Long(er) distance running

[emma_jo]

Hi there,

I've always been quite active (running, cycling, rock climbing & dance) and I've been starting to take my running a little more seriously and started running 10kms (~6.25miles) 2 times a week... Unfortunately, it cause my blood sugars to go crazy!! I have to run my blood sugars painfully high (18mmol/l) before I go and I'll be <2.0mmol/l when I get back, even if I've had a snack before hand. I run at the same times, either in the evening or afternoon, 2 hours after a main meal.

Now here's the really weird part. I discussed it with my GP (who like me is a T1) and he suggested I reduce my long-acting insulin on the days I went running. Which I did, but I still have to run my blood sugars really high & I still go hypo. Then I tried having a sugary snack on the way run. Thankfully, I didn't go hypo... in fact my blood sugars went up to 25mmol/l... I mean seriously?! And my GP suggested I stopped trying to do so much... which is silly, there are world class athletes with diabetes, what do they do?!

Any help or pointers would be greatly appreciated, it's beginning to irritate me slightly...

It's also worth mentioning, that overall the exercise makes my control much better, it's just before and during the run!

Em

 

[cugila]

Hi Emma Jo.

Take a look at this site Runsweet. It is an excellent resource for ALL types of sports and Diabetes.

http://www.runsweet.com/DiabetesAndSport.html

Ken.

 

[fergus]

Hi Em,

I run and cycle too so I know it can be tough to keep the numbers right before and after. Even so, your experience sounds extreme. 18 to 2 on a 10K!
I'm wondering what your insulin levels are like. How much basal and bolus are you using?

fergus

 

[emma_jo]

Thanks Ken - at a glance that looks really helpful, I shall investigate when I get back from a days walking!

Fergus - I'm on 14 Lantus in the morning and then my Novorapid varies considerably depending on what I'm doing during the day... Typically, on a work day when I'm stuck at my desk it's 8 in the morning, 6-8 at lunch & 6 in the evening... Having said that, If I bike into work, I cut my lunch time dose to 4 to avoid a hypo on the way home (6.5mile bike ride). Also if I bike in, my blood sugars go crazy high all morning (16+) (with a normal insulin dose)... my consultant thinks this is because of adrenalin. I'm inclined to agree because the same happens when I go rock climbing, although not as pronounced, 13+.
At the weekend when I'm much more active, my typical novorapid is 6-4-5... My consultant thinks I'm already on a low insulin dose for my weight, 62kgs.

I'm beginning to think I need to have a more regular regime, but that's always resulted in me getting extremely 'blue' & doesn't really fit in with my lifestyle. My Hba1c was 7.2 and before that it was 7.3 - which my doc said was great for T1, I don't know how true that is... but it's also made him think I don't have a problem... I personally think it's becuase although my blood sugars are high some of the time, they spend a lot of time being too low aswell!!

Sorry, that might all be an information overload!! Thanks for your help

Em

 

[cugila]

Hi Em.

Some information about HbA1c . The full resource it is taken from is here:
http://medweb.bham.ac.uk/easdec/prevent ... abetes.htm

Extract:
HbA1c measures the amount of glucose attached to the red blood cells The HbA1c gives a good guide to the blood glucose level over the previous 8-10 weeks. It is used as a measure of long-term Diabetic control. The usual result in someone without diabetes is 4.0-6.0%.

The best result in Diabetes is 6.0-7.0%. At this level most long term complications can be prevented, whilst at the same time avoiding severe hypos (hypoglycaemia). Below this level there is a higher risk of a bad hypos. Above this level there is an increased risk of complications. Before conception and during pregnancy, slightly lower levels are preferred.

That's what most HCP's aim for. A lower level is always a bonus and a goal if it can be achieved.

Ken.

 

[phoenix]

Hi Emma .I've had a similar problem, and my weight/ total insulin on MDI was similar to yours.
I partially solved it on MDI (enough to do a marathon) but to be honest it is now far easier on a pump because I can turn my basal down to a dribble during exercise and at times I suspend it entirely. I seem to need very little insulin for exercise, but need 'normal' amounts whilst sedentary The trouble with a long term insulin is that you can't switch it off. Your doctors idea of cutting basal on exercise days was also suggested to me but it does depend upon a certain amount of preplanning and I was never that organised.

What I did on MDI was to test frequently, before. during and after exercise and experiment with different types of carbs and bgl . I tried starting at different levels, eating long acting carbs before etc etc

From testing I discovered that my levels dropped drastically during the first 20-30min (interestingly the Runsweet site confirms this as a 'normal' phenomena). I found that it didn't matter how high my blood sugar was before, it still fell to a hypo level so it was useless making levels artificially high. I did/do reduce the bolus by a unit or so with the meal before but not drastically.
After about the first 20 mins I took a couple of dextrose tablets I was then OK for another 20- 30 minutes when I'd take some more dextrose, normally only 1 tablet. I never need much to lift my levels. (1 dextrose tab has 4gms carbs)
On longer runs after the first hour or so my levels took longer to drop so I didn't need to take dextrose quite as frequently. When doing the very long runs in training and the marathon I would drink a 'sports' drink during the later stages.'
It worked, I was able to complete the runs but I'm not fast and not competitive, I think thatwho people want to be competitive need a very different type of strategy. (ie they need to keep their levels higher all the time)

I find that I often go low about 5-6 hours after exercise so reduce the bolus of the meal following exercise. I have read advice that taking a small snack of mixed protein and carb immediately following exercise can help prevent this later drop. Its something I haven't, but should try.

