Download a transcript of this episode
1. [4:24] Stomach Distension
2. [9:16] Exercise and Blood Sugar
3. [18:57] Insulin, A1c and Weight Gain
4. [26:21] Post-Game Nausea, Sweating and Dizziness
5. [31:45] Rheumatoid Arthritis Nodules
6. [35:32] Meningioma & Multiple Sclerosis
7. [44:09] Heat’s Effect on Training
1. Stomach Distension
David Says: Hi Robb, First of all, I love the podcast. Thank you for what you do. I have had a problem for as long as I can remember. My stomach appears distended no matter how “in shape” I am. When I flex my abs I have a 6 pack, but when I release my stomach it sticks out and looks like a gut and has a hard quality. Its like a balloon is inflated in my stomach. I am 5 ft 8 in and 170lbs. I have been doing crossfit for about a month and paleo for about 2 months. I have always thought that my back is “swayed” more than other people’s, but I don’t really know. Any insight you have would be much appreciated. Thank you so much for your time!
2. Exercise and Blood Sugar
Dawn Says: Hi Robb and Mark,
I started going to Crossfit in May and have recently started a 45 day Paleo challenge. What I love the most about eating Paleo is that I went from injecting around 60 units of insulin a day to about 7-12 units a day. I’ve had diabetes for 20 years, and it is incredibly liberating to be able to lower how much insulin I have to depend on. But here’s my question. On a typical morning I’ll wake up and have a blood sugar of 105. Then I’ll go to Crossfit to do my WOD. I don’t eat anything before I go, and I never eat after 7pm the night before. After an hour at Crossfit, my blood sugar will be 220. It’s constently jumping at least 100 points while I’m working out at Crossfit. This has never happened before; I’ve always had a problem with low blood sugars while running or doing other kinds of workouts. The frustration comes because I’m trying to take as little insulin as possible, but I’ll have to take 5 units just to correct the high blood sugar, and that’s before I’ve eaten anything. Any thoughts? Suggestions? Thanks so much!
3. Insulin, A1c and Weight Gain
Laurie Says: Hey Robb, Remember me? I’m the one who jumped down your throat after you made a comment about Type II diabetics who basically just need to change their evil ways and they’ll be fine…
We exchanged a few emails and you suggested I might be a type I, not type II. Ringing bells?
You were right. I was finally able to get referred to an endocrinologist who ran the bloodwork and confirmed that I am most definitely a type I (LADA).
My endo is concerned that my HbA1C is too low because I am experiencing hypo unawareness. (I don’t notice anything “wrong” until I get down to about 40.) My last HbA1c was 5.9, which you and many others consider way too high.
At the same time, the insulin is causing me to gain weight which annoys the bejesus out of me. So my doc thinks I should let the numbers go up a bit (strive for a 6.5) and cut the insulin back. She’s worried mostly about the hypo unawareness but has sympathy with my frustration with the weight gain, and thinks this will kill 2 birds with one stone.
I eat mostly paleo with the exception of heavy cream in my coffee (can’t do milk and black espresso is just too much for me). I live in Switzerland where cows still roam the fields and alps, so my stock of beef is of good quality (as is the dairy from these cows). I need insulin even for meat and veggie meals, and generally use the 6-hour type rather than the fast acting (which would require several small shots over the next 3 hours after a meal).
I know you’ve gotten away from using the HbA1c as an important measurement but my mind is still clinging to the “lower must be better no matter what” mentality. Long story, short question: what’s your take on my docs recommendations? Thanks for a quick response if you can!
4. Post-Game Nausea, Sweating and Dizziness
Evan Says: Hi Robb and Greg, Like everyone else I thank you and all your guests for the great podcasts.
My unique snowflake moment is this. I play lacrosse (I’m a goalkeeper) at a reasonably high post-collegiate level and about an hour after every game this season I have been experiencing a sudden nauseated feeling, dizziness and profuse sweats which lasts for about 10 minutes. It’s not impacting anything else in my life but it feels awful while it’s on.
I’m 1.87m and about 90 kilograms diet is approaching ‘paleo-hood’ but could be better. My pregame meal is usually an omelette or similar with a black coffee and post-game it’s generally some fruit and nuts with water.
I don’t get this feeling after heavy weights or conditioning sessions – only games. So, do you think this is generally just a carbohydrate depletion issue? Inadequate hydration? Interested to hear your thoughts.
