Hypoglycemia and Spinning

[Catrin]

I have mild diabetes, or pre-diabetes (my specialist refuses to come down on either side). It actually doesn't matter which as the treatment for both is the same - a tightly controlled diet and lots and lots of exercise. No problem, we can do that :D

The problem is that things can get a little, dicey, after spinning class - even when I eat an hour or so prior :( My specialist wants me to get some sugar during the class, but the drinks such as Gatorade are just too sweet and have too many calories.

Does anyone else have this problem? How have others solved it? I am resistant to drinking anything other than water but if I can come up with something that I can add to it that won't be too sweet...

I guess it is time to figure this out now, before I get my bike out on the roads this spring.

[tulip]

You can dilute gatorade with water. G2 is their lower sugar drink. You can dilute that, too. Or dilute juice with water. Find what works for you.

[KnottedYet]

Unfortunately, the sugar you need to prevent hypoglycemia is going to be sweet and have calories. That's the nature of the beast...

I am finding that I do quite well snorfing down clif blocks during riding, and drinking water (or clif drink mix). They don't give the huge blood glucose spike and crash.

Maybe if you eat Blox, you would be better able to tolerate the brief burst of sweetness? Then you could drink just water.

Have you worked with a nutritionist yet? Mine was quite helpful.

[sarahspins]

even when I eat an hour or so prior :(

A couple of things here... first, timing a meal/snack that way before a workout can contribute to hypoglycemia if you have a delayed first phase insulin response... when you time that with increased glucose uptake by your muscles, it would not be a surprise at all if you go low. So I wouldn't recommend doing that... at most, have a light low-GI snack immediately *before* your workout or mid-way through. Like a Luna Mini or energy gel (you'd be surprised that most are relatively low GI, despite seeming like syrup), or something more protein heavy and light on the carbs.

Second, most type 2/pre diabetics who are not on diabetes medication such as insulin or sulfonylureas don't really need to worry about lows - and I don't say that to suggest that they CAN'T happen, more that it's just really unlikely unless you already had a documented medical history of hypoglycemia.

Third, 'dicey' feeling may not actually amount to any medical concern at all. Do you have a glucometer? Are you using it? Do you know if you legitimately 'low' during/after spin class or do you just think/feel like you are? Plain and simple, you can't rely on how you "feel" - you have to test, not guess. Low is <60 mg/dl. Anything higher is probably just fine. I often finish rides in the 70's and sometimes 60's and I don't worry about it at all. You might consider checking your blood pressure too. Mine is sometimes on the lowish side, and that can be really unsettling when on the bike... I will feel like I am going to black out and sometimes I have to stop until I feel better, but I've never been low when that has happened.

A true hypoglycemic event shares a few of the same hormones that are produced/used during exercise (in particular, adrenalin and endorphins, which is what actually contributes to many of the symptoms of being low, and glucagon, which is used by the body to release stored glycogen to fuel your muscles, can make you feel a little woozy on top of that). It's all a normal part of how the body works... so you may end up with 'low' symptoms when your blood glucose is really quite normal. I know it happens to my husband.. every time he's wanted to test because he feels "shaky" his blood glucose is in the 80's - totally normal.

I second the suggestion for some sort of diluted carb source during class. I usually alternate between diluted gatorate (some flavors are better than others when diluted, I prefer the "blue" one, whatever flavor that is - maybe glacier freeze?) and tri-berry nuun on my rides (I take plain water too, but rarely drink any unless it's super hot out). My gatorade is usually diluted more than half strength... it's probably like third strength so it's really not overly sweet.. nuun tastes sweeter, and that has no calories.

The only other advice I have, is that if you don't have a glucometer, get one, and use it. Test at 10 minute intervals until you have some reassurance that your body isn't doing anything crazy. You'll definitely want to have one when you're riding on the road, along with some kind of fast acting glucose if you did have a true low.

[Triskeliongirl]

I am a mild type I diabetic, so I understand what you are talking about.

