I have great difficulty balancing morning exercise with diabetes — a frustration I have written about previously, here and here. Whereas exercising in the afternoon or evening will typically cause my blood glucose to plummet, exercising in the morning makes it spike — making me feel horrible during the workout itself, and also messing up my morning.
Recently, ASweetLife’s own Robert Scheinman emailed me about this, and together we tried to brainstorm reasons this might be happening. The most likely culprit would seem to be that my liver is particularly fond of dumping out extra glucose in the morning, which means that the harder I work out, the higher my blood glucose tends to go.
I’d thought of this idea before, but emailing with Robert made me realize something else: whereas I usually take Symlin nearly every time I eat — the medication that slows your stomach emptying and prevents glucose-dumping by the liver — I typically do not take Symlin on the mornings when I work out. My reasoning was simple: the fact that Symlin slows your stomach down means that it makes it much harder to recover from lows because your body doesn’t absorb the sugar (the solution is to suck on things so that the glucose absorbs through the tissues of your mouth itself, but that takes a while). Since exercise can sometimes cause scary lows itself, I didn’t want to add Symlin to the equation.
My logic was sublime, except for the fact that without added insulin, my blood sugar never goes down during morning workouts — and since I typically wake up at a good blood glucose level, I typically don’t have to take a correction bolus in the morning. In other words, in the morning, I’ve only got basal insulin on board and there isn’t any residual insulin from a meal or correction hanging around in my system waiting to be activated.
All this is to say that I realized that I might be able to use Symlin to maintain this waking blood glucose level and to prevent my liver from dumping extra sugar into my blood — the trick is to take the Symlin on an empty stomach before the workout and not eat anything (because if I ate anything, I’d have to take insulin, which I don’t want to do on the off-chance that the workout makes me go low).
With no bolus insulin on board, I’m highly unlikely to drop during the workout. And with Symlin, I am less likely to have a blood sugar spike caused by a liver-produced glucose dump. The possible result? A steady bg during my workout. Can you imagine?!
Now, the astute reader may notice one large flaw in this plan: it means doing hard workouts on an empty stomach. Not ideal. So I’ve come up with another possible solution: eating a hardboiled egg — no carbs, and therefore no need for insulin — before my morning workouts. I have yet to try this egg idea, but my hope would be that it would get at least something in my stomach so that I’m not entirely running on reserve. Granted, since the body mostly uses carbohydrate for short-term exercise needs, the egg may not actually provide much fuel for the workout. It also might mean that I have eggy burps on the rower, which is a disgusting idea. But if it helps my blood glucose, I’m okay with it. (As a comparison, when I don’t take Symlin and eat a 7-gram carb cottage cheese before a morning workout, I have to take 2 units to cover it — and sometimes still go high.)
And frankly, I feel so shitty during my workouts when my blood glucose is high that fasting doesn’t sound like a bad compromise. This morning, for example, my pump was not properly clipped — and my blood sugar went to 250 at 8am and has still yet to come down, despite multiple correction boluses. I felt and feel horrible, not to mention extremely frustrated. But when I took Symlin during last week’s workout, my bg remained steady, even though we were doing sprints.
Now, I know Symlin isn’t for everyone – it’s another injection, it can be tough to get insurance approval for (you usually need your doctor to make the request), it can make it harder to recover from lows, and it can make you nauseated the first couple times you take it. (More on Symlin here.) But if you can get over those hurdles, it’s worth a try. I’m going to experiment with fasting/eating a very low-carb snack before morning workouts and taking Symlin, and will report back on the progress. In the meantime, if you’ve got your own tips for managing early morning workouts, post them to the comments!