5. Rheumatoid Arthritis Nodules
Cathy Says: I started a gluten/dairy free diet seven years ago, shortly after being diagnosed with severe rheumatoid arthritis. I have been on medication, off medication and back to medication again. Currently I am on Methotrexate and Enbrel as well as following a strict paleo diet for the last year. My body seems to need the combo of drugs and diet as one doesn’t seem as effective without the other. When I was on my two year break from meds I starting developing nodules. Since being back on meds, paleo diet, and basically in remission, the nodules continue. I know methotrexate can contribute to nodules but I am wondering what else is going on in my body despite feeling better than I have in years. If diet is helping, wouldn’t the nodules eventually stop growing?
6. Meningioma & Multiple Sclerosis
Sarah Says: Hey Robb, I’ll get straight to it. Two and a half of years ago at age 31 I was diagnosed with a golf ball sized olfactory grove meningioma (benign brain tumour), and later that week with Multiple Sclerosis.
The tumour was removed (along with my sense of smell), so now I’m tackling the MS. Luckily it has remained at a level where it barely meets diagnostic criteria – so no drugs. I’ve been paleo for a year but with 10% cheats, very strict for the past few months, and have just started autoimmune paleo. I also take a high does of vit D3, B12 and fish oil as prescribed by my naturopath.
I am now fitter, stronger, and feel better than I ever have, having spent he past year focusing on strength training. I rarely think about the MS it’s so mild, but I want it to stay that way. So what is it with my brain that I got both? My neurosurgeon and neurologist’s advice only intersect with “you are an unusual case” (at least they agree). Is there anything extra I should be doing to take care of myself based on all this brain stuff?
7. Heat’s Effect on Training
Emma Says: Hi Robb and Greg, Im trying to lose some weight. SHOCKING i know! Diet is not the problem. Ive got the paleo shtick down cold. However, due to the financially restricting conditions of being 23, a freelance journalist and living abroad I dont have the funds for a gym membership so I am doing some strength training at home and sprints outside in 30 second intervals with 30 seconds rest for about 15 minutes three times a week trying to work up to real tabata sprints (tried tabata at the begining of my get leaner and stronger and stop drinking so much wine initiative and nearly vomited -lovely)
So this would all be fine except I live in Beirut, Lebanon. Its the Middle East. Its almost July. Its hot. Its Really hot and humid. I keep myself as hydrated as i can and since my workouts are short and intense im not worried about sun exposure. Obviously the heat makes the workout harder but not impossible.
What Im wondering is how does the temperature affect the biosignaling that would usually come from this kind of workout. Are my workouts more or less effective (or exactly the same) because I do them in a very warm environment? Is there any virtue to manipulating the temperature of the space in which I work out when possible?
Ill spare you the shpeel about my excessive gratitude. Just rest assured that if the podcast were to stop there would be a lot of us missing you and your brain dearly.
Re the first question… I believe the pro bodybuilder “swollen gut” look is caused by HGH and is commonly referred to as “HGH Gut.” From what I have read, HGH not only grows the muscle but also all the organs so it puffs out the stomach.
Joe Brancaleone says
That’s interesting as I’m dealing with something similar to the first question. My upper abdomen specifically protrudes out more. Hard as I try I can’t see good ab definition in a relaxed pose. I figure some sort of stubborn fat but it’s not that soft. Maybe genetics of a natural body type that’s especially difficult to change.
If it were organs such as the stomach, wouldn’t there be an asymmetrical puffing out?
Joe Brancaleone says
I mean asymmetrical horizontally
I guess I will take a swag at this. I have been diagnosed with a mild form of Hyper-lordosis. It goes by the name name sway back, monkey but, and some other colorful name. One side effect of this is that causes is my stomach to poke out while in a relaxed state…even if I flex and form a six pack. The “poking out” is caused by the curve of the spine. I have been acting it with some yoga and stretching. Not sure if this is what the fella has…but its a start.
More podcasts after Robb has been drinking please!
