exercise and bg

[pauleo]

Hi everyone,

I am new. I an having sporadic fbg measurements in the prediabetic range but not every day. Exercise consistently makes my blood glucose elevate. For example, last night my bg was 99 at 8.30pm. I exercised between 8.50 and 9.25pm. And my bg was 113 at 9.45pm. (My fbg was 99 this morning).

My question is - why is this happening and how (ab)normal is it? I have educated myself a little about blood sugar, and I know that exercise causes the liver to start manufacturing glucose from its stored glycogen. But I'm trying to figure out if what is happening is bad or good in my case, if it's a permanent effect or something that I should be trying to 'improve', how I might do that etc

Thanks for any help,
Paul.

[pauleo]

Hum guess I asked a boring question, lots of views but no replies! :)

[Daryl]

Hum guess I asked a boring question, lots of views but no replies! :)

Not boring, Paulo. Hang in there, maybe we'll get an answer or two :lol:

I found this:

"Also, the type of exercise that you do can cause blood sugars to rise (albeit temporarily); a short period of intense (near maximal) exercise, especially when done in the morning before eating, can cause your blood sugars to rise during the activity and stay elevated for up to two hours afterwards. These effects are found in both non-diabetic and diabetic individuals and are attributed to an exaggerated hormonal response to intense activity."

They don't go much more into than that, but here's a link nonetheless:

http://www.nfb.org/Images/nfb/Publications/vod/vodwin0216.htm

[pauleo]

Thanks Daryl. I wasn't doing intense exercise but I appreciate the link. I know that kicking up my glucose reading by 15 points is not disastrous but didn't know if everyone saw this effect, and if there were some easy tips to avoid it like exercising for a shorter/longer time, or at certain times of day etc. Looks like it might be a not-so-common problem, so I'll see if I can find a way to reduce it!
Paul.

[Daryl]

Paul, to the best of my knowledge, my blood sugar drops when I exercise, even just 10 minutes on a recumbent bike can knock it down several points. Diabetes can be maddening in its refusal to be easily pinned down.

[eddiemcm]

Pauleo
Intense weightlifting always makes my BG
rise a small amount.Aerobics usually makes
my BG decrease(as much as 50 points) but
sometimes aerobics makes my BG rise slightly.
That's how it is with me.
Eddie

[pauleo]

Ah interesting, thanks Eddie. BG decrease makes more sense.
I had some spare time yesterday and tried doing four small exercise
sessions spaced throughout the day. (My rough idea was to see if I
could spread out or dilute the glucose release after exercise).
I had the same roughly 15 point increase in my final exercise session
but it dropped again after an hour, normally it stays longer at the elevated
level, so maybe it's somewhat controllable if I can figure it out,
Paul.


Pauleo
Intense weightlifting always makes my BG
rise a small amount.Aerobics usually makes
my BG decrease(as much as 50 points) but
sometimes aerobics makes my BG rise slightly.
That's how it is with me.
Eddie

[MizKitty]

Bumping this up as I'm having the same problem and don't know what to do about it.
Exercise, even moderate exercise, is spiking my BG. Sometimes significantly, I've seen spikes as high as 172.
Since I've finally got my numbers down to near-normal, I've really been working lately on achieving tight control, no spikes over 120, which Dr Bernstein says is needed to stop diabetes from progressing.
So this is distressing, and I don't know what to do about it, aside from "quit exercising", which really wouldn't take much arm-twisting in my case, but hey, I'm trying!

[Daryl]

Kitty, do you work out in the morning? Dr. B said on the recent teleseminar that almost everyone will see a spike early in the day from exercising, he advised to try to do it later in the day.

[RobLL]

Type 1s tend to have an easier time with some of this, but type 2s have a crapped up messenger system between their pancreas and liver. Liver is supppose to produce glucose as needed, in type 2s it often produces glucose very inappropriately. Some type 2s can lower morning BGs with a measured amount of exercise, others of us (me) only see it raise.

[MizKitty]

Kitty, do you work out in the morning? Dr. B said on the recent teleseminar that almost everyone will see a spike early in the day from exercising, he advised to try to do it later in the day.


Thanks for that info Darryl, but no, I'm an evening exerciser. Today I measured 107, walked a mile at 5:30pm, and half hour later was at 134.

[Daryl]

Okay, hmmmmmm. How low did it go down? How long did it take? This is perplexing!

[MizKitty]

Well let's see ...[[get's out meter]]...it's now 3 hours later and I'm now at a pretty normal for me 111. That's on no food, I haven't eaten since the walk.

Should I possibly expirement with having a little protein either right before or right after? Which would make more sense?

[Daryl]

Well, it might not hurt to experiment with both, but why do you think it would help?

Do you take insulin? Dr B talks about adding a little fast acting insulin to cover spikes from exercise. He also mentions prolonged exercise being more effective than shorter term. Of course, what constitutes "prolonged"? :)

This is one of the toughest areas of diabetes control, it doesn't seem like exercise affects anyone the same.

[dancinbr]

Well exercise for me generally brings it down.

However, this is after I get up.

I have a BFG that sometimes is up.

I eat breakfast, take my meds, wait a couple of hours. Then I see that my BG has gone down. Then I take a walk and my BG does go down further.

It is a well known fact that you will see BG rise when you have not had food for some time. You must eat to get it to come down. Now, I am speaking from a T2 prospective.

Go back and read up more on Dr. Bernsteins' Diabetic solution book. I know I need to sit down again and reread it now that I have been at this for a few months.

[MizKitty]

Well, it might not hurt to experiment with both, but why do you think it would help?


I'm not sure what I'm trying to get at. Trying to figure out the science of it all I guess. Tying in what Dancinbr said, about BG going up if you wait too long to eat...the reason for that is because the liver has sensed BG dropping too low so releases glucose to compensate...
I have to eat something very shortly after waking up or this happens to me, my BG will climb till I eat something.
So I thought spiking with exercise could be a similar problem... the liver sensing the depletion of inner muscular energy stores and releasing glucose to replenish them.
Wondering if eating will stop that then too?
What science is at work when eating something stops your BG from rising?

He also mentions prolonged exercise being more effective than shorter term. Of course, what constitutes "prolonged"?

I did some more research on this, and you are correct, Bernstein says you need to keep exercising if this happens. Because during exercise you begin to accept insulin and to burn up carbs. As you get lower your liver begins releasing glucose into the blood. To have your sugars drop you have to continue exercising.


SIGH.... are you sure I cant' fix it with more eating, rather than more exercise?
lol

He also says that over time, your liver will get better at providing the proper amount of glucose as your body adjusts to lower scores.

It's a miracle I'm getting myself to do what amount of exercise I'm doing. I'm doing what I can do for right now. I guess I'll just have to hope my liver catches on sooner rather than later.

[dancinbr]

I'm not sure what I'm trying to get at. Trying to figure out the science of it all I guess. Tying in what Dancinbr said, about BG going up if you wait too long to eat...the reason for that is because the liver has sensed BG dropping too low so releases glucose to compensate...
I have to eat something very shortly after waking up or this happens to me, my BG will climb till I eat something.
So I thought spiking with exercise could be a similar problem... the liver sensing the depletion of inner muscular energy stores and releasing glucose to replenish them.
Wondering if eating will stop that then too?
What science is at work when eating something stops your BG from rising?



I did some more research on this, and you are correct, Bernstein says you need to keep exercising if this happens. Because during exercise you begin to accept insulin and to burn up carbs. As you get lower your liver begins releasing glucose into the blood. To have your sugars drop you have to continue exercising.


SIGH.... are you sure I cant' fix it with more eating, rather than more exercise?
lol

He also says that over time, your liver will get better at providing the proper amount of glucose as your body adjusts to lower scores.

It's a miracle I'm getting myself to do what amount of exercise I'm doing. I'm doing what I can do for right now. I guess I'll just have to hope my liver catches on sooner rather than later.

The whole body mechanism and glucose is quite complex. We learn from each other and that is terrific. I know I am learning more each day as I listen to experiences shared here.

Now to do what I promised myself to do. Take Bernsteins' book off my shelf and read it again, slowly with a whole lot more understanding

[Cajunboy47]

My walking time is morning, an hour after breakfast. My breakfast is always low to no carbs. I take my supplements (vit, min, acids, herbs) 30 mintues prior to breakfast. If I check FBG and post walking BG, I usually have a drop of 10 to 15 points after walking. FBG is usually between 95 to 115. On some occasions, I do have a rise and it is always surprising to see the rise. After much thought, I think it has something to do with the way I ate the night before as to the time and amount of carbs. Just my simple thinking, but I think my evening meal should be very low carb so I'm in a fat burning mode by morning, therefore with a low/no carb breakfast, after exercise I'm still in a fat burning mode, therefore liver is not converting protein to glucose for energy, thus, no spike in BG reading after exercise... Anyone with different thoughts, please correct me.... I'm just reading this thread for the first time and find it interesting how we're seeing and noticing impact in BG from diet and exercise.... One thing I am sure we all realize is timing of everything is everything.... :)

[Daryl]

SIGH.... are you sure I cant' fix it with more eating, rather than more exercise?
lol



:lol: Well, I have my doubts, but I've been wrong before :)

[lfchanin]

I'm not sure what I'm trying to get at. Trying to figure out the science of it all I guess. Tying in what Dancinbr said, about BG going up if you wait too long to eat...the reason for that is because the liver has sensed BG dropping too low so releases glucose to compensate...
I have to eat something very shortly after waking up or this happens to me, my BG will climb till I eat something.
So I thought spiking with exercise could be a similar problem... the liver sensing the depletion of inner muscular energy stores and releasing glucose to replenish them.
Wondering if eating will stop that then too?
What science is at work when eating something stops your BG from rising?



I did some more research on this, and you are correct, Bernstein says you need to keep exercising if this happens. Because during exercise you begin to accept insulin and to burn up carbs. As you get lower your liver begins releasing glucose into the blood. To have your sugars drop you have to continue exercising.


SIGH.... are you sure I cant' fix it with more eating, rather than more exercise?
lol

He also says that over time, your liver will get better at providing the proper amount of glucose as your body adjusts to lower scores.

It's a miracle I'm getting myself to do what amount of exercise I'm doing. I'm doing what I can do for right now. I guess I'll just have to hope my liver catches on sooner rather than later.

Hi Kitty,

I think that it's quite true that as glucose in the blood becomes depleated that the liver can over-compensate and cause elevated blood glucose levels, which in turn stimulates an insulin response in people that have one. However, there is a lot of published science on the subject of exercise, and unfortunately it does not appear to be as simple as just that single explanation.

