Author Topic: Weight lifting and Dawn Phenomenon  (Read 1228 times)

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Offline thomas

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Weight lifting and Dawn Phenomenon
« on: 06 June 2015, 02:18:11 PM »
Hi All,

Long time no speak! Hope everyone is well.

Since diagnosis, I've been doing a good chunk of cardio (currently hitting around 20km a week). Last HBA1C was 6.7, so OK.

However I've recently been doing weight lifting in the evenings, 4 times a week, followed by an extremely low carb dinner (Mackerel, spinach, tomatoes, broccoli avocado - delicious).

However I've noticed on the evenings when I do weight lifting, I get hit really hard by dawn phenomenon the following morning. I'll put my head down to 5mmol and wake up at around 14. If I don't do weight lifting, I get no dawn phenomenon at all.

Has anyone else ever encountered anything similar, or heard of this? Would be curious to know what I could do to counter act it (short of using a different insulin). I guess there is some heavy muscle repair going on over night, which might cause a good release of sugar.

On Novorapid and Lantus. Type-1

Best wishes.

Thomas

Offline sedge

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Re: Weight lifting and Dawn Phenomenon
« Reply #1 on: 06 June 2015, 02:56:34 PM »
I honestly don't know Thomas - but wonder if you might not do better by actually having some carbs?  The equivalent of eg a diabetic marathon-runner having to have high carb snacks during a race?  Violent exercise whether it's aerobic or anaerobic depletes the body's stores of all sorts of things  - not just your liver's stash of 'carbs' - so perhaps the general depletion causes your liver to try and make the rest of the body work better and hence throws glucose as all the depleted cells?

That's thinking 'out loud' and I have a better idea now!  - increase your Lantus dosage to compensate for what your liver is going to do?  Taking Novorapid would be a bad idea because it might work too fast.  OTOH, Lantus might not work either cos it's usually a day at least before increased or decreased doses show their real effect - so maybe you'd do better on Levemir anyway, which those of us who loved it found worked properly and as we expected it to,  from the very first jab of the altered dosage?

Just my thoughts anyway FWIW.

BUT

What have you tried already?  Anything?
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Liam

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Re: Weight lifting and Dawn Phenomenon
« Reply #2 on: 06 June 2015, 03:51:23 PM »
I think I have an even better idea that Sedge! Can you do some over night basal testing to see what is happening and when. That is always the first step to fixing an overnight problem. I'm thinking like Sedge for after that but want to know more of the results before trying anything. The highs might be caused by a low overnight (and the liver over doing the fixing of that) for all we know without testing and adding more insulin will make that worse not better.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline nytquill17

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Re: Weight lifting and Dawn Phenomenon
« Reply #3 on: 06 June 2015, 05:26:31 PM »
Personally I find myself more prone to exercise highs from weight lifting then from cardio. But that's usually during or immediately after, not hours delayed. Still, counts as "something similar", and makes me think there is something about resistance exercise that invokes the liver in a particular way, different from other exercises.

I agree with Liam though, more info before doing anything! Especially with Lantus. I had similar problems with Lantus, waking very high in the mornings, and turned out I was having lows in the night and rebounding. A lot of times *reducing* my dose actually got me better results than increasing it! But I was never able to get those peaks fully ironed out and could not make Lantus compute for me at all, let alone with a more active lifestyle. From what I've seen online, a significant proportion of people using Lantus have this problem, that is, that it's "peaky" and can cause lows all by itself. With exercise also a factor, middle of the night lows (or at least significant drops, enough to set off your body's alarm bells) are a definite possibility so I wouldn't risk an increase.

I definitely recommend trying Levemir - you may not get on with it in the end, but most people find it more agreeable than Lantus especially when it comes to dealing with a variable and/or active lifestyle, much simpler to adjust and much more predictable/less peaky. Worth a try to see if it suits you better anyway! But it takes time to get a new prescription, and in the meantime, overnight testing I think is your  next step! :)
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline sedge

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Re: Weight lifting and Dawn Phenomenon
« Reply #4 on: 06 June 2015, 06:13:40 PM »
ROFL - that was daft of me!  Of course you should test to see what your basal is doing and when!  First, before you do anything I've suggested.