Mark R. says
Just listening to your response to question two and it helped reassure me that my recent programming adjustment was probably a good call. As I unfortunately only get about 4-6 hours of sleep during the week due to work (desk job), I switched to doing only mobility work (Ido’s stuff) 2-3 times a week for about an hour at a time. I walk a mile or so everyday while commuting, so I guess I get in some cardio too. I used to do a met-con (~5-12 minutes) with prescribed rest periods after my mobility work, but just figured that they weren’t worth it as it took me days to recover from them. I also cut back on pure strength work (squats/deads) as they also tend to take a lot out of me for a day or two and I just don’t really care much about moving these lifts any higher. I’ve adjusted my food to match what you/Ido/Mat prescribe (mostly meat, non-starchy veggies, quality fats, eggs, fermented dairy, 1-2 pieces of fruit) plus some unflavored coconut water here and there. I used to have a lot more potatoes/rice. I also stopped doing any IF’ing (smaller meals throughout the day per Ido’s general recommendation) and added in some electrolyte tablets to help with hydration (thanks Kelly Starrett).
I’m hoping that these adjustments will allow me to get to around 8-10% body fat from my current level of about 16% and that my sleep schedule won’t c-block things. After cutting back on carbs, I have noticed that my love handles have come down some but I still measure 36″ at the waist. Pretty much all I care about now is leaning out, feeling good, and improving my handstand. I once had aspirations to go to the games, but now realize that training for it would burn me out in no time.
Overall, do you see anything that I’m missing that might help me out or am I pretty much screwed until I can sleep more?
Mark R. says
Check that, I usually get about 5-7 hours of sleep during the week. Though it probably doesn’t make a difference as the only time that I don’t need a couple of alarms to get up is on the weekend, where I can usually sleep-in at least one of the days. Thanks again.
On #4 it sounds a lot like post-adrenaline dump and all that goes along with it.
Yeah, I was thinking the same thing. Reminds me of my hypogylcemia episodes back in the day as well.
Sounds very similar to a panic attack also.
I came across a very interesting blood sugar response scenario in a Type I Diabetic recently, and I was wondering if you have seen anything like it before. In response to exercise this person’s blood sugar would always decrease to below 100. The exercise she engaged in was either running as far as possible at a high rate of perceived exertion, or a body building routine consisting of 3 x 10 upper body and lower body days. The only thing that did change over time was the distance run (because she could go farther). The main reason for working out was loss of weight. After a year of this type of exercise on a consistent basis, and a considerable loss of weight, her blood sugar after exercise was in the 300s no matter the type. Since she had always trained in the same exertion range I am wondering if you might be able to speculate as to the physiologic adaptation that has occurred? Since she had never participated in any kind of exercise be it inconsistent or consistent my thought is that she has made a transition from an “untrained” to a “trained” state. I speculated that her body responded to the intensity of exercise initially with a rather large IGF-1 secretion. In a more “trained” state her body is not producing as much IGF-1 after exercise and needs the insulin that would be produced from healthy Beta cells. Is the release of IGF-1 in response to exercise to delayed to account for low blood sugar in a Type I Diabetic right after said exercise?
Robb Wolf says
there might be something to this but I think this fits our normal story…as people get fitter they can trash themselves worse.
Robb, this is a comment about your observation that parents of autistic children have been one of the two “camps” that refuse to believe Paleo can offer any hope of improvement.
In fact, there is a very strong movement of parents that are pursuing biomedical treatments for autism (often referred to as a DAN! approach, for Defeat Autism Now!) and diet is always the first stage of intervention (and although they aren’t talking about Paleo for now, the diets that are being used are very similar to Paleo). Unfortunately though, this movement is not mainstream, and many parents refuse to believe in it–and are even dead-set against the idea, as you’ve learned.
I used to incline toward that mindset–thinking that the diet for autism was some sort of lunatic fringe–until I tried a Paleo diet with my 4-year old autistic son with astounding results. Now I constantly feel like kicking myself for not pursuing this earlier. But, rather than beat myself up, I’ve decided to do what I can to spread the word to other parents.
So, Robb, I hope you don’t stop mentioning the link between autism and diet/gut health just because some parents jumped down your throat about it. I understand where they might be coming from. Autism can be really, really heartbreaking, and it can mess with a parent’s head. People have different ways of coming to terms with it, and unfortunately that can sometimes involve a sort of blind acceptance.
I think the main thing parents need to hear is that something like 80% of autistic kids (as well as ADHD kids and kids with allergies) improve on a strict Paleo diet (a 90 day trial, as per one well-known proponent of the approach). This is not as difficult as it seems, and it could be a life-changer for a child.