According to the study linked below, (much of which is over my head) insulin has little or no effect during very intense exercise. It gets quite complicated, and of course not all the scientists/experts agree on all points. That being said, as a layman let me attempt to interpret the portions of the study that I think I understand.

Intense Exercise Has Unique Effects on Both Insulin Release and Its Roles in Glucoregulation (http://diabetes.diabetesjournals.org/cgi/reprint/51/suppl_1/S271?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=exercise+%22type+II%22+dehydration&searchid=1&FIRSTINDEX=20&resourcetype=HWCIT)

We've all been taught to think of insulin response as being the primary hormone in regulating our blood glucose levels, and in most of our daily activities, including low and moderate exercise, it is. However, the study shows that both fit non-diabetic and fit diabetic subjects will suffer from hyperglycemia after just 20 minutes of very intense exercise. Even with subjects with normal metabolisms it still takes them 40 - 60 minutes to restore their normal pre-exercise blood glucose levels, and in doing so first hyperinsulinemic conditions are induced.

The study also tested type I diabetics. Not surprisingly, lacking an insulin response, this induced a sustained hyperglycemic condition that had to be reversed with increased dosages of fast acting insulin. Although the study did not test type II diabetics, since their insulin response is somewhere between a non-diabetic subjects and a type I diabetic subjects, it is not unreasonable for us to conclude that they would also become hyperglycemic and that it would take longer than 60 minutes to restore their pre-exercise blood glucose levels.

During these bouts of intense exercise, despite the increased production of plasma glucose, insulin production remains uneffected. During these intervals, other hormones, not insulin, are mediating the body's metabolism. It is only after several minutes into recovery does insulin regain it's control.

Now with regard to Dr. Bernstein's advice to keep exercising to reduce the elevated blood glucose, if this study is correct, then the doctor's advice will only work if the exercise is not truely in a sustained anaerobic state. The body requires adequate amounts of insulin to transport glucose from the blood into body tissues, and insulin apparently is only produced in an aerobic state. The measurements in the study clearly show that even in non-diabetic subjects insulin is simply not being released during intense excercise despite the existing hyperglycemic conditions.

So to me the take home message is that sustained (lasting several minutes) true anaerobic exercise (>80% VO2max) should not be pursued on a regular basis by diabetics because it WILL induce unneccessary blood glucose spikes.

I don't think Dr. Bernstein's advice is harmful for sustained vigorous aerobic exercises, even if they occasionally peak into the anaerobic range for a few minutes. However, there appears to be other studies that present a better way for diabetics to exercise vigorously with less loss of glucose control. (By the way, I know Dr. Bernstein advocates anaerobic exercise, but I believe that if someone can sustain these intense levels of exercise for more than 20 minutes then, regardless of what their so-called theoretical target heart rate, they can't actually be in anaerobic mode. What has happened is that through conditioning a person has extended his/her actual target heart rate beyond their age group.)

Enhancement of fat metabolism by repeated bouts of moderate endurance exercise (http://jap.physiology.org/cgi/content/short/01302.2006v1)

Here's the abstract:

This study compared the fat metabolism between "a single bout of prolonged exercise" and "repeated bouts of exercise" of equivalent exercise intensity and total exercise duration. Seven men performed three trials: 1) a single bout of 60 min exercise (Single); 2) two bouts of 30-min exercise, separated by a 20-min rest between exercise bouts (Repeated); and 3) rest. Each exercise was performed with a cycle ergometer at 60% of maximal oxygen uptake. In the Single and Repeated trials, serum glycerol, growth hormone, plasma epinephrine and norepinephrine concentrations increased significantly (P < 0.05) during the first 30-min exercise bout. In the Repeated trial, serum free fatty acids (FFA), acetoacetate and 3-hydroxybutyrate concentrations showed rapid increases (P < 0.05) during a subsequent 20-min rest period. During the second 30-min exercise bout, FFA and epinephrine responses were significantly greater in the Repeated trial than in the Single trial (P < 0.05). Moreover, the Repeated trial showed significantly lower values of insulin and glucose than in the Single trial. During the 60-min recovery period after the exercise, FFA, glycerol, and 3-hydroxybutyrate concentrations were significantly higher in the Repeated trial than in the Single trial (P < 0.05). The relative contribution of fat oxidation to the energy expenditure showed significantly higher values (P < 0.05) in the Repeated trial than in the Single trial during the recovery period. These results indicate that repeated bouts of exercise cause enhanced fat metabolism compared with a single bout of prolonged exercise of equivalent total exercise duration.


Here's a layman's discussion of the above study.

Repeated sessions of exercise burn more fat than a single, long session (http://www.physorg.com/news103964322.html)

You'll notice the author of the article puts emphasis on the improved fat loss of resting between workout sessions, versus one long continuous workout. However, as I mentioned, in addition this approach should be of particular interest to diabetics who wish to exercise vigorously with minimal elevation of blood glucose levels.

I had occasion to try this method out very recently. In the past after a strenuous weight lifting workout I found my blood glucose spiking up to 190. Earlier this week I had too much carbs for breakfast and found my blood glucose to be 201. Here's my log for the day:

10:26 AM fasting BG 133.
11:00 AM Brunch oatmeal, blueberries, banana.
12:04 PM BG 201.
12:37 PM BG 160.
1:09 PM BG 96 following 6 minute 00 second mile warm-up run on elliptical & 26 minutes of weights.
1:28 PM BG 92 following 19 minutes of rest.
1:45 PM BG 94 following 17 minutes of weights. (Finished 1st set total 43 minutes)
2:20 PM BG 102 following 35 minutes of weights (Finished 2nd set 35 minutes)
2:39 PM BG 99 following 19 minutes of rest.
3:37 PM BG 99 following 43 minutes of weights (3rd set) plus resting during 15 minute drive home.
4:16 PM BG 108.
5:50 PM BG 88.
7:03 PM BG 92.
7:30 PM dinner salmon, brocoli, string beans.
Metformin XR 500 mg.
8:39 PM BG 97.
9:37 PM BG 94.

[Please pardon a digression]
To put the above readings in perspective, before I discuss them perhaps I should provide a bit of background regarding my personal situation. I'm a 60 year old, thin type II diabetic recovering from colon cancer. I'm 6'0" tall and last year my weight dropped down to 144 pounds during treatment. During recovery I had no trouble regaining body weight, but unfortunately I found I had lost a lot of muscle weight and replaced it with fat. So at 157 pounds I was out of shape, skinny and flabby. I joined a gym run by a local hospital and starting researching bodybuilding, nutrition and exercise. For 5 months I've been weight training, I tripled my caloric intake and recently I started a low carb diet. I haven't had much success in increasing my body weight, only a two pound increase, but my Body Fat % has decreased from 17.2% to 12.3%, and my abdominals are just beginning to show.

Anyway the whole point of this is that I've started to more carefully monitor my blood glucose levels and I find 1) my control isn't all that great, and 2)despite the strenuous exercise, it's a lot harder to maintain glucose control while I'm taking in 2,700 calories daily. Hence all the daily records.
[End of digression]

So getting back to my blood glucose readings, I got up a late with a not to good fasting reading. Then I had a high carbo breakfast (not realizing at the time that oatmeal and a banana had so much carbos), and an hour later my blood glucose is at 201. Not good. It was my weight lifting day, so I drive to the gym, but this time I take my monitor with me. By the time I'm ready to start exercising my blood glucose is down to 160. So I start my warm-up run on the elliptical. With all that sugar I break a personal record running a mile in 6 minutes flat. Most of the run was aerobic, toward the end for the last five minutes or so I was close to my maximum heart rate for my age (160 BPM), so maybe I'm in the anaerobic mode for a few minutes.

I start my weight routine. After working out for roughly 30 minutes I rest for about 20 minutes, workout for 30+min, rest 20 min., etc. I do three complete sets on 13 machines for a total lift of more than 64,800 pounds, a 25% increase over my previous best day.

All during my workout my GB stays between 92 and 102, when normally if I had attempted a single strenous workout it would have spiked at about 190.

Following the workout the reading stayed between 88 and 108 for the remainder of the evening.

In summary resting between workout sets managed my blood sugar spikes and helped increase my total weight lifted. Of course having started the workout with an usually high amount of blood sugar no doubt contributed to the good performance, but regardless the improved control, both during the workout and after, is a big plus and I plan on making this a part of my normal routine.

I hope this long-winded post (my first) helps you in pursuing vigorous exercise without jeopardizing glucose control.

Larry

[MizKitty]

You seem to have me confused with someone who wants to exercise.

LOL!

Thanks for that good info. It makes sense. So the take-away message I'm getting, to avoid more episodes like the day i was doing strenuous yardwork and tested and found my BG was way up to 176, a number I hadn't seen in months, I should work/rest/work/rest. Testing frequently will let me know how long those work periods can be. And this actually does just as good a job of burning fat as pushing on non-stop.

Welcome to the board, and congratulations on your recovery and achievements!

[NorthPeace]

If I take a half hour walk after dinner I seem to get good glucose levels the next morning. 83 the other morning, though I am averaging 92 - 94 without the walk. I will walk tonight to test again.

[v-effect]

Hi all,
An earlier poster claimed that "Type 1"s seem to have an easier time with am exercise. This is absolutely not true! I wake up- am I too low / too high to exercise? I lower my basal rate, trying to predict when I'll be able to exercise, and for how long. Whoops- exercise delayed and basal rate too low and now running high! Oh and low carbing too- not enough insulin floating around to support the exercise, I better counterintuitively bolus before am exercise.
I could go on. Not a big deal, but I'm always wary of sentences that begin with "Type 1s have an easier fill in the blank" Nothing is easier.
V.

[lfchanin]

Thanks for that good info. It makes sense. So the take-away message I'm getting, to avoid more episodes like the day i was doing strenuous yardwork and tested and found my BG was way up to 176, a number I hadn't seen in months, I should work/rest/work/rest. Testing frequently will let me know how long those work periods can be. And this actually does just as good a job of burning fat as pushing on non-stop.

Welcome to the board, and congratulations on your recovery and achievements!

Hi Kitty,

Thanks for the welcome. :wave:

Yes, by alternating strenuous workouts with rests we can do more exercise, minimize blood glucose spikes and, according to the study, it actually increases the rate of fat burning versus a single non-stop workout.

By the way, if you are doing strenous yardwork in a warm climate, dehydration can also be contributing to your high blood glucose reading.


You seem to have me confused with someone who wants to exercise.

LOL!

