[kbiker3111]

I have a few questions for any type 1 diabetics out there who are willing to lend an ear. Are there any on this forum?

 

[fsrxc]

I have a few questions for any type 1 diabetics out there who are willing to lend an ear. Are there any on this forum?

Um, yes, depends on what you're asking.

 

[kbiker3111]

Basically I'm having low blood sugar problems while training.

This is my first year of serious training for racing. In the past my rides rarely lasted past an hour or so and never had the prolonged intensity that I train with now.

My fasting and overnight levels are normal. Its when I go on 2-3 hour rides, I experience severe blood sugar drops. For example, last saturday I went on a 2.5 hour trail ride: My blood sugar before the ride was 250, I ate an orange before the ride(w/o insulin), during the ride I drank 30 grams of carbs in Gatorade, and still at the end of the ride my blood sugar was around 60.

Right now I use a system of (fast acting)Novolog and Lantus(glargine) baseline insulin. I'm really comfortable with this and would like to know if theres any way to adapt this system to endurance workouts. If not, how well does the pump work for endurance athetes? I'm just trying to figure out what other type 1 cyclists do.

Thanks

 

[fsrxc]

Basically I'm having low blood sugar problems while training.

This is my first year of serious training for racing. In the past my rides rarely lasted past an hour or so and never had the prolonged intensity that I train with now.

My fasting and overnight levels are normal. Its when I go on 2-3 hour rides, I experience severe blood sugar drops. For example, last saturday I went on a 2.5 hour trail ride: My blood sugar before the ride was 250, I ate an orange before the ride(w/o insulin), during the ride I drank 30 grams of carbs in Gatorade, and still at the end of the ride my blood sugar was around 60.

Right now I use a system of (fast acting)Novolog and Lantus(glargine) baseline insulin. I'm really comfortable with this and would like to know if theres any way to adapt this system to endurance workouts. If not, how well does the pump work for endurance athetes? I'm just trying to figure out what other type 1 cyclists do.

Thanks

I'm in Canada so I use different units, but, I use Gatorade on rides, with a carb snack immediately after (maybe test then eat). With very few mid-ride lows. I think it's important to test *before* the ride, and bring your sugars up, don't start a ride low.

No time for more, might add some later.

 

[kbiker3111]

What type of insulin do you use? I'd like to find a way to avoid eating constantly while i train.

 

[scheckler]

I am a type 1

and am very brittle( my blood sugar is real difficult to control). I use the exact same insulins as you. I do not "train" for races though. I usually ride 4-5 days a week on 1.5 to 3.5 hour rides. I have to constantly monitor my blood sugar during rides. I have found that Power Bars work real well for my riding. Costco has them in a 24 bar box for $19.99.

You also should discuss your situation with your doctor. My Lantus dosage has dropped from what my doctor first had recommended. When I am working out and riding frequently I sometimes do not need to give any Novolog before or after meals either. As I am sure you know, exercise has a tremendous effect on your insulin levels.

This is an interesting subject for me, thank you for posting it. I have always wondered about actually doing a race but was always concerned about having low blood sugar during the race and having to stop to eat.

I hope this helped.

 

[fsrxc]

What type of insulin do you use? I'd like to find a way to avoid eating constantly while i train.

I'm using NPH and Humilog, so mid-day lows are always a risk. If you're using Lantus you should have a bit easier time than me. My thinking is - if exercise is driving my blood sugar down, it's a sign I'm using more energy, so eating more carbs is not a bad thing. I don't intentionally reduce my insulin before exercise, since I train almost every day, so I find it easier to adjust my food to match my energy output.

I've found for running and biking, that when I sip (one gulp) gatorade every 5 minutes (I regularly check my computer/watch and stick to it) I usually keep my sugars in check. This is easier to adjust than say a power bar or gel which gives 30-40g carbs in one shot.

