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.
- 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
- 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
- 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.
- 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.
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.
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.
I will be running in a trail half this Sunday and I plan to have some fun with it if this newly acquired cold lets me go. Might be a forced taper. I already have my 1/2 marathon time this year of 1:28 in the local Miles with the Giant 1/2 marathon course and can play with the pacing this weekend. I am thinking of pushing it a little earlier on and trying to hold onto some of the relay teams.
I have learned lots of this from others and some from experience.
- When I need to be sure my pump site stays in, have a second one already in. The other will fall out otherwise
- Mastisol makes thinks stick when I am running in hot and humid weather
- 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
- 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
- Always carry too much carb. I like Gu and blocks, but it doesn’t matter, and stuff happens.
- Use a temp basal to avoid feeding insulin
- 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
- Deal with dosage changes quickly because they happen often
- 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
- 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
- Running shorts all need pockets
- Play with dosages and learn how you react to different efforts
- My ranking of running surfaces is ranked trail, track, then road. But dirt tracks suck