Sorry for the long-winded treatise, :o but you did say you were trying to "figure out the science of it all". ;)

Larry

[pauleo]

lfchanin - i just found this, then realised it's the same study you posted

-----------------
http://health.yahoo.com/news/177955

"To investigate, the researchers had seven healthy men complete one long workout and then two shorter workouts [with a 20 minute rest in between] on exercise bicycles.
...
The men showed lower levels of insulin and blood glucose during the second phase of the two-part exercise session."
------------------

i might try it, intense aerobic-alternating-with-anaerobic exercise (15-20 mins total) normally gives me a 40-point increase in BG, which exceeds what i get from any (low-carb) meal and it also takes a while to drop afterwards. i would be happy if a rest and second exercise period could bring down that increase more quickly.

[lfchanin]

lfchanin - i just found this, then realised it's the same study you posted

-----------------
http://health.yahoo.com/news/177955

"To investigate, the researchers had seven healthy men complete one long workout and then two shorter workouts [with a 20 minute rest in between] on exercise bicycles.
...
The men showed lower levels of insulin and blood glucose during the second phase of the two-part exercise session."
------------------

i might try it, intense aerobic-alternating-with-anaerobic exercise (15-20 mins total) normally gives me a 40-point increase in BG, which exceeds what i get from any (low-carb) meal and it also takes a while to drop afterwards. i would be happy if a rest and second exercise period could bring down that increase more quickly.

Hi Pauleo,

Yes, based on the research I quoted earlier, and our own personaly experiences, sustained (15-20 minutes) anaerobic exercise will induce hyperglycemia, and that's true for fit non-diabetics as well as diabetics. To get to 15 to 20 total minutes, the anaerobic exercise bouts in these studies are usually achieved by some sort of high intenisty interval training, such as sprinting alternating with a slower "resting" pace. However, the rest period is short enough that the heart rate doesn't drop into the aerobic range, for very long if at all.

I believe that occasional, short anaerobic exercise can benefit a diabetic. An example might be a mile run for a fit diabetic. Obviously this depends on the conditioning of the individual. I recently ran a mile in 6 minutes flat. This started out at a moderate pace in the aerobic range and toward the end, I'm guessing the last minute, I was running at a faster pace at maximum heart rate for my age.

However, I don't think that repeatedly exercising at true anaerobic intensities for sustained periods of time (15 - 20 minutes) will lead to better blood glucose control, because we will find ourselves continually requiring several additional hours to recover our pre-exercise blood glucose levels.

With regard to my remark about "true" anaerobic intensities, it should be noted that generally most of us use the simple formula:

Maximum Heart Rate (MHR) = 220 - age

So in my case my MHR is 160. However, that is only valid if I have average fitness. If I am more fit than the average 60 year old then my MHR will be higher, and conversely if I am less fit, it should be lower.

When Dr. Berstein suggests continuing exercise to reduce exercise induced higher blood glucose levels, it certainly can't be at anerobic intensity levels. There are two reason for this. 1) Only world class athletes can sustain true anaerobic exercise for more than 20 minutes, 2) as long as an individual is in a true anaerobic state, insulin response is shut off and blood sugars continue to rise. The fact that Dr. Berstein can continue to exercise at > 80% of 152 beats per minute for sustain durations, doesn't mean he is in a true anaerobic state. It just means that he is much more fit than the average 68 year old. His real maximum heart rate is probably greater than 160 and he is undoubtedly exercising in the aerobic range for him where there is an insulin response.

Larry

[RobLL]

Has anybody used fast acting insulin to control BG highs before weightlifting. In just the past couple months I have gone from about 115 to 130 after either weight lifting or HIIT

[pauleo]

Larry,

Thanks for your thoughts. About me, I am trying a few types of interval training at the moment, with variations on how far I let my heart-rate drop in the aerobic period. Typically I do two of the following three things as a warm-up before weights -

Firstly 10 mins on a treadmill, starting on a level gradient, but increasing to gradient between 7% and 10% for 40 seconds at the 3, 5, 7, 9 minute points. My heart rate is 150-160 at high gradient and drops to 130s for level gradient. More importantly I guess, it feels like a good heart rate, in that I feel like I'm tiring at the end of the 40 second high-gradient stages.

Secondly is 500m sprints on a rowing machine. I start with a pace of about 2.05, then 2.00, then 1.55, then whatever I can manage below 1.55 (not much). In between each sprint, I rest completely and let my heart rate drop from 140-150 to about 100. I throw in an occasional 30 second all-out sprint at a pace of about 1.35.

Finally on spin bicycle, I do ten mins, in 20 second units of medium speed (pedal rotations), high speed, and then zero effort (zero means spinning the wheels but no resistance), and I vary the resistance at each new one minute set, including doing high resistance where it's hard to move the pedals. Heart rate is 130-140s and drops to 120s. I don't seem to hit 140-150s on a spin cycle unless I really work at it for some reason.

I just made these routines up, but I was partly inspired by Dr Bernstein's book. Also Art de Vany has a web-page, if you do not know it - if I summed up my understanding of his philosophy, it would be that changing heart rate during exercise is hugely more important than steady-state heart rate,
For that reason, I'm not wanting to do anaerobic exercise for 20 mins, amy more than wanting to do aerobic exercise for 20 mins, I am concentrating on variation in heart rate.

One thing I did not experiment much with is interspersing weights with sprints - currently all my 'moving' exercise is at the start, followed by weights.

I wish I understood a bit more abut the BG increase during exercise. I can easily believe that the overall effect of such exercise is good. But I would like to be able to use exercise to control whatever glucose store is being released during exercise, I feel in the dark about the actual process that's happening,

Paul.

[lfchanin]

Has anybody used fast acting insulin to control BG highs before weightlifting. In just the past couple months I have gone from about 115 to 130 after either weight lifting or HIIT

Hi Rob,

The first study I referenced earlier states that for intense exercise:

Hyperglycemia occurs and persists in insulin-infused diabetic subjects in the postexercise period, indicating the need for additional exogenous insulin during this period. Thus, those patients who become hyperglycemic after intense exercise may need an injection of ultra-rapidly acting insulin at a time determined empirically.


Not the most helpful response to say "try experimenting". I think they are reluctant to suggest taking insulin before a workout due to the increased likihood of having a hypoglycemic incident.

Frankly I'm surprised that your blood glucose didn't go a lot higher with High Intensity Interval Training. I recommend that you discontinue HIIT. Do you have any insulin response whatsoever? If so, it might be helpful to rest between weight lifting sets.

Larry

[lfchanin]

Larry,

Thanks for your thoughts. About me, I am trying a few types of interval training at the moment, with variations on how far I let my heart-rate drop in the aerobic period. Typically I do two of the following three things as a warm-up before weights -

Firstly 10 mins on a treadmill, starting on a level gradient, but increasing to gradient between 7% and 10% for 40 seconds at the 3, 5, 7, 9 minute points. My heart rate is 150-160 at high gradient and drops to 130s for level gradient. More importantly I guess, it feels like a good heart rate, in that I feel like I'm tiring at the end of the 40 second high-gradient stages.

Secondly is 500m sprints on a rowing machine. I start with a pace of about 2.05, then 2.00, then 1.55, then whatever I can manage below 1.55 (not much). In between each sprint, I rest completely and let my heart rate drop from 140-150 to about 100. I throw in an occasional 30 second all-out sprint at a pace of about 1.35.

Finally on spin bicycle, I do ten mins, in 20 second units of medium speed (pedal rotations), high speed, and then zero effort (zero means spinning the wheels but no resistance), and I vary the resistance at each new one minute set, including doing high resistance where it's hard to move the pedals. Heart rate is 130-140s and drops to 120s. I don't seem to hit 140-150s on a spin cycle unless I really work at it for some reason.

Hi Paul,

You're welcome.

I would suggest that you do what I did, take your blood glucose monitor with you to the gym and take readings at key intervals to see what is happening, especially after those 150 - 160 stints.


I just made these routines up, but I was partly inspired by Dr Bernstein's book. Also Art de Vany has a web-page, if you do not know it - if I summed up my understanding of his philosophy, it would be that changing heart rate during exercise is hugely more important than steady-state heart rate,
For that reason, I'm not wanting to do anaerobic exercise for 20 mins, amy more than wanting to do aerobic exercise for 20 mins, I am concentrating on variation in heart rate.

I haven't read any science on changing heart rate, but many bodybuilders recommend varying the routine on a regular basis. From a diabetic standpoint I don't think extended aerobic exercise would hurt glucose control unless it exceeded about two hours. As I mentioned I do think 20 minutes of true anarobic exercise would be harmful to glucose control.


One thing I did not experiment much with is interspersing weights with sprints - currently all my 'moving' exercise is at the start, followed by weights.

I think this depends on your goals. Since I'm thin, and trying to gain lean body weight, I think it would be counter-productive if I did a lot of cardio on my weight training days, other than as a warm-up. However, I'm trying to do get into a routine whereby I do cardio on my "off" days.


I wish I understood a bit more abut the BG increase during exercise. I can easily believe that the overall effect of such exercise is good. But I would like to be able to use exercise to control whatever glucose store is being released during exercise, I feel in the dark about the actual process that's happening,

Paul.

Here's my layman's interpretation.

Regardless of whether you are non-diabetic or diabetic, if you do any kind of low intensity exercise, where the heart rate is averaging an aerobic rate, then your blood glucose will gradually decrease until some point where the liver kicks in and throws glucose back into the blood stream. So say you're running at an easy pace, your blood glucose will decrease as circulating insulin pulls glucose out of your plasma while glucogen is pulled out of your muscles. Then, at some point determined by the amount and intensity of the exercise, when a good deal of muscular glucogen is depleted, your liver kicks in, over-compensates, and converts its glucogen back into sugar causing a spike.

Now if you are exercising in an anaerobic state, your insulin response is turned off (this is true of non-diabetics and diabetics), and as glucogen in your muscle becomes depleted the liver starts dumping glucose, but there's no insulin response to moderate the increase so the glucose keeps rising. It only take 15 to 20 minutes of anaerobic exercise to cause a very significant spike in even fit non-diabetic subjects. (When all the available glucose is depleted exhaustion sets in, exercise ceases, and you are forced into an aerobic state.)

So in a way non-diabetics, and type II diabetics, become type I diabetics during the period of intense exercise, because they don't have an insulin response. It is only during recovery, when insulin response is resumed, do the distinctions between normal, type II and type I reappear. So after intense exercise the non-diabetics require 40 - 60 minutes to regain their pre-exercise blood glucose levels, the type II's require more than an hour, and the type I's can't regain control without additional dosages of insulin.

