Exercise induced hyperglycemia

I’ve been type 1 diabetic since 1996. I’ve been experiencing strange phenomenon of exercise induced hyperglycemia, like say my blood sugar was 110mg/dl fasting, once i start playing soccer or gym or any strenuous exercise, it shoots up to 200 or even more , I need more insulin shots to control it. None of the endos cud gv a satisfactory explanation for tht. I’m on 3 short acting and Lantus at nights.

Hi Dr. Ash! @Dr.Ash

This happens to me when I exercise during hot weather. I actually had to stop power walking with my toddler during July and August this year because my blood sugar shot up so much. I also had a really difficult time at the pool. When my family went to the beach for the day, I spent most of the time in the shade of an umbrella trying to keep my blood sugar numbers under 200.

I’m an orthopedic spine surgeon by profession dealing with type 1 for the last 23 years. Initially I was a teenager, so my control was poor, bt once I attended my.medical school, I started having a tight control. I’ve studied a lot on T1D, bt even many endos cudnt answer this phenomenon of exercise induced hyperglycemia. Due to long standing DM i developed mild hypoglycemia unawareness, so my endo suggested Insulin pump and CGM to counter these issues. Planning to get one by December.
Hw ru managing this issue of exercise induced hyperglycemia?
Dr Ash

I was diagnosed in 1963, and growing up we were told to exercise to bring down high numbers. It wasn’t until I was maybe in my 20s that we were told exercise could drive up numbers that were already high; and the possibility of exercising increasing numbers when you’re in normal range is even more recent. There have been a number of discussions on the forum where people shared having the issue and what they did to manage it but I don’t recall seeing any explanations so I did a little Google searching and found this article: https://www.diabeteshealth.com/exercise-often-raises-blood-glucose-in-type-1-diabetes/
I’ve skimmed through it but plan to read in more detail later. From what I’ve read is a little technical but not difficult to read. Hope it helps!

I have a Freestyle Libre CGM and i use it a lot when I am exercising. This summer I couldn’t even power walk in the late afternoons without issues, so I focused on cleaning the house. At the beach, I relied on my Afrezza inhaled insulin because it works quickly. I also use Humalog but the Afrezza works faster and brought my high numbers down within minutes. When I am at the pool, I use Humalog if I catch the rise early. Otherwise I use Afrezza.

The Freestyle Libre really helps me know not only what my blood sugar number is, but how it is trending - either up, down, or steady.

Hi Dorie,
Thanks for the great piece of info. I always guessed tht there wud be some mechanism responsible for elevation of BG post exercise, bt your article cleared all my doubts, which even best of the endos cudnt. Thanks again for the article, usually I take a shot of regular humalog on empty stomach just before the work out sessions even when my blood sugars are normal, so that my levels post exercise remain within normal limits, and its working most of the times. And as the article says, it doesnt happen when i just brisk walk instead of gym.
Lemme share another concern, when my blood glucose raises above 200mg/dl , modt of the times I get stomach upset, diarrhoea, nausea, abdominal bloating, belching, foul smelling flatus etc until my blood sugars are normalised for atleast 4-5 hrs. Being a medical doctor, i know its coz of diabetic gastroparesis. Bt the symptoms of hyperglycemia varies in my as per the geographical area I live in. When Im in Africa and India, my hyperglycemia symptms are gastric related as I described. In other parts of the world like Middle East, Canada, USA, its most of the times just hyper acidity and once I take insulin shots , it gives relief frm the acidity. Do you have anything similar in ur experience?

DiabetesHealth was once known as Diabetes Interview - I had a subscription and found it to be a very variable resource. I let my subscription lapse so don’t keep up with the articles but I do find them very informative and maybe even during edge when I find one in a Google search. You’ve had Type1 for a while so forgive me if I’m telling you something you already know. Another one of the book Think Like a Pancreas which I just discovered last year or the year before after 50+ years with Type1! Since you’re a doctor you may find it redundant but you never know.

I haven’t traveled much but husband is from Senegal so I do enjoy his dishes, and my favorite food is Indian. Occasional I do get some of the symptoms you described but they’re not tied to my numbers. I’m also starting to have issues with indigestion and am working with my primary care physician in that. I’m attributing all of that to age myself.

