I might have to go down to Coney Island to check these guys out before the baseball season comes to an end. Two type-1 diabetics playing for the Brooklyn Cyclones (minor league). One player uses a pump, the other does not. I really think that is great — they both are using what works well for them.
http://cityroom.blogs.nytimes.com/2010/07/10/sweat-bats-right-slides-left/
Heat safety is something I am acutely aware of on a personal level. As a diabetic athlete, it is of even greater necessity because I can use my senses to identify low and high BGs. However, when high heat temps, and high humidity hit my BG sensitivity is thrown out the window. This is because I am constantly thirsty, always a little tired and may or may not have a heat headache.
I found this guide made by Gatorade for the NFL (and football players in general):
It’s a pretty good guide and very informative using football references to make their points on heat safety. The points are quite clear — prevent, prepare, hydrate, and plan. I have to admit, my plan for heat stroke would obviously not to hit that point, and to be aware enough before that point to seek professional help, since I usually train alone. But for preventing, knowing the symptoms are key. One thing I did not realize is that it can take 10-14 days to acclimate to warmer conditions. However, the biggest point is to hydrate regularly and properly. Replacing electrolytes and sodium (and sometimes carbs too) seem like a no-brainer these days, but it was not too long ago when that was not as common knowledge.
Personal Story
As a kid, I once had the unfortunate experience of an ambulance ride and ER visit. During the summer months of June, July and August from a young age, we learned how to race sailboats. All day, every day; with a break at noon on land for lunch. One day I passed out during lunch. An ambulance was called, and the people around me knowing I was a Type 1 Diabetic, the EMTs instantly administered Glucose via gel under my tongue. However, by this point I was already coming to (since I was being fed Coke from the fountain). Upon being admitted to the ER, I learned that I was both dehydrated AND had low sodium. A disastrous combination – with a slightly low, and at that point in the ER I was trying to lower my BG after way too much soda and Glucose gel while they got fluids into me by IV.
Learning Experience
Stay hydrated, watch the color of your urine. And make sure you urinate regularly. And test frequently (like I really needed to say that).
http://blogs.fasterskier.com/krisfreeman/2009/12/02/nerves-of-sugar/
As a diabetic I have to balance the “fight or flight response” on my own. I get nervous before a race and release sugar just like everyone else. Unfortunately my regulatory system is broken and I have to give myself the appropriate amount of insulin. This is where things get tricky. How nervous I am affects how much sugar I release into my body: more Nerves equals more glucose . The difficult part is there is no real way to monitor how nervous I am.
-Kris Freeman, 12/2/2009
This post by Olympian Kris Freeman really gets me thinking. How to monitor your nerves to find out how much the natural release of sugar into your body? It’s not just elite athletes like Kris that have this happening, this happens to me all the time on the bike, on boats, or even heading into a big meeting. Your body has a physical response to a mental stimulus.
I personally have found some correlation in the length of time I spend “nervous” – basically preparing and how long/how high the BG can go. In sailing, there is a half hour-to-fifteen minute period to the start where I will spike. When cycling or running, it really depends how long I am waiting around to start. The more time spent standing around, the higher I will go (the more time I have spent thinking rather than doing).
It would be interesting to see if any breathing or relaxation exercises have any effect.
There is a downside to every huge upside — something you can prove in life, money and diabetes. It’s called opportunity cost. Diabetes is a math game. A really annoying one where the rules always change.
I wrote about feeding the basal with enthusiasm. However, I forgot to mention a very key downside that hit me recently. Basically, I take more basal (currently Lantus) than I need to keep my BGsat 115 (my target, not my goal). Therefore, if I do not eat, I will go low. Not a problem with exercising (exacerbating the lower need of insulin), I eat and want to eat constantly.
Got home late last night at 8pm with a BG of 80, I proceeded to eat 90g, bolused correctly. I continued to feel hungry, and therefore continued to eat (an unknown amount via blind eating for an hour plus). Falling asleep with a BG under 100, I felt good. However, bolusing for blind eating is tricky, especially so close to bed time – so I made a guess. The guess was wrong — by a long shot. I woke up very early and was very thirsty — the cue to know instantly I am running very high.
The worst part about being high is how difficult it can be to come down. The usual ratios do not work. If you are 1u:60 points when you are 200-275, everything over 275 may take more insulin to bring down. So from 275-350 you may need 1u:40 points, and anything above that may need 1u:30 points. Basically, the higher you get, the harder it is to fall. In my experience, I really hate to do this kind of math when realizing a high BG and just do a normal 1:60 correction. However, in an hour I will see that I am not coming down fast enough.
Given the above situation, let’s say I was 400 and want to get down to 115. I would need 1.6u to get me to 350 (1:30), 1.9u (1:40) to get to 275 and 2.6u (1:60) to get to 115. For a total of about 6.1u — versus about 4.75 that I would take using my 1:60 baseline approach. The difference? 1.35u or about 80 BG points.
Guess what happens when I used 1u:60 this morning instead of my more complicated formula? I was 260 3.5hours after the correction. Makes sense, since 80 points higher 3+ hours ago can easily translate into an additional 65 points over a few hours of higher BG.
Moral of the story
1. Watch what you eat before bedtime. It can really mangle your morning.
2. Feeding your basal has the side effect of giving you lower BGs right now (as does increased metabolism from exercise) but Carbs on Board may not appear till later in your BG. Must have enough insulin to cover.