Any kind of exercise improves insulin sensitivity AFTER the exercise. There have been studies showing that for weight training this improved sensitivity lasts longer than typical low to medium "cardio" exercise. By resting between weight lifting sets, we are able to do more weight lifting exercise without spiking our blood sugars. So doing weight lifting is my priority in trying to improve blood glucose control. Since the body needs to rest from weight lifting, I think less strenous "cardio" exercise on the off days makes sense to keep the metabolism and insulin sensitivity up, albeit at a lower level that the weight training days.

Larry

[pauleo]

Thanks again, that's all food for thought. Just have to figure out what to do with that 20 minute rest period at the gym now!

[lfchanin]

Thanks again, that's all food for thought. Just have to figure out what to do with that 20 minute rest period at the gym now!

Hi Paul,

Drink lots of water. ;)

Larry

[RobLL]

Ifchanin - up until a few weeks ago I controlled BGs soley by low, almost no carbing. I now am taking Metformin, just had dose upped to 1000 mg. I think I need to be on insulin. I had some phase one response as of last year, but generally my BGs have gone down hill in the last year. I just started metering, against Dr's wishes the end of December.

[lfchanin]

Ifchanin - up until a few weeks ago I controlled BGs soley by low, almost no carbing. I now am taking Metformin, just had dose upped to 1000 mg. I think I need to be on insulin. I had some phase one response as of last year, but generally my BGs have gone down hill in the last year. I just started metering, against Dr's wishes the end of December.

Hi Rob,

Since you have an insulin response I definately think you should do everything you can to avoid spiking your blood glucose during exercise. So I think you should seriously considering avoiding HIIT and rest between weight lifting sets. Take your glucose meter with you to your workouts and monitor how the exercise is effecting your control and adjust accordingly.

I haven't closely followed the subject of type II diabetics taking insulin, but I imagine that it is highly controversial. For Dr. Berstein maintaining tight control with the help of insulin is a no-brainer, since he must take insulin to live. For type II diabetics I don't think its all that straight-forward a decision. He states that it helps the pancreas rest, but others suggest that it leads to increased insulin resistance. I certainly haven't ruled out taking insulin at some point if I need to, but I haven't figured out what my average fasting blood glucose levels would have to be to induce me to go that route.

After my bout with cancer I've become more conciencious about my health and I've just recently taken steps to tighten my glucose control. So I've started exercising, drastically reduced my carbs, and increased my Metformin dose to one 500 mg extended release with each meal (it was 1000 mg in the morning). My control is improving, but its difficult because I am trying to gain weight and my caloric intake is high.

When you stay you started metering against Dr's wishes, are you saying that your doctor disapproved of you monitoring your daily blood glucose? If so, it sounds like you need to look for an other doctor.

Good luck.

Larry

[pauleo]

an argument for staying properly hydrated during exercise. written by a person with type I diabetes but presumably it applies to anyone.

----------------------
http://sarahdiabeticmusings.blogspot.com/2006/09/controlling-post-exercise-highs.html
The second of these is ketones. Your body releases ketones when you are burning fat/muscle rather than available carbs in your bloodstream. The possibility of this happening was actually brought to my attention by Scott over at Scott’s Diabetes Journal, and I was so intrigued by it I had to test it out on myself! Sure enough, after an especially long and hard workout, I had quite a bit of ketones! I’m actually amazed that this isn’t something my doctor hasn’t brought up as it sure drives home what I try to enforce anyhow when working out: DRINK MORE WATER! The presence of ketones will make you resistant to insulin, helping to feed that high you may already be heading for because of unabsorbed carbs! Hopefully this will help to reduce those ketones in the blood stream. Do not let yourself get dehydrated during a workout; the highs are rough to recover from!

[lfchanin]

an argument for staying properly hydrated during exercise. written by a person with type I diabetes but presumably it applies to anyone.

----------------------
http://sarahdiabeticmusings.blogspot.com/2006/09/controlling-post-exercise-highs.html
The second of these is ketones. Your body releases ketones when you are burning fat/muscle rather than available carbs in your bloodstream. The possibility of this happening was actually brought to my attention by Scott over at Scott’s Diabetes Journal, and I was so intrigued by it I had to test it out on myself! Sure enough, after an especially long and hard workout, I had quite a bit of ketones! I’m actually amazed that this isn’t something my doctor hasn’t brought up as it sure drives home what I try to enforce anyhow when working out: DRINK MORE WATER! The presence of ketones will make you resistant to insulin, helping to feed that high you may already be heading for because of unabsorbed carbs! Hopefully this will help to reduce those ketones in the blood stream. Do not let yourself get dehydrated during a workout; the highs are rough to recover from!

Hi Paul,

Apparently the subject of ketosis, especially for diabetics, is somewhat controversial.

I'm going to continue to research the subject, but here's an article that's 180 degrees from the opinion that you quoted.

The Insulin-Smart Life Extension Program (http://www.smart-publications.com/life_extension/insulin_smart.php#Ref6)

Here's an excerpt:


Dietary Ketosis Accelerates Results

Some life extension experts are taking the low glycemic approach to an extreme -- with excellent results. Very low carbohydrate diets such as the well-known Atkins diet produce a state of benign dietary ketosis (BDK), which has been found to have an exceptionally rejuvenating effect on the biological terrain. The consumption of about thirty or fewer carbohydrates a day may promote a myriad of advantages, including longevity and weight loss, and the reversal many of the conditions associated with aging. The BDK diet has all the benefits of the low glycemic diet, and also offsets cravings, discourages yeast infections (candida), balances mood disorders, and reverses heart disease. (4)

Being in ketosis is the quickest, safest, and healthiest way to control hyperinsulinism and burn off excess body fat. The key to its effectiveness is a shift in the body's fuel supply. Several studies have shown that as carbohydrate intake is sufficiently lowered, the metabolism shifts from a glucose-based energy supply to one that utilizes the body's own fat. This mechanism, called lipolysis, occurs during sleep, fasting, and when insulin levels are low. (6)

After two days without carbohydrates, the absence of glucose induces lower insulin levels which cause the desirable metabolic shift. As lipolysis begins, the body enters into ketosis. First, fats (triglycerides) are split into glycerol and free fatty acids. These are then broken down into simple compounds called ketone bodies, which in turn are used as fuel by the brain and muscle.

The degree of fat utilization can be inferred by measuring blood or urine levels of ketones. The level of ketones in the urine can be measured at home with Ketostix®, which are available over-the-counter (OTC) at any pharmacy. A slight state of ketosis is reflected by a light peach color. The more ketones that are released, the deeper the state of ketosis, and the darker the shade of the stick. Purple, which reflects the deepest state of ketosis, also indicates that maximum fat loss is occurring. However since insufficient water intake can cause concentrated urine (and the false impression of elevated ketones), it is important to drink plenty of water when following this diet.

The basis of the BDK diet is proteins, fats and very low carbohydrate-containing foods, with meals consisting of eggs, fish, fowl, meat, cheese, dairy cream, non-starchy vegetables, herbs, and spices. Breakfast might consist of an egg and cheese omelette with a side of bacon; lunch, a tuna salad with greens and creamy dressing; and for dinner, steak and lobster drenched with butter and a side of sauteed broccoli. It is surprisingly simple to follow, and is satisfying as well. (4)


The above article seems to be more in line with many, perhaps most, of the other Low-Carber forum members.

Larry

[RobLL]

Hi Larry - I started two or three days ago with my higher Metformin dose. It was nice to see my morning and after breakfast reading at 92, hasn't been there for a couple months. So I took my meter to the gym. Here is the workout and the results. Incidentally the workout is Escalating Density Training, two exercises alternately for 15 minutes, the goal being to get more done each time.

************
Starting BGs 92
Warm up with some Mag Mob easy, and pulldowns at 140,160,180 lbs

Superset chinup and pushups with feet on a bench. Total time was 15 minutes. Rests started at 30 seconds. I narrowed my grip this time from outer shoulder to inner shoulder, and started with:

4 sets of 3 chinups and 6 pushups
7 sets of 2 chinups and 6 pushups
2 sets of 1 chinup and 3 pushups. ran out of time.

Total pushups in 15 minutes: 28, four more than previous record. Yeh!
BGs 117

My back was a little sore, so I passed on my second superset of squats and deadlifts, and did HIIT, running. I only did 3/4 a mile in running mode, and ran a little slow given achy back.

3 laps of trot/walk to warm up
10 1/2 sets of 1 lap fast, 1 lap walk
2 lap cool off
BGs 120

(14 laps is a mile)

Sauna, to Library for a while, home and 1 1/2 hour later

BGs at 118

Interesting. Not so high so as to scare me, but will see how long they take to get under a hundred.

[Cajunboy47]

Rob,

I notice your BG is still going up after exercise. You took Metformin and it still rises after exercise.

A couple of questions:

1. Are you eating a high protein breakfast?

2. If you didn't exercise, would your BG still rise like that?

[RobLL]

Rob,

I notice your BG is still going up after exercise. You took Metformin and it still rises after exercise.

A couple of questions:

1. Are you eating a high protein breakfast?

2. If you didn't exercise, would your BG still rise like that?

Three eggs, and quite small pork steak, big hunk of raw cabbage

Generally up or down 10 points from whatever FBG was. Always goes up with exercise - light, medium, heavy.

[lfchanin]

Hi Larry - I started two or three days ago with my higher Metformin dose. It was nice to see my morning and after breakfast reading at 92, hasn't been there for a couple months. So I took my meter to the gym. Here is the workout and the results. Incidentally the workout is Escalating Density Training, two exercises alternately for 15 minutes, the goal being to get more done each time.

************
Starting BGs 92
Warm up with some Mag Mob easy, and pulldowns at 140,160,180 lbs

Superset chinup and pushups with feet on a bench. Total time was 15 minutes. Rests started at 30 seconds. I narrowed my grip this time from outer shoulder to inner shoulder, and started with:

4 sets of 3 chinups and 6 pushups
7 sets of 2 chinups and 6 pushups
2 sets of 1 chinup and 3 pushups. ran out of time.

Total pushups in 15 minutes: 28, four more than previous record. Yeh!
BGs 117

My back was a little sore, so I passed on my second superset of squats and deadlifts, and did HIIT, running. I only did 3/4 a mile in running mode, and ran a little slow given achy back.

3 laps of trot/walk to warm up
10 1/2 sets of 1 lap fast, 1 lap walk
2 lap cool off
BGs 120

(14 laps is a mile)

Sauna, to Library for a while, home and 1 1/2 hour later

BGs at 118

Interesting. Not so high so as to scare me, but will see how long they take to get under a hundred.

