Diabetes Management
• Diagnosed in the states, March 97 and went onto a B.D. Mix
• Always maintained regular testing, which allows good control and close manipulation
- If my sugar levels are good, I feel good
- To get an better idea of how my blood glucose level will be affect during exercise I will test my sugar level 30mins before an activity and then as I start the activity, a single reading means very little by itself
- It takes a fraction of a second to test and know exactly where I am, rather than leave it till later and feel lowsy
- I try to always take my diabetes kit where ever I go, it means I don't have to restrict myself to specific times and activities
- With one exception, at first I would take my tester, insulin and glucose tablets out with me on a night in the town. This was a problem as my pockets were packed, so then I stopped taking my tester out,
I then found myself guessing what insulin I needed to cover the glucose in my drinks, the problem being that alcoholic drinks have a tendency to make your sugar levels rapidly increase and then with the same velocity decrease especially when using rapid acting insulin,
So on a couple of occasions I found myself waking up surrounded by my mates and missing a large portion of the night, so I stopped taking my insulin with me just incase I ever had the urge to use it a the wrong time,
So I steer clear of drinks that will have a major impact on my sugar levels sticking to Low carb larger's etc, that way I can leave my diabetes at home and enjoy the night.
• Tried various insulin types and mixes, with twice daily injections
- When I eat and use insulin to adjust my blood glucose I work on a simple base:
-1 unit of rapid per 15g of carbohydrate
-1 unit of insulin to reduce my blood glucose by 1 mmol/l
- During exercise I've found that the effectiveness of insulin and the speed at which it works almost doubles (which is why I take extra care i.e. always have a snack bar handy (Nutri grain bar, low in fat high in carb's etc), therefore:
-1 unit of rapid per 30 g of carbohydrate
-1 unit of insulin to reduce my blood glucose by 2 mmol/l
• Previous insulin was Humulin I, problems with Nocturnal Hypos
- When I was training hard through the day on occasion I'd go to bed with a blood glucose of e.g. 6 mmol/l, then in the morning my blood glucose would be 13 - 16 mmol/l, which to me meant I need more insulin
- The problem persisted so I decided to wake up at 3am and check my sugar levels to see what was happening in the middle of the night
- I found that my blood glucose was low which matched the peak period of the insulin's duration, with readings around 3 mmol/l and that the high glucose readings in the morning were a direct result of prolonged low blood glucose which could sometimes result in fits especially after a hard training day
• Now using once a day Basal Insulin, 'inject it and forget about it'
- Due to the characteristics of this generation of insulin, which doesn't have a peak period and lasts 24 hours, I have found that my problems with nocturnal hypos etc have completely disappeared
- I also use it as an extra shot when competing in triathlon, as rapid insulin doesn't last long enough and is very aggressive to the point where I cant act quick enough if I get it wrong and other insulin's with peak periods meant I had to time my race to perfection
- Basal Insulin allows me much more flexibility so I race better, eat better and in general feel better so when I walk up to the start line I know I can race 100% just like everyone else
QUESTION???
"Do you have a suggested strategy as to how to approach races so as to keep glucose levels reasonable. I have tried raising the glucose level before I do a race but am worried about this going too high. Is this what you mean by the "spike" referred to in your diary?"
"What are the effects (on physical activity) of this "spike".. My other approach has been to start lower and consume glucose tablets every so often as I run....."
