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Cycling T1 ...

Discussion in 'Type 1 Diabetes' started by maskellp, Jul 18, 2014.

  1. maskellp

    maskellp Type 1 · Member

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    Hi,

    I am a keen cyclist and struggling with MDI, on Levemir and NovoRapid.

    Basically if my BG is over 10 I feel lethargic on the bike and can't keep up on group ride, therefore I have some QA, but if the ride is over 3+ hours, by the end I can't keep up cos I'm eating constantly.

    Just wondered what/how others cope with endurance exercise?

    Is a pump better for this type of exercise?

    Would self funding a CGM help? I could tell later in a ride if I was going low or just tired!

    Any help and advice would be appreciated.

    Phil
     
  2. norwaycook

    norwaycook Type 1 · Member

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    I'm a nearly 60 year old who has had diabetes for over 50 years. Still cycle normally just for an hour getting to and from work a couple of times a week.
    Just


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  3. norwaycook

    norwaycook Type 1 · Member

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    Sorry fingers too big for phone, well just recently gone on the pump works better controlling your long acting insulin basal just takes a bit of setting up a bit of experimentation Used to cut my slow acting insulin down the night before I was cycling by 20 % or more now with the pump normally cut by 50% one hour before and during any cycle


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  4. Auckland Canary

    Auckland Canary Type 1 · Well-Known Member

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    Hi,

    I am on exactly the same regime and cycle about 200 miles a week and will be doing the Ride London 100 in a few weeks. I can't be of a huge amount of help here as my blood can be very erratic. I've done 40-50 miles and hypoed as well as the same distance and coming back higher than when I left. I generally ride solo so don't have the problem of trying to keep up with others. You could always ask if people minded stopping for 1 minute for you to do a test though.

    What you find may help is to not worry too much about long acting type carbs during the ride but just get your way through the ride with Dextrose or jelly babies or whatever takes your fancy. These are easy to eat on your bike and you can store them in your pockets very easily. Obviously after the ride you need to monitor your levels over the next 12 hours etc because of this risk of delayed hypo and take on board longer acting carbs

    I am not sure about a CGM but others will be able to give you advice on how they work .I believe pumps do make long term strenuous exercise easier but again never having had one I don't know.

    There is a cycling group called Team BG which frequent these forums and you can also Google them and most of them are Pump using T1's so hopefully one of them will see this and pop up soon to help you out or you can email them directly.

    Good luck!
     
  5. maskellp

    maskellp Type 1 · Member

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    Thanks for the info, I always find it hard to explain BG to anyone at the hospital when on a check up as mine are so erratic on the bike too. I will google Team BG


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  6. Robert 2170

    Robert 2170 Type 1 · Well-Known Member

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    Hi I am on the same insulin and the same happens when out on the bike trying to keep my levels up also if if is hot they go down even quicker and I don't feel the hypo even when I stop only when u test I no I am low have been down at 2.5 and still not felt it when I asked the doctor they are saying it is because I am doing something so do I just keep going till j fall off
    I no they say reduce the day before insulin but don't always get out or something happens so I would like to no if the pump would help before I go back to the hosp in September


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  7. noblehead

    noblehead Type 1 · Guru
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    I would imagine endurance exercise would be better managed using pump therapy than MDI, take a look at Runsweet for some tips and advice on exercising with type 1 diabetes:

    http://www.runsweet.com/
     
  8. Marshmallow Man

    Marshmallow Man Type 1 · Newbie

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    Hi, i'm on novorapid and levemir, I do 70 - 80 mile rides regularly, i tend to test every hour during rides aiming to keep bm's between 10 - 14. I usually have porridge and a banana pre ride with just 2 or 3 units novorapid. (I'd usually have 9 or 10 units). I take a good supply of jelly babies and have one every 20 mins, also a SIS energy gel if bm less than 10. Continue to check bm's post ride as can go up if stopped off for coffee and cake. Hope this helps.


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  9. Bebo321

    Bebo321 Family member · Well-Known Member

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    Hi Phil,
    Have you looked at the TeamBG site yet? Fancy joining us on the mHealth grand tour? There are a couple of stage places left, and you will learn loads! Most will be pumping, and CGMs will be used by most.
    Get yourself signed up if you can, or certainly get yourself lined up for next year.