I've seen it recommended for diabetics to eat an extra ~30g carb per hour of exercise. Obviously this will vary based on intensity, temperature, your own metabolism etc, but it seems to be pretty close based on my experience. I think for gatorade and most energy drinks, one scoop = 30g carbs, which they recommend mixing with 500ml water. I usually carry ~1.5L of gatorade (camelbak or watever) on a 2-3 hour ride.

To compare to your example below, you ate an orange (~15-20g carb?) and drank 30g carbs in gatorade in a 2.5 hour trail ride, so you might have been ok if you drank another 30g. I'd say you should try carrying more gatorade, and pick a regular interval to drink (make it a habit), and you should have less lows.

 

[fsrxc]

-snip-

You also should discuss your situation with your doctor. My Lantus dosage has dropped from what my doctor first had recommended. When I am working out and riding frequently I sometimes do not need to give any Novolog before or after meals either. As I am sure you know, exercise has a tremendous effect on your insulin levels.
-snip-
I hope this helped.

Good point I didn't mention, I have to change my insulin doses quite frequently, changing weather, work times etc, so that's a given. Kbiker may have to reduce baseline doses since he (she?) is doing more exercise than before. I just don't reduce my dose because I'm planning a ride that day...

 

[scheckler]

Yes

Good point I didn't mention, I have to change my insulin doses quite frequently, changing weather, work times etc, so that's a given. Kbiker may have to reduce baseline doses since he (she?) is doing more exercise than before. I just don't reduce my dose because I'm planning a ride that day...

I agree totally. Once I have determined what my Lantus doseage should be, through trial and error, it is consistant- I do not change the Lantus(baseline)doseage. If I started exercising less I would reevaluate my Lantus doseage with my doctor. Every diabetic is going to be somewhat different in the way they handle exercise and insulin.

fsrxc, you have good knowledge of this subject. I think I will try gatorade in my water to see how it works with my riding. I do not know why but power bars, if eaten at the right time, seem to really keep my blood sugar level on strenuous long rides. But again, that is just me, it may not work for others. Exercise is sooooooooo good for us diabetics

 

[- Jeremy -]

What type of insulin do you use? I'd like to find a way to avoid eating constantly while i train.

I'm not diabetic, but I thought I'd throw in my 2 cents on this one.

Even non-diabetics should eat "constantly" while riding. I eat 25g carbs every 15-30 minutes depending on intensity. I don't necessarily need to during rides of 2 hours or less, but I've found that eating during rides of any length drastically reduce my recovery time.

I'd suggest using plain water or diluted sports drink for fluids and use Hammer Gel in a flask. Hammer Gel has a much larger ratio of Complex carbs to Simple sugars than most gels. I've heard that this helps diabetics control their blood sugar and reduce spiking.

- Jeremy -

 

[Homer Simpson]

The carb boom or hamme gel is a good idea. This is pretty fast acting stuff and does not tend to cause a spike that other sugar sources may cause. Thats's the problem with something like an orange, lots of sugar. You need a carb source that is rapidly absorbed but long acting, like a gel of some sort. Something with complex carbs and a little protein can be beneficial. A little gel then somthing more solid to provide a longer source of carbs can help.

Long term diabetics can experience the effects of low blood sugar at levels higher than a normal person. This is due to your body resetting itself to be used to the higher blood sugar. If effect, your normal blood sugar level becomes higher than a non-diabetic.

My mom is a diabetic on a sliding scale and my grandmother was diabetic too, but non-insulin dependant, she just watched her diet. It took my mom a few years to get her blood sugar under control, partly due to not altering her diet and no exercise. But she did get it under control finally.

A very important thing for diabetics is too look for evidence of nerve damage, especially in the feet. When I did my nursing clinicals on the cardiac floor, most of the patients were diabetic. Our diabetic nurse educator told us that many diabetics die from cardio-vascular problems caused by high blood sugar. But most diabetics do not get enough (any?) exercise.This is not meant to scare you, just to educate you to be careful. Many doctors just treat the disease with insulin and do not try to modify the patient's life. It's not that they don't care, they are just realists, they know most people will not exercise.