Congratulations on getting your pump and CGM soon - have you decided which you’ll get? You don’t say where you live but in the US the pump players are
Tandem Tslim
Minimed and

Tandem and Minimed both have closed loop systems with CGMs - Tandem works with Dexcom CGM and Minimed has its own. I believe Omnipod is working on connecting with a CGM but don’t know details. Omnipod is the only tubeless pump here. There may be additional pump and options in other countries - it would be interesting to know what’s available where you are, and if you would like to share your choice please do.

My apologies, I’m basically frm India bt I have been abroad for more than 18 yrs now. Currently m shuttling between the UK and Nigeria for work purposes. In India Minimed is the most popular one. In the UK too its Minimed, m.planning to go for Minimed 780G which is the latest one and yet to be approved in the US, I guess. I usually operate long hours around 6-8 hrs which mandates me to ensure adequate BG levels before the start of the surgery inorder to finish it uninterrupted which tend to derail my glucose control over long term. I’m relatively new to pumps, so qid seek advice on it, if ur using one.
Good to know m.nt alone in this war against type 1. I was so embarrassed initially during my teens and early 20s to come forward as a diabetic ,especially due to those looks with sympathy , which affected my glycemic control. I overcame.it eventually and leading a relatively healthy life now.

No need to apologize. I envy your opportunities to travel with work you love.
I use Tandem so can’t give and feedback on Minimed’s system although there have been discussions about it and it’s CGM on the forum. Ask questions - I’m sure people here will be happy to give feedback.

This used to happen to me when i used to play football, i would shoot from 120 to 250-300 sometimes, it was worse if it was hot out. Only happen in games and not practice. Then i would crash if i took any insulin.

My dr thought it was adrenaline.

Something similar happens when i lift weights. But its only goes up 20-40 points not 150.

But when i run or walk for an extended period it will bring my sugar levels down.

@Dr.Ash Hello Dr. Ash, and welcome to the JDRF TypeOneNation Forum. Since 1957 I’ve been trying to figure out how to manage my diabetes best in all type of situation, including heavy and prolonged strenuous activities.

As you know, there is a difference between aerobic exercise and anaerobic activities and that they affect your body differently. Aerobic exercise generally tends to lower body glucose levels while anaerobic activities generally increase glucose levels during the activity and for a short time thereafter and then several hours later can cause a severe glucose drop. Right now following a 65 gram dinner with BGL up to 130, I’m on the lookout for a drop within the next couple of hours because of the 150 minute workout that I completed at noon. One way I counteract the expected BG drop is about an hour before dinner, I ate a 15 gram of carb snack without taking insulin; also during my exercise activity I continually sip a sugar-laden drink [Gatorade] for hydration - dehydration can raise havoc with glucose levels.

There are a few extended conversations on this Forum about exercise; you can find them by using the “search” feature at the top of this page.

Thanks Dennis, I appreciate it.
Good to know that even with type 1, we can try to lead a near normal life with Lil efforts and understanding the physiology. Thanks for the suggestions.

Hi Dorie,
Thanks. I hope tandem is working good for you.
Stay blessed.

Ashraf @Dr.Ash , yes, with diabetes we can live full, active, and productive life - really live without bounds as long as we understand our own body and know how and when to use insulin.

My earlier response addressed only the exercise aspect and I missed something important - you did not mention taking any insulin before beginning your activity. As you must have observed, just simple daily moving-about, without morning insulin, will drive your body glucose level [BGL] quite high - even without eating. Your circadian clock will dump adrenaline and other steroids into your system to get you moving - without insulin, I suspect your BG could be higher than 300 mg/dl within 4 hours. You can very easily program a Profile in the pump which you expect to begin using in December. I use a Tandem t-Slim x2 plus Dexcom G6 and employ the Control IQ [CIQ] algorithm to assist holding my BGL in range.

Exactly sir, mng hyperglycemia on empty stomach when we delay insulin shots was a major concern, so I started takig a shot before hitting gym with lil snacks which keeps my levels controlled even after exercising.
After joining this forum, I learnt many things which I didn’t learn even in my medical school.
Thanks to you all for the invaluable info. As the saying goes, chronic patient has more knowledge than a newbie doctor. Lol.


Thanks Dennis! Very helpful. My son is 12 years old. He experienced same hyper situation during his tennis sessions. Now he has switched to cycling and indoor Table tennis but it still spikes. he has been strongly recommended to practice Yoga.

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