1. I second the recommendation to use a glucometer. I would get symptomatically hypoglycemic even if my blood sugar is in the normal range when I consumed a pre-ride meal with carbs, since our bodies can actutely sense the RATE of change of blood sugar. If you let it get too high at the ride start, and then you start exercising, exercise will cause a massive translocation of glucose transporters to the plasma membrane, which is a good thing, but if the blood sugar then clears too quickly you will feel hypoglycemic even if you are not.

2. The way I solved the problem, is to eat a high protein (but no carb) pre-ride meal, being sure that I start the ride with normal blood sugars, and then I use a drink called muscle milk light during my ride which, which I mix at 10g CHO, 25g protein per bottle. You can also metabolize protein for fuel on the bike (deaminate amino acids to carbon skeletons that feed into TCA cycle).

[KnottedYet]

Addendum: if you are truly going hypoglycemic, please get a medic alert bracelet or necklace. When I fall low (30-40) I get incredibly confused and agitated and don't even think of eating my emergency sugar, in fact I will resist eating.

If you get low enough to pass out or become confused, you want folks who find you to be able to figure out what's going on.

Mine say: HYPOGLYCEMIC Feed Me Sugar (never hurts to spell it right out!)

RoadID is my favorite, and they don't jerk you around like American Medical ID. www.roadid.com

[Becky]

+1 to all of the awesome info that the others have shared!

Vitalyte is a good, lightly-flavored electrolyte drink choice that's lower-carb - only about 10g CHO per serving, compared to 15-25g CHO for many of the other mixes. No need to dilute it and therefore alter its electrolyte concentrations.

If I need a lot of carbs at once, I prefer to eat solid food. Vitalyte is good for sipping throughout longer rides (alternating with water) to ensure that I'm getting some carbs in the whole time. I stick with Nuun or plain water for shorter rides.

Ask your doc for a glucose meter. Most docs seem to have a huge stash of meter samples- I haven't needed to pay for one yet.

[Catrin]

I do have a problem with hypoglycemia, and I use a meter regularly - my blood glucose has been as low as 29 and as high as 250, though things have stabilized quite a bit with rigid diet control and exercise.. I do generally have a light meal prior to spinning or other intensive exercise activities like when I work with my personal trainer. It has been a mixture of high protein and light carbs and I will consider if that is still an appropriate mix.

I thought that I needed to eat at least an hour before the class, and will experiment with eating immediately prior to it - there may well be a delayed insulin response (we have suspected this already). My specialist has encouraged me to experiment with the timing, as long is it is no longer than an hour prior - and she has told me more than once to drink something other than pure water when spinning...

Thankfully my trainer's wife was in the locker room with me last night and figured out what was wrong, bless her, and she got some orange juice and stood there and basically bullied me to drink it :o (which was a very, very good thing for her to do) Last night I did not have my meter with me, that will not happen again.

My trainer suggested today that I try one of those Gatorade powders so I can dilute it to my desire - will also check out the Nuun and other things that have been suggested.

Thanks to everyone :D

[Catrin]

I am a mild type I diabetic, so I understand what you are talking about.

1. I second the recommendation to use a glucometer. I would get symptomatically hypoglycemic even if my blood sugar is in the normal range when I consumed a pre-ride meal with carbs, since our bodies can actutely sense the RATE of change of blood sugar. If you let it get too high at the ride start, and then you start exercising, exercise will cause a massive translocation of glucose transporters to the plasma membrane, which is a good thing, but if the blood sugar then clears too quickly you will feel hypoglycemic even if you are not.

I just re-read your post, and I did not know this. I do get seriously low upon occasion, but have also noted feeling that way even when I wasn't. In my case I think it is totally related to what/when I eat...and it is difficult to judge when my glucose levels peak. Things have improved, but are still unstable - which is why they started my use of a meter last summer. I have had occasional problems with hypoglycemia since I was at least in my teens.