Hi Rob,

Glad to hear that the Metformin is helping, but if your blood glucose is increasing while exercising it means to improve control you need to rest between sets. I realize that this is counter to your Escalating Density Training rationale, but that training obviously wasn't designed to improve the blood glucose control of diabetics. ;) And, as I mentioned, neither is HIIT.

If you're satisfied with these rises fine, but personally I would modify my routines. As diabetics we have to balance sometimes conflicting objectives. As I mentioned, in my case my desire to gain lean body weight conflicts with my desire for glucose control.

Take care.

Larry

[lfchanin]

In just the past couple months I have gone from about 115 to 130 after either weight lifting or HIIT

Hi Rob,

I believe as your Escalating Density Training and HIIT routines continue to compress more exercise into a given duration, you will find that this trend will, continue despite the Metformin.

As I described earlier, during really intense exercise your insulin response is turned off. So it won't matter much that Metformin has improved your insulin sensitivity if there's little insulin to work on while you're exercising. Only during recovery does the insulin response return and with it the benefits of Metformin. That's why we need to rest to permit the insulin and Metformin to work.

Larry

[Cajunboy47]

Hi Rob,

I just want to touch base on that rising BG during exercise. I had asked you if your numbers go up or down when you don't exercise and when you stated "generally goes up or down", so I assume that was your answer for what happens on the non-exercise mornings.

I don't think 10 points up during exercise is anything to worry in the short term, but long term it may present a problem... I don't do weight training, have no opinion on it other than it isn't for me..:), but I walk a lot and if my BG would go up each time I walk, I would get extremely worried as to why, even if it is just a 10 point rise.

I've heard several folks mention that resting between sets can alleviate the rise. Have you tried resting between sets and if you did, does it make a difference?

[RobLL]

Hi Rob,

I just want to touch base on that rising BG during exercise. I had asked you if your numbers go up or down when you don't exercise and when you stated "generally goes up or down", so I assume that was your answer for what happens on the non-exercise mornings.

I don't think 10 points up during exercise is anything to worry in the short term, but long term it may present a problem... I don't do weight training, have no opinion on it other than it isn't for me..:), but I walk a lot and if my BG would go up each time I walk, I would get extremely worried as to why, even if it is just a 10 point rise.

I've heard several folks mention that resting between sets can alleviate the rise. Have you tried resting between sets and if you did, does it make a difference?

The ten to twenty is days I don't do heavy exercise. Weightlifting and HIIT seem to be good for a 20-30 point jump. I have not experimented with rests between sets, although I intend to.

[RobLL]

Saturday -more rest between sets:
eight sets of stenuous mobility moves
hard swiss ball bridging exercise
4 sets (two each side) of stepups, 10 reps per, 30 lb DB each hand

Medium Intensity Intervals
2 minutes warm up
80% normal max 30 seconds
60% normal max 30 seconds
60 seconds easy pace and tension
Repeated intervals a total of 5 times
2 minutes cool off

BGs were 105 earlier in the afternoon, and 93 when I got home



Sunday, Normal or no rest between sets.
Today I took 200 mg of ALA and 500 Evening Primrose before I did exercise at the gym,
EDT pushups and chinups,
and because my back was a little sore only did 2 sets each deadlift and squats, with 1 minute between sets.

WhenI left home BGs were 102,when I got home my BGs were 100.

So thanks Ifchanin, for the heads up. I think I am finding a couple ways to avoid getting a BG rise.

[lfchanin]

So thanks Ifchanin, for the heads up. I think I am finding a couple ways to avoid getting a BG rise.

Hi Rob,

I'm glad things are working for you.

Live healthy.

Larry

[pauleo]

I've modified my training, not to take 20 minute rests, but to take many short rests in my warm-up. Currently I'm indoor-rowing only for warm-up. I do

500m rowing (approx two minutes).
complete rest till pulse rate about 90

Repeat the above four more times, each time beating the previous 500m time by 1-2 seconds. I then do the same thing all over again, but substitute 30s all-out sprints for the 500m row.

My BG increase is about 10 points or lower. By the way, before I started this new scheme, I recorded my BG before and after 20 minutes of HIIT, and it went up 60 points. Don't know if that was just a bad day or not because I switched to the new style after that.

Larry (or anyone) - I know you are practicing the 20 minute rests, any opinion on multiple short rests versus one longer rest?

[lfchanin]

I've modified my training, not to take 20 minute rests, but to take many short rests in my warm-up. Currently I'm indoor-rowing only for warm-up. I do

500m rowing (approx two minutes).
complete rest till pulse rate about 90

Repeat the above four more times, each time beating the previous 500m time by 1-2 seconds. I then do the same thing all over again, but substitute 30s all-out sprints for the 500m row.

My BG increase is about 10 points or lower. By the way, before I started this new scheme, I recorded my BG before and after 20 minutes of HIIT, and it went up 60 points. Don't know if that was just a bad day or not because I switched to the new style after that.

Larry (or anyone) - I know you are practicing the 20 minute rests, any opinion on multiple short rests versus one longer rest?

Hi Paul,

I think that any sustained (~15 - 20 min) intense (anaerobic) workout will cause a spike in blood glucose that can not be avoided during exercise for the reasons I explained earlier. To moderate those increases we must permit our insulin response to return, and to do that requires a reduction in the level of intensity into the aerobic range. So long as the rest periods are long enough to permit the pulse rate to lower into the aerobic range, and are sufficiently long for the insulin response to reduce the spike, your approach will work. There might be an exception to this if the workout extended into several hours to near exhaustion. When that happens even moderate or low intensity exercise might cause undue stress on the body causing it to breakdown muscle tissue to glucose.

Theoretically if your approach permits you to extend the total length of your workout, at a pulse rate elevated over the resting rate, it might result in superior weight loss and improved control because your metabolism would be increased over a longer duration. I have no idea whether this routine would lead to better performance or an increase in lean body weight over other routines.

From a practical standpoint most people can't spare large amounts of time exercising. If you can its certainly worth a try. Even my one or two rest periods have greatly increased the time I spend in the gym.

Larry

[RobLL]

Ifchanin - you might want to check just a few threads down(Climbing on Mt Rainier), intense sustained exercise can drop blood sugars, admittedly mountain hiking is a little more extreme than a gym. My interest in this experiment was to see how much carbs I could use without raising BGs.

[pauleo]

Larry,

It's clear, and thanks for the explanations throughout the thread. To summarize, anaerobic exercise turns off insulin response at the same time that the liver is releasing glucose into the blood stream. Hence an increase in BG in proportion to the time spent in the anaerobic state. Rest periods, whether a 20 minute rest or multiple short rests between short sprints, allow insulin to turn back on and reduce blood glucose.

(BTW my multiple short-rests were not motivated by a training reason, it's only that there is no good place to rest in my gym for 20 mins or to walk outside.)

That's one key issue - keeping BG down during exercise. Another one is what kind of training best improves insulin sensitivity and why. My short understanding of insulin resistance is that insulin is signaling cells to accept glucose, but too few receptors on cell membranes are acting on the signal. It seems resistance training gets most recommendation for improving insulin sensitivity (my simple guess is that it's creating new muscle cells with lots of insulin receptors ready for more weight training). But Dr Bernstein is keen on sustained anaerobic exercise like elevated treadmill (maybe motivated more for T1 reasons than T2), and aerobic exercise also has good effects. That seems to cover most possible activity, but I haven't read anything about how to mix the different types for best effect. Not sure it's an unknown area or if there is any research there,

Paul.

[lfchanin]

Ifchanin - you might want to check just a few threads down(Climbing on Mt Rainier), intense sustained exercise can drop blood sugars, admittedly mountain hiking is a little more extreme than a gym. My interest in this experiment was to see how much carbs I could use without raising BGs.

Hi Rob,

Very impressive!

However, what I specified by "intense" was specifically anaerobic exercise. As I said during anaerobic exercise we have little if no insulin response, but our liver is still dumping glucose into our blood stream to deal with the exercise energy requirements. So we experience a glucose spike. It is after the exercise, during recovery that insulin response kicks in and reduces the blood glucose. Repeated bouts of anaerobic exercise (or vigorous aerobic exercise for that matter) followed by recovery periods, will quickly result in low blood sugar, particularly as in your case, when there is a large net negative caloric intake for a relatively long duration. In fact, we can reproduce low blood glucose levels even without the intense exercise associated with climbing Mt. Rainier, :D simply by not eating.

Larry

[lfchanin]

Larry,

It's clear, and thanks for the explanations throughout the thread. To summarize, anaerobic exercise turns off insulin response at the same time that the liver is releasing glucose into the blood stream. Hence an increase in BG in proportion to the time spent in the anaerobic state.

Hi Paul,

Yes.


Rest periods, whether a 20 minute rest or multiple short rests between short sprints, allow insulin to turn back on and reduce blood glucose.

Yes, but it is the duration of the rest that is critical. As I said in my earlier posting, the duration of the rest would have to be long enough to permit the insulin response to reduce blood glucose response triggered by the intense exercise. I used 30 minutes of exercise and 20 minutes of rest because it matched the scientific study that I referenced, and coincidentally it takes me about 30 minutes to compete a set of exercises. I only tested this routine once, but it worked fairly well.


That's one key issue - keeping BG down during exercise. Another one is what kind of training best improves insulin sensitivity and why. My short understanding of insulin resistance is that insulin is signaling cells to accept glucose, but too few receptors on cell membranes are acting on the signal. It seems resistance training gets most recommendation for improving insulin sensitivity (my simple guess is that it's creating new muscle cells with lots of insulin receptors ready for more weight training). But Dr Bernstein is keen on sustained anaerobic exercise like elevated treadmill (maybe motivated more for T1 reasons than T2), and aerobic exercise also has good effects. That seems to cover most possible activity, but I haven't read anything about how to mix the different types for best effect. Not sure it's an unknown area or if there is any research there,

Paul.

Yes, most authorities believe that "resistance" training is superior to "aerobic" training. But there is a big difference in doing strenuous weight lifting in which you are repeatedly in the anaerobic mode for maybe a few minutes followed by recovery, versus running for 20 minutes at 80% VO2 max.