Nb. These are my numbers — that work for me. Your numbers will not be the same as my numbers.
Nb. Blind eating is a curse for diabetics. It’s something I know I should never do, but I do it. It causes havoc to my numbers, but I doubt this will be the last time I ever do it.
Yesterday I went for a little 50 mile bike ride. However, for the past few days I have been running BGs from 60-95 or so. When I woke up in the morning I was at 70, and after eating a small breakfast, still under 100 a few hours later. Suiting up for my ride, my numbers continued lower to around 60 — so I started consuming: 26g via soda, 30g glass of chocolate milk, 20g candy, 40g bread and cheese. I did not bolus for any of that food. During a few mile warm up I remained in the 60s, so continued drinking Gatorade and downed 1 GU (20g). So I’ve consumed well over 100g of carbs — and finally start getting my BG to 100. And that’s where it stayed for the entire ride (where I added a bag of chips, 20g and a sandwich, 35g). I bolused nothing, zilch from 10am till 6pm when I got home and feared having a huge amount of Carbs-on-Board (COB) and took a few units of Novolog since I was at 180.
Why did this happen and work in my favor? I’m taking too much Lantus — and this is partly my purpose. I am doing something known as feeding the basal. I only slightly reduced my Lantus dose for riding, not nearly enough to require adding fast-acting insulin to the mix.
In all reality, not much has changed in preparation of exercising. COB, IOB are still the two items I am always conscious of – just how they get to me changes. While on the pump, I always disconnected before working out for 1.5 hours or less. This would tend to leave me in a basal deficit when I got out of the shower and reconnected and I would be forced to bolus immediately to both fill the cannula and get some insulin on board. However, now using Lantus, I do not have that insulin deficit when disconnecting. On the other hand, I do not start working out with a BG <180, Carbs-on-board and limited Insulin-on-board. I have purchased fun-sized candy that are 10 grams each – one or two candies are usually enough to get a BG <150 into my acceptable pre-workout range (also ensuring limited IOB). On the flip side, using the pump, I could be at any BG, and as long as I lowered my basal far enough in advance, I could raise my BG manually without additional carbs (however, I would end up going into further insulin deficit during the period of disconnect from the pump).
Not having to worry about the insulin deficit from disconnecting is a huge benefit for me during exercise – one reason why I am currently considering the OmniPod for my next pump.
As for the OmniPod in particular, I used a demo Pod for a few days over the weekend and I was somewhat impressed. Although the device is significantly large, it stays in place and has a smooth surface all around, unlike some of the MiniMed infusion sets I have used over the years. However, the inside information is calling for a 40-50% smaller Pod late 2010 or early 2011 (awaiting FDA approval). From the investor relations slides, it appears to retain its distinctive shape in a smaller package.
I have been thinking quite a bit about why Kris Freeman “bonked” in the 30KM Pursuit in Vancouver. It has been very well published — for the more normal audience. But it is a perfect case study for all levels of athletes. It is important to realize that at the level he competes there is no way he could be competitive starting a race and keeping with BG 200 like many others try to keep from going low. Kris understands his body and what it needs to be close to perfection. However, this being diabetes, and countless changes that can result over the course of race as long as the 30KM — pushing a little harder to make a pass may result in a tiny bit more of a BG reduction without ensuring a carb to back up that move. Basically, Kris cannot compete with the “buffer” that many of us use to keep from going too low. That brings with it risks — especially when he cannot test his BG during an event (he would lose). Therefore, only by training over and over — he learns how his body will react along a race course by testing BG over predetermined areas.
Bonking in in diabetics can really be a two fold event since a more traditional bonk where you are at the end of your glycogen stores. However, it may look and act much like a hypoglycemia in diabetics. It would not be unreasonable for both to happen — although it seems as though Kris really just had hypoglycemia — since a few minutes after getting sugar into his system, he was off and pounding the snow again.
Because New York winters are cold, rainy, and sometimes snowy, working out in a gym is almost a necessity. Not to mention sunrise near 8am and sunset at 4:40pm is debilitating to the mental game of getting outside before and after work. However, going from 8+ hours at the office sitting at a computer, talking on the phone and eating – changing gears to workout mode can through you out of wack.
For the diabetic athlete the working out poses an interesting challenge.
For the insulin pump user there are a handful of key issues to think through:
All of these types decisions rest on a few key decisions: your personal insulin resistance, Insulin on Board, Carbs on Board and the type of activity you intend to take on.
The diabetic using Lantus actually might have it a little easier — since the basal adjustments are not a factor until an injection takes place – and you can feed your basal carbs as needed.
For an easy example, let’s say I have no carbs or insulin on board and have a BG of 120. Potentially a perfect way to start a workout, but it still requires a little more work. If I plan to do 30 minutes of reasonable cardio (say 10/min mile pace on the treadmill) and lift for another 30 minutes, I will have a low BG if nothing is done. One option would be to eat carbs prior to the exercise in an amount and time that would counter act the exercise to. A second option would be to run modify the basal 30 minutes prior to the exercise (to artificially increase the BG) and during exercise either disconnect or run another lower basal during exercise. Neither is a foolproof system nor you will find that most pumpers will utilize a combination of the above, since even in our simple example it becomes complex rather quickly. Especially with disconnecting a pump, because a lack of basal can be debilitating when you reconnect (and somewhat scary if you bolus immediately after reconnecting after a workout to “replace” the basal).
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