2. The way I solved the problem, is to eat a high protein (but no carb) pre-ride meal, being sure that I start the ride with normal blood sugars..

I guess I need to be more strict about when I test before spinning. I have learned that I can't change ANYTHING in diet or exercise without consequences - and am trying my best to avoid starting medication. My doctor has offered it, but it is currently only one option.

I haven't started riding more than an hour as I am still practicing in parking lots, but I need to get as much of the nutrition thing figured out before I start riding Stella down back roads by myself....

All of the other advice is helpful as well. I picked up some Clif Blocs and will check out Nuun and Vitalyte in the near future. I strongly dislike the taste of Gatorade, even diluted, so that is the last choice in my list. Obviously spinning class, while intense, is of lower duration than a good ride, but this is a start.

Thanks again!

[Triskeliongirl]

I control my diabetes with diet and exercise. Its taken me a few years to understand it all. I found it most helpful to keep a notebook, and write down everything, time, food, exercise, blood sugar, etc. That is how I worked out a regimine that works for me. What works for me, is to choose food/exercise combos that never let my blood sugar go above 120 (peak at ~1hour post meal) and be back under 100 by the 2 hour mark). On the bike I feel best in the 100-120 range.

I also found it very helpful to read the book Dr. Bernstein's Diabetes Solution. You also want to enlist the help of a good endrocinologist, especially one that supports diet/exercise control, with medication as a last (but sometimes necessary) resort, if that is what you seem to want.

[Catrin]

Thankfully my specialist is being very supportive about my efforts to control by diet/exercise. I document all of my intake and exercise, I need to be more consistent about testing my glucose. I need to develop a specific schedule for testing, but the problem is my activities are timed differently throughout the week so it doesn't make sense to test at the same time every day.

Sometimes my glucose runs quite high, other times I can't seem to get it over 68 - but all in all things seem to becoming more balanced so my efforts seem to be paying off. It is finding the right combination of things...

[Eden]

Just a note NUUN is electrolyte only - no carbs, no sugars. It is good when you do not want calories in your drink (I generally carry a bottle of NUUN and a bottle of Cytomax).

Go to a bike shop and experiment around with drink mixes - you can generally get small packets and there's certainly more out there than Gatorade. Gatorade is probably the least thought out formulation of everything out there. It has lots of plain old sugar and high fructose corn syrup, lots of sodium and not a whole lot else. The brands you can get in sports stores usually have rice syrup, maltodextrin, dextrose and not HFC's. Some contain some protein as well as sugar. I think they also contain better thought out mixtures of electrolytes.

[softthings]

i am type 2 pre-diabetic. i found this article the other day, and it is pretty helpful for type 1s as well.http://www.insulinfactor.com/graphics/pdf/diabetes_cycling_article.pdf

also, make sure you don't eat or drink anything, ANYTHING with high fructose corn syrup. it is the worst type of sweetener for diabetics. check the gatorade for that, i have found that their "lighter" version contains hfcs as well.

that being said. you need to carb up before you ride, play around with the amounts. drink water or low car drink during. if you still feel wonky after, then fruit. natures' candy or some slow releasing carbs such as whole grains are going to be your best bet. after i ride i do a fruit and yogurt or milk smoothie. milk and chocolate milk are great for post ride. just make sure it is low fat. also, if you feel like you are having a dip, and you need some sugar, make sure whatever you eat doesn't have a high fat content, it slows the release of the sugars into your body. so, no chocolate or things with nuts or nut butters in them if you need something quick. hope that helps, if you have any more questions, feel free to pm me! good luck!

[softthings]

also......http://www.myra-simon.com/bike/bike-food.html

[Triskeliongirl]

Thankfully my specialist is being very supportive about my efforts to control by diet/exercise. I document all of my intake and exercise, I need to be more consistent about testing my glucose. I need to develop a specific schedule for testing, but the problem is my activities are timed differently throughout the week so it doesn't make sense to test at the same time every day.