Do you keep a medic-alert ID with you to let peole know you are a diabetic if something happens to you. Many cops will think you are drunk when you are just having problems with your blood sugar. Make sure your riding buddies know you are diabetic and what to look for and what to do for you if your blood sugar gets too low.

You will succeed in controlling this disease.

 

[kbiker3111]

Thanks for responding everyone this is really helpful.

To compare to your example below, you ate an orange (~15-20g carb?) and drank 30g carbs in gatorade in a 2.5 hour trail ride, so you might have been ok if you drank another 30g. I'd say you should try carrying more gatorade, and pick a regular interval to drink (make it a habit), and you should have less lows.

Thats a good idea, i suppose its something I just need to work out something that i can repeat every time I ride. I like Gatorade because its so cheap to buy the powder, but maybe gels would work better.

Its hard to change Lantus doses in preparation for rides, because it takes a couple days for the change to complete take effect. I'll change my dose as part of a taper for races, and when I stop riding altogether, but thats about it.

 

[drc]

pump therapy?

Would an insulin pump be an option for you? It's great to be able to adjust the basal insulin to the nearest 0.05u/hr at any time.

on a different note, there's interesting data showing increased blood sugar due to catecholamines (adrenaline and noradrenaline) when you hit about 90% of your VO2max for 5 minutes or more.

 

[kbiker3111]

Would an insulin pump be an option for you? It's great to be able to adjust the basal insulin to the nearest 0.05u/hr at any time.

on a different note, there's interesting data showing increased blood sugar due to catecholamines (adrenaline and noradrenaline) when you hit about 90% of your VO2max for 5 minutes or more.

Have you used the pump? Does it work well with preventing lows during exercise? Its been offered to me before, but I don't like the idea of having something attached to me all the time. If it were really helpful in preventing lows during training, I would be interested in trying it out.

 

[seatstay]

Cycling coach with Diabetes

If anyone is looking for the opportunity to speak or work with a cycling coach that has strong knowledge on Diabetes, energy production, and training feel free to contact me. I have diabetes and have been racing both road and mountain years. I use insulin and currently I am using the pump for several reasons, too many to list here. I would be open to speaking with anyone who has questions on insulin requirements, diet, energy production and training.

Feel free to shot me a question on anything. It would be my pleasure to help anyone out.
Contact me at: [email protected]

 

[fsrxc]

If anyone is looking for the opportunity to speak or work with a cycling coach that has strong knowledge on Diabetes, energy production, and training feel free to contact me. I have diabetes and have been racing both road and mountain years. I use insulin and currently I am using the pump for several reasons, too many to list here. I would be open to speaking with anyone who has questions on insulin requirements, diet, energy production and training.

Feel free to shot me a question on anything. It would be my pleasure to help anyone out.
Contact me at: [email protected]

Good to know, I'm still pretty new at this. I've been biking for years, coached some too, but I was only diagnosed in 2001 (type 1 at age 41), so still lots to learn.

 

[scheckler]

That is real cool

If anyone is looking for the opportunity to speak or work with a cycling coach that has strong knowledge on Diabetes, energy production, and training feel free to contact me. I have diabetes and have been racing both road and mountain years. I use insulin and currently I am using the pump for several reasons, too many to list here. I would be open to speaking with anyone who has questions on insulin requirements, diet, energy production and training.

Feel free to shot me a question on anything. It would be my pleasure to help anyone out.
Contact me at: [email protected]

of you, seatstay. I am 41 and was diagnosed when I was 5. I have a lot of experience with this disease but am always learning something new. One thing I do know, as I said before, exercise is soooooo good for us diabetics... well, actually exercise is good for everyone.

 

[drc]

I've been on a pump for 8 years. As long as I remember to reduce my basal rate prior to exercise for the duration of exercise AND that following night I can reduce my hypoglycemia events a lot without having to overeat. The attachment thing occasionally annoys me but a day or two on multiple daily injections reminds me of all the benefits of the pump.