Anyone who is interested in more information about this approach (and/or moral or logistic support) is more than welcome to contact me on the forum (username=Anjikun). You can even jump down my throat if you want–I will still strongly encourage you to try the diet if you haven’t already, which is what I wish someone had done with me when my son was first diagnosed!
I could also write another testamonial for the site (if Robb is game to put it up there ;-).
Robb Wolf says
I’d love ea testimonial…and I hesitated going down that path but it’s just been interesting. In the many years of running the blog and the hundreds of posts that have gone up I’ve only had these two camps (autism & type 1 diabetes) that have just come out SWINGING. Seemingly angry that I dare to suggest there might be hope or a better way. It’s just interesting to me, and obviously, it’s chapped my ass a bit.
It’s strange how once people have accepted that something is permanent and incurable, that the mention of the possibility of helping it with something simple seems offensive to them, or almost like you’re insulting them. What an interesting thing the mind is.
Keep fighting the good fight, we’ve got your back 🙂
Robb Wolf says
Something else to consider – Low Vitamin d for Autism..
There is a small but growing community that are supplementing vitamin d to their autistic children and seeing great improvements in their social interaction and verbalization.
For more information on this treatment – look at the Vitamin D council.
Hi Evan and Robb
Evan, if what you are describing an acute onset of sweating, nausea, and dizziness for about 10 minutes, with the worst part of the experience a few minutes in, this sounds like a classic vasal vagal response.
The big question is – does this occur after your fruit and nut snack? If so, the hit of acid/fructose from the dried fruit might be to blame. I used to have a similar experience after soccer games as a kid. We finally figured out that it was the orange slices.
I can induce a similar experience if I take an iron pill or a zinc pill after an extended bout of running (soccer game). Perhaps try waiting a little longer to eat or drink any non-water beverages after your event.
If that works, then maybe just try the nuts and see if you again experience the 10-minute ordeal. I have a large hunch that this has to do with the fruit/acidic/citrus component of your post-game nutrition (and not what you are eating before the game).
Hi Dawn and Robb,
We actually see small increases (say, 10-25 points) in BG before and after non-diabetic adults complete a stress test (cardiovascular test done on a treadmill at the hospital or doctor’s office). This phenomenon is quite common. Although counterintuitive (we would think that BG would drop), this occurrence is not limited to the diabetic population. Of course – Robb – you mentioned the stress component. A cardiovascular stress test is, of course, stressful, and this may be responsible for this surge in BG – but my point is merely that this effect is easily observable in non-diabetics (although, not in the order of 100s of points) and does not seem to mean that anything is especially wrong. I saw a case two weeks ago where a man who normally tests at a BG of 65 completed a stress test and clocked in at 108 later. We retested the next week at a follow up – back down to 66.
Robb Wolf says
Really interesting. Now here is why it IS important, especially from the perspective of doing CrossFit: People are subjecting themselves to stressors that make a cardiac stress test look easy, and they do it on a nearly daily basis. And because the stress is randomized it’s tough if not impossible to acclimatize. I’ve talkeed with many of the CrossFit old guard…folks doing this stuff since the 2001-2003 range and we do not see great outcomes. Not without significant modification to the programming, modifications that clearly make it NOT CrossFit.
CrossFit defines it’self as “Constantly randomized, functional movements, performed at high intensity.” make it non-randomized, modify the intensity with planned ramp-ups…it’s no longer CrossFit.
This is why I heed your advice (no crossfit) and stick to lifting heavy things, walking around, and sprinting only every now and then. The amount of psychological and physiological stress that people subject themselves to is no joke. I really like how you have talked about the importance of stress in your podcast – it’s REALLY important (like sleep :)). I really enjoy your podcast.
I actually study the associations among stress physiology and the subjective (psychological) and behavioral components of stress. I’m especially interested in the impact of social stress on physiological changes in pro-inflammatory cytokines, e.g., IL-6 – and how well laypeople perceive this process happening in unacquainted others. Self-reports of stress are actually most often uncorrelated with physiological indices of stress (e.g., Mauss & Robinson, 2009), which renders the whole picture even more intriguing.
Please let me know about your 10-minute spells. I would be very curious to know if they vanish after you discontinue the post-game sugar (dried fruit) hit.
Thanks for all that you do, Robb.
Robb Wolf says
Thank you, and anytime you’d like to do some blogging on this I’d love to host it.
