Just wondering if i could get some advice and opinions. I am finding im getting low rather easily and quickly when i train in cycling, sometimes running and ALWAYS when swimming. I have tried numerous combinations including:
1) 0.5 unit bolus (and minor basal reductions the night before exercise) for breakfast/lunch or whichever prior to exercise. The result= no power and didn’t train well. Its as if i need my normal 1 unit bolus to shuttle that glucose into muscles. (1 unit is what i have at lunch and breakfast because both meals have 30gms of carbs)
2) I have tried low GI carbs and waiting around 1-2 hours prior to exercise. I have also tried high GI carbs about 15mins prior to exercise. The result= Still get very sharp drops in bs within 30 mins.
What was worked for my triathlon races is this: 1 unit bolus in the morning 2-3hours out from the start to cover around 55gms of carbs. It usually gets me to around 10mmol which is great (if it doesnt i just have to have a few jellybeans to top it off). I do a 300m swim (yes, 300m only!) and have a Gatorade prime in the first transition (30gms of quick acting carbs), ride 15km while drinking a powerade along the way, and finish the 3km run. I finish back on 10mmols. It goes down after that over a fairly short time, if it doesn’t i bolus but usually don’t have to. Anyway for an event that lasts all of about 45 mins, i need 55gms carbs for breakfast + 30gms in transition + 15gms on the ride. 45mins of exercise and i need around 100 grams of carbs just to get through! These feels crazy to me. I feel like im sucking down carbs just to stay afloat.
Ill give you another example. Today i got up, had a banana and 30gms of oats and 1 unit (to cover the oats, the banana to try and spike me a bit). I got to 7mmols before i took off for a run (in about an hour after taking food and insulin). Now perhaps i needed to wait more because i had full effects on insulin on board. But in only 4kms i was down to 3.1. I took glucose tabs and jelly beans to see out 10kms. It was at moderate pace. At lunch i had 1 unit to cover lunch (30gs of carbs), 2 hours later went to the gym and lifted weights. Finished that about 2hrs later with bloods at 5mmol (weights slightly spike me then level out). I then had a powerbar with 40gms of carbs in it before i went for a swim after weights. I waited about 15 mins and my bs got up to 7.5mmols. The powerbar was working and my sugars were seemingly on the way up. I swam 35 laps of a 25m pool and lost my power and technique went to crap so i knew i must be getting a bit low. Jumped out and i was 3.3mmol.
Does anybody else feel like their really sucking down alot of carbs to keep afloat with exercise? Sorry for the long post, but does anyone have any suggestions. I have tried to spike with larger amounts of most things from brown rice to energy gels, often with insulin still ‘fresh’ in the system and often when its well out (eg 4 hours like my swim today). Im at a bit of a loss in trying to maintain high bsugars for any length of time during exercise, intense or not, stopping short of becoming a carb addict. I assume the honeymoon period may have something to do with it. I think when im off my honeymoon and my insulin needs increase i think i might get a pump.
I've read all that stuff but, just based on my observations with my CGM/ BG meter, the maltodextrose-based fuel seems to take about 2 hours for me to "process", which sort of makes it useless for "fixing" errant hypos? I am sort of with Timmy on this, in that my main use for the stuff is to eat before the race, if circumstances transpire that make me run lower than I want to be, as sort of a "meal enhancer" but, even then, it doesn't seem to work fast. I prefer to have a piece of toast or two though, as I've never run into any GI issues running. If my BG is low or heading that way, I want something that's going to work *now* to fix things before it slows me down?
Whats up Timmy! Quick question...what are you using for basal insulin (lantus, levemir) and how much are you using? What are the "minor changes" that you make prior to a training day?
I ask because I find that it can play a huge role in what's going on, especially for endurance training.
First let me say that you are doing everything right in the sense of experimentation, logging, and especially coming here for help. I've had this condition for a long time, and it never lets you rest. I don't care if you're a pumper, shooter, honeymooner...what works for you today might not work for you tomorrow, so the key to success is to be patient with your numbers and not allow diabetes to frustrate you.
My take is that you may be taking too much basal insulin for your level of activity, especially as a honeymooner. Since your body may still be producing insulin, the combination of natural insulin and synthetic insulin could be a little much, especially in the water...where every muscle in your body from your diaphragm to your quads is demanding sugar just to keep you afloat. I find that surfing or just swimming in the ocean is the most taxing activity when it comes to my blood sugar...which makes sense when you consider the amount of muscle activity it takes just to battle the current and stay afloat.
...ironically, I have to cut this long reply short to treat a low blood sugar right now (60mg/dl) but I look forward to your response brother!!
im using lantus, if i exercise hard at night or will be in the morning then its 7 units. Usually wake between 5.5-6mmols. Otherwise its 8units and i wake 3.7-4.5.
I train every day except for tuesday in which i just do weights. That doesnt move my sugars too much, only up slightly then slight dip again.
I will try more pure malto gels. I usually have one about half an hour before training. I dont know, unless i really try with a tonne of carbs, i find it hard to get above 8mmols.
Go treat that low man hahaha
What about experimenting with using straight honey as a fuel source, vs. gels?
to be honest i have read about, but not tried honey, only on my oats and that spiked my to oblivion...its downside was the GI issues while running. Fructose doesnt agree with me guts at all. I have seen some honey 'gels' from stinger, i will most likely try them. I need that spike which lasts. Had 1 cup brown rice and waited an hour and tested twice in that time before exercise. 30mins = 7.4, 1 hr = 6.4!! (and that was 1 unit of insulin taken 4 hours prior to cover lunch, so the novorapid should be gone in 4 hrs!)