Of all the diabetes authorities I regard Dr. Bernstein as the most credible. However, I don't think he's infallable, nor do I consider him an expert on exercise. Furthermore, thet fact that he is a type I diabetic can't help but color his recommendations. He's learned to adjust his insulin dosage to account for sustained anaerobic exercise. I don't have that means of adjustment yet, and I hope to defer it for as long as reasonable. Being able to do HIIT with minimal blood glucose spikes isn't a compelling reason for me to start taking insulin. :D

In addition, as I have mentioned a few times earlier, due to his exceptional conditioning, it is quite likely that his exercising pulse rate, while indicative of an anaerobic mode in the vast majority of 73 year olds, may not in fact be high enough to place him in HIS true anaerobic mode.

As far as mixing the various types of exercise, I haven't seen any studies aimed at type II diabetics either. I think that resistance training should be our primary exercise. Ideally we should vigorously exercise almost every day. However, since our muscles need to rest between workouts it is not advisable to do resistance training daily. Therefore, I think we must settle for aerobic exercises on off days. It will increase our metabolism, but not as much as resistance training. Next we have to consider whether we need to lose weight, gain weight or maintain weight to determine how much aerobic exercise. In my case, I'm trying to gain weigh so long bouts of aerobic exercise would probably be counterproductive. For a person with a lot of extra weight to lose, perhaps more protracted aerobic exercise might be better.

Larry

[eddiemcm]

I do moderately intense aerobic shadowboxing for 3 minutes about an hour after a meal.It will lower my glucose levet 25-40 points maybe 70 percent of the time.It has no effect
for maybe 30 percent of the time.10 minutes of power
weightlifting in the evening raises my glucose slightly(maybe
10 points) but it subsides after about an hour.That's the
way it works with me these days.
Cheers
Eddie

[lfchanin]

I do moderately intense aerobic shadowboxing for 3 minutes about an hour after a meal.It will lower my glucose levet 25-40 points maybe 70 percent of the time.It has no effect
for maybe 30 percent of the time.10 minutes of power
weightlifting in the evening raises my glucose slightly(maybe
10 points) but it subsides after about an hour.That's the
way it works with me these days.
Cheers
Eddie

Hi Eddie,

Just three minutes of exercise resulting in a 25 - 40 point decrease certainly is well worth the effort. I think I'll try to get in the habit of doing some sort of exercise after eating.

Obviously a 10 point increase shouldn't be a cause of concern, unless one's pre-exercise blood glucose levels were already high. This discussion of resting between exercises is really aimed at avoiding exercise induced increases that simulate a large, high carbohydrate meal.

Larry

[pauleo]

I do moderately intense aerobic shadowboxing for 3 minutes about an hour after a meal.It will lower my glucose levet 25-40 points maybe 70 percent of the time.It has no effect
for maybe 30 percent of the time.10 minutes of power
weightlifting in the evening raises my glucose slightly(maybe
10 points) but it subsides after about an hour.That's the
way it works with me these days.
Cheers
Eddie

Any thoughts why it sometimes works and sometimes not i.e. is there any identifiable factor?

Something this discussion made me think about - the standard medical blood glucose tests are mostly connected with food (or lack of it) - fasting BG, GTT, two-hour post-prandial BG. (HbA1C is different but cannot be done by the individual). But maybe there are also some useful tests that could be done on exercise-induced change in BG. When I read your mail, I was already wondering whether I could define a standard repeatable exercise for myself, and measure my BG before and after the exercise to get the rise or fall, then check if it was a stable sort of measurement so that I could use it to look for improvement over time. But it seems like your experience at least shows that exercise results vary from day to day.

[RobLL]

Any thoughts why it sometimes works and sometimes not i.e. is there any identifiable factor?

Something this discussion made me think about - the standard medical blood glucose tests are mostly connected with food (or lack of it) - fasting BG, GTT, two-hour post-prandial BG. (HbA1C is different but cannot be done by the individual). But maybe there are also some useful tests that could be done on exercise-induced change in BG. When I read your mail, I was already wondering whether I could define a standard repeatable exercise for myself, and measure my BG before and after the exercise to get the rise or fall, then check if it was a stable sort of measurement so that I could use it to look for improvement over time. But it seems like your experience at least shows that exercise results vary from day to day.

One of the things that slows down this forum is a lack of regular contributors. Do we perhaps have the critical mass to do something like pauleo suggests. The bunch of us could start setting up some parameters and do some testing. To some extent it would be anecdotal, but I think possibly significant anecdotal. Rob

[lfchanin]

Any thoughts why it sometimes works and sometimes not i.e. is there any identifiable factor?

Something this discussion made me think about - the standard medical blood glucose tests are mostly connected with food (or lack of it) - fasting BG, GTT, two-hour post-prandial BG. (HbA1C is different but cannot be done by the individual). But maybe there are also some useful tests that could be done on exercise-induced change in BG. When I read your mail, I was already wondering whether I could define a standard repeatable exercise for myself, and measure my BG before and after the exercise to get the rise or fall, then check if it was a stable sort of measurement so that I could use it to look for improvement over time. But it seems like your experience at least shows that exercise results vary from day to day.

Hi Paul,

Apparently HbA1C can be done at home.

Check your A1C level at home (http://www.mendosa.com/homeA1c.htm)

However, as you know having this type of 3-month average reading on demand still wouldn't offer any insights as to why a particular exercise bout was ineffective in reducing blood glucose over the period of an hour or so.

Needless to say there are other variables that could have effected Eddie's results other than the duration and intensity of his exercise. The most likely one is a difference in the size of the meal, the carbohydrate content, and the composition of the meal, % protein and fat. Other contributing factors might be a difference in how active he was earlier in the day.

The point is, HbA1C is the definitive test to look for improvement over time. However to improve HbA1C we must improve our daily blood glucose profiles. To do that we must use our "instanteous" blood glucose monitors multiple time during the day to get visibility of spikes and from that infer what we did to cause them. The usual means for achieving this is to keep a log of relevant activities (exercise, duration & intensity; meals, amounts & composition; medications & supplements; etc.) during the day accompanied by before and blood glucose readings.

Larry

[lfchanin]

One of the things that slows down this forum is a lack of regular contributors. Do we perhaps have the critical mass to do something like pauleo suggests. The bunch of us could start setting up some parameters and do some testing. To some extent it would be anecdotal, but I think possibly significant anecdotal. Rob

Hi Rob,

Interesting idea. It may be worth a try if the objective was specific enough, and the variables were sufficiently controlled.

However, aside from the differences in our metabolisms, there's a lot of other factors that might make drawing conclusions from comparisons of limited value. For example, variations in type of exercise, level of fitness, diet objective, i.e. weigh loss, gain or maintenance, age, medication, etc.

Larry

[pauleo]

About the exercise test, I'll give a specific example of what I was thinking about.

Say I go to the gym on day 1 and my BG is 90 before a (fixed, repeatable) exercise and 100 afterwards.

On day 2 I go to the gym and my BG is 100 before the same exercise and 110 afterwards.

Day 3 I go and BG is 95 before and 105 afterwards.

This would be typical in that my starting BG varies from day to day because I eat different things, I arrive at the gym at different times etc. But in the example above, the change in BG caused by my fixed repeatable exercise is always 10. If this is the case, that change in BG is really acting as a reliable indication of how my body is reacting to the exercise, so I am getting some useful information. Also if I keep tracking it over weeks and months and see a slow decrease from 10 to 9 to 8 etc, then I have evidence of an improvement.

That's the idea - is the change in BG induced by a fixed exercise a stable type of number, that factors out the everyday fluctuations? (I think it's more likely that the change in BG fluctuates all over the place, but this is what I was wondering about).

Of course you couldn't use that number to compare between different people. That's not what it's for, it's to test one individual's improvement.

Also it's true that we already have measurements like FBG that allow one to track day-to-day progress so maybe exercise-related BG measurements don't add anything.

[lfchanin]

About the exercise test, I'll give a specific example of what I was thinking about.

Say I go to the gym on day 1 and my BG is 90 before a (fixed, repeatable) exercise and 100 afterwards.

On day 2 I go to the gym and my BG is 100 before the same exercise and 110 afterwards.

Day 3 I go and BG is 95 before and 105 afterwards.

This would be typical in that my starting BG varies from day to day because I eat different things, I arrive at the gym at different times etc. But in the example above, the change in BG caused by my fixed repeatable exercise is always 10. If this is the case, that change in BG is really acting as a reliable indication of how my body is reacting to the exercise, so I am getting some useful information. Also if I keep tracking it over weeks and months and see a slow decrease from 10 to 9 to 8 etc, then I have evidence of an improvement.

That's the idea - is the change in BG induced by a fixed exercise a stable type of number, that factors out the everyday fluctuations? (I think it's more likely that the change in BG fluctuates all over the place, but this is what I was wondering about).

Of course you couldn't use that number to compare between different people. That's not what it's for, it's to test one individual's improvement.

Also it's true that we already have measurements like FBG that allow one to track day-to-day progress so maybe exercise-related BG measurements don't add anything.

Hi Paul,

Gotcha.

If you're concerned about improving blood glucose control as it relates to intense exercise, I think for many of us the approach you describe needs to be refined a bit. First you need to test your assumption about multiple, small rest periods. To do that you need to measure your before and after blood glucose for each intense session to see if your levels are progressively getting higher or not. If so, you need to increase the duration of the rest. (Obviously if we're only talking about 10 points for the entire workout, then it probably doesn't matter much. However, some of us have experienced quite severe spikes that need to be controlled.) Once we've optimized the ratio of exercise to rest, then perhaps a before and after workout trendline might be helpful.

Agreed that other measures, such as daily fasting blood glucose, help to determine our day-to-day progress, but it doesn't really tells us much about whether our exercise method is hurting control. Therefore exercise related measures DO help us pin point a possible source of a loss of control. Once the optimum exercise to rest durations are determined, we only need to test before and after the workout, just like we do with meals.

Larry

[pauleo]

Right. And what I was getting at is the whole idea of improving insulin sensitivity, by identifying a way to measure improvement, and then trying different mixes of exercise to see what is most effective.

The information about rest periods in this thread has been very useful and directly helped me. It feels like a good success. But then, thinking about it, this was a situation where simple testing was sufficient - we can use a BG meter to test on the spot before and during exercise, to get immediate feedback on what works. It is obviously a much more difficult case to figure out changes in insulin resistance, because the changes are long-term, and because every aspect of life is influencing this not just exercise.

So what I was trying to get at, or wondering about, is if it's possible to somehow isolate some exercise related measurements that relate to insulin sensitivity, and then just work on them. It's an attempt to simplify the problem, and get food and tiredness-level and stress-level etc out of the picture, to make it easier to figure out the most beneficial exercise.