Hi Ashley and Robb,
Thanks for putting this question in the show and for the follow ups. It means a lot to get a response from the source!
So I had a game yesterday. I had a decent whack of sweet potato about 2 hours before the game and did not get the full experience of the nausea, sweats, dizziness etc but did feel that brief weakness which normally precedes the other symptoms. I actually had not had any nuts or fruit either. So perhaps just winding up the pre-game carb will do the trick?
Ashley, interesting that you mention the vaso-vagal thing. About 6 years ago I had what I was told at the time was a vaso-vagal syncope in which I passed out without any warning. I have had nothing like it since except for these last few months post game. I was cleared of any cardiac issues back then and that seems unlikely now.
Interesting! Sounds like the pre-game nutrition was it after all. I’d be curious to also hear if adding back the fruit and nuts (with the pre-game whack of sweet potato) still helps you avoid the (worst of the) symptoms. I wonder if eating on an empty stomach (versus a stomach with perhaps a bit left, due to having eaten pre-exercise) after strenuous exercise (which changes the PH of the stomach) might be a worthy thought. By eating a bit before exercising, you might be preventing your stomach from reaching a certain PH post-exercise. Does this make sense?
Just for clarity – Vasovagal responses (not sure what happened with my spelling the first time! As Robb would say, “I don’t know if this means I need more, or less, coffee”) afflict people with no documented cardiac problems. Vasovagal responses can result from a variety of conditions – from reactions to pain (e.g., menstrual cramps) to reactions to food eaten on an empty stomach in particular situations (e.g., after an extended fast, when stomach has a particular PH). Vasovagal responses do not require that someone faints (syncope) – you can have a vasovagal response without syncope. I can induce a vasovagal response in myself by taking a zinc or iron pill on an empty stomach after exercising. You can read more about the vagus nerve and parasympathetic/sympathetic arousal to better understand the physiology of the response – again, vasovagal responses are not necessarily indicators of cardiac issues.
I’d love to write something – I’m proposing my dissertation next week (3 hours before leaving for AHS!), so in a couple weeks might be best. What’s the best way to move forward with writing a post for you? I’m looking forward to hearing your talk at AHS, and hope to get a chance to meet you!
Robb Wolf says
Just jump in and do it when you get a chance!!
Cybil Cooper says
In question 2, I’m wondering if Dawn is on an insulin pump? Just a thought, but if she is, she might want to try a temporary basil rate. It typically takes much less insulin to control blood glucose levels than to bring high levels down. Cut it off at the pass Dawn! I’d start your experiment with a 35% increase starting 1/2 hour pre-WOD and extending through 1/2 hour post-WOD. Of course you’d want to check your BG throughout as you are getting used to your needs. You may need more or less than 35% and you may need it for a longer time post-WOD or none pre-WOD. The thing about a bolus is, having a whack of insulin on-board during intense exercise could cause lows and still end up with highs after. FYI- I am not a professional of any sort…unless you count being the pancreas for my 10 year old daughter who has Type 1, then, I’m a professional Pancreas Impersonator! 🙂
I’m 59, male, have had Type 1 (some call it 1.5)for the last 29 years. I use an insulin pump, eat Paleo, do scaled Crossfit and long distance bicycling, i.e. randonneuring. The Paleo is for the last 4 months and Crossfit the last 2. Paleo is the best adjustment I’ve made for my Diabetes management since I started using a pump.
My last A1c was 5.3 and Lipid panel was all normal. I’ve dropped 40 lbs of fat and gained 2 lbs of muscle. My body fat is at 20% and I’m working towards 12-15% to achieve a better weight to power ratio. I’ve reduced my basal insulin by 45% and generally I only need to bolus when I eat fruit about a 75% reduction. My low blood sugars are fewer than those found in my physician’s general diabetic population.
I was fortunate to start out with “Tight Control” (multiple injection and carb counting) so the long term effect of the disease are nonexistent. However, the 40 lbs, came from the ADA, USDA recommendations!
Should Type 1’s eat Paleo? YES!!! Don’t relent!
BTW – When I was first diagnosed I asked my physician how early 20th century diabetics managed their disease. In addition to the general not very well, new technology, etc. he said, “They ate mostly meat!”
Thanks for you work and voice.
Robb Wolf says
Keep us posted Chuck!!
