Cycling and Type 1 Diabetes management

[DiabeticJim]

Hi all - this is my first post to this forum. I'm hoping to hear from other T1Ds that have have an interest in cycling and how they deal manage their diabetes.

I ride once or twice a week - whenever I can get the chance in fact. I mostly ride early mornings and do about 3hrs at a decent pace covering 30-50 miles on the average ride. Sometimes more, sometimes less. There's the occasional sportive and might have a go at racing this year.

I use an Animas Insulin Pump and have recently started using the Freestyle Libre too. I tried the Dexcom CGM which links to the Animas Pump but I actually prefer the Freestyle Libre - but that's a discussion for another time.

The problem I am having is keeping my levels in my target range at the start and throughout my cycle rides. My BGs almost always spike after breakfast and drop back down to normal before lunch even when not exercising. The problem is that having high BGs really does affect performance - anything over 14 mmol while exercising is not good. I notice this too. My bloods drop down within range about 1-2 hrs in.
Breakfast usually consists of 2x instant porridge packets, banana and fresh berries, glass of OJ watered down (only 10gms carbs of OJ) and a strong coffee.
I've recently started taking my bolus for breakfast about 15 mins before eating and that seems to have helped with the spike - yet to try that pre cycling though.

Dropping my basal by -70% an hour or two before and then dropping it down to -90% when I start seems to work best. If I dont do this then I'll almost certainly hypo fairly quickly - I've even left the pump at home before now (does not help at the coffee/cake stop though . I carry a small bag of jelly babies and eat a few along the way. If I know there is a big climb coming up I'll pop a few in advance. The freestyle Libre makes it very quick and easy to check BGs en-route. I can fish the reader from my pocket and scan the monitor without stopping The arrows telling my how quickly BGs are falling are very useful too.

Do check out the pro cycling team - Team Novo Nordisk. They are an inspiring group of people and have some good advice but its quite generic on the website i.e. try to keep BGs in target range - derrr :/
You can follow me on Twitter here for my occasional tweets on Diabetes and other rubbish.

I'm really interested to hear from other cyclist diabetics on their experiences - I hope to hear from you soon.
James

 

[ElyDave]

Take a look at my blog Jim, I've been working this out myself over the last 2 and a half years, and bar the odd surprise seem to be getting there, just off to the gym, but can post in more detail later.

Whereabouts are you located? If not too far we could even head out together any compare notes.

 

[zicksi101]

Yes, the pro's tend to prefer simple advice as every body is different, and what works for one person with diabetes may not work for another.

I'm no cyclist, however it might be useful to see what your blood glucose does when you wake up without having breakfast on a rest day to test whether you are perhaps experiencing a dawn phenomenon effect, it can cause blood glucose levels to rise due to stress hormones.

I found some detailed considerations on this from a triathlete recently which you may find interesting: http://t1diabetictriathlete.weebly.com/blog/training-on-empty-considerations-from-a-type-1-diabetic

 

[DiabeticJim]

Yeah - the 'everybody is different' comes up a lot eh? I know it's true but it would be good to know exactly what others are doing.
My bloods are usually fine pre breakfast.
@ElyDave - I'm London based. Could you post a link to your blog?

 

[ElyDave]

http://adventuresofanathleticdiabetic.blogspot.co.uk

it's in my signature, but I dont think you see that on the app vs a browser.

As an example, today I had a half-hearted 50km on the upright this morning (also ride recumbent) with a TBR on the pump of 30% of normal starting about an hour ahead of time (prefer 2-3 hours but woke late).

BG went like this
pre ride 15g carbs, put BG up to 6.7,
45min 5.0 20g,
90min 4.6 10g,
2hr 6.3 none

Lunch an hour later had BG 5.3

 

[tim2000s]

Hi @DiabeticJim , if I'm honest, I think you'll struggle to keep that breakfast under control if eating it before getting on your bike. For breakfast cereals, I tend to need to dose about 30 mins ahead of the meal as they spike me like crazy, and I've had similar experiences with porridge. You may need to try bolusing a smaller amount before getting on your bike, or potentially changing what you eat. @ElyDave typically don't you eat a low carb diet?

 

[ElyDave]

I do these days @tim2000s, but not always.

When more carby, my general method for long distance was to set a 30%tbr three hours ahead if possible, and reduce bolus with a bowl of porridge, or even no bolus. That accepted a short term spike to prevent a big drop about half an hour into the run or ride.

Remembe that as well as increased insulin sensitivity, you also have other receptors triggered by the exercise.

 

[zicksi101]

Yeah - the 'everybody is different' comes up a lot eh? I know it's true but it would be good to know exactly what others are doing.

It does, I understand. It's my standard disclaimer because the first thing I noticed is that you are on a pump and I'm on MDI.

Training "on empty" is what works best for me to keep my BG stable when training for running races, I do eat carbs, I just find the best time to have them is post exercise or perhaps during.

