Managing BGs on race day?

A few websites to explore and search for other people's answers to your questions:
www.runsweet.com
http://www.teambloodglucose.com/TeamBG/Home.html

You don't say when you take your Levemir - if taking twice in each 24 hours, eg morning and bedtime, you have more options to adjust, as well as adjusting times and doses of short acting Novorapid.

You could take more insulin, but at the risk of a decent hypo later.

A flat out 5km will have your adrenaline shooting up during the race, as will the excitement pre-race, and your liver will be dumping glucose into your system in response. I see something very similar when I race, but not quite that extreme so far.

What happens if you increase the insulin dose to cope with the high BG before the race is that afterwards, when your muscles and liver are re-absorbing that sugar you WILL have a hypo, so need to test regularly post race for a coupel of hours and maybe have a snack as well. Alternatively, you could have a low carb breakfast, and something like an energy gel immediately before the race and see how that goes.

I tend only to reduce the levemir in the morning for a long run or ride and just vary the novarapid for the quicker stuff.

Personally I would try this out outside the race just to see how my body reacts. For me, anything at steady state easy runs sees my BG drop like a stone even on reduced insulin, as do some intervals; but give me a high paced tempo run of 2k warm up-6k at HM pace or higher-2k cool down, my BG hardly shifts, maybe goes up a touch. I would actually accept my BG up as high as 10-12 pre race, as long as it comes down OK afterwards.

I too have been experiencing problems with my blood sugars being incredibly high (31) after a hockey training session which takes place between 7.30-9:30 in the evening (i don;t take any insulin with dinner) and then being low by 1/2am ish when i 'm waking up with readings of 3.1 or less. My consultant was slightly confused by these readings, but after seeing the specialist nurse, she switched me from Lantus to Levemir. She advised that i split the dosage, taking half at night, and the other half in the morning. I'm not sure whether this might be something you want to consider on race days, but my initial reaction would be to lessen the novorapid and split the levemir and see how you go.

@fredskitz , I'd consider taking just a little novorapid with your evening meal to keep the blood sugars moving in the right direction, but monitor during practice, maybe every half hour or so and eat as necessary. Afterwards, have another snack and monitor afterwards.

I'm assuming you eat before the practice here

zicksi101 said:

Have noticed that before parkrun, my BG goes up more than usual prior to running, then really drops. Wonder if anyone has seen similar effects on race days and what their strategy is for managing this?

Take this morning for example:

Before breakfast - 10.3, took normal insulin dose which usually would hold this BG
Pre exercise - 18.8, no ketones, did not take insulin
Post exercise - 6.2

It's normal in my case to see a drop of about 10 in my BG when doing 5k distance generally.

BG doesn't drop as much when I go slower e.g. at 10k pace. Have also noticed a flat out 5k really seems to get my heart rate up: have recently got a monitor and seen max HR go 9bpm higher during parkrun than I managed in a max HR test!

Can imagine the best way to control BG in this scenario might just be to take on more insulin before breakfast, then take on a snack just before the 5k so carb takes effect while I'm running? Alternatively, I wonder if increasing novorapid but cutting levemir in the morning could work?

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Do you notice any difference in your BG and level of fitness? I'm on insulin and I always had to watch for hypos no mater the intensity or length of the run.

Over the last 3-months I've been focusing on build muscles and core strength and my BG sometimes hardly budges after a long run?



Sent from Runner2009 Burt

zicksi101 said:

Monitoring pace for a given distance has been useful. The only time I've had a hypo this year during a long run was when I suddenly had a breakthrough and started going 40 seconds per mile faster.

On subsequent runs immediately after that, keeping that pace but taking on more carbs and starting to take them a little earlier helped avoid any subsequent hypos there.

I think level of fitness is a factor, but find that difficult to quantify given that I generally get faster if I get fitter!

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Hi Zicks101,

Congrats on your parkruns!
Hopefully you're beginning to get to grips with your BGs.

