Type 1 Exercise question

Think Like a Pancreas.

Honeymoon may be a factor, but I've never seen such a significant effect. Maybe the dose reduction kicked my pancreas back into activity.

This evening, easy 10km run, 8 min/mile pace
Before 6.1
5k - 4.4, 15g carbs taken
10km, 6.1
That was about 4 hours after last bolus

Good discussions with the Registrar today, showed them all my data for this year with all of the points where I've gone low with exercise despite dose reductions, timing management etc. He went off to talk to the pump consultant and DSN and they are going to support me getting a pump on the basis of avoidance of uncontrolled, rapid onset hypos and the need for excess carb consumption to manage them

That's the first hurdle over, they go to the internal panel in Feb, which will hopefully agree and reccomend me. It's then over to to the CCG to agree funding

FIngers crossed

same here, I always carry something with me just in case.

My point in all this is that needing to have a snack after 5km of running is just bloody ridiculous to be honest, and the quantities of carbs I need to keep ingesting on a long run or ride is preventing me from fully exploiting my fat burning mechanisms, which are much more important in endurance sports.

straygaijin said:

I'll aim to keep nibbling throughout a long event - I prefer to buy gels in a bottle and then I can fill up a small flask to take with me to sip throughout - If I use gel packets you need to use them all at once. I also try to eat more solid food in the earlier part because I know later on I might have difficulty taking anything solid.

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I go with NAKD bars, 9-bars and similar, nice slow release and a bit of protein in them as well, also smll bags of nuts and dates, same effect. Gels tend to come in later, when I need a good quick hit, or like you don't want solids.

Today, tried a basal test in the morning. Normal breakfast at 6am, test as usual at +2 hours then every 2hrs until 4pm was the plan, with no lunch and no coffee.

Went like this
6am 4.4,
8am - 4.5,
10am - 4.5 ,
12noon - 5.2,
2pm - 5.1 ,
3pm - 3.7 suspended, 20g snack tested here 'cause I felt a little light headed.

Going to drop my morning basal from 4 to 3.5 and evening from 5.5 to 5, as i keep needing a bedtime snack to wake up anywhere near 5.0 BG.

This evening's run
After my snack, at 6pm, 12 hours after the last bolus - 6.3
At 5km - 5.4
at 10km - 4.1

Jujst about manageable, but I wouldn't have wanted any bolus hanging around.

SO, the experiment continues, long group ride today, 50 miles, pretty slow and steady as we had some new folks out and they were struggling a bit.

Talked to the DSN in the week, who works with quite a few athletes, and decided to go with 1 unit basal (down from 3.5) adn 1 unit QA (vs 3 for that breakfast) before heading out. I have to say it worked very well as a strategy and did not leave me chasing the insulin with carbs. To be honest it was a lower intensity than usual, but it's a promising start.

One of my concerns with the very low basal was a high later in the day, but so far (half past four in the afternoon) that's not been the case. It went like this
06:00 - 5.1,
06:30 - 50g carbs, 1U levemir, 1U Novorapid
08:30 - 10.0, cycle 8km to meeting point
09:00 - 5.6, 15g carbs
09:45 - 7.9, 30g carbs over next 45mins
10:30 - 7.4, 15g carbs
11:00 - 10.0 - stopped 20 mins for someone to fix a puncture,
12:00 - arrived home, just before the ambulance, but that's another story
12:25 - 5.6, 10g carbs
13:00 - 8.0, lunch 50g carbs, 2U
13:40 - 6.4 - pre driving
14:20 - 5.3, 2 hrs post meal.

dancing-paul said:

Hey. I'm a dancer / choreographer in training. Diagnosed in April 2013. My day consits of 8am-7pm dancing. I spoke to my diabetes nurse who said I should take a bag if sweets into class with me and eat them throughout. This really helped. However as you can imagine got fed up of eating sweets in between exercises or routines. So I decided to reduce my lantus from 2/3 units to 1 unit or not taking it at all. This was a great improvement. I still had the energy in my muscles to power through the sessions and no sweets involved at all. I was waking up around 5/6 Mmols/l and maintained this without hypos during dancing. After each class I tend to have a carb/protein sandwich and a small pack of sweets.
I've also been going to the gym in addition to dancing and continue to control diabetes very well with this regime. I rarely go hyper or hypo.
As you can imagine I have a high carb and high protein intake. And eat an insane amount of food.
Snaking in between class is the key.
So maybe half hour before you run have a mars bar and then when you get back a protein to carb ratio sandwich.

My novorapid insulin carb:units is 20g:1 unit

Hope this helps. X


Sent from the Diabetes Forum App

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sounds like it's working well Paul, that's essentially the strategy I'm using, but not over such long days as you. I think the trick is matching the dose reduction to the activity level so that you can keep going with enough carbs and calories to fund the activity but not need to chase the insulin.

What I want to get back to is as close as possible to my pre-diabetes regime where i would not have been needing to snack before an hour's exercise.

Teh long runs/rides are a different kettle of fish, closer to your dancing where you're working at more moderate effort but for a longer period of time and need some degree of carbs going in. I'll bet you have a fairly well developed fat burning metabolism as well though, which is the ideal thing to fund endurance.

The experimentation is now to try and find a low enough dose to keep the glucose moving in the right way, but not too high that I need to keep shovelling in the mars bars.

Basically I test before every session and If I'm <5 will snack. If >5, no snack before I start. Either way I test after 30mins on a shorter session and take carbs if needed, then test again at the end.

craig81 said:

Hi Dave,

Can't comment on the long cycling training as I'd probably need stabilisers to stay on a bike these days.

However, I do a fair bit of running. Since being keto adapted I find that my blood sugars stay very stable when I'm doing long and relatively low intensity runs. I'm also quite sensitive to caffeine and it spikes my blood sugar. For example, one hour after consuming green tea my blood sugars raise by 3 mmols if I don't take any insulin. For coffee, depending on the strength, it can be between 4 to 6 mmols if I don't take insulin. The reason is that caffeine creates insulin resistance (pretty similar to what happens in the body during both the dawn phenomenon and when there are periods of fasting) where the muscles become less sensitive to insulin and the muscles turn to fatty acids for fuel. Would it be worth trying tea or coffee 40 mins before you run to test it out? Might help ramp up your fat burning metabolic pathway. Of course everybody has a different response to caffeine so it may not work for you. Let us know if you try it. Cheers, Craig.

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Thanks Craig, that's an interesting response to the green tea as well, which should be lower caffeine. I'm drinking coffee on and off pretty much through the day, and certainly at breakfast every day, so should be getting whatever effect is due.

I hadn't heard of the insulin resistance from caffiene, I thought it was a different mechanism whereby the caffeine releases FFA and triggers that mechanism, so the blood sugars can elevate - either way the outcome will be the same.

As for me, I've been continuing the experiment and having some interesting findings. On some shorter runs where my 5km test leaves me just a few km back home or to the hotel (i.e. somewhere safe) I've not been having carbs when I've been dropping down below 5.0 and have been finding that the drop off seems to slow.

Example at the weekend on a 10km - BG before 6.3; at 5km 4.3; at end 4.1, no carbs taken, this was pre lunch
Sunday 12km (which came in under the hour ) pre 7.4; 5km 4.6 20g carbs; 10km 4.8, no carbs; 12km 5.2 15g carbs

The 12km was about 2hr 30 post lunch so some bolus still hanging around, but it's certainly heading in the right way, and I'm quite surprised at the slowing in the drop off. More experimenting to follow.