Sometimes my glucose runs quite high, other times I can't seem to get it over 68 - but all in all things seem to becoming more balanced so my efforts seem to be paying off. It is finding the right combination of things...

You want to be testing ~30 min and 120 min. post prandial, and recording the details of food consumed and exercise performed. There is a nice form you can copy from Bernstein's book, that lets you record food, activity and blood sugars, and bring to your doctor for review.

[sarahspins]

but the problem is my activities are timed differently throughout the week so it doesn't make sense to test at the same time every day.

You're right, it wouldn't make sense, but I don't know a single person to tests at specific times of day, only in relation to specific events (food, activity, etc)... so if you were to just test before/during/after spin class, even if that is not even close to the same time of day each time, it's still relevant and useful information that can let you know what's really going on while you're on the bike.

As a real Type 1 that produces *no* insulin at all, I have to balance the insulin my body needs with food and activity on a daily basis, I test a LOT - at least 10 times a day, and I wear a continuous glucose monitor too. I have a pretty good idea at this point what being on a bike (or anything else) does to me, but occasionally I'm thrown for a loop.. it's best to always be prepared for the unexpected, but you can't do much without information :)

[Catrin]

You want to be testing ~30 min and 120 min. post prandial, and recording the details of food consumed and exercise performed. There is a nice form you can copy from Bernstein's book, that lets you record food, activity and blood sugars, and bring to your doctor for review.


I typically do check 2 hours after eating, that is generally when it is the highest, didn't know about the 30 minute check. I will check out his book. Thanks! I also like to check before/after spinning or an intense training session as that is when I typically have the most risk for hypoglycemia (afterward).

[Triskeliongirl]

I typically do check 2 hours after eating, that is generally when it is the highest, didn't know about the 30 minute check. I will check out his book. Thanks! I also like to check before/after spinning or an intense training session as that is when I typically have the most risk for hypoglycemia (afterward).

It should actually be the highest ~30 min. after a meal, and back to normal within 120. If its not, the meal had too many carbs for you. When I worked out my on the bike nutrition, I would monitor before exercise, and then roughly every 30-60 minutes during, and of course after. Now I carry my meter on my bike, but only measure if I feel that something is off.

Sometimes I would get just symptomatically hypo on the bike, sometimes truly hypo, but only if I ate too many pre-ride carbs (this is called reactive hypoglycemia). We may not be the same, which is why I am careful to advise you take measurements, record everything and show it to your doc. I highly recommend the Bernstein book. I know people tell you that you need pre-ride carbs, but for people with impaired glucose tolerance that may not be a good idea. I don't consume any carbs until I am actively exercising, since exercise increases glucose tolerance, and even then only small amounts, like in the drink I described. But use your meter to figure out what is best for you. Its just as bad to go too high as too low. I think its best if you can stay in the 80-120 range. Good luck and keep us posted how it goes.

[Catrin]

Last night I tried a protein only meal before to my workout session and the later spinning class. At the start of spinning class I ate three of the Cliff Blocks (1 serving, 100 calories and 22 grams carbs). When I got home, 2.5 hours after eating the Blocks 0 my blood sugar was STILL 155... ok, the Blocks aren't going to work for me.

My endo wants me to have some kind of sugar in my water through class - so will try and find something that isn't TOO high and dreadful tasting. I just hate drinking sweet things when I am thirsty though...but perhaps this will work better than the blocks...

[Becky]

Last night I tried a protein only meal before to my workout session and the later spinning class. At the start of spinning class I ate three of the Cliff Blocks (1 serving, 100 calories and 22 grams carbs). When I got home, 2.5 hours after eating the Blocks 0 my blood sugar was STILL 155... ok, the Blocks aren't going to work for me.