For basal testing, if you don't know, here's how to do it

http://www.diabetes-support.org.uk/info/?page_id=120

You would think I might have remembered that, considering I was one of the authors - DOH !
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline thomas

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Re: Weight lifting and Dawn Phenomenon
« Reply #5 on: 07 June 2015, 11:01:39 AM »
Morning all,

OK - great, thanks for the suggestions. I'll do a basal test Monday night, see what's happening. I checked my BG at around 2am the other evening - and nothing was out of the ordinary, so I don't think I'm bouncing back from a hypo.

I'm a little loath to move away from Lantus, as it works really well for me during the day (and has worked even better overnight, before I started weight lifting). I get the usual immediate rise in BG during the workout and during cardio (with a dip a couple of hours later) - so all is expected in that regard.

Testing ahoy! Will update in due course.

Offline nytquill17

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Re: Weight lifting and Dawn Phenomenon
« Reply #6 on: 07 June 2015, 01:13:32 PM »
With Lantus, I found my hypos to be about 7 hours after injecting it, like clockwork. From what I saw online, I was a bit of an outlier, as other people with the same problem tended to have theirs around 5-6 hours after injecting.

On the other hand, most people have a natural dip in their blood sugar, part of their circadian rhythms, around 3-4 a.m.

So I think those two times, 3-4 a.m. and 6 hours or so post-evening Lantus shot, will be good times to be sure to test for. If everything looks good throughout the night and particularly at the most likely trouble spots of the night, then you should be safe to increase your Lantus on weightlifting days. But be aware that it may not make much difference, because Lantus takes 3 days for any new changes to take full effect. It's not an insulin that adjusts well day-to-day, for most people. But it might for you! :)
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline Liam

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Re: Weight lifting and Dawn Phenomenon
« Reply #7 on: 07 June 2015, 04:45:18 PM »
I had a problem a bit like you with Lantus expect it was either every night or every day. I could get good numbers for either night or day with it but not both. I then tried Levemir which I took as two does and got better control with that. I could also change Levemir more day to day to match things I knew would happening. Anyway good luck with the basal testing, I know it is a real drag to do but sometimes we just have too.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline thomas

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Re: Weight lifting and Dawn Phenomenon
« Reply #8 on: 09 June 2015, 05:06:29 PM »
OK, results are in

Usual weight lifting session, then ate low carb dinner at 9.30pm - (1u Novorapid, which in hindsight should have been 2u).

1u of Novorapid will typically correct me by 5mmol. Yes, quite sensitive.

21.30pm - 6.5mmol
23.00pm - 16u Lantus
00.00am - 9.3mmol (1 u correction dose)
02.00am - 8.6mmol
04.00am - 9.3mmol
6.30am - 11.8mmol

If I don't weight lift, I can go to sleep and wake up with the same BG level... so i'd be curious to hear suggestions to remedy?  8)

Offline nytquill17

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Re: Weight lifting and Dawn Phenomenon
« Reply #9 on: 09 June 2015, 07:51:01 PM »
Does look like you'd be safe to increase your basal on those nights. That'd be the first thing I'd try.

Actually no scratch that. First thing I'd do would be to also basal test on a non-weight-lifting night. I notice that most of the rise happens between 4 a.m. and 6:30, so after your 1u correction at midnight is done working, and right in the period of time where most people tend to have dawn phenomenon. You might also be having dawn phenomenon on regular nights, only you don't notice it because you don't have the additional rise from the weight lifting. Going to sleep and waking up with the same BG level tells you very little about what's actually happening to your BG overnight. I realize this doesn't seem totally relevant to figuring out what to do on your weight-lifting nights, but knowing what your nighttime pattern normally looks like can help you to see by contrast just what the weight lifting is actually doing to your BG.

