What (Kinda) Works Now

Chris sent me a message saying that someone might ask me about running with type-1 diabetes. I haven’t yet heard from him/her, but it got me thinking about what I’m doing now and how it’s going. It’s not perfect, of course, but I’m actually in a pretty good place.

Let’s start with the big disclaimers. First, this is what (kinda) works for me. Your diabetes may vary; it likely will. Second, this has only recently started working for me; it could all change tomorrow. Third, it assumes that you use an insulin pump and that your basal and bolus rates are correct-ish; mine are getting there. Finally, I can’t consistently reproduce what I do in training when I’m racing; something always seems to happen.

Remember, three big things impact BGs during exercise: insulin, food, and intensity. (There are other things, but these are the big ones that you can control.)

Active Insulin: I tend to workout when I have no (or, at least, minimal) insulin on board. For example, I swim and do my long running/cycling first thing in the morning before any boluses. And when I workout in the afternoon, it’s been 4-5 hours since my lunch bolus. This means that there’s very little extra insulin to bring down my blood sugar. When I do have rather high BGs (but no ketones) because I misjudged a meal, for example, I will sometimes give myself a little insulin. I’m really conservative doing this, though, since it usually brings me down more than I think it will.

Basal Insulin: I am starting to think that changing my basal insulin has less of an effect (for me) than I had originally suspected. This might be because my basal rates are fairly low now, or it could be that my body is better at using fat and carbs together than it was in the past. Who knows? Anyway, when I run or ride my bike, I set a 30% reduction 1-2 hours before I start. Usually longer in the afternoon and shorter in the morning, since I like sleeping. When I swim, I set a 0% basal rate (i.e., no insulin) starting 45-or-so minutes before I hop in the water. There are three reasons: (1) I’m skittish when it comes to insulin and water, (2) it’s similar to what happens during triathlons, where I need to detach from my pump to leave it in transition before hopping in the water, and (3) it seems to work.

Food Before: Food is not the best part of the three for me. I want to eat more before I train, because food is fuel, and I hate running out of steam. (We’re remarkably like people without diabetes in this respect.) Food normally means insulin, which violates that whole “minimal insulin on board” thing. But I’m working on getting myself in a mindset where I can experiment with small amounts of insulin to cover pre-athletic carbs. High glycemic foods still spike my BGs when I’m working out, often more than I would like. Lower glycemic things do better, but quantity counts; 20g of carbs from Greek yoghurt about 10 minutes before I did a two-hour run worked well yesterday, the first time I tried it. Be careful here.

Food During: I tend to eat like I don’t have diabetes when I bike or run. It’s just how it works for me. I eat an energy gel every 45 minutes to keep up my energy. I also carry a full tube of glucose tablets with me, just in case. And I drink water. Water is important.

Food and Insulin After: I find that I always need to give myself insulin after I’m done exercising. I haven’t yet figured out how much to give, but I usually bolus the full amount of any correction I would need (or enough to bring me down 25 mg/dL [1.5 mmol] if my BGs are in range). After really hard workouts, I like a protein-rich snack with carbs. (Odwalla’s Chocolate Protein Monster is my favorite.) These carbs and protein are important for recovery, and I find it necessary to bolus the full amount for this snack, even though I will eventually be more insulin sensitive for the next 24 hours after big workouts.

Frequency: It helps to have a regular frequency, usually three or four times per week (or more). If I workout at least this often—although I can’t remember the last time I did less—my insulin sensitivity stays much more “normal” than if I don’t. Consistency is key.

Supplies: I bring these things with me on my workouts.

  • A full tube of glucose tablets
  • My pump (enclosed in a Zip-Lock bag to keep perspiration from killing it)
  • My BG meter when I go on longer runs or when I’m curious about what’s happening on shorter outings. I use the OneTouch Ultra Mini just for exercise.
  • Energy gels. I’m not very brand-loyal; I like vanilla and chocolate Gu and Clif Shots and just about any Hammer Gel flavor.
  • Water (in a FuelBelt Sprint Palm Holder)
  • I also carry about $10-15 with me in case I need to buy some extra food.