Kevin Greer says
In Paul Chek’s book “How to Eat, Move and Be Healthy!”, he discusses a similar case to the guy with the first question about the distended stomach. In Chek’s example, it was a fitness model, who was otherwise lean and in great shape, but who suffered from the same problem. In her case, it turned out to be a parasite infection.
Hey Robb, re: The post game nausea, migraine and profuse sweating.
What a coincidence because I just came back from a game of basketball and I am suffering some major migraines, and nausea right now. I don’t usually get migraines but 2 things that happened today was
1) I didn’t take any magnesium supplements. I used to take at least a teapsoon pregame and one afterwards. Magnesium deficiency is known to cause migraines, and migraines and nausea go hand in hand. So this might be it.
2) I haven’t been eating much fat lately. Usually it consists of 70% of my diet.
I actually did eat some rice today as well, so I don’t think I was lacking carb wise.
When I lift weights I never have any problems at all regardless of what I eat. (I do starting strength, 300lb squat, and slowly moving up).
Re – #2. I don’t understand why the type 1 PWD should avoid intense exercise to lower insulin requirements. Can you elaborate? Does this apply regardless of body comp? For example, if this person is at target body fat levels, should they still avoid insulin, even to the point of avoiding intense exercise?
Robb Wolf says
I cover this in the podcast and in previous posts!!
I’ll take that as a yes, then?
I’ve listened to the last 40 or so podcasts, and I’d appreciate if you’d elaborate.
If type 1’s with good body comp should avoid intense exercise to lower insulin requirements, shouldn’t everyone? What’s the difference if the insulin is manually released via injection (or pump) vs. automatically via the pancreas?
Ibrahim Yasin says
Hello there Mr. Wolf,
My name is Ibrahim Yasin, I’m 25 years old, have had Type 1 diabetes since I was about 10, have been doing crossfit for about 3 years, and have been doing “real” Paleo a little less than one year. I say real because I had been doing the half ass version by not eliminating dairy and peanuts before that. With all that I would say I am taking less than 1/4 of the insulin I took before the Crossfit/Paleo combo.
Being a human, I too experience a sympathetic nerve response to doing an intense WOD. Like others, my blood sugar at the end of my WOD would be higher and I would have to take a small amount of insulin in response to the response.
I have tried the recommendation you gave to the author of question 2. In which you suggested that a small amount of insulin be taken before doing the WOD. I have found that it is very rare that this works out well (Almost always ending in hypoglycemia in the middle of the WOD). Despite taking even less insulin before a recorded WOD than I had taken the last time I preformed the exact same exercise after. I think you were on the right track when you were saying there are just way too many variable to how you body is going to react to a WOD.
So my statement is this, the risk of having a hypoglycemic reaction while lifting a 115# barbell over head is a greater risk then the short temporary increase in blood sugar levels. I just make sure I always take my insulin with me to the gym to shoot up with the roid junkies at the end of my work out when I need to. I guess the question comes down to how much damage is really being done by having a increased blood sugar for let’s say 45-60 minutes if you count the time it takes for insulin to do its job.
Food for thought let me know what you think.
Hi all Type 1 diabetics (and maybe the type 2 as well). I started CF about 3 months ago an too experienced the highs post workout. Frustrating bc they are hard to treat once above 200. July 5 I started on a continuous glucose monitor (Dexcom) and it has completely changed the way I eat (I started Paleo right after) and I no longer spike above 200 during a WOD. With a CGM I see what my sugar is and where it is going 24/7. If I am dropping during a workout I have my tabs with me and I dont let it go below 80. If I start to rise above 160 on those heavy weight days I can take a small bolus (about .1 or .2 works for me) to stop the rise. I recommend this for all diabetics who are tired of the surprise highs and lows. We too can do intense workouts!
Two questions I have for Robb, or anyone else who is educated in this subject; 1: why does my sugar sometimes rise from protein? This does not happen all the time. Im trying to track when it does and doesnt, maybe dependent on amount of protein or timing with exercise? Should I try a square wave bolus? How long/how much? 2: perfect breakfast for a 130lb diabetic female who wakes at 8am and does Crossfit at 10?
I understand this is an old post but just out of interest-do you run your basal rate at normal rate and add in extra insulin or do you do a temp rate(approximately how much) and add extra bolus if bgl rising?cheers Monica