I’ve been taking metformin for a couple of months now and it has made a huge change in my life. I used to wake up most mornings with blood sugar levels of 130 – 180. Now I wake up most mornings with blood sugar level of 90-120. This to me is absolutely amazing. After years of trying different things, including diet and different basal rates I finally solved this problem with the help of a drug usually prescribed to patients with type 2 diabetes.
But like most things in life, solving one problem creates new ones. Waking up high, although not healthy, was convenient as I go running most mornings and need my blood sugar to be higher than normal. (My doctor always tells me my blood sugar should be at least 150 before I run.)
This morning when I woke up at 4:45 a.m. my blood sugar was 95. When I saw the number I smiled to my self, happy to see a good number once again. I lowered my basal rate on my insulin pump to 30% and got ready to run. I went out a little after 5:30 a.m. and stopped to check my blood sugar after a little less than a mile. It was 98. I took a gel and continued. I took another gel 2 miles later when my blood sugar was 88 and the again 3 miles later (115). When I finished my 10.25 mile run my blood sugar was 135.
This is how my blood sugar has been during most of my runs since starting metformin. I find myself taking 2-3 gels on relatively short runs just to keep my blood sugar above 100.
This morning while running, after I took my third gel, I thought maybe I should just disconnect all together when I run – just leave my insulin pump at home. I’m a little scared to do it although it actually makes sense. I would be happy not having the extra sugar equipment on me, but I’m not sure I can go so long without any basal insulin. I also don’t know about longer runs. I’m not sure, but it seems to me that after 15 miles my blood sugar starts to get higher. I don’t know if it’s a result of taking too many gels early on or just something my body does to prove that diabetes has no rules and it will screw you every change it gets.
I guess the only thing to do is to try. I know the careful (and smart thing) to do would be to lower my basal rate to 20%, see what happens, and then lower it again and again if necessary. But the idea of not running with an insulin pump is so tempting that I may just try it and see what happens. I guess I’ll go with my gut (or my blood sugar level) when I wake up tomorrow morning.
Michael – I’m having the hardest time trying to tweak my basal to make sure I don’t go low when I run. I’m not talking long runs either – 4 to 5 miles at most. I feel like I need to lower my basal an hour to an hour and a half before the run, otherwise I go low. For example : the other day I lowered my basal to 30% a half hour before my run. No IOB except for my basal. Started the run with my bs around 130 and 20 mins into the run I was in the 40′s.
Very frustrating.
If your runs are short enough you can run on the insulin in your system and take advantage of the fact that your muscles will soak up that glucose very efficiently. The problem arises when you run out of insulin altogether and there isn’t any available to help your muscles get fuel. I did this once and was shocked at how lame I felt, the energy was absolutely gone. The next day of endurance exercise i gave plenty of insulin and glucose and I was fine. It was like night and day. I think if you go for over 60 minutes, you might have to make sure you have insulin in your system, even if it’s way less. I think you are probably doing it right with your current method.
Michael, I’m going all the way to 2h runs (a half marathon for me) without the pump. Usually insulin lasts 3-4h and if your basal rates aren’t too small, you should not get into DKA that easily, especially in the mornings when hormones delay the insulin resorbtion even more.
What works for me is leave the basal rate untouched (to make sure I have the insulin in the system that I need), fill up on carbs if I’m under 130 or so before my run. I use gummy bears, so I can really take just enough for the run and not overdo it. Plus they’re quick to go into the system. With a bit of trial and error I’m now at a point where I can come home with pretty much the same glucose that I’ve started out with. Just for safety I carry gel, but I only rarely need it and mostly when I had a meal before (so most likely the bolus is then too much and not the basal rate).
Good luck!
disclaimer – I’m not a doc, only a T1D with a pump!
I hear you on the frustration of having to eat a ton to stave off a low while you’re exercising. I talked to my endo about how to prevent lows during afternoon/evening workouts, and she suggested that I drop my basal insulin even earlier than it sounds like you’re doing — like one and a half hours before I exercise — since it takes that long for the temp basal to really take effect. What if you tried that?
Also, it seems to me there are two possible variables here:
1. The metformin itself is causing you to be more likely to go low during exercise
2. The metformin is merely helping you stay lower at night/wake up in target and, therefore, that what you’re really struggling with is how to avoid lows during a long run when you start with a bs in a low-ish normal range. (I guess it could be a blend, too, but you see what I mean.)
If I were you, I’d try taking the metformin and dropping my basal to at least 50 percent (or in your case down to 20 percent) a full hour and a half before your run. Eat enough that you start around 130 or so and see if that helps. if it doesn’t, then you can experiment with dropping the basal an hour and a half beforehand and disconnecting the pump — but carrying it with you in case you see your bs start to creep up (which I think it would might do after a certain point in a really long run as your body begins to release more glucose for energy). In other words, your experiment sounds like a good one as long as you bring your pump with you.
Oh, also, for what it’s worth, I frequently disconnect during afternoon workouts (when I fear I might go low) and have never had a problem going too high afterwards (these are 45 min or hour-long spin and kickboxing classes, so it’s pretty intense). Back in my running days, I also would sometimes run 3-5 miles without the pump, with no ill effects (though for some reason I felt more apprehensive leaving it at home during a run than I did taking it off at the gym).
good luck!
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I’m going to add a couple two cents in here. Just watch out for post exercise highs if you disconnect or lower it a lot. I find I struggle with that.
Maybe lower basals even earlier….