There are some other things I like, but they don’t have anything to do with diabetes preparedness. I have a Petzl Tikka headlamp, which is great for running on these dark afternoon; I’ve never had a jacket as nice as my Asics one; and I need shorts and pants with pockets . . . and a drawstring. (Without the drawstring, all of the extra stuff in my pockets makes ‘em fall right off.)

Good luck! And just remember, do whatever works; there’s no single right way.

This entry was posted in Cycling, Diabetes, General, Life Lessons, Reluctant Triathlete, Running, Swimming. Bookmark the permalink.

7 Responses to What (Kinda) Works Now

  1. Jess says:

    you, sir, are amazing! i am in awe of you and other PWD who make exercise such a priority. i am not a fan of exercising (read: i HATE it), but i am trying to sneak some in. but D of course makes everything more complicated. the fact that someone as athletic as you still doesn’t have it all figured out makes me feel better about my own attempts and frustrations. thank you for sharing!

  2. Scully says:

    I really love reading other T1 athletes detailed “how to’s”. I gain a lot of info from it even though I already have my own system. This was awesome.

  3. Jacquie says:

    Okay. So I saw the title of this post and thought “Ooh! I need to get back to by walk/jog kind of thing. Let’s see what Jeff has to say! This is just the inspiration I need.”

    I read a few paragraphs and recognized some of my own habits and experiences.

    By the time I got down to “Food and Insulin After,” I was in full “Eff it” mode. Seriously: so many variables!

    But the “consistency” brought me back. I’ll be channeling you the next time I put on my runnin’ shoes!

  4. Jeff Mather says:

    Jacquie and Jess: It’s so true that there are so many variables. My hope is that it’s useful to see how one person tries to manage them all, whether you’re looking for minor tweaks to make or are just getting started (for the first or twentieth time).

    I’m not a dogmatic You Must Exercise kinda guy—though I think it’s a good idea for everybody who can. I just want to help out the people who are at the point that I was a couple years ago, the ones who are saying “I’ll never get there!” or “I wish I knew where to start.”

    Plus, once you’ve nailed down a few things, they aren’t variables anymore, right? :^)

    Baby steps, my friends.

  5. Tracey says:

    Hiya, just stumbled onto your blog, and I really liked this post. It makes me happy to hear others talking about training and racing with diabetes…nice to know I’m not alone. Just thought I’d throw out there what works for me. I’m a Type 1 PWD, 17 years diagnosed. I’m also a triathlete and a 5 time marathoner currently training for my first ultra.

    My workouts have to happen early in the AM, so I get up, test, eat a normal breakfast with normal bolus calculations. I have to eat before, not for the diabetes but because I’m one cranky runner without it! About a half hour before I set out the door, I set my pump to about a 60% reduction in basal rate, for the length of time of my workout and then for about a half hour after my predicted finish time.

    Generally my race fuel is Hammer products, and I tend to bring my own and store them in my pockets and use them first. As I go along, I’ll take replacements of the official race gels and keep them as backups, just in case. For hydration on long training runs, I use Nuun tabs because they don’t have added sugar and they have light flavor. During races I tend to go with water as long as possible, then switch to a water/gatorade combo.

    I also carry money and a cell phone on my runs, and I’ve got a RoadID in addition to my normal medic alert bracelet.

    I’m usually a touch high when I get home, if I am I’ll cancel the temp basal, eat some food and bolus appropriately.

    There were times when this wasn’t as easy. I’ve only recently discovered how effective and easy temporary basal rates are. They’ve changed my whole perspective on training, as well as finding an endo who not only supports but encourages my racing and training.

  6. Jeff Mather says:

    Tracey: Thank you so much for posting what works for you. It’s amazing how differently everybody does this, and I’m glad that you shared. Good luck on your upcoming ultra race!

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