    It would be well worth you joining the sporty diabetics type 1's facebook page - loads of keen cyclists there to help with advice.
    Pump is definitely the way to go for endurance sport because just as @norwaycook says, you can drop your basal right down (up to 80%) when you are riding. The guys on the tour try to cycle at around 6.5 and mostly stay pretty level throughout.
    Couple of things to look at on the website - the type 1 case study movie http://www.teambloodglucose.com/TeamBG/Type_1_Case_Study.html
    and just out of interest the mhealth movie 2013
     
    #9 Bebo321, Jul 19, 2014 at 11:05 PM
    Last edited by a moderator: Jul 19, 2014
  10. Bebo321

    Bebo321 Family member · Well-Known Member

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    Hi there,
    Pump would definitely help - just because it is far easier to control and reduce your circulating insulin during exercise. I suggest you likewise take a look at the TeamBG type 1 case study movie (link above) just to see how it can be done.
    Watch out for lows - remember if you have had a low one day, you have a reduced hypo awareness for the following 24hrs or so, so it's important to be extra careful.
    CGM would be the next consideration - catch those pesky falling bloods before you fall off your bike!o_O:)
     
  11. Bebo321

    Bebo321 Family member · Well-Known Member

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    Hi Auckland Canary,
    Great that you do so much cycling! All the best with your upcoming Ride London 100.

    You may benefit from joining the Sporty diabetic type 1's facebook page (link through TeamBG), as cycling comes up as a topic quite frequently - and there will be plenty of advice if you have any particular queries.
    Anyone can be a part of TeamBG, and it covers all forms of exercise. :)
    We're going to be getting our cycle club up and running before long, which will hopefully give us an opportunity to put on more rides that people can join in with and offer more opportunities to share advice and support.
    Feel free to get in touch through the website if you have any questions - we're always happy to help where we can.
     
  12. ElyDave

    ElyDave Type 1 · Well-Known Member

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    If you want to start an East Anglia Branch just let me know, I'm up for that.

    Just donw two hard days cycling in the Austrian Alps

    Day 1 80km / 1100m climbing / 25kmh average
    Day 2 - 90km / 1800m climbing / 21.5kmh average - one big climb of 1000m in 13km, that was hard. Team Novo Nordisk Jersey photographed at 1600m up an alp

    I'll do a full write up of insuling management strategy later, just got back this evening
     
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  13. JRW

    JRW Type 1 · Well-Known Member

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    We are all so different, I have just got back into cycling after being diagnosed as T1, and on Levemir and NR. I'm up to 40 miles at the mo, but don't take any NR with the banana at the start of my ride, and need to take on about 60-70g of carbs per hour whilst cycling. After 2hrs cycling on Sat my BG dropped from 11 at the finish of my ride to 6 2hrs later. I'm still on a big learning curve.
     
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  14. Bebo321

    Bebo321 Family member · Well-Known Member

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    That sounds really very good JRW. Is there anything in your results you don't understand?:confused:
     
  15. JRW

    JRW Type 1 · Well-Known Member

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    Yeah, loads of things, my bg drop after exercise can vary a lot after the few rides I've done since diagnosis. Also, if I'm on normal levemir levels and do a 30min cardio + weights at the gym can result in massive drops in BG . As I can't always predict when I exercise I can't lower my basal every time.

    What I will say is that it seems possible for me to get a reasonable level of control for aerobic exercise, and you can be cautious and take a lot of carbs with you.

    I feel liberated to be back out on the bike again, after 18 months being diagnosed T1 I finally feel like I'm getting my life back.
     
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  16. ElyDave

    ElyDave Type 1 · Well-Known Member

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    JRW, I'm not far from your positions, having only been daignosed 14 months myself, but on eof the first things I did was to work out how exercise affects my BG control, mainly because I had a 40-mile race 2months after diagnosis.

    I tend to split it into long and short duration, short being an hour or less.

    Short - manage with reductions in bolus if exercising within 2 hours of the dose. If exercising later than that, monitor BG regularly and take carbs, but I can still see massive drops in BG i.e. from 7.5 to 3.0 in 5km of running (20-25 mins). Steady running/cycling/rowing drops my BG like nobody's business. Intervals can make it rise if very short/sharp rather than high paced/long distance. Yoga and weights it stays steady.

    Long - reduce basal and bolus. Typically these start in the morning and I'm reducing my basal from 3U to 1U, breakfast bolus from typ 2-3U to 0.5U just to keep blood sugars moving in the right direction. Again monitor regularly 45min riding/5km running for me by experiment. Eat regularly, little adn often. I've found that I'm more efficient than most texts would suggest as I've deliberately trained my fat-burning abilities. I'm typically on 40-50g carbs per hour vs the suggested 60-100 depending on pace/speed. I go with a combination of high and low GI foods.

