Exercise!

I've started cycling into work again, after a break of over a year, which has led to some interesting things diabetes-wise.

I decided to start cycling again for a few reasons. Mainly, I really missed it. I used to cycle all the time, but then when I was writing up I was just too tired, and then I was ill, and it fell by the wayside. Since we moved to our new place I've been getting the bus, but it's bugged me that I'm then dependent on bus timetables to get anywhere, not to mention the expense. I also need to lose some weight. I'm about a stone heavier than I'd like to be, and I've started making some changes (omg, I love the kinect fitness!), but I figured that cycling eight miles a day has got to be a good addition! I also know that exercise helps my diabetes control. I used to see differences when I wasn't cycling, and I generally used to run with less highs, and needing less insulin when I was cycling.

So, putting all of those things together, and inspired by the lovely weather we've had recently, I finally got my backside in gear, got my bike serviced, figured out the route to work (but still managed to get lost. Twice...), and started cycling again.

I wasn't sure what effect to expect on my BG and insulin levels. I was already cycling when I went onto MDI, and I'd hadn't cycled for a few months when I started on the pump. The upshot being that I knew how to manage cycling on MDI, but that was when I was trying to make lantus work for me when it really didn't match my basal needs. I had no idea how to do it on the pump. In addition, I tend to find that the first few days of any new exercise tends to hit me quite hard, in that I drop through the floor, but then my body adjusts and things even out.

And this is what I saw for the first few days. Even with using 50% basal rates, for up to an hour before the cycle, during, and after, and free carbs, I was still hypoing more often that I'd like. I had a look at my results, and set up a new basal profile (imaginatively entitled 'exercise') which was pretty much just a 25% reduction of my previous basal. That worked, for a day or two, and then my body got over the shock of the cycling, and I started to run high again, so I switched back to the old profile.

At the moment, I'm tending to find that I don't have to change my basal at all to go cycling, which was a surprise. What is an even bigger surprise is what to do about my breakfast bolus. On MDI, I used to reduce my breakfast bolus by 30%, and that seemed to work quite nicely. If I try that on the pump, it keeps me steady during the cycle, but then I rise a couple of hours later. It seems that I need the full bolus, just not all at once. I've been playing about with the extended bolus, and so far 70% up front with the rest over an hour seems to be best. I'm dropping a little before lunch, but I'm starting to suspect that's a basal issue.

The interesting thing is that if I screw up the extension on the bolus (like I did this morning - I tried reducing the bolus by 10%, but then didn't increase the percent up front to keep me steady, so I was high after two hours), and I end up high at the two hour mark, they seem to be fairly stubborn highs. They're not too high - mainly 10/11, but they seem to need more insulin to come down, whereas the same amount of insulin, but given in the right proportions seems to keep me steady. It's been fascinating to see how much being high at that point has an effect on my insulin resistance.

Of course, the other thing is that there are several points in the day now where I'm dropping, and I think I'm now seeing the general effect of consistent exercise on my insulin sensitivity. You know what that means: basal testing. Roll on the sugar free jelly!

Steroids and insulin resistance

I've been on steroids for my rebellious immune system for about two months now, and, ignoring the effects they've had on my BG, I feel so much better! I don't think I really believed a couple of pills could make such a difference, but I actually feel pretty much back to normal now, and there was a time a couple of months ago when I wasn't sure if that would ever happen. I've been seeing my liver doctor every couple of weeks for monitoring, and it's been amazing to watch my liver function tests improve. They're still not completely back to normal, but they're a hell of a lot closer than they were. He's dropped my steroid dose, and has introduced azathioprine, which is another immune suppressant that should allow me to bring the steroid dose right down, possibly all the way to zero, and then I'll most likely end up on a kind of 'maintenance' dose.

The reason I wanted to make this post was mainly to talk about the effect that the steroids have had on my BG/insulin resistance. When I was diagnosed with AIH and started on the steroids, I found it quite difficult to find any information on the effect it would have on my diabetes control other than 'it'll probably make your BGs go up" which, while useful, is a bit limited. There seems to be lots of information on people who have been diagnosed with type 2 as a result of long term steroids, but nothing on type 1, or really anything on what to expect in people who are already diabetic. The kind of information I was looking for was things like how much of an increase are we talking? Is it something that changes as my body gets used to the steroids? Is it an overall increase in BG? I wasn't really looking for a medical opinion, just some stories from people who had experience of this that might reassure me that what I was seeing wasn't unusual.

So I thought I would do a post about my experiences, just in case it helps anyone else out there. :) The first and most obvious thing is, yes, my BGs did go up. And I mean UP. I was hitting the high teens/low twenties pretty much from the first couple of days, and they were resistant little blighters. I made a lot of use of temp basals, and then figured out where I needed the increase in insulin. This seemed to happen twice - I had an initial jump the first few days after I started on the steroids, and I increased my basals and things settled down, then I had a second jump about ten days after I started. I'm not sure how normal this is, and I was really wary about increasing my insulin, but I went with it and managed to get things settled back down again. I've also had 'dips', where my insulin resistance takes a drop and my insulin requirements and BGs go down, and I think that might be to do with the steroids actually working and my liver getting better, so taking some stress off of my system.

This is where my basal rates have ended up after all of that. The blue line is what they were before this whole thing started, and the green line is what I'm on now. Yes, that really is 12 units an hour at one point...! The highest I needed was 14 units/hr at that time. I've noticed an overall increase in insulin needs, but the main increase is the huge spike in the afternoon. I take my steroids in the morning, so I suspect the afternoon peak is the steroids kicking in (I'm finding the whole thing quite interesting from a scientific point of view!). I've also had to increase my insulin to carb ratio over that period, as I seem to be quite sensitive to carbs at that time, so my insulin:carb went from 1u:8c to 1u:5c, and in addition my evening ratio went from 1u:9c to 1u:7c.

I have to say, the pump has been indispensable during this - I can't imagine trying to deal with this on lantus! Being able to use temps basals, and respond to things quickly has really been instrumental in helping me to keep my BGs in a reasonable state. Don't get me wrong, they're not perfect, and it's been a lot of work and I still tweak and get things wrong, but I really feel that the control I've been able to maintain would not have been possible for me on MDI.

And now that I feel my basal rates are sorted, my dose of steroids has just been reduced, which will screw everything up again. *rolls eyes* Oh well!