For whatever it's worth, I usually do a blok at a time. One blok is 8 g of carbs (CHO) and raises my BG about 40-50 points. That's the beauty of the bloks...you can fine-tune the "dosage" without making a mess :)

Try eating just one and then testing every 30 minutes or so. See how it affects you. Diabetes is a total pain in the you-know-what, but learning how your body works with certain foods, exercise, stress, etc. really does make it more bearable.

(((Catrin)))

[KnottedYet]

Do you have a nutritionist or diabetes educator working with you?

I hate to say it, but you are going to die if you don't knuckle down, accept this, and work with it rather than against it.
We are not nutritionists, nor are we diabetes educators, and this is not a licensed clinic.
We do not know all your issues.
We can only tell you what works for us.

I really feel we are doing you more damage than good at this point, and you must work with a nutritionist or diabetes educator.

[Catrin]

I agree it's time to return to the nutritionist - I was just wondering what works for others. Yeah, there is a little denial there as well but am working through it...

[Veronica]

I use Gu2O in my water bottles. It's not too sugary. Only 5 of its 26 carbs are sugar.

And there is nothing wrong with working with a nutritionist. I work with one because I want to eat as healthy as I can.

Veronica

[Triskeliongirl]

I concur that you need to get professional help with this. Blood sugar fluctations are very serious business. Being too high and too low are both very dangerous situations. If your endo is not experienced in using diet/exercise to control diabetes, then perhaps you need to find another endo.

We've told you what works for us, but each of us may not have the same physiology as you. If your blood sugar was still 155 after exercise, that is an indication that your glucose tolerance is more impaired than you think. Has your endo had you do a 6 hour glucose tolerance test (and measured your insulin levels throughout)?

[Catrin]

If your blood sugar was still 155 after exercise, that is an indication that your glucose tolerance is more impaired than you think. Has your endo had you do a 6 hour glucose tolerance test (and measured your insulin levels throughout)?

Typically my blood sugar is fine after exercise, or low, this is the first time I've seen it high. The only difference was the cliff blocks - probably just too many carbs. It is probably time to revisit my endo and consider finding another one. I've already made an appointment with my nutritionist.

I've only had a 4 hour glucose tolerance test, and they tested my blood sugar levels twice in the process.

Thanks for everyone's helpful advice!

[Becky]

I hate to say it, but you are going to die if you don't knuckle down, accept this, and work with it rather than against it.


Easy there....we diabetics generally don't take kindly to being told that our chronic condition will kill us. I know that you mean well, but those are harsh words.

Diabetes is one of those delightful ailments where, no matter how good the doc, it really does come down to self-management and lots of experimentation. It's like driving a manual transmission all the time, and no one clutch is like another....you just have to figure it out, and you're going to stall a few times along the way. That stuff can really get a person down....been there...

My healthcare team is very good, but they can't do it for me. All the really good stuff I know about my D came from testing and trialing and experimenting on my own.

(Didn't mean to get on my soapbox there....no offense meant.)

[KnottedYet]

Easy there....we diabetics generally don't take kindly to being told that our chronic condition will kill us. I know that you mean well, but those are harsh words.
...
Diabetes is one of those delightful ailments where, no matter how good the doc, it really does come down to self-management and lots of experimentation.
(Didn't mean to get on my soapbox there....no offense meant.)

No, we don't take it kindly. But sometimes we have to face the facts. If we don't manage our blood sugar, IT WILL KILL US.

And one can't do a good job of experimentation unless one has some education to direct it. Otherwise it's just flailing blindly.

(no offense taken)

[Catrin]

No, we don't take it kindly. But sometimes we have to face the facts. If we don't manage our blood sugar, IT WILL KILL US.

And one can't do a good job of experimentation unless one has some education to direct it. Otherwise it's just flailing blindly.



Yep...and I do tend to start experimenting a little early - so I understood where your words were coming from.

[Becky]

No, we don't take it kindly. But sometimes we have to face the facts. If we don't manage our blood sugar, IT WILL KILL US.

And one can't do a good job of experimentation unless one has some education to direct it. Otherwise it's just flailing blindly.

