, grape juice, prunes, etc. Sometimes hypoglycemia hits me fast and hard and I don't recognize the signs. That's when I pass out.

2. Diabetics shouldn't inject insulin less than 1-3 hours before a workout or when they're working out because the body is really insulin sensitive while a person is working out and for a few hours afterwards. Through trial and error, eventually you figure out how much less insulin you require when you're working out.

The only time I inject insulin when I'm working out is if I've screwed up somehow and I'm hyperglycemic, or if I've just worked out too hard, because sometimes working out too hard can make me hyperglycemic as well as hypoglycemic. It just depends on the day, how much stress I'm under, etc. etc.

So to combat all that crap, I test my blood glucose every 30 minutes when I exercise. I take two readings before I workout: 30 minutes before and immediately before. Then I have my work out. If it takes more than 45 minutes, I'll go into the locker room and test my BG again. I also test my blood glucose when I'm finished my workout and again every hour or so for the next 3-5 hours to make sure I'm not going hypo. Yeah, it's a pain. But it's easier to prevent hypoglycemia or hyperglycemia than it is to treat it ;)

Blood glucose levels in diabetics who exercise really is all over the map, but there are many elite athletes who are Type 1 diabetics. You just have to know your body and what it can and can't do.
 
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOH!

That makes sense.

So is that really the only reason diabetics have for not exercising is the risk of passing out? Dont get me wrong, im not making light of diabetes and in no way am i making fun of it but if its manageable, are people just to lazy to try and figure its not worth the risk?
 
It's really difficult to manage blood glucose. Until you've had to do it, you have no idea just how hard it is without doing any exercise. It can take months to learn how to stabilize your blood glucose (and some diabetics NEVER get the hang of it).

When you add exercise that to the equation, it becomes even more difficult, especially if you are doing anaerobic workouts, which is what I do. Lifting heavy weights isn't always a good idea when you're diabetic, because anaerobic workouts are far harder on your body than aerobic workouts and the different biochemical reactions can wreak havoc on your CNS, blood glucose, blood pressure, etc.

But I'm very stubborn ;) I made a decision a very long time ago that I wouldn't let it get the best of me. And I haven't, despite it being an extremely daunting task.
 
I'm sorry to go completely out of left field, and I have enjoyed to dialogue on this thread, but:

do you pronounce is "diabetees" or "diabetiss"? I'm sure you know why I ask, and I apologize again.
 
according to dictionary.com it is with an I. Do you know how to read IPA?

/ˌdaɪəˈbitɪs, -tiz/

the page also provides a "written" pronunciation thingy:
[dahy-uh-bee-tis, -teez]


Though I bet there could be differences between variations of the language
 
Hey FT, you might as well post what's relevant. Heck, even post what isn't relevant :D

I've always said "Die-a-Beet-us". A lot of people say "Die-a-Beet-ease" though ...
 
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