As I said, it worked but not as well as being able to cut my basal with a pump, I was able to go for an all day bike ride recently with no hypos, no regular dextrose tabs and only a normal picnic lunch .

 

[blackbird]

Phoenix, your answer was so relevant to me, it answered a question I have been asking myself since being diagnosed. I was almost there, but couldn't quite get my head around the fact that I needed glucose throughout my exercise, as everyone else seems to say reducing your bolus before exercise is sufficient to prevent a hypo. I will always hypo about 30 minutes into exercise no matter how high my levels are, and have found that the only way to prevent that happening is to take dextrose tablets (only one or two needed) every 20 or 30 minutes, and then have to watch for hypos later in the day. It took a while to get my stamina up again after being so ill when diagnosed and don't want to dip into that level of unfitness again!

 

[emma_jo]

Thanks Phoenix, that sounds exactly like what happens to me!! My blood sugars plummet 6hours after exercise, I've found carbs and protein didn't work, I just moniter my BG when I'm expecting them to start dropping- That part of exercising I have got down to an art, and find it highly predictable, thankfully! I've also found I can eat pretty much anything and not send my BG sky high, so I usually treat myself to a well-earned pudding

Bravo on running marathons, I think 10k is my limit I'm going to try dextrose tablets 20mins in to my next run... I think I need to have a play with sugar intake when I run!

Thanks for all your help, it's very refreshing after being told to "stop trying to do so much!",

Also my running partner says thanks I think he was getting fed up of me being so irritable before and after running!!

Em

 

[phoenix]

good luck Emma, but you'll have to keep annoying your running partner for a while , whilst you check your levels. My husband used to run off for a couple of hundred metres and then come back because he hated stopping. He leaves me to it now but wouldn't let me run by myself for a long time after diagnosis.

 

[three1ne]

Hi Emma.

I dont really feel confident enough to give you advice so instead I thought id let you know a bit about me as I run a lot and may be you can take something from my results.

18 to 2 seems a crazy range. Are you running soon after an injection?

For a while I had been running 4 times a week. 4 miles at a time. From the 20th May I increased this to twice a day, 4 times a week, 4 miles a time. Morning and Evening.

For my morning run, I always run before breakfast, and therefore, before I Inject. That way I can guarantee a balanced sugar level throughout (normally around 6-7) plus I always have a Dextro tablet before hand. Unfortunately im struggling with waking up early and currently start my run around 9am - 10:30am. Which means I have been eating breakfast as late as 11:50am which isn't ideal as today when I came back from my run (11:15am) my sugar level was 9.5 which I assume is because my insulin from dinner time last night has all run out.

As little as 6 months ago (when I ran after dinner) I wouldnt run unless my BL was 14. Still the same 4 miles. I would come back and often be in the low 4s, high 3s. Even though I felt I needed my BL at around 14 to be able to sustain a run I wasnt comfortable with the double figures and questioned this at my clinic. I was recommended no higher than 12BL. I still wasnt too comfortable with this. I was also recommended to take some biscuits out with me. I actually laughed when I was told this. Why dont I just take a picnic out with me? Lug a picnic blanket over my shoulders and wrap myself up in a windbreaker..

Anyway, I learnt, through the help of these forums (Fergus was noticeably very helpful) that my carb intake was too much. I also wasnt injecting at lunch time. Basically because I was a little naive, although that came from some bad advice from my clinic who were telling me I had perfect control (top 5% of diabetics) which was an outright lie, which lead me to eat what I wanted without almost no thought at all. Anyway, thats all mentioned in another thread.

Taking the advice from this forum led to a more concious diet. My sugar levels were more stable and I ended up confident about running with a starting sugar level of 6-8BL. Which would normally end up no lower than middle 4s after my run.

 

[emma_jo]

Thanks three1ne,

I can't do exercise in the morning, especially first thing before breakfast and insulin- my blood sugars spike up to 15+, usually the 18 mark again. If I eat and take my insulin, they go up to 12+.

I have since tried going for a run with my BG at 10 and having some sweets 20 mins in when my BG was 4.5... When I got back (41mins of exercise) my BG was 2.0... however I didn't feel as exhausted. I then went on to have a really unpredictable hypo, 12 hours later- 1.8mmol/l?! This is all very odd...

I don't think cutting out carbs would be a good idea? I though diets were suppose to be mostly carbs...

Em

 

[phoenix]

Ouch, thats too low.
I'm sorry that happened. I wonder if your basal is generally too high?? I
Have a look at the runsweet website, it maybe that there is some more help there note on their front page

Do you have problems with your diabetes and sport? If so ask your G.P. or consultant to refer you to our (England's only) specialized diabetes and sport clinic

I don't know how easy that is to do but at least with a type 1 doctor you're perhaps more likely to get a sympathetic response.