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Type 1 diabetes and sports

T

theotsik

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Hello to everyone

My name is Theodoros (Theo) Tsikouris. I am from Greece and I am 25 y.o.
Luckily, I have diabetes type 1 the last 12 years and I say luckily because it has offered to me a better everyday life, when I started to take care of it.

In addition, I am a triathlon athlete in Ironman distance races (3.8km swim, 180km bike and 42.2km run), the youngest man in Greece (at 20 y.o.) who have finished such a race.

I started this thread for giving inspiration, feedback about the sport life of a diabetic person and for exchange ideas about anything on sports and diabetes

I believe that diabetes is not a problem but a different point of view of life and I will accept questions to help people turning diabetes into a weapon and not into a barrier.
‍♂️‍♂️‍♂️ View attachment 33195
 
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Hi @theotsik I too agree with your philosophy on sport and type 1.
I am not in the triathlon league but enjoy a bit of running, cycling, weights and climbing.

In the past, I have found www.runsweet.com a useful resource.
 
Welcome @theotsik Great post and great achievement :)

I find fuelling for sport the greatest challenge with type 1 and managing insulin, I run and cycle, however no where near your distances, but find getting the balance right between ensuring muscles have enough glycogen to sustain the activity as well as keeping levels within range and avoiding hypos is key.

What dietary advice do you follow ?
 
Juicyj said:
Welcome @theotsik Great post and great achievement :)

I find fuelling for sport the greatest challenge with type 1 and managing insulin, I run and cycle, however no where near your distances, but find getting the balance right between ensuring muscles have enough glycogen to sustain the activity as well as keeping levels within range and avoiding hypos is key.

What dietary advice do you follow ?
Click to expand...

Hello @Juicyj

The fueling is a big deal for sure.
For small distances I use cereal bars (25-30gr each) which give to me slow-release carbohydrates and plus sugars (high release carbo.). But you must calculate how much they increase your blood sugar and choose for that one specific type of cereal bar.

What distances do you prefer?
If you do for example half marathons or bike more than 50kms, the cereal bars will not do. You want something with much more fat.

My dietary is not different from the other non diabetic people. I stay away from foods with a lot of fat and I use before training (as much as 1-1:45’ hour) food with slow and high release carbo.

In addition, before I go to training I want my blood sugar to be 200-220mg/dL (so I don’t eat anything in most of cases)

But the game changes dramatically when we talk about marathons and Ironmans

I hope I help
 
Hello @theotsik

At the moment I am only at 10km and average 30-40km on the bike, i'm finding it harder to go any further than 10km running due to energy levels, I prefer to also be below 12mmol/ or 220 prior to exercise and if I do this I can keep steady during exercise, I also use a pump so apply a temp basal 30mins before I start and for the duration of exercise.

I prefer mornings also for exercise, I have joined a running club but they run in the evening and I haven't got the balance right yet so ended up hypo which was fun explaining to strangers, who were great. So time of day is also a tricky one to balance, I have tried fuelling with carbs in the morning before running but this didn't work either as started at 18 mmol/l which was very tiring, so striking a balance is a battle.
 
Juicyj said:
Hello @theotsik

At the moment I am only at 10km and average 30-40km on the bike, i'm finding it harder to go any further than 10km running due to energy levels, I prefer to also be below 12mmol/ or 220 prior to exercise and if I do this I can keep steady during exercise, I also use a pump so apply a temp basal 30mins before I start and for the duration of exercise.

I prefer mornings also for exercise, I have joined a running club but they run in the evening and I haven't got the balance right yet so ended up hypo which was fun explaining to strangers, who were great. So time of day is also a tricky one to balance, I have tried fuelling with carbs in the morning before running but this didn't work either as started at 18 mmol/l which was very tiring, so striking a balance is a battle.
Click to expand...

Ok

I have exactly the opposite training hours (late after 10pm everyday because of work) and yes, the time for training always plays a role!

I have not a pump but I suggest first of all you do not apply a temp basal and you can try glucose caramels which you can carry them on you.

If you still have low glucose problems try to change the caramels with cereal bars

The last thing would be a temp basal, in my opinion because you can simplify your life and you have already tested all the other ways..

I am a dentist but not a endocrinologist so I have the basic medical knowledge about diabetes

You must try a lot of things to find which one is best for you. The best doctor for you is you
 
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Hi there @theotsik,
From what i recall from past education there seem to be three general ways for us TIDs to manage exercise.
1) eat before and during exercise and then extra food some 6 hours later
2) mainly to reduce the insulin dose which will be acting during the exercise and to also cover some 4 to 6 hours after completing exercise
3) a mixture of 1 ) and 2)
For me in the past exercise of any duration tended to put my blood sugar up in the first hours, so eating extra food early on just made that worse, in fact i had to up my insulin a bit beforehand but always watch out for the hypos later at about the 6 hour mark although some have told me they start to drop bsls nearer the 3 to 4 hour mark.
My exercise was in kayaking, walking a number of kilometres regularly and relatively short distance jogging, not in any competive sense.
But in the last few months i have been on a very low carb diet and have found that my bsls with gentle to moderate exercise i now tend to drop bsl in the second hour or so and then less so at about the 5 hour mark,
But if i do very strenous exercise the bsls do rise first early as before. I tend to dose up on magnesium after a bit of heavy exercise as i gather we diabetics tend to have higher magnesium loss than non-diabetics. And since on low carb/ keto- diet i have also increased my sodium intake as i gather that the lower doses of insulin i now take lead to less retention of sodium.
I understand that for long distances events that athletes are tending towards fat-burning and keto diets as they find fat burning sustains them better than periodically having to dose up on carbs.
A Dr Noakes in South Africa has written a book in the past about running from the carb-loading viewpoint and has recently 'recanted' and is now writing another book apparently emphasising the fat- burning, keto-, low carb diet for training and events in the long distance type events.
Best Wishes for whatever works for you.
 