When I refer to a spike I mean your sugar level rises rapidly rather than gradually, this depends on what type of food is taken, i.e. locuzade tablets etc and high sugar foods raise sugar levels rapidly whereas starchy foods raise your sugar level more slowly, have you heard of the Glycemic index, anything high on the scale will rapidly increase sugar levels, I hope that cleared it up a bit,
The problem is when you eat lucozade etc your sugar level rapidly increases and if too high you feel tired or sick even irritable, it also makes exercising much more difficult, I steer clear of high sugar/glucose products because of this fact only if its absolutely necessary i.e. nothing else available in the middle of nowhere having a hypo, believe me its happened but I'm still here, so its obviously not the end of the world,
OK, my strategy for half marathon, its based on maintaining as you go, so start with sugar level of around 7-8 mmol/l, be sure to test 30-40 minutes before the start and then approx 10 minutes before the start, the idea being to show which way sugar levels are going, ideally they should be constant, you shouldn't really be having insulin 1hr before the start, only if its to take the edge of high sugar levels
Then I'll carry with me a snack or two, I use nutrigrain bars called elevenses, they contain roughly 30g of carbohydrate and most sporting research shows that we burn 60g of carb every hour of continuous activity, you might need more or less so try a few different things, so after 1 hour or so I'll have my snack, if you know that your sugar levels are a bit high then just eat the snack later on or not at all if its not needed, you should look at magazines etc they give a pretty good picture of how the body reacts to exercise (were no different), its just a matter of adapting the information into a diabetics perspective (after all there only guidelines), which can be pretty enlightening,
In long events such as half marathon you could experiment with reducing your night time insulin a little the day before, this is so you don't have to eat as much or reduces the risk of hypos during the race, as insulin is more effective during exercise,
The only exception to this rule is, I have found that short max efforts i.e. 100%+ where you are pushing yourself to the limit and beyond, can make your sugar levels rise, so if you experience this don't worry, in this circumstance I take an extra shot of my basal insulin usually taken the night before but I though I'd try something different, it worked for me:
Example (When racing in triathlon):
Night before; Take usual 12 units of Basal Insulin,
Morning; Have usual breakfast and short acting insulin ideally two hours or more before the race, then one and a half hours before the start take extra shot of Basal Insulin, 10 units, the idea being it takes two hours to start working and will therefore begin 30 min's into the race as this is when in the past my sugar levels began to rise and I hit a massive slump in performance (like there was nothing left in the tank),
During race; Depending on glucose levels before the race may eat snack before swim, on the bike section I use hydroactive sports water toped up with water in my water bottle, these drinks are lower in sugar and not as highly concentrated, alternatively dilute other sports drinks, I also have snack bars ready in transition just in case, can easily pick on up for the run with losing time,
After race; As I now have twice as much basal insulin as normal its a good idea to monitor sugar levels closely and at meal times take less short acting for the same food,
Night time; Take usual 12 units of Basal Insulin.
I use this in triathlon because I don't have time to stop during a race and take extra insulin, which wasn't a problem to begin with but as I became more competitive it was a big handicap, also taking short acting insulin makes your sugar levels go all over the place and is very difficult to judge correctly, and a mistake can really send you out of control i.e. extra rapid, your sugar levels fall, then you eat to compensate and your sugar levels fly up again and so on,
Try different things, hope this helps, let me know if anything is unclear....
QUESTION???
"I was wondering why you take your Lantus at 8 p.m. and have you ever taken it regularly at other times. I am trying taking mine on a morning as I am still experiencing nighttime hypo's. Any advice would be appreciated."
Ok, my race regime is different from my everyday regime, here's why,
When I started to get well into the triathlon process I found that my sugar level would rocket up through the roof when I did a sprint or a olympic distance event, I started by doing tests during a race and taking short acting insulin if need, as you probably know they don't stop the clock for anything,
From things I've read and also experienced I know that a sprint has different demands on glucose releases and insulin in an athletes body, apparently in a sprint to fuel your muscles your body dumps a load of glucose into your blood stream but being diabetic means I didn't have the insulin to go with it,
So I needed more insulin, I couldn't use my short acting, why because it doesn't last the entire event and to top up would mean stopping, no good,
So I thought I'd use my Basal Insulin as it doesn't have any peak periods and would be like topping up my insulin level for the race, therefore when my body kicked out the sugar I had the insulin to go with it, your probably asking yourself how much I took, well I guessed, I take 12 units usually on a night so I took and extra 10 when I did my race, funnily enough it worked:) it also allowed me to use a electrolyte sports drink (as its not as explosive as lucozade and the others sports drinks) on the bike section,
Then after the race you've obviously still got extra Basal Insulin, so for the next 24 hours I just watch my levels and maybe cut back slightly on meal time injections,
Why inject at 8am, its relative to the start of my race, My Basal Insulin takes about 2 hours to get going, so I inject 1 1/2hrs before the race, it also means if the start is delayed I'll still have the same amount of insulin working in my body, as Basal Insulin doesn't peak like other insulin's:)
With regards to night time hypos, do you ever experiment with reducing you insulin and seeing what happens, that's what I do, It might be you're taking to much, or if you've done allot of exercise that day you might be more sensitive to your insulin, what I do on days when I know I'm going to be doing long periods of low intensity stuff, I'll reduce my Lantus the night before from 12 units to about 8, otherwise I found I was eating loads to keep my levels up...
Most of this stuff I found by experimenting, the Doctors and DSN's I talk too said they would have a panic attack If I told them about the races that I do, everyone's diabetes is slightly different, Anyway, let me know how you get on.........
