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Comment by Mari on April 7, 2013 at 2:47pm

Hello Athletic Diabetics! I wanted to be sure this group knew about diabetes exercise CampWILD for adults with diabetes. We are offering two $1K scholarships, you need to apply by April 10th! Check it out, http://campwildscholarship.com

Comment by MikeMack on March 22, 2013 at 9:27pm

I'm sure this has been discussed here before, but what has been your experience mountain Biking with an OmniPod? Just started on mine about a month ago. I've road biked with it and did fine, but a little more concerned about mountain biking. Any thoughts?

Comment by acidrock23 on February 14, 2013 at 4:00pm

This chart is pretty handy and I've used it as kind of the theoretical model while running 7x 1/2 marathons and 2x fulls plus lots of training runs since 2009, when I began running regularly. I know I've seen it online but haven't been able to find it so I took a pic of the one in Think Like a Pancreas.

The conversions work for basal or bolus adjustments. Moderate intensity for 31-60 minutes, adjust your basal down to 67% normal or have a snack and bolus for 67% the regular amount. I don't do that much snacking and have found that 8-12g of carbs/ 3-5 miles usually covers my needs pretty well. I get home from work and if I'm 85-90, I'll toss down a glass of skim milk, probably 10G of carbs, get dressed and start on a 3 mile run and get the "Predicted High" alert on my CGM, run and, as I get close to home, I'll see the "Predicted Low"

Sometimes, I get thrown off by CGM variance but it is something that I think I've gotten better at with practice. I usually run 3-4 days/ week and do strength training (pushups/ pullups/ crunches) on off days, mixing in bicycling when I can when it's not winter in Chicago.

I usually try to get my BG to around 120 for the start of a race but have a lot of issues getting cranked up on adrenaline before races that seem to make my BG run up while I'm waiting in the corral. I would suspect that team sports might have the same effect? I would think goalie would be a great position but would probably be adrenaline-filled due to the stress, infrequency of goals, etc. At least you could keep your meter and snacks by the post!

Comment by Nyadach on February 14, 2013 at 3:29pm

This is quiet a handy site also for info:
http://www.runsweet.com/DietAndNutrition.html

Comment by Bradford on February 14, 2013 at 1:30pm

PhDiabetes I was speaking to a group of endos at a conference once and one of them showed me a chart (she'd made a copy from a book?) that she gives to her patients that's kind of along the same line as to what you're referring. I can't recall the resource off the top of my head :-/

There are a few places out there that have similar insulin and carb suggestions. Here is one for insulin (and carb) adjustments (as well as carb intake), and here is one for suggestions of how many grams carbs to eat based on a type of exercise (this is only relative, of course, b/c it does not mention intensity, but it's a start for those that are really unsure).

Like you suggested, a lot of people have to use trial and error to figure this out, unfortunately. I think a more standardized (or at least more publicized?) chart that could be used as a "starting point" would be greatly appreciated (or would greatly benefit) people throughout the diabetes community.

Comment by PhDiabetes on February 14, 2013 at 12:21pm

I realize that every body is unique, but it would be really useful to distill these various factors into algorithms/decision trees. Better yet, it would be great to have a protocol with worksheets for testing out a person's limits with different kinds of exercise, kind of like how the endo had us perform basal rate evaluations when we went on the pump. Then, the patterns could be used, at the individual level, in managing various exercise scenarios as they arise. I imagine most people probably to this informally or on their own, but it would be great to have a set of practices or recommended procedures for doing it more systematically.

Comment by Bradford on February 14, 2013 at 10:11am

I agree Biomuse. I actually have to increase my basals when I'm racing cyclocross and when I race crit races b/c I race anaerobically the majority of the time w/ those, and my BGs tend to rise quite significantly (which we know is different than endurance-based aerobic efforts which cause BG to lower, most of the time). I also often have to bolus prior to this exercise even w/o food, which of course sounds counterintuitive, and of course would not recommend w/o first consulting w/ your healthcare team.

Chris' example of his son is a great example of this concept, especially given the extra influence that hormones play on BG (little to no stress hormones during practice, but definitely a lot of cortisol and adrenaline on game day, which cause insulin resistance).

In general though, if you take your pump off (even if you're sitting on the couch watching tv and not exercising), your BG will rise w/o that basal, and this is noticeable after an hour or more. It is potentially more noticeable the higher the basal rate (and would also depend on sensitivity factor for that time of day for that person), so of course is largely dependent on the individual.