kitedoc said:
Hi there @theotsik,
From what i recall from past education there seem to be three general ways for us TIDs to manage exercise.
1) eat before and during exercise and then extra food some 6 hours later
2) mainly to reduce the insulin dose which will be acting during the exercise and to also cover some 4 to 6 hours after completing exercise
3) a mixture of 1 ) and 2)
For me in the past exercise of any duration tended to put my blood sugar up in the first hours, so eating extra food early on just made that worse, in fact i had to up my insulin a bit beforehand but always watch out for the hypos later at about the 6 hour mark although some have told me they start to drop bsls nearer the 3 to 4 hour mark.
My exercise was in kayaking, walking a number of kilometres regularly and relatively short distance jogging, not in any competive sense.
But in the last few months i have been on a very low carb diet and have found that my bsls with gentle to moderate exercise i now tend to drop bsl in the second hour or so and then less so at about the 5 hour mark,
But if i do very strenous exercise the bsls do rise first early as before. I tend to dose up on magnesium after a bit of heavy exercise as i gather we diabetics tend to have higher magnesium loss than non-diabetics. And since on low carb/ keto- diet i have also increased my sodium intake as i gather that the lower doses of insulin i now take lead to less retention of sodium.
I understand that for long distances events that athletes are tending towards fat-burning and keto diets as they find fat burning sustains them better than periodically having to dose up on carbs.
A Dr Noakes in South Africa has written a book in the past about running from the carb-loading viewpoint and has recently 'recanted' and is now writing another book apparently emphasising the fat- burning, keto-, low carb diet for training and events in the long distance type events.
Best Wishes for whatever works for you.
Click to expand...

Thank you for your reply @kitedoc

In long distance races or workouts I eat snickers (hell yeah) and i replace the electrolytes with saltstick capsules (brand name) or just thick sea salt
 
Hi, I run 5-10k races, cycle 30-60 mile hilly courses (not racing) as hard as possible and have done 3 sprint triathlons and a half marathon once. I train regularly and am a type 1 on a pump and CGM, having been on insulin for 48 years.

I find the effects of different distances and intensities depend on whether I'm in training/competing in the threshold, aerobic or anaerobic zones. I try to start activities at ~12mmol and will take glucotabs, gels or Clif Bars (longer acting peanut flavoured) as a mixture of quick and slow release glucose to sustain me through the activity.

I use a Freestyle Libre CGM which I find better than the Dexcom G6 option. The Dexcom is stomach mounted and more affected by hydration balance but also has a tendency to fall off after a few separate exercise sessions - no matter what I do to keep it on. The arm-mounted Libre is less of a problem on both these two counts, but it's not continuous so has no high/low alarm function (a blessing if it keeps going off in meetings until the level returns to normal after corrections). I just scan periodically through the activity with the supplied Libre handset, which is easier than a phone.

Practice doesn't make perfect here, but practice does help me to understand how much and what type of carbs I need, and when. Regular restocking carbs mid event is vital to maintain performance, but I'm more likely to go low than high during the event/exercise, somehow I'm always on the back-foot trying to get my levels back up, asap.

For example, a 5k race such as a ParkRun on Saturday morning, I'll eat a bowl of porridge an hour before hand, depending on blood sugar level, I may take a couple of glocotabs or a gel just before the race and switch off my basal dose for 30 minutes, I won't need anything during the race as it's too short to run the levels sufficiently low and after I take a unit of insulin but then may need to hit the Kit Kats later in the morning! I've practiced this 5k strategy many times, but my half marathon glucotab intake was going fine for the first 10 miles, then my glucose dropped too low and it was like wading through treacle - not enough fueling practice at this distance!

Post exercise, my blood sugar usually rises with the liver's glycogen release response, so I always counter with at least 1 unit of insulin immediately afterwards, then monitor glucose levels frequently. Shorter events cause more immediate glucose drops as I rebuild glycogen stores, longer events can see my blood glucose drop the next day, sometimes as late as 24 or even 36 hours later I can still be topping up with sweeter foods to counter the lows from the liver rebuilding it's long chain glycogen stores from the shorter chain glucose in the blood.

Only you can know your own body, it's response to exercise type and intensity and how much insulin/glucose is needed, and when. There are so many factors involved that it's difficult to have a definitive algorithm to assist the decision process. This why I have found the CGM, pump and practice so important. But one other thing, the diabetes condition adds a whole new dimension to competitive exercise and endurance sports.

I'm hoping the sports-tech wearables industry continues to develop technologies that enable my diabetes control methods to interface with them so I can see what's going on more readily.
 
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