Problems & Solutions of a #Diabetic Athlete

As a diabetic I run into some problems unique to us, or just me, while running. Some of them just stumped me how obvious the solution was, others I am still throwing darts in the dark at sometimes, others I am following the clues.

  1. Hypoglycemia while running – Before I had a pump I would have to eat quite a bit before, without bolus, and during a run else my glucose levels would drop and I would become hypoglycemic. Currently, I use a pump and I reduce my basal to 25% of normal 90 minutes before I start. This will usually keep it dropping a little but I do not need a lot of carbohydrates during and none before the run. I try to keep my glucose between 5.5mmol/L(100mg/dL) to 8mmol/L(150mg/dL) as I seem to work best there. Another benefit of the temp basal is that if I run out or forget carbohydrates I can just stop or walk slowly and my blood sugar will rise back to normal. I don’t usually go running within 4hrs of a bolus so the only insulin working is the basal and at the low effort it will become inadequate
  2. Pump site falls out – This one threw me for a bit. I tried just Skinprep, Skintac, and Tegaderm but it did not stay stuck when I got hot and sweaty. I found a product called Mastisol that along with a Skinprep application seems to mostly work. But not always, so in long races, especially in the U.S. where a Canadian is hard pressed to get coverage, I will wear or bring a spare site with me. I do this when I’m back country trail running too
  3. Hyperglycemia after running – This one isn’t as common but I know other endurance athletes that deal with it, it generally affects those doing short high intensity workouts. For me, pretty much every time I run it will happen. I am still working on this one and there have not been a lot of guidelines to help me. Currently I am retuning my temp basal to normal about 20min prior to stopping and bolusing for the insulin that I will be missing in my basal for the next 2hrs. My temp basal is 25% of normal and say I was using 1unit/hr normally. That leaves me needing an extra 1.5units to cover the gap. I suspect I will need to add more but have not tested yet; the liver is still pushing out a lot of glucose at the end of a run. I try not to eat a lot of high GI foods for a few hours after too.
  4. Dropping a high blood sugar quickly – I have been able to text and figure out how fast my blood sugar drops with a normal basal. Currently about 20mmol/L(360mg/dL) in 30min. If I have a large high sugar level that I let slip by, instead of waiting for insulin to work over hours I will go for a 20-30minute run. It seems to work well and I carry lots of carbohydrates and watch the CGM. I like this because I can just go run not planning it for 90min and take control of he high sugar

That is about all I can think of now. I will add more blog entries as more problems come up or I think of others.

It’s Still Reading Day – Part Deux

I have been reading “Type Type 1 Diabetes: Clinical Management of the Athlete” by Ian Gallen and now have a few more insights into some strategies for controlling post exercise hyperglycemia(high blood sugar) in type-1 diabetics. I seem to have highs after almost all my workouts whether it is an hour or two or more. So I do not agree that it is a high intensity phenomena only and I have spoken to others who agree.

The one guideline mentioned as there is little research on this still is I may need double my normal basal rate for up to two hours poet exercise. This seems to coincide with my experience. The risk is timing, too early and I may go low; too late and I will spike high. My last run I was able to keep control by returning my basal to normal 20 minutes before completion and bolusing the other half up front at about 10 minutes before I stopped. I will try this again and see.

It is too bad there are so few guidelines on this. My A1C would be probably a full percent better and that is significant.

As for running, I’m thinking tomorrow. This is the most time off I have had in a while and I don’t like it. But sick days are sick days and it is the end of her season. Maybe a forced timeout is a good thing in the big picture.

No 1/2 Mathon Today, it’s Reading Day

So I am sick, it sucks but the head cold moved to my chest and that killed my aspirations of racing today.  However, all was not lost.  I have been thinking and reading about Diabetes and exercise.

I no longer fear the lows, I can control them quite well these days as I have a CGM and I have been modifying my doses to accommodate my changing needs.  The last couple nights I have had less than 1mmol/L drop over an 8hour period.   I am OK with that.  The piece of the puzzle I am still working on is the post exercise hyperglycemia.   It is still like throwing darts, but I am close.

What I currently try to do for moderate/long runs:

  • Temp basal down to 25% – 30% 1.5hrs-2hrs prior to run, I don’t know an exact timing yet.
  • 15min-20min prior to finish of run, return basal to normal or another temp basal at 110%-125%, I don’t know the number yet.  Bolus at least 1unite-1.5units of insulin and use CGM to gauge correction dosage in addition.  I know the CGM shouldn’t be used for dosing but it is practical.

The results are generally OK and with the more aggressive dosages I have been able to keep my glucose below 10mmol/L.  I still have to wait to eat any real carbohydrates unless I am correcting a low though.  It seems that carbohydrates work a lot quicker after a run.

The problem is that I am using the force too much for my liking here.  And there is some risk involved if I where to not be able to stop.  Then again, I can just walk the rest.   That is an important safety feature of a temporary basal reduction during exercise.  It only takes a few minutes for my glucose to start to rise if I don’t have extra insulin in me post run.  If I were to run out of carbohydrate sources, I can just walk easily and my glucose will rise quickly.

As for during the run, I will eat about 20g-25g of carbohydrate an hour and usually will not drop too much.  I am happy in the 5-7mmol/L range and will usually not eat until I get there.  This helps with the post run hyperglycemia as I am starting at an OK number.

Well more reading and hopefully I can run tomorrow.  I signed up for a Strava challenge this month to run as much vertical as possible and I am really excited.  Hills are fun.

Things I have learned as a diabetic runner

I have learned lots of this from others and some from experience.

  1. When I need to be sure my pump site stays in, have a second one already in. The other will fall out otherwise
  2. Mastisol makes thinks stick when I am running in hot and humid weather
  3. If I forget to have a second site and my pump site falls out during a race pull out at the next aid station, it’s not worth going DKA
  4. When my blood sugar is high, a 15-30 minute run will drop it back. Mowing the lawn works too, but I don’t like my lawn that much and a lawn mower going at 1am isn’t good for neighbourly relations
  5. Always carry too much carb. I like Gu and blocks, but it doesn’t matter, and stuff happens.
  6. Use a temp basal to avoid feeding insulin
  7. Turn off the temp basal 20minutes before stopping if I can, or do a cool down if it is a race and bolus too. I use 1.5 units but that’s me. Otherwise I can shoot up from a 5mmol/L to 25mmol/L in 25minutes
  8. Deal with dosage changes quickly because they happen often
  9. Keep you pump in a waterproof belt, it may no longer be waterproof as we all seem to walk into walls when it’s clipped to our hips
  10. Adrenaline can sky rocket your blood sugar, wait and see then treat. I cut the correction by the same percentage I cut my basal rate
  11. Running shorts all need pockets
  12. Play with dosages and learn how you react to different efforts
  13. My ranking of running surfaces is ranked trail, track, then road. But dirt tracks suck