I didn't ask what position was being played on the soccer field, but that is definitely one of the important variables (much more running and possibly anaerobic activity going on in an intense match as a midfielder or a forward), and the other variables you mentioned are also important points to consider.

Comment by Biomuse on February 14, 2013 at 10:00am

Bradford, with regard to rise in BG after an hour or more of intense exercise - careful: that may, or may not, have anything to do with a lack of basal insulin.

It more likely is a result of gluconeogenesis and glycogenolysis in the liver as a result of the combined actions of glucagon, cortisol, adrenal catecholamines and growth hormone which antagonize insulin and raise blood sugar.

How much of these hormones show up is dependent on several things, including how hard you exercise, for how long and even how nervous you are before and during the exercise (e.g. Chris's example where his son is high during real competition, but low during practice).

When you are exercising, your muscles don't require insulin to absorb glucose, as they can also absorb it directly without using insulin at all. But: those hormones counteract that, because they are trying to raise glucose.

So these factors - exercise regularity, intensity, duration, emotional state, starting glucose level, carbs - are all in play and working against each other.

I've had full days of hiking (aerobic exercise, not nervous) - much longer than 1 hour, where I barely needed a unit of insulin for 7 hours. But I've given talks where BG's been through the roof in 30 minutes without moving.

Best rule: USE your CGM and fingersticks and observe, observe, observe.

Good refs:
http://www.medscape.org/viewarticle/438374
http://bit.ly/12OKg5L (starting p.83)

Comment by Chris on February 14, 2013 at 8:58am

My T1D 12-year-old son also plays soccer. This year he is on a competitive, traveling team -- very high intensity soccer. We have found that his blood sugar tends to drop during practices, but rise during games due to the adrenaline rush. He has a Dexcom CGM, so that help us plan ahead. We also have him test at half time and eat some carbs if his blood sugar is trending downward. If he eats after a game he needs to reduce the bolus because his blood sugar will eventually fall an hour or two after the game is over. Because his blood sugar seems to rise during games, we try to have him leave his pump on (wears an Omnipod). I'm more comfortable with him taking his pump off (turning it off or reducing the basal rate)during practice because his BG tends to fall, so less insulin is probably better in that situation. Tournaments where he is playing 2 or 3 games in one day are really tricky -- so many things causing a rise and/or fall in blood sugar - in addition to all of those adolescent hormones which also make things challenging. FYI -- I have also found that his new Dexcom Platinum CGM will continue to receive his BG data if I'm holding it on the sidelines while he is playing - something to consider for parental piece of mind if your child doesn't want to wear the CGM while they play.

Comment by PhDiabetes on February 14, 2013 at 8:05am

Great question. Just finished 4th soccer season coaching my 9 year old son (2nd season since he was diagnosed with T1d). Part of the reason I coach is to keep a closer eye on him. He's on the Animas Ping. He takes off the pump as well during soccer games. He's a "full contact" kind of player, and I don't want the pump to get damaged. Plus, it's important to him to be discrete about his diabetes and does not want the pump to fall out of his pocket or off of his waistband (that being said, he does keep it on most practices). My general approach is to have him get a number before warm-up, and if his BG is much under 150/160 with any significant amount of IOB, I'll make sure he eats part or all of a protein bar. IOB and last meal are considerations, since his practices and games have tended to follow meals. I try to gauge where his BG is headed or might head based on these factors and plan what to do based on that. I have been prompting him to check at half-time as well and to add carbs or bolus to correct, accordingly. Last year, the games (4 on 4, no goalies) seemed to wear him down and we were more concerned with lows. This year (6 on 6, goalies), I've noticed his BG's oftentimes going up after games, relative to where he started. Maybe it's the increased adrenaline from the competition. My biggest concern is that he's going to go low during games but be so into the competition and exertion that he does not attend to his hypoglycemia symptoms until he's bottoming out. That's happened once or twice but we caught it. I'm ok if he's a bit high (up to 250) during games. He's getting great physical exercise, which is great for his body and overall BG control, and we can easily correct his BGs at the half or after the game. If she's goalie, she could keep shot blocks/glucose tabs tucked off to the side by the outide post, in case she needs something. Also, you might try experimenting with the pump on/off and just have her check at several intervals during the game to see what her BG's do. After a few games, you should have some good data to go on. I'd like to hear how things work out for you. For what it's worth ...

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