The localo diabetes educator could hook you up with a 'dummy pump' so you could find out what it feels like to be attached.

the pumps are expensive, about $6k, plus the consumables run about $150/month. Insurance often helps with the cost. You need to learn carb counting and specific analytic processes to learn how identify the cause of highs and lows--basal vs bolus issues, pump and infusion set malfunctions, etc. You can't really "test ride" a pump

Have you used the pump? Does it work well with preventing lows during exercise? Its been offered to me before, but I don't like the idea of having something attached to me all the time. If it were really helpful in preventing lows during training, I would be interested in trying it out.

 

[sherwood]

I've been on a pump for 8 years. As long as I remember to reduce my basal rate prior to exercise for the duration of exercise AND that following night I can reduce my hypoglycemia events a lot without having to overeat. The attachment thing occasionally annoys me but a day or two on multiple daily injections reminds me of all the benefits of the pump.

Hey DRC,
Did you find that your insulin requirements were greatly reduced when you got things sorted out with the pump? I know you probably were using NPH and R eight years ago, but I have found that nightime Lantus coupled with 4x daily injections of humolog makes it extremely hard to lose weight due to frequent hypoglycemic incidents, and the necessary sugar level adjustments to keep things right. Especially when I ride more. I suspect that a multi times per day basal flow of lower doses of insulin provided by the pump could ulitmately reduce total insulin requirements. Have you found this to be true?

And how often do you move your injection site? I have heard that it should be moved daily, is this true. Also, I see you recently did some riding in Moab, and that you live in Nevada, how do you protect the insulin in your pump from becoming overheated on hot days? I have found that anything over about 85 degrees renders my whole vial useless. Has this been a problem for you? How do you know when you are getting "bad" insulin? Is it easy to change?

And where do you keep your pump when you ride? In a jersey pocket, or taped to your body?

I am currently on the fence regarding the pump, and I am very encouraged by your experience so far.

Thanks,
Sherwood

 

[seatstay]

I have lived with Diabetes since the age of 6. I have been ridding and racing for years. I have used injections for years, Lantis and Humalog. I am very recently on the pump which I clip to my shorts(lyrca). I refused to go onto a pump becuase of my Martial Arts training. Since I decided that if I have time to train with anythig else then I have time to ride more and get faster on the bike. So all I do now is ride.

I have just switched over to the pump to help me with better energy production, stable power output, and proper fuel replacment. I have learned how to control my lows/ hypos. by proper insulin adjustment. Before my use with a pump I was able to ride for five-six hours with almost no complications. I did a 24 race and placed 2nd with no hypo. complications. I checked my blood sugar every lap and fueled properly during each lap.That was alot of work.

There are some important things to realize when training and managing Diabetes:
Hart rate
Metablosim
Diet
Medication
Self Discipline

To be a good competitive athlete:
YOU HAVE TO WORK TWICE AS HARD AS EVERYONE ELSE.

I would have been pro years ago if it was not for my Diabetes. I do not allow it to stop me so I have to work harder than eveyone else on the starting line. When my training is critical I weigh my food at all meals. I check my blood sugar anywhere from 10-15 times a day. I rarely checked my blood sugar when I was on injections during a ride because I found what worked for me and I had to study so much to know what I was doing. I am now checking my blood sugar during my ride every 45-60 minutes because of my new pump managment. My goal is to get eveything down perfectly. Most doctors cant believe that I test so often and several times before a ride. After my rides I rarely experienced any hypo/low episodes.

Medtronic make a sensor that operates like a pump. This Sensor records your blood sugar activity for about 60-70 hours. I have also used this sensor to see how my body was reacting to my ridding. I also had this on my bike shorts. I attach the pump to me just above my Glut. Med muscle so if I crash I do not screw things up. The pump is on my shorts(lycra style) hanging from the back. I crashed the other day and fall on my left side, no complications to the pump.

If anyone is interested in working with a coach that specializes on this topic or just wants to ask a question please feel free to contact me. [email protected]