    Fasted training is something I've been playing with and had intended to do more in the last few weeks, but I've got an achilles problem at the moment.

    One other thing I would say to you is to make sure you have your basal dose right to start with, otherwise you can't start to experiement with dose reduction from any rational/controlled basis. You need to do some fasted basal tests at various points of the day. I took my basal down by over 50% by doing this, and have temporarily reduced it further due to the current hot weather.

    Let me know if I can help any more, but the main thing is to experiment yourself as we all respond to the exercise slightly differently.
     
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  17. maskellp

    maskellp Type 1 · Member

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    I know everyones different, but do you guys get a spike in BG for the first 1 to 2 hours on a long ride? I've read this is adrenaline/cortisol and other such helpful hormones, if the spike is big I then feel lethargic, I therefore need QA on board to counter this, but if I haven't reduced background enough I am then chasing my tail with low/hypos towards the end of a long ride! Any ideas how to combat the spike?
     
  18. Bebo321

    Bebo321 Family member · Well-Known Member

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    Great advice from @ElyDave there.
    To reiterate some things - getting your basal right will really help. Also obviously exercise as far between meals as you can.
    Some find that eating a lower carb diet also helps (generally because you have less insulin on board)

    Specifically addressing your issues - your varying BG drops?
    Depending on the intensity you are working at, you will be burning up glucose at various rates. Higher intensity means that your muscles will prefer to use glucose over free fatty acids and other sources of fuel.
    What can often happen however is that with added energy demand (and higher heart rate) your liver will fuel some of those energy needs - releasing its on-board stores of glycogen/glucose, and in order not to end up with high blood glucose levels, you can have a mismatch between how much fuel your body is burning vs how much you are carbing. What you will do however is effectively build up a glucose 'deficit', which will need replacing in the hours after your ride. (This fuel will basically be needed to re-stock the liver and muscle 'bank')
    The drop that you mentioned - 11 to 6? Firstly, the initial reading 11 was possibly skewed by the fact that you had not long finished your ride, and your liver was playing 'catch-up' (that is, the liver doesn't stop producing glucose as soon as you finish exercise, and this can be the cause of quite a significant BG rise after you finish exercising)
    Secondly, the drop will just be some of that glucose 'deficit' being filled up - it's just your liver and muscles re-stocking.
    Really it sounds as though you're doing a great job - just keep doing what you're doing, and record everything. It's useful to build up data from a training route that you can repeat and vary in intensity just to help learn more and fine-tune your regime.
    Sometimes when I'm out riding with some of the more experienced T1 cyclists, if they are only a few miles from home and don't want to take another gel when their bloods drop, they will suddenly sprint off up a hill just to take advantage of the liver glucose release that they know this will cause.
    Also, to counter any potential BG fall after a ride they will take on board a recovery drink with bolus reduced by 50-75%.

    As to the BG rapid drops when you haven't had time to reduce insulin? - you know that it's the insulin doing that to you.
    I would suggest you try to get yourself a pump as soon as you can - you will then have the flexibility of being able to reduce your background insulin at any point when you choose to exercise.

    You should consider signing up for a stage of the mHealth tour - if you take part in the health study you will get to use a Dexcom CGM. That way you can track bloods constantly and get to grips with exactly how your bloods behave both day and overnight with exercise.
    Failing that, just keep an eye out for the next TeamBG ride to see if you can come along.

    Keep up the great work! Join the Sporty Diabetic Type 1's facebook group and you'll find there are plenty of cyclists there who can offer support over specific queries too.
    http://www.teambloodglucose.com/TeamBG/Home.html
     
  19. ElyDave

    ElyDave Type 1 · Well-Known Member

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    I don't tend to get that on club/general rides. I can soemtimes get an adrenaline-related spike pre-competition, but that gets chewed up pretty quickly as well.

    Take a look at your intensity as well, higher intensity can cause the liver dump. are you riding on your own or in a group?
     
  20. maskellp

    maskellp Type 1 · Member

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    I only tend to get it when on group rides as the pace is higher from the off, when out on my own I can ease into a steady pace for the first 1/2 hour to warm up.

    This has me thinking, group rides are mostly 6ish am on Sat/Sun, solo rides tend to be evenings after work, this might not be exercise related at all and dawn phenomenon!
     
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