(no offense taken)

It may kill us....but why make bad news worse by speaking harshly? A gentle word can convey the same message. *shrugs* Sorry, I don't see how this is a good tactic, especially in the typed word. And, in the interest of full disclosure, I was given a "face the facts" lecture in person once by someone who barely knew me, my level of control, or my knowledge on the subject. It was humiliating, depressing, and infuriating.

Education is key, but I don't rely on my healthcare team for it- they're really good, but they're not me. Much of what I've learned about diabetes came from the internet and from talking to others. YMMV.

[Triskeliongirl]

I know Knotted Yet pretty well from the forums, and am sure she was just trying to get us all to slow down, and stop practicing medicine over the internet. She is right. While all our posts were well meaning, without knowing how the OPs body responds to carbs, we could be setting her up for disaster.

Yes, I worked out my stuff via lots of experiments, but I also received guidance and support from my endo in doing it.

And knotted yet is right, Diabetes is the 'silent killer' and knowledge is power. I watched my dad die an early death from the complications of type I diabetes, and that now motivates me to live what even my endo considers an impossibly healthy lifestyle. My A1Cs are lower than his normal patients, since I am willing to use diet and exercise to control this, something most patients are not.

[sundial]

I also found it very helpful to read the book Dr. Bernstein's Diabetes Solution.

Would this book be helpful for someone who is hypoglycemic but not diabetic?

[Triskeliongirl]

I think so. Diabetes is on some ways an operational definition. I have been diagnosed with diabetes and hypoglycemia at various stages in my life, but told I was OK when I was in good control. This just led to confusion, since being symptomatic is really just a sign of poor control, not that you don't have issues with blood sugar control. The book is great for explaining how to normalize your blood sugars, which is important for anyone that has a hard time to doing that eating a conventionally healthy diet.

[sundial]

Thanks Tri! I'll have to look into getting this book.

[Triskeliongirl]

As a follow up, please be sure you guys keep your doctor in the loop if you are planning to experiment with dietary control of blood sugar levels. While dietary approaches to normalizing blood sugars are great, if you are on any blood sugar lowering medications, your doc will probably want to adjust their dosae first.

[Catrin]

Addendum: if you are truly going hypoglycemic, please get a medic alert bracelet or necklace. ......
RoadID is my favorite, and they don't jerk you around like American Medical ID. www.roadid.com

What is the deal with American Medical ID? It's become even more apparent that I need to get a medic alert something or other and I had been told that American Medical ID was the most recognizable one out there. I do like the looks of the RoadID, but was wondering what problems there are with American Medical ID.

I am experimenting with adding Gu Electrolyte Brew to my water during training/spinning, and that seems to be helping AND I can tolerate the taste (it isn't overly sweet or overpowering). It does have carbs in it as well as electrolytes - and Performance Bike has the mix on sale :) http://www.performancebike.com/bikes/Product_10052_10551_1076453_-1_400030_400004_400109

I don't know why I've been so resistant to adding stuff to my water, it isn't like my doctor hasn't been telling me to do so :o

[KnottedYet]

What is the deal with American Medical ID? It's become even more apparent that I need to get a medic alert something or other and I had been told that American Medical ID was the most recognizable one out there. I do like the looks of the RoadID, but was wondering what problems there are with American Medical ID.


American Medical ID is a company that advertises itself well. http://americanmedical-id.com/ When you go to check out, it takes 3 or 4 tries before you get to the final screen. Each try, they slip something into your order (a duplicate ID, a wallet card, a second alert charm) which you have to actively remove. I finally gave up in disgust and didn't order from them at all.

Medical ID's in themselves are standard, no one company is special. Your corner jewelry store will have them, will fit them to you, and engrave them for you.

This company http://www.fiddledeeids.com/ has some clever designs, and their basic bracelet is the cheapest I've seen anywhere. http://www.fiddledeeids.com/simple-simon-medical-id-bracelet-p-4.html