Replies to This Discussion

Permalink Reply by acidrock23 on April 2, 2012 at 6:04pm

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?

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Permalink Reply by dino on April 2, 2012 at 10:12am

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!!

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Permalink Reply by timmy on April 2, 2012 at 5:30pm

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

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Permalink Reply by Super_sally on April 2, 2012 at 7:57pm

What about experimenting with using straight honey as a fuel source, vs. gels?

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Permalink Reply by timmy on April 2, 2012 at 9:03pm

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?

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Permalink Reply by Chad R on April 2, 2012 at 11:50pm

I have been in the same spot as you, just a couple years ago. While it sounds like you are pushing things a bit further than I did in terms of exercise, the principles are still the same, I was using MDI with Lantus and was on a strong honeymoon period and pushing my body very hard physically. The proper way to manage your BG in the honeymoon period is EXTREMELY different than for those who are off the honeymoon phase. I have a few recommendations that are specific to the honeymoon phase.
1. Feed your body as much carb as it needs, there were evenings where I would polish off over 200 g of Gatorade, use as much as your body needs.
2. If possible do not exercise with rapid insulin in your system, your body is making enough insulin of its own and any amount of rapid used to make me crash, even 1 unit and a lot of carb. try not eating a meal 2 hrs before a workout as there will still be a bit of mealtime insulin in your system, eat the meal 4 hrs before if possible and eat your snacks to control BG around 30 min before the workout and during.
3. Right now any carb that you put down your body will respond with insulin, so if you are using short acting carb like Gatorade it is more important that you are drinking it frequently than it is that you take large doses. Gatorade or any quick sugar will start raising your BG in 10 min and will be gone in around 30 - 40 min at this point you are at risk of your BG dropping so keep topping up every 20 to 30 min. You will likely do better by using medium or long acting carb like granola bars or protein bars to provide a baseline sugar release and then toping up with some gatorade if you are running lower than you want to be.
4. Each different type of exercise will have a different rate at which carb is burned running tended to be the highest for me often at 90 g/ hr when I was in the honeymoon and as you mentioned weight lifting actually tends to raise BG and most other sports were somewhere in between. Keep logs of how many carbs you are burning per hour for each activity and use those values to plan your carbs for future events.

Considering the type of routine that you are pushing, you would likely do well with a pump, as you could simply disconnect 3 hrs before the workout and then you would not need to be fighting as hard to balance your carb and insulin levels. You could just let the injected insulin fade away and let the amount that your body makes fuel you during the long endurance events.

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Permalink Reply by timmy on April 3, 2012 at 12:08am

thanks for the tips chad. Can i get some opinion on some things?
1) RE: feeding as much carbs as i need. If carbs are used to 'correct' bs, do they end up storing as bodyfat? I was always drilled with calories in vs calories out and i can only assume this remains true in type 1...
2) I do try and not exercise with insulin, and at most, i will give it 2 hrs atleast. Most of my exercise is done around 5pm, with my last bolus at around 12 for lunch. I can maintain steady bs levels inbetween.
3) you might be right about the bars, i did think brown rice would be similar though? I have used powerbars lately and that didnt work but i only tried that once some im willing to go more bars. I think powerbars is 40% glucose/fructose mix though so thats probably why. I did come across a gel that team type 1 use which is basically cocoa and agave which is low GI. Even thouhg im in australia i might see if i can get my hands on some and down a few for a baseline and top up as i go with the spikey stuff.
4)Your right about the different events, but i never though to log what im eating before with the rate of mmol drops etc into it. Im going to draft up a spreadsheet with my training sessions and document what i eat, when, exercise involved, bs before during and after as well as carb burn rate. Love your thinking 99!

And definately about the pump, however the educators dont really want me on a pump this early and im not sure about it either in terms of being in my honeymoon. When it ends i think its definately on the cards.

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Permalink Reply by acidrock23 on April 3, 2012 at 4:03am

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?

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Permalink Reply by Chad R on April 3, 2012 at 8:16am

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.

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Permalink Reply by timmy on April 3, 2012 at 4:16am

hey AR- My training and races are all sort distance stuff. 10km runs or less, often 3-6km intervals/hills with the one long run of 10kms (no marathons here!). Swimming at most is 1.5km in any one time. Again, i interval that at times and do slow steady stuff aswell. Bike is similar, 30km max distance, often days when its just hill repeats. More sharp intense stuff, including one brick session a week of bike to run. Mind you i am doing a half ironman ride leg of 90kms in a month so that will be interesting! Will carry my monitor on that ride.
I have no idea how you keep/stay at 120 (6.6mmols), if i went out the door at 6.6 for anything i would want to make sure i had a gel or something to go with that because 6.6 would go to 3 in about 10 mins!
Not all of my exercise is intense and fast, but its not easy either. My intervals of which i do 3 max week (1 each dicipline) are fairly taxing.
And your right about the pump. There is a pump info night with the educators in july. The educators like to go softly softly with us newbies and i can undersand why, but i do think im an exception to the rule with the amount of exercise and type i do.

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Permalink Reply by acidrock23 on April 3, 2012 at 4:37am

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!

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Permalink Reply by Chad R on April 3, 2012 at 8:32am

AR
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.

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