For info: it's not an accurate basal test if you also have fast-acting insulin on board at the time. But you weren't really trying to basal test here, just to see whether you were dipping or rising at night. Since you did still see a rise, you can still confirm that you're safe to increase your basal on weight-lifting nights. But you don't actually know just how much of a rise you actually get nor when exactly it happens (what the curve is) because that bolus insulin can't be ruled out. And had you had a dip instead, it would have been impossible to draw any conclusions. It's ok to let your BG run a bit higher during a basal test so long as it isn't dangerously high (say, over 15 or wherever you theoretically test for ketones) in order to get clear data.

For further info: if 1u drops you by 5 mmol/L, correcting a 9.3 could theoretically have brought you down to 4ish overnight, yikes! Since you are so sensitive, have you considered getting half-unit pens? (Although no pen can accurately dose out less than 2 "clicks", so on a full-unit pen, the smallest accurately delivered dose is 2u, and 1u for a half-unit pen. Less than that and you can't be certain that you got the entirety of the dose due to the mechanics of the plunger).

If increasing basal doesn't work, it seems counterintuitive but I might try having a small amount of slow carbs with dinner or at bedtime. Or even just after the workout. How the body reacts after exercise has a lot to do with the fact that it is replenishing its stores and rebuilding tissue/repairing microtears. Sometimes trying to do that on too little fuel can lead the brain to declare a state of emergency, which causes some protective mechanisms to kick in that naturally increase BG and/or IR, so you can end up with higher BG from lower carbs and lower BG from higher carbs. Doesn't always apply of course, but when you're stumped, it's worth trying everything!

Another possibility could be to split your workout sessions - not meaning to pry, you may already be doing this; ignore if so! But say if you're doing a full-body session every other day, switch to doing lower body one day, arms and core the next, or however you care to split it up, but so that you're doing less intense sessions more often (less stressful to the body). And/or, add a cardio workout on your weightlifting days, a small one so you don't exhaust yourself, but it might help to counteract the weightlifting rise.
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline thomas

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Re: Weight lifting and Dawn Phenomenon
« Reply #10 on: 09 June 2015, 11:15:22 PM »
(Although no pen can accurately dose out less than 2 "clicks", so on a full-unit pen, the smallest accurately delivered dose is 2u, and 1u for a half-unit pen. Less than that and you can't be certain that you got the entirety of the dose due to the mechanics of the plunger).

That's news to me! I've tried half-unit pens before, but they have been terrible build quality. I simply gave up asking for a Novopen Echo a year or so ago.

if 1u drops you by 5 mmol/L, correcting a 9.3 could theoretically have brought you down to 4ish overnight, yikes!
Wasn't worried about this - I was confident through experience it wouldn't happen.  ;)

Ok - next i'll test on a non-workout night and report back. Happy to keep testing, to try and work out how to fix this most appropriately! Your comments are most appreciated - thanks for the direction.

And on the workout, I already split it, so I don't think it's too strenuous, but thanks for the suggestion.

I generally eat 35 minutes after the workout - low carb, high protein. Would this qualify as 'right after' the workout, or are we talking within 5 minutes?

Thanks again everyone!



Offline nytquill17

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Re: Weight lifting and Dawn Phenomenon
« Reply #11 on: 10 June 2015, 12:58:11 AM »
I'm not a fitness expert or anything but I think 35 min after should be fine. You could try upping the carbs in your post-workout snack/meal if you get stumped - it may not change anything or it may make things worse but if you're not getting anywhere with other methods it could be worth a shot!

Oh, and I don't think anyone's mentioned runsweet.com yet in this thread? It's a site aimed at T1/insulin-dependent diabetics and exercise, in particular running and cardio, but there might be some info on there that could help!
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline Liam

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Re: Weight lifting and Dawn Phenomenon
« Reply #12 on: 10 June 2015, 09:18:28 AM »
I'm interested in your results. I plan to start weight lifting myself sometime this year. I'm with Nytquill, I'd like to see results from a non weight lifting night. She has covered most of the things I've thought of. So not much to add.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg