How manage heavy caloric output?

I’m 72 years old, and just diagnosed (6 weeks ago) with T1D. I’m an experienced, if mediocre, athlete from some time back (best marathon 2:58, for example). But I don’t yet have much experience as an athlete with known diabetes.

I’ve had a 1-1/2 year battle with leg cramps. Nocturnal leg cramps had me sleeping in a chair, and I had to give up Orange Theory Fitness workouts because of three episodes of severe exercise-induced cramps. When I say severe, I’m referring to 10-15 minutes before ability to stand up, 30 minutes before I could walk, and two weeks before I could work out again.

It now appears that these problems were a result of my developing but undetected diabetes. Nocturnal cramps are essentially gone, starting a few days after I started insulin. I’m now ready to try Orange Theory Fitness again. However, I’m concerned about how to manage my first outing with such a heavy caloric load. Obviously, I’ll start with a relatively easy workout, but I was generating 700-800 calorie workouts, so even an easy OTF workout is going to be a bigger event than things I’ve been doing on my treadmill and recumbent bicycle at home.

I’m looking for suggestions about the best way to manage this. Should I go right after a meal and not take insulin? Should I go when my blood glucose has stabilized at a low level after a meal, and try to guess the required intake and eat continuously (gels, most likely)? Is there some other approach? I’m mainly just worried about handling this right the first time. Once I’ve done it successfully, I’m sure it will be easier. Any assistance would be appreciated.

[I posted this in Athletes With Diabetes before I discovered this group, where it’s more appropriate. Sorry for the extra post.]

hi @Ceolmhor, diabetes is very much like a science experiment, because everyone has different inputs/reactions and everyone’s insulin sensitivity and metabolism is different, & etc.

6-weeks in… I bet they started you on 70/30 or 1-2 long acting shot plus mealtime shots - it does matter because if you are taking a basal (long acting) insulin it can be hard to figure out where you need to cut back insulin, or increase intake of glucose. your best bet is to work with a nutritionists and a CDE ( certified diabetes educator) for some beginning strategies.

the fastest acting (injected) insulin starts to work in 15-30 minutes and hangs out for 4+ hours. meaning that if you take a meal time shot and work out anytime in 4 hours, that insulin will absorb faster, work harder, and your blood sugar could drop fast as well. This is where I can go the lowest. if I know I am going to be active, i use half (or sometime less) the fast acting insulin and then I start my activities about an hour after i eat when my blood sugar is up at about 140. If you are on a long acting insulin, that insulin will hang out for up to 24 hours. You’d have to adjust your basal as well, before you knew for sure if you are going to be active. One big difference is that I have a insulin pump, and I can turn down (or off) my basal insulin if I know I am going to be very active. straight shots will not let you do that so easily.

there is a lot to know and learn, don’t try to get it all in the first couple months. I always recommend a book “Think Like a Pancreas” for all of these things and to get an understanding of what and how you can manage any level of activity while on insulin. keeping active is the very best thing you can do for yourself and good luck to you.

Hi, @Joe. Thanks very much for your reply. I’ll start with your one-hour, half-bolus approach and go from there. And thanks for the pointer to “Think Like a Pancreas”. I downloaded a Kindle copy, and look forward to reading it. It sounds like just the right approach to the subject for my needs.


This is a difficult question and not always the same answer which makes it an experiment most of the time. Now that I am done talking in circles, the reality is that keeping blood sugar in a normal range is like walking a tight rope. Always carry something to eat and check your blood sugar frequently, not just when you are feeling low. I have learned that I can not just go by how I am feeling at the moment and guess. When you excercise strenuously, you can go very low very quickly and then find yourself in trouble. When I plan to do some strenuous exercise, I purposely let my blood sugar go a little high by cutting back on the insulin and eating more carbs. Through experimentation, I have a reasonable expectation of how much my blood sugar will drop over a certain amount of time doing this or that exercise, but it doesn’t always behave the same way. A book that I have found helpful is “Diabetic Athletes Handbook”. This book, as well as, your nutritionist and CDE can help you with an educated plan balancing insulin, exercise and nutrition. I wish you well.

Thanks, Karen. I think you’re right that I have to give myself permission to experiment a bit. I’m still quite early in my experience with T1D, and learn new things every day. I did just a long-slow-distance jog yesterday, and thought I had about the right compensation, but my blood sugar was 50 points high at the next meal. So I need to either take on more food before or during the exercise, or take a little more glucose with the previous meal. I’m sure I’ll get the hang of it eventually.

Anyway, thanks for the encouragement and the book pointer. When I finish reading “Think Like a Pancreas” – a fun and informative read – I’ll take a look.


Hi, I am wondering how you are doing now? Have you got a better handle on things? I noticed that you mentioned not taking insulin before working out? How will your cells get the glucose they need without insulin? I personally have to double my basal insulin during workouts (on a pump) to compensate for the liver producing copious amounts of sugar. Before I was on the pump I would dose a bit extra bolus with my before workout meal to cover the liver’s production of glucose. If I felt a bit loopy during my workout I would check my sugars and see that they had gone over 200. I have yet to experience a low during intense workouts. I’d enjoy hearing your experiences.

I see I’m a year and a half late replying to your message, but I have settled on a routine that seems to work well most of the time. I eat a slightly-more-carby meal than usual, bolus for about half, set a temp basal, try to start my workouts as SG is about 180, monitor every 10-15 minutes to see if I need either glucose or insulin to hit my target SG of 100 at the projected end of the workout, take a protein smoothie (no carbs here unless needed), continue to monitor every 10-15 minutes to catch rebounds, and drop the temp basal when I seem to be past serious rebounding.

My one remaining frustration is that I’m still not good at hitting my 180 SG target at just the time I prefer. Some breakfast foods seem to cause a much slower rate of increase than others, even without high fat or fiber content.

And writing that reminds me that I’ve mostly switched to morning workouts, giving me more time to gradually get things back under control on the rare occasions when this approach fails.


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@ceolmhor, Just hearing that you are still at it made my day. Good work Rudy.

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