I did look around for some material on insulin sensitivity at amazon yesterday. Sadly the popular books all look like they won't add anything to what I have already got (Dr Bernstein and a couple of others), while the academic books on diabetes and exercise cost a fortune. It's a pity because there's obviously an audience of lay-people who want this info to try to apply ideas in practice.

[lfchanin]

So what I was trying to get at, or wondering about, is if it's possible to somehow isolate some exercise related measurements that relate to insulin sensitivity, and then just work on them. It's an attempt to simplify the problem, and get food and tiredness-level and stress-level etc out of the picture, to make it easier to figure out the most beneficial exercise.


Hi Paul,

As you know exercise greatly improves insulin sensitivity for several hours following vigorous exercise. Unfortunately, even if we could devise a means of measuring insulin resistance (versus blood glucose levels) after exercise, it's a transient condition that, for the most part, disappears by the next day. Therefore, I doubt that we could accurately infer any long-term effects by taking short-term measurements. I think that the long-term improvements in insulin sensitivity (as mesured by HbA1C) produced by exercise are related to changes in body composition, i.e. a decrease in fat, particularly abdominal fat, and an increase in overall lean body weight.

Larry

[pauleo]

Hi Paul,

As you know exercise greatly improves insulin sensitivity for several hours following vigorous exercise. Unfortunately, even if we could devise a means of measuring insulin resistance (versus blood glucose levels) after exercise, it's a transient condition that, for the most part, disappears by the next day. Therefore, I doubt that we could accurately infer any long-term effects by taking short-term measurements. I think that the long-term improvements in insulin sensitivity (as mesured by HbA1C) produced by exercise are related to changes in body composition, i.e. a decrease in fat, particularly abdominal fat, and an increase in overall lean body weight.

Larry

Hum, this email has made me realize that we have a different understanding of insulin sensitivity.

I thought insulin sensitivity was not something that varied day-to-day at all, but could only be altered over the long-term by diet and exercise. I was thinking it was to do with the structure of cell membranes or other places that accept signals from insulin. When the cell membranes and other places are ignoring signals from insulin, then glucose sits in the bloodstream and the result is T2. But I thought these were things that could not be changed immediately with exercise.

But you are saying something different - that insulin sensitivity improves immediately after exercise, and then the effect fades. Is that something that has a physical explanation in terms of cells and the liver etc?

I understand your final point - visceral fat is particularly bad, while lean muscle is good presumably because it's very good at accepting glucose.

(Incidentally, I've always assumed 'insulin sensitivity' and 'insulin resistance' are antonyms, not even quite sure if that is true.)

Finally, yes, maybe it's too optimistic to think there are ways to infer long-term effects, and identify best types of exercise, just with a glucose meter. Still what a great technology!

Paul.

[lfchanin]

Hum, this email has made me realize that we have a different understanding of insulin sensitivity.

I thought insulin sensitivity was not something that varied day-to-day at all, but could only be altered over the long-term by diet and exercise. I was thinking it was to do with the structure of cell membranes or other places that accept signals from insulin. When the cell membranes and other places are ignoring signals from insulin, then glucose sits in the bloodstream and the result is T2. But I thought these were things that could not be changed immediately with exercise.

But you are saying something different - that insulin sensitivity improves immediately after exercise, and then the effect fades. Is that something that has a physical explanation in terms of cells and the liver etc?

I understand your final point - visceral fat is particularly bad, while lean muscle is good presumably because it's very good at accepting glucose.

(Incidentally, I've always assumed 'insulin sensitivity' and 'insulin resistance' are antonyms, not even quite sure if that is true.)

Finally, yes, maybe it's too optimistic to think there are ways to infer long-term effects, and identify best types of exercise, just with a glucose meter. Still what a great technology!

Paul.

Hi Paul,

I'll see if I can find an authoritative source to support my statements.

I am under the impression that immediately following vigorous exercise our metabolisms are closest to being normal. No doubt this is due to our bodies' need to quickly replenish glycogen stores in muscle tissue and the liver, and to supply glucose to power our vital functions. During recovery from exercise we have observed that blood glucose is lowered more rapidly than any other time. As we know it is insulin that is the mediator in the transfer of glucose from the blood into mucle and liver tissue. So if glucose is being transferred into tissue faster after exercise, and insulin is the means by which that is accomplished, then we may infer that our insulin receptors are working more efficiently at that time.

Larry

[lfchanin]

Hum, this email has made me realize that we have a different understanding of insulin sensitivity.

I thought insulin sensitivity was not something that varied day-to-day at all, but could only be altered over the long-term by diet and exercise. I was thinking it was to do with the structure of cell membranes or other places that accept signals from insulin. When the cell membranes and other places are ignoring signals from insulin, then glucose sits in the bloodstream and the result is T2. But I thought these were things that could not be changed immediately with exercise.

But you are saying something different - that insulin sensitivity improves immediately after exercise, and then the effect fades. Is that something that has a physical explanation in terms of cells and the liver etc?


Hi Paul,

Here's one scientific study supporting my point.

Effects of exercise on glucose tolerance and insulin resistance. (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=2674587&dopt=AbstractPlus)


The evidence that exercise reduces resistant to the action of insulin has generated interest in the possibility that endurance exercise training may be a worthwhile primary therapeutic intervention in the treatment of mild non-insulin-dependent diabetes mellitus (NIDDM). Unfortunately, the results of several studies of exercise training in NIDDM have been discouraging since improvements in oral glucose tolerance (OGT) did not occur or were quite modest even though insulin resistance was reduced. Recently it was determined that 12 months of endurance exercise training at 75-90% of VO2max could normalize OGT in men with mild NIDDM when the post-training OGTT was performed within 18 h of the last bout of exercise. This, coupled with the fact that the enhanced action of insulin is lost in trained persons within a few days of cessation of training, suggests that improved glucose tolerance in NIDDM patients may be partly due to the persistent effects of the last bouts of exercise. Acute exercise in the form of 7 d of intense walking/cycling has been shown to improve glucose tolerance despite a significantly smaller increase in plasma insulin levels during the OGTT in NIDDM. Apparently, the improvement in OGT was due to a decrease in resistance to insulin over the short term since no changes in body weight, body fat, or VO2max took place. Thus, acute exercise of sufficient intensity and duration can increase peripheral insulin action and may contribute to the effects of long-term exercise training on improvement in OGT and the amelioration of insulin resistance in patients with NIDDM.


Larry

[pauleo]

Thanks for the reference. I need to chew that over even though I read it through a few times...

[lfchanin]

Thanks for the reference. I need to chew that over even though I read it through a few times...

Hi Paul,

You're welcome.

Here's a couple of more studies demostrating short-term improvements in insulin sensitivity due to exercise.

Insulin-stimulated muscle glucose clearance in patients with NIDDM. Effects of one-legged physical training. (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=7657022&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus)


Physical training increases insulin action in skeletal muscle in healthy men. In non-insulin-dependent diabetes mellitus (NIDDM), only minor improvements in whole-body insulin action are seen. We studied the effect of training on insulin-mediated glucose clearance rates (GCRs) in the whole body and in leg muscle in seven patients with NIDDM and in eight healthy control subjects. One-legged training was performed for 10 weeks. GCR in whole body and in both legs were measured before, the day after, and 6 days after training by hyperinsulinemic (28, 88, and 480 mU x min(-1) x m(-2)), isoglycemic clamps combined with the leg balance technique. On the 5th day of detraining, one bout of exercise was performed with the nontraining leg. Muscle biopsies were obtained before and after training. Whole-body GCRs were always lower (P < 0.05) in NIDDM patients compared with control subjects and increased (P < 0.05) in response to training. In untrained muscle, GCR was lower (P < 0.05) in NIDDM patients (13 +/- 4, 91 +/- 9, and 148 +/- 12 ml/min) compared with control subjects (56 +/- 12, 126 +/- 14, and 180 +/- 14 ml/min). It Increased (P < 0.05) in both groups in response to training (43 +/- 10, 144 +/- 17, and 205 +/- 24 [NIDDM patients] and 84 +/- 10, 212 +/- 20, and 249 +/- 16 ml/min [control subjects]). Acute exercise did not increase leg GCR. In NIDDM patients, the effect of training was lost after 6 days, while the effect lasted longer in control subjects. Training increased (P < 0.05) muscle lactate production and glucose storage as well as glycogen synthase (GS) mRNA in both groups. We conclude that training increases insulin action in skeletal muscle in control subjects and NIDDM patients, and in NIDDM patients normal values may be obtained. The increase in trained muscle cannot fully account for the increase in whole-body GCR. Improvements in GCR involve enhancement of insulin-mediated increase in muscle blood flow and the ability to extract glucose. They are accompanied by enhanced nonoxidative glucose disposal and increases in GS mRNA (glycogen). The improvements in insulin action are short-lived.


The effect of prior exercise on oral glucose tolerance in late gestational women (http://www.springerlink.com/content/m117m662628u7426/)


Glucose tolerance deteriorates over the course of a normal human pregnancy as a result of increased peripheral insulin resistance. In contrast, physical exercise has been shown to improve glucose tolerance and blunt the insulin response to a glucose load in insulin-resistant individuals. The purpose of this study was to determine the effect of exercise on glucose tolerance and the insulin response in healthy women during the third trimester of pregnancy (33 weeks of gestation). Five subjects underwent oral glucose tolerance tests (a) 30 min following a 30-min exercise bout on a cycle ergometer at a relative intensity of 50% maximal aerobic capacity, and (b) on a control day without prior exercise. The area under the glucose concentration curve was not different between trials, while the area under the insulin concentration curve was decreased by 23% in the exercise trial compared with the control trial (P < 0.05). These results suggest that the insulin response to a glucose load is improved in late gestational women by a single bout of moderate intensity exercise.

[pauleo]

Ah thanks. A fair part of this is escaping me, but I have taken a good step forward. So there are two measurements that are relevant to measuring insulin resistance - glucose measurement e.g. in response to GTT, and the amount of insulin in the blood. In the last two sentences of the last abstract, for example, the glucose measurements have stayed the same, but less insulin was required to get that same glucose level, hence insulin sensitivity has increased. So a BG meter alone is not enough to get a measure of insulin sensitivity.

[lfchanin]

Ah thanks. A fair part of this is escaping me, but I have taken a good step forward. So there are two measurements that are relevant to measuring insulin resistance - glucose measurement e.g. in response to GTT, and the amount of insulin in the blood. In the last two sentences of the last abstract, for example, the glucose measurements have stayed the same, but less insulin was required to get that same glucose level, hence insulin sensitivity has increased. So a BG meter alone is not enough to get a measure of insulin sensitivity.

