I have had some time to think about my experiences at this amazing race. Right after the race I was overwhelmed with exhaustion and didn’t really feel like running another really long race again, let alone a 50km or longer race. Then, after a nice meal, a beer, and a good night’s sleep I came to realize what I had accomplished.
I was semi-competitive for most of first 50km race but ran out of juice in the last 5-10km without having run more than 32km in my life. I was around 20th at the final aid station and was passed by about 40 people during the final ascents. I ended up finishing in 60th out of 177 people with a time of 6:22hrs. I was really tired and ended up stopping often. My heart rate was sky rocketing when walking. However, if I did it again I think I know how to better push through the exhaustion. I have used this in recent 5km races and workouts to push.
I did not have any issues regarding my diabetes. My insulin pump site stayed attached and I remembered to insert a spare(did not need it), keep another in my bag along with a syringe. I was within a good range the whole race and I cannot complain what so ever about this. Even my control following the race was amazed and I had to guess on the dosage a bit and accommodate what I guess would be a lot of glycogen depletion.
I learned that a really slow run is a world faster than walking and it generally turns into a faster paced run. After a hill or a quick break I was able to say lets go and just ease back into it. I have been meaning to read it, but the title of the book “Relentless Forward Progress” is very apt in this case. I kept repeating that title and pushing through.
The conditions were really good. It started cool, but not cold and I wore a long sleeve shirt and shorts. Towards the end it got warmer but for the first 3 aid stations I did not need to refill my water. Afterwards I ran out before each aid station. I was expecting more snow, but there was only a little and it was easy to get through. The mud was awesome. Not so deep that you got stuck, but it made people try to go around. Big mistake. I was passing others trying to navigate around the mud and working half as hard.
As for after the run, I was not broken. Trails are amazing for that. They hurt and tire you but generally leave you intact. A few months before this race I did a half marathon on the road that broke me for a month.
That leaves now. I am focusing on some faster races and then will do another 50km race in October. The Wild Duluth 50km race. Should be exciting and not too hot. Next week is the first mile race of the season and I have won a couple local 5km races in the past month. Running fast is fun too.
I thought I would share my thoughts on my first ultra yesterday, the Superior Trails Spring 50km. Not the running part, it was great but I worked on that for months before the race. I am really excited about how well my blood sugar was both before and after.
I used a pump and a CGM. I found a way to keep them stuck to me for over 6hrs I was out there and didn’t need to go to my backup site I had inserted, my spare site in my backpack or a syringe. My checklist seemed to help as it kept my mind on what to bring because luck would have it that if I forgot my spares like I did at my first trail marathon, I would have needed them and ended up pulling out.
The race started at 7am and I wanted to eat prior so I got up at 2:30am so that the bolus was mostly gone. In the past, the tail end of the bolus becomes very significant with the change in sensitivity I have. Normally under 0.1units wouldn’t be noticed. Then at 5am I set a temporary basal of 15%.
As expected, I started trending up going in but started the race at about 7.0mmol(125) and this continued for a bit and then started to drop. At about an hour in I started dropping a bit, this seems to be the magic time, and I ate a sport gel. This brought me back up and it kept trending up for a while. So I used a correction bolus of 0.2units and upped my basal to 20% of normal. This is where I wish my pump had a smaller increment than 0.025units/hr as it seems that somewhere between 0.150 and 0.175units/hr for the first few hours would have been perfect and later on, somewhere between 0.175 and 0.2 would have been. But I just kept bouncing my glucose between 6.0mmol and 10mmol after the initial little high of around 11mmol. I am not complaining at all. Although, I did notice that 7mmol/L seemed to be the sweet spot for how I felt.
Long story short, I was able to run my race, perform well and diabetes did not get in my way. It has kicked me in the butt enough times and I actually feel invincible now. I have no hypo’s or hyper’s much past 10mmol/L, it is possible to have decent control in tough situations.
As for the running part, I trained for about a 5hr race and had about 5hrs in me. I think I was top 20 until the base of Moose Mtn on the way back and between there and the finish I dropped 40 spots to finish 60th out of 177 people. I have never run more than 3.5hrs before so I cannot complain. I actually don’t feel beaten up or hurt much at all. I have hurt way more after a hard or really long run. I feel invincible almost. So maybe it is time to throw some speed back in the game and own a 5km or two. Get that time under 18min again.
Since I started pumping I have been using a temporary basal to keep my blood sugars from going low while running. Sometimes it is a little too low or too high but in general if I use 25% of my normal basal amount I will be fairly stable during the run. That is, until I stop. Then a few minutes later it skyrockets with the dreaded post exercise hyperglycemia, except most of the time I am not sprinting or working at 90% effort that it is commonly associated with.
What is happening is as I finish the run my muscles need far less glucose, I am low on insulin and my liver continues to send out lots of glucose. A perfect storm to create high blood sugar.
My strategy is to replace the insulin before I stop running to limit the amount of rise in blood sugar. But I have been conservative until recently and just returned my basal to normal and gave a small bolus 15-20 minutes before I finished. This has limited the rise, but I still could not eat for at least a couple hours. The last couple runs have been encouraging. I have a CGM now and I can be far more aggressive in my treatment. I have been setting my basal to 2X normal for 2hrs and replacing the insulin I am missing with a bolus ( 0.75x(normal basal)x2). Again, about 20min early. I may have been a little over but I am close. I had a couple mild lows of around 3.8mmol/L(68), but I just ate. Also, I could eat without a huge rise in blood sugar. Both times I have kept my blood sugar under 7mmol/L(126). Wooh hoo!!!
This will have a huge affect on my next A1C as these post run high blood sugars are the source of my trouble. I am usually pretty good at being in range otherwise and with a little fine tuning I might be suprising a few people in a couple months.
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 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