For the record, i thought maltodextrin were just longer chains of dextrose. Their GI rating is the same?
How much are you training, like Ironman distances, where you are going for 8 hours at a time, or training for 4-5 hour sessions? I usually do my "carb loading" mostly the day before the event for a longer race, e.g. marathon or 1/2 marathon or most of the long training runs that I did last summer, 3+ hours. Then I eat lightly that evening (really, a couple of "carby" beers is it, liquid bread, no GI/ porta-potty impact...) and then a bigger than usual breakfast, 2 pieces of toast, usually 8-11G of carbs each, about 2-3 hours before showtime, although when I had trouble getting going in the AM, some of the training runs, it might have been less time? I test before I run and try to be near 120. If it's lower, I have fast carbs. If its like 90s, I'd check IOB (a pump will tell you how much insulin "on board" you have?) and if there's any, I'd consider a GU of some sort but most of the time skip them. If I eat those, it's as much for the caffeine as the food.
I wouldn't worry about the "this early" business w/ a pump. If you are training for a full-ironman and are having problems with lows, I think that now would be the time. Even if you are oriented towards the shorter distance tris, that's still several hours in the saddle (pool, shoes...LOL...) and I still think that a pump would be an improvement over the challenges of shots. One thing they mentioned when I'd gotten my pump was that the NPH insulin I was using only had a 53% chance of peaking when it was supposed to. They implied that Lantus/ Levemir also had some peakiness although I don't recall the %age but if there's any variability in peaking, that can contribute to the sort of "what the hell was that?" numbers that you seem to be experiencing? A pump will also help you record your data pretty accurately, in terms of knowing your body and your dosages and all that. Writing stuff down can be just as accurate but seems like it would be more inconvenient when you are out on the road, pool, etc. If it's outside the "educators" paradigm, perhaps you can explain your training regimen to them and show them how the lows are cropping up? That is likely outside of their paradigm too and could perhaps justify the pump if they play jerkball and won't hook you up?
1) I think that this is different for each individual, for me when I became T1D I had a hard time eating enough food to maintain weight and still maintain good BG control, so I viewed the ability to eat a bunch of extra food without insulin as a good thing durring/after excersise, but i think there are also some who gained weight. In the end you don't have much choice, as you need to maintain proper BG. If this is a major problem for you, then yo need to reduce or eliminate as much external insulin as possible, dropping your lantus dose or getting a pump are the only other options.
3) If doesn't need to be anything specific, just study the glicemic index of foods and find something in the medium or long range to use as a baseline. I never ate much brown rice, so I can't say for sure, but I would guess that it would work.
4)Log your BG before, after and the amount of carb and the amount of time for the event, this will allow you to calculate the rate that you are burning carb. Then you can have a proper estimate of how much carb that you expect to need for future times that you repeat this same type of exercise.
As far as the pump goes, it is just another method of getting insulin under your skin. I would say that it was an improvement in my BG control (honeymoon or not) while exercising. If you bring up the fact that the routine you push is much more strenuous on the body that the tpical person and you have a strong need to turn off your insulin supply for large parts of the day, most people do not. Perhaps you could be considered as an exception in terms of getting a pump this early.
For those distances, I don't worry about "fuelling" w/ extra long-term carbs, e.g. rice and granola bars. If my BG is a shade low, I'll have a 6 oz glass of skim milk or V8, maybe 10G of carbs, to "fuel" and usually will have another 20-30G of carbs while I'm on the road, like run 3 miles, see where I'm at on the CGM (usually a shade lower than when I started is my goal there...) and have half of my Gatorade.
I used to make "custom" gatorade by buying the powder (which is also a lot cheaper, like $2-3.99/ 5 gal...) and dumping like 45G into my Amphipod bottle and then a second bottle with 15G/ bottle. These days, I just do pretty close to "regular", 25G of carb / 8 oz and it seems to work about right.
I agree intervals are taxing. I have been pretty lazy about doing them, although I'm 44 and, frankly, don't want to blow a gasket! I had been going long/ slow, trying to get dialed into a planned 10:00/ mile marathon pace (this in October...hee hee...) but had a 5K on St. Patrick's day so I just did maybe 5 interval sessions on the treadmill, short, like 2 miles but 9-9.5 mph for .1 and slowing to 7.5-8 mph, would work out to about 15 minutes for 2 miles (including warming up for .25 mile...) and I was 1) totally knackered and 2) BG was in the toilet the next day. I just ate a bit more than usual but it worked and I ran a 23:17 (easy to remember!) at the race, a PR by like 40-50 seconds! Maybe the slower energy also had to do with running in the winter, even though it was mild this year, it is not as much fun as running in nice weather we are into now.
July is a long way away. I would start on them immediately. In the US, part of the deal was that to get "coverage", I had to log numbers for a month. I dunno what other stupid tricks they may have their to exploit their power relationship but I think that if they are squidgy about it, you should take them out for a run and work them over!
Right now I do things very similar to you, I don't worry about fueling with long term carb either, but I am off the honeymoon and have also switched to a pump. Two years ago, things were much different. When we turn down the basal rate on our pumps we can set the amount of insulin that is hitting our body to be equal with the glucose form our liver, leaving relatively stable BG. Timmy cannot do this, he has two streams of insulin that are steadily hitting him throughout his exercise, his Lantus shot and the insulin that his own body puts out. Any time that his BG is high, his body will send extra insulin, dropping his BG and if the sugar stream runs out he is vulnerable to go low form the lantus stream and increased insulin sensitivity. As long as the sugar stream stays steady, then his body's insulin stream stays steady and his BG stays flat. This is one of the key differences between exercising with full T1D versus in the honeymoon phase.