ElyDave gave a good explanation of what's going on in your body. On your parkrun days, your adrenaline is really kicking in at the start of the run, and is causing your liver to release a load of glucose into your bloodstream. It would be good to use a bit of insulin to pull this down a bit - at 18.8 your body won't be performing at it's best.
My suggestion would be to manage that down a little, but have a bite of an energy bar (protein/carb) to ensure you then don't suffer a nasty drop during your run.

It's generally not a good idea to have injected/infused insulin circulating around your body when you exercise, as insulin inhibits the action of glucagon. A higher level of glucagon in the blood causes the liver to release glucose (through glycogenolysis) into the bloodstream. Therefore with insulin suppressing glucagon levels, it puts you at risk of a hypo once you begin to exercise (at least until your insulin level has come back down again).
As you exercise your BGs will quickly begin to fall, but you can manage them with a small 'boost' of energy going back in.

Best thing is to give it a go in small steps - make tiny adjustments first, then work up to optimum dosing/eating as you go.

As ElyDave points out, the early high BG caused by an early adrenaline liver glucose dump will need to be replenished, along with replenishing the used up glucose stores in your muscles - so be mindful to keep a check on your BGs during the rest of the day. (I am guessing you are already managing this)

Keep up the good work!

TeamBG has just begun to take part in parkrun events, and are currently putting a calendar of dates together. Oak Hill parkrun in East Barnet on 10th May if you want to come along and share with others!

Also, you may like to consider asking to join the sporty diabetic type 1's Facebook page - you'll get a lot of advice there too if you get stuck.

Happy running!!!

fredskitz said:

I too have been experiencing problems with my blood sugars being incredibly high (31) after a hockey training session which takes place between 7.30-9:30 in the evening (i don;t take any insulin with dinner) and then being low by 1/2am ish when i 'm waking up with readings of 3.1 or less. My consultant was slightly confused by these readings, but after seeing the specialist nurse, she switched me from Lantus to Levemir. She advised that i split the dosage, taking half at night, and the other half in the morning. I'm not sure whether this might be something you want to consider on race days, but my initial reaction would be to lessen the novorapid and split the levemir and see how you go.

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Hi fredskitz,

Holy smoke, that is a high reading! I can't imagine you will be performing at your best with that BG.

I am wondering if there isn't a better solution for your situation?
I am assuming that when you say you are not taking insulin with dinner, you mean you are eating some time before and not after you play.

It would appear to me that the high bloods you are recording after you finish playing are the result of two factors; firstly the meal that you have eaten is releasing glucose into your bloodstream unchecked, and secondly the high exercise/adrenaline game is also causing your liver to release even more glucose into your bloodstream.

When you inject your night time insulin, yours muscles and liver are so eager to replenish their stores, they suck the glucose out at a speedy rate, causing your BGs to drop like a stone - and unfortunately to a low level.

You will be the best person to know what 'fits' for you in terms of managing this, but some options might be:

1) Split the levemir dosage (as recommended) - this would work to a point, however it won't stop you from having your bloods run very high during/after the match, it will only prevent you from going low in the night.

2) Consider eating a lower carb meal before the match - helping to keep BGs in a more 'normal' range throughout the game

3) Consider taking a reduced injection of your quick acting insulin with dinner instead of none at all. This will help take the edge off any BG spike, but may also help reduce the BG rise through your body's 'liver dump'

4) Your low during the night? Even taking into account all of the carbs you have eaten 'insulin free' at dinner, your body still has an energy deficit from all of your exercise. Consequently once you are able to get more of a handle on your BGs during the game (to the point that your BG is no longer super high at the end of the game) consider taking on board a recovery drink. Again just reduce your insulin rather than going without altogether. Replenish your stores properly and after a good night's sleep you should feel bright and full of beans in the morning.

Sorry there is no easy solution - but it's well worth trying to get a handle on it. Dropping from 31 to 3.1 within the space of a few hours must make you feel pretty shabby, so persevere.

Keep us posted on progress.

Well done, is that a PB?

Try to keep it under 10mmol/l next time, you'll probably find that you can actually perform better.