 

[DiabeticJim]

I think you're right tim2000s, there are a lot of carbs in my breakfast - 80-90gms. That combined with taking the bolus just b4 eating.
I'm definitely going to try changing my breakfast to something lighter in carbs and more slowly absorbed.
Low carb routines are great for keeping levels under control but I don't want to lose weight. I don't have much to lose. I burn about 1000calories in an hour on the turbo and well over 2000 on a decent ride. Just a low carb brekky for me I think.

 

[tim2000s]

Low carb routines are great for keeping levels under control but I don't want to lose weight. I don't have much to lose. I burn about 1000calories in an hour on the turbo and well over 2000 on a decent ride. Just a low carb brekky for me I think.

I typically manage to eat 700 calories for breakfast with no carbs at all - all eggs and meat. Combine that with bulletproof coffee and you'd easily have 1200 calories with no carbs in it at all. Once you start the day with that calorific intake, and maintain normal meal sizes for the rest of the day, it's pretty hard to lose weight!

 

[DiabeticJim]

What do you eat to get up to 700cals? A fried egg is only 90

 

[ElyDave]

Even the leanest amongst us has plenty of fat reserves for a days cycling, we just need to learn to use it.

Take the bullet proof coffee - 25g butter and 25g coconut oil would be about 400 kcal on their own. Add a three egg omelette and some bacon and you're getting towards 800 easily.

Have you compared the Garmin and Taxc calorie figures? They can be very different depending on their base algorithms and factors such as wheel slip/pressure, your bodyweight etc.

 

[tim2000s]

What do you eat to get up to 700cals? A fried egg is only 90

275g scrambled eggs and 125g smoked salmon and you've hit 650 calories.

Fried eggs are around 196 calories a pop as well, so three of them and two rashers of bacon and you're there.

 

[ElyDave]

275g scrambled eggs and 125g smoked salmon and you've hit 650 calories.

Fried eggs are around 196 calories a pop as well, so three of them and two rashers of bacon and you're there.

I like this low carb stuff, lunch today was a two egg omelette with saucisson-sec, mushrooms and shredded sprouts, plus a coupel of oatcakes smothered in butter.

Now to go and work it off on the turbo trainer.

 

[zicksi101]

That sounds like it may well be a perfectly valid solution @DiabeticJim.

Changing your fuel source to something higher in protein isn't necessarily better. Dr Bernstein says that, in general, you need to bolus 1u of insulin for every 25g of protein you eat in a fasted state anyway.

So that's why I only eat if I need to when going out for a run without a pump.

 

[ElyDave]

The idea is not to change to protein, but to change to fat.

 

[zicksi101]

My point is simply that, from a pure type 1 diabetes point of view, a high fat diet also tends to contain a certain amount of protein.

So when I have 2 bacon rashers and 3 eggs for breakfast, I know that my individual requirement is to have 4u of Novorapid to cover the protein (for me this is an extended bolus of 2u + 2u) for that high fat meal.

If I have 40g of porridge, I need 4u to cover it.

So, ultimately, whatever dietary choice is preferred, the diabetes is still managed through insulin and exercise.

 

[Amrit1712]

Hi, finally found some cyclists!!! I try to cycle a lot but only tend to do about 20 miles at a time. I'm entering a charity event from Oxford to london 52 miles later this year and am excited but also nervous. Being on MDI at the moment (pump soon though) I found it difficult to decide how much insulin to take off and when to check as constantly stopping to check becomes tiresome. Any advice for when I'm out on the road? I so tend to go out in the early morning so what should I eat beforehand? I didn't take any insulin and just had a banana last time and my levels were around 15 for the whole ride...

 

[Amrit1712]

Also may I just ask what do you take on rides and where do you put it?

 

[DiabeticJim]

Hi @Amrit1712

Unfortunately, I cant help you re insulin doses on MDI - I'm on a pump - it gives great flexibility when it comes to exercise as mentioned in the previous posts.

This is what I carry when I ride:

In a VERY small saddle bag:

• 2x CO2 canisters and adapter
  
• Repair patches
• Tyre levers
• Spare inner tube
• Multi-tool
• Latex gloves (very useful for staying clean when doing any repairs)

In my jersey pockets:

• Jelly babies - I pop a few of these when things get tough
  
• Banana or two and/or cereal or breakfast bars - no overpriced energy bars or gels for me
  
• Freestyle Libre CGM monitor - I cant recommend this device highly enough!
  
• Diabetes ID card (with emergency contacts and advice on treating hypos)
• Credit/debit card
• Cash
• Mobile Phone

And my Animas pump - but I've ridden without it several times without issues.
Dont forget, plenty of water too.

Quick update - Taking my pre-breakfast bolus 15-30 mins before eating and dropping the carbs down (just a little) seems to be helping with the extreme post breakfast BG spikes I was getting. Still yet to experiment with this and a ride though.