Hi Paul,

I think it's fair to say that even these scientists are inferring improved insulin sensitivity without really having any fundamental insights as to the exact mechanism(s) whereby exercise improves sensitivity. Sort of like my inference in my earlier posting.

They are measuring total glucose levels over time or glucose clearance rates while keeping the incoming glucose load constant, and determining whether or not the amount of insulin required to clear the glucose from the blood is decreasing. Since they see a decrease in the amount of insulin needed, from that they are inferring that insulin sensitivity has increased, but they still don't know exactly what the mechanism is. (Exercise certainly is not bringing beta cells back from the dead. ;) ) They see some contributing factors, increased blood flow could bring more insulin in contact with more tissue cells, increased glycogen production in recovery certainly will clear the blood faster, etc. They also can rule out some non-contributory factors. Since they know that there wasn't any changes in body composition in the short time of these tests, they can rule out reductions in abdominal fat or increase muscle mass as being a contribution factor, even though we know in the long term these are factors that improve insulin sensitivity.

Larry

[pauleo]

Yep right, it's a very complicated system and there are only limited ways to look inside to see what's happening. It's only a week ago that it was announced that osteocalcin is a significant hormone affecting BG, so clearly the basics are still in flux.

A different issue, but something that this thread made me think about - internet forums like this one prove there are people doing all kinds of experiments with diet and exercise to try to improve health. And medical researchers no doubt have an endless list of experiments they want to do. I wonder why there are no clinical trials over the internet, where researchers email diet sheets, exercise instructions etc and interested lay-people do the experiments, getting blood tests or other tests as required at a local clinic. It's probably not as ideal as recruiting locally and have indiividuals actually attending a clinic where the researcher works, but it seems like it could be workable. For one thing, if a clinical trial was a subject of internet discussion for everyone involved, like the discussions here, it might be very motivating for people taking part.

[RobLL]

On that bit of hiking I did on Mt Rainier one of my reasons for using Dove dark chocolates (I realize that glucose would have been more scientific) was to see if I could use a lot of carbs. I didn't know if I had enough insulin/insulin sensitivity to keep my glucose levels between 80 and 110. Would I go low, would I go high.

When I fasted for a colonoscopy at about hour 21 I dropped down to about 40. I normal person, as I understand it, would have stayed above 70 in that situation.

One of my further suspicions is that a number of these extreme tests just with fasting/glucose/exercise might differentially allow one to indirectly answer a number of questions about one's entire glucose metabolism, duplicating in some broad way all the expensive tests Dr. Bernstein recommends.

[lfchanin]

A different issue, but something that this thread made me think about - internet forums like this one prove there are people doing all kinds of experiments with diet and exercise to try to improve health. And medical researchers no doubt have an endless list of experiments they want to do. I wonder why there are no clinical trials over the internet, where researchers email diet sheets, exercise instructions etc and interested lay-people do the experiments, getting blood tests or other tests as required at a local clinic. It's probably not as ideal as recruiting locally and have indiividuals actually attending a clinic where the researcher works, but it seems like it could be workable. For one thing, if a clinical trial was a subject of internet discussion for everyone involved, like the discussions here, it might be very motivating for people taking part.

Hi Paul,

No doubt there are a number of clinical trials on diabetes. Apparently that's how they discovered insulin in the first place.

Clinical Trials (http://www.diabetes.org/diabetes-research/clinical-trials/trials-home.jsp)

However, there might not be many trials that fit your concept. I have seen some long-term studies in which the subjects were given a diet to follow over a long period and results monitored. However, as you say these types of studies are not ideal because they have loose controls, and a great deal is riding on the compliance of the subjects. They are generally not as highly regarded as other studies where the control is more rigid because of the clinical setting.

An other factor is that many of the blood tests being conducted are difficult enough to setup even in a clinical setting, and are simply not available at conveniently located "walk-in" labs. Sometimes catheters are installed in the subjects and glucose, insulin and other hormones, or some other medication is both continually monitored and automatically administered depending on the requirements of the study.

Larry

[lfchanin]

One of my further suspicions is that a number of these extreme tests just with fasting/glucose/exercise might differentially allow one to indirectly answer a number of questions about one's entire glucose metabolism, duplicating in some broad way all the expensive tests Dr. Bernstein recommends.

Hi Rob,

I'm not sure I'm following your statement. Are you saying that by measuring your blood glucose after certain events such as fasting for a fixed duration, eating a controlled portion of carbs, taking a measured duration and intensity workout, etc., that we should be able to predict our glucose response for different situations? If so, I agree within limits. After all, my suggestion to measure glucose response throughout a workout and adjust rest periods long enough to minimize spikes, is based on this premise of repeatability. By the way, in fairness to Dr. Bernstein, he recommends testing our carb tolerance in a similar manner.

However, in the real world I find it may not be possible to always avoid unexpected interactions between multple glucose altering events.

For example, today I had a blood glucose surprise that was no doubt caused by unintended interations between events. :o

I measured my BG before going to the gym, it was 112. I did one set in 30 minutes, rested 20 minutes and then did two more sets in about 45 minutes. After resting about 30 minutes I took my readings and was happy to see that my BG was 113 after exercise, just about the same as when I started exercising. So far, so good. My resting routine seemed to be working as predicted.

Then out of curiousity I decided to take an other reading after 45 minutes to see how far down my BG had gone. I still hadn't gotten around to eating yet. I was astonished to discover that my BG had spiked to 175 while resting! I'm guessing that this glucose reaction was caused by fasting. It turns out that all this working out and resting, and other distractions, had greatly delayed my lunch, so I had been fasting for about 7 hours. In addition, during this time I had a rather strenous workout. So I figure that my BG continued to decrease rapidly from the 113 reading until my liver said, "Wait a minute here! We need some more glucose to keep thing running!" So it dumped a bunch of glucose bumping it up to 175. So I go ahead and finally eat my lunch, a large portion of tuna salad and a large salad and 500 mg of metformin. One hour later the 175 reading is down to 97.

In summary, the whole point in this long-winded discussion is to highlight that even if we go to the trouble of precisely measuring "standard blood glucose altering events", unfortunately real life has a way of imposing combinations of non-standard events that make it a little more challenging to predict outcomes. This of course doesn't mean that we should abandon talking measurements. Without knowing how we react to these standard events we wouldn't be able to have a even modicum of predictability.

Larry

[RobLL]

Larry - that was a fascinating incident. I don't think these sorts of singular events could replace the Berstein Battery (and in fact wish my docs would start doing some of the most pertinent). But it would be likely if one collected one's regular responses with some extreme responses that someone like Dr Bernstein would have some pretty good suspicions of what is going on.

Incidentally I have had only 3-6 readings over 150 in the 8 months I have been monitoring. All relating to eating a MODEST amount of carbs. Exercise has never put me over 125, I think. I need to do some charting. But I suspect my docs would not be interested in analyzing what I found.

[pauleo]

But I suspect my docs would not be interested in analyzing what I found.

That lack of interest is probably familiar to many people. It relates to a point that I was trying to make earlier about using the internet, which I'm not sure I communicated very well. My guess is that somewhere out there in the world are diabetes researchers who really would like to get such measurements. And in places like this forum, we are motivated to make and communicate such measurements. It seems like a missed opportunity that the internet is not used to get data to the researchers.

(OK this process would be completely different to traditional clinical trials, and probably any analysis and conclusions would be judged less reliable because the data is being collected from anonymous sources on the internet - still my guess is that it would be useful.)

Well what do I know. If I was doing research on diabetes and exercise though, I might just come to this forum and ask if interested people would keep a journal for me,

Paul.

[lfchanin]

Incidentally I have had only 3-6 readings over 150 in the 8 months I have been monitoring. All relating to eating a MODEST amount of carbs. Exercise has never put me over 125, I think. I need to do some charting. But I suspect my docs would not be interested in analyzing what I found.

Hi Robb,

Make sure that you take your measurements following an intense workout (> 80% VO2max). Don't wait to do all of your workout before taking a reading. If you are still doing HIIT a good test would be to take a reading after 15 minutes of grueling exercise, then continue to take readings while in recovery. Make sure to take a reading about 30 minutes into recovery.

I've attached a chart of a study of the glucose response of fit, non-diabetic subjects. FIG. 1. Comparison of responses during 40 min of moderate intensity exercise (50% VO2max) (white data points) and 15 min intense exercise (87% VO2max) (black data points) in normal young male subjects.

Notice that for the intense exercise the pre-exercise plasma glucose is less than 5.0 mmol/l and rises rapidly to about 7.8 mmol/l in about 30 minutes following the end of exercise. Converting mmol/l to mg/dl (what our meters measure) we get a pre-exercise reading of about 90 mg/dl rising to about 140 mg/dl. I should emphasize that these readings are the mean reading of an entire group of fit, non-diabetics. It is likely that fit, type II diabetics would experience even higher spikes.

Larry

[pauleo]

I only started to include free-weight exercises in my gym routine a few months ago but I'm a convert to the idea that free-weights are superior to weight machines (and more enjoyable - I look forward to squat thrusts, the intense focused effort feels like it does you good). I originally got a free introductory lesson at my gym which involved about five core exercises, but now I would like to expand my routine. Any ideas on best way to proceed? Is a personal trainer a good investment? (I would rather pay for some lessons than get an injury!). What about websites and books?
Thanks, Paul.
(p.s. For websites and books, I am also generally interested in how exercise works and best ways to exercise, not just guidelines for free weights.)

[mathmaniac]

The website for ACE is a good resource. Google American Council on Fitness. They will send you a good newsletter too!

[Daryl]

Muscle and Fitness has always been a great source of information, covering the entire gamut of muscle-building.

http://www.muscleandfitness.com

[RobLL]

I only started to include free-weight exercises in my gym routine a few months ago but I'm a convert to the idea that free-weights are superior to weight machines (and more enjoyable - I look forward to squat thrusts, the intense focused effort feels like it does you good). I originally got a free introductory lesson at my gym which involved about five core exercises, but now I would like to expand my routine. Any ideas on best way to proceed? Is a personal trainer a good investment? (I would rather pay for some lessons than get an injury!). What about websites and books?
Thanks, Paul.
(p.s. For websites and books, I am also generally interested in how exercise works and best ways to exercise, not just guidelines for free weights.)

Best single book ever is New Rules of Lifting, available at Amazon for about $15, get yourself over $25 with another book and its free shipping.

[pauleo]

thanks all, the websites are great (exercise photos at ace very useful) and i'll take a look at the book this evening.