Type 1 Ultra

endurance sports in the weird and wonderful world of type 1 diabetes

Confessions of a diabetic ultrarunner.

Every night when I go to bed, I make sure that there is some carb source beside the bed – a juice box, sports gel, halva, whatever. But I practise finding it in the dark, so that if everything goes out the window and I get the dreaded creeping night time low I’ll have half a chance of sorting it out.

I’ve just run my 2nd 100km event in two weeks. I’ve got a couple of niggles to work through with Physio and maybe yoga before next weekend’s road 100km. I might not make a personal best time goal, but I’ll get it done.

The thing though that plays on my mind is how erratic my blood sugars have been today. The day after a higher intensity long run is always a bit up and down. Travel is probably involved, which usually means long spells of sitting down, which means insulin not getting as active as it should, if at all. A lot of eating is DEFINITELY involved.

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But I’ve also just had to really dose extra to get sugars heading down from a high high before sleep. Is it bad tubing? We’ll, I’ve replaced that – always fun to stab yourself just one more time – just in case. Did I count carbs badly? I don’t think so. Has the insulin I used for an intramuscular injection ‘gone off’? Well, that’s hard to tell unless you have a lot of spare time to use it, wait, test, reuse, and retest. Am I just a lot less sensitive today? It would go against conventional wisdom to be significantly less sensitive after sport, but conventional wisdom also knows that type 1 can work in mysterious ways.

So?

So I watch my sugars finally respond to insulin and start coming down, so I can prevent longer term effects of the disorder and not wake up feeling sunburnt from the dehydration, as fluids from organs are redirected to dilute blood glucose levels that are way too high.

And I reach out to make sure I know where the juice box is so I can find it if I need it, when movement will be an act of will.

Filed under: exercise and type 1, run like you stole it, trail running, type 1 & ultramarathon, Type 1 diabetes, , , , , ,

13 Responses

  1. I wonder if it is damaged muscle. I read that damaged muscle inhibits glucose intake. I cannot imaging a 100km run of any sort not doing something nasty to ones legs.

    • Roger Hanney says:

      ‘Nasty’ is a bit subjective 🙂 I like to think of it as ‘conditioning’. I think that is part of it, definitely, although I plan to write to Ian Gallen at http://www.runsweet.com to ask about this and a couple of other things. I think cortisol is also a part of it, as a byproduct of inflammation that blocks the action of insulin, but there are some specific objective measures that physiologists should know to answer this question. How long after activity it is present in the body and so on. I do find, though, that taking an anti-inflammatory during recovery and preventing spikes with intermuscular insulin seems to prevent and smooth spikes.

  2. Sorry, wicked damage to ones legs. Like Klingon Painstik’s enhance ones character 🙂 Congrats on consecutive 100’s. I’m excited to be working on my first 50k this spring at the superior trail races.

    There’s work saying cortisol does it too, from what I can find. There’s also some work with a different reason http://www.biomed.cas.cz/physiolres/pdf/61/61_81.pdf “Strenuous exercise induces delayed-onset muscle damage including oxidative damage of cellular components. Oxidative stress to muscle cells impairs glucose uptake via disturbance of insulin signaling pathway”

    Not that it matters for us unless it helps us deal and figure it out eg more basal/anti-inflamitory’s. Different scope, but after my last 1/2 my basal needs went up 40%. They started coming down when I started training again but all the patterns are different now. My night is more sensitive and my day less. Thank god for CGM’s, they enhance reaction time so well.

    I just wish the pumps had an equivilant of basal patterns for bolusing and a distinctive beep when the temp basal runs out.

    • Roger Hanney says:

      Great feedback and info. Thanks! I agree. It’s shortsighted the way that pump ‘modes’ are programmed. I do think it’s improving though. I’m really happy with my Vibe from Animas but need to dig down into some of that kind of detail. Mostly I just free range it, focusing on function and outcome, rather than trusting it to do all my equations for me. I’ll even inject basal slow acting, maybe an extra 4-6 units after a long run to smooth things. I find what you’re talking about happens for me after a marathon, with the increased need for basal. Would be great if there was a measurable formula for prediction which would incorporate intensity and duration from the preceding 24-72 hours.

      • Almost every run I do will cause a high blood sugar after. Chris Jarvis calls it the Whip because it can shoot up quick. I suspect most of it is because I use a temp basal and go from a running state where I have low insulin, my liver is pumping out glucose and my muscles can take in that glucose to a state where the muscles don’t need it. So I am trying to find the process that gets more insulin in my system when I stop so that the liver stops pumping out glucose and the insulin can help get what is there into use. Hormones play a role too I think.

        This is the part the endo sees and says, your control in the late afternoon needs work.

        For me, this is still far better than not using a temp basal or using MDI. I could not eat enough to run more than an hour and starting with a high blood sugar. Feeding insulin sucks.

  3. Roger Hanney says:

    Yep, I had that same thing happening and then I read one of the Team Type 1 cyclists’ blogs. What he does is just take a corrective bolus when he gets back in from a ride because he knows it is going to spike. I do this too but after an ultra I’m conservative because nausea means I might have a hard time getting carbs in if I take too much, so I might spread the dose. Also, your endo sounds like they need a lesson in Type 1. If you want perfect sugars, sit on a couch with a CGM and dose any time your readings go over 7mmol/L. If you want a healthy type 1 diabetic, get out and do things and adapt when your sugars go off the ranch. It’s so much better for you to be active and capable than perfectly controlled.

  4. Problem is I see the endo every six months. I see the rest of my team whenever I like bit I schedule monthly to keep me on my toes. So he didn’t know why. The CDE nurse and dietician aren’t bad.

    I had a conversation in my last visit with them and they remarked at how often my dosage changes. They have clients at never do it independently or some more than once a year. I adjust it often apparently.

  5. So how long is a long training run for a 50k race? 4hrs?

    • Roger Hanney says:

      I think that up to about 60km, it’s good to have long runs in training that are at least as long as your race will be. But at some point, the law of diminishing returns will kick in. Doing 110km on a single run in training will more likely harm a 100km race outcome than benefit it if the effort is too high and the runs too close together. It’s different for everybody and there are many different approaches that can achieve comparable outcomes. Double days and tempo runs, hill sessions and interval training are staples though.

      • Linda Britz says:

        Roger, I am running my first 100 miler in November and I am searching for advice on nutrition. Can you give me some tips?

      • Roger Hanney says:

        There are some favourite foods and drink options definitely, but the best advice for any ultra and especially a miler is to train with what you’re going to use and use what you’ve trained with. There will be some nice surprises on race day like salted, buttery potatoes, and ginger beer (or ginger ale when you can’t handle any more sweet stuff) but you need to rely mainly on the nutrition that has worked all day for long training days, and using the same bladder/bottles/packets/snaplok system that you’ve trained a lot with.
        This close to your race, it’s also not much time to train to eat less. Check out Volek and Phinney’s book on Low Carb and High Fat for Performance – http://www.artandscienceoflowcarb.com/the-art-and-science-of-low-carbohydrate-performance/ but that’s worth playing with for your next race.

        Main tips & recommendations
        1. Use things that have worked reliably for you over long sessions, not just whatever everyone else says is working for them
        2. I have switched to mainly Tailwind as my main carb source. The Naked flavour is awesome. I put about 180g of powder into a 500mL bottle and mix with water for about 4 hours worth of nutrition. Make sure to have plain water too to rinse with after drinking the concentrate.
        3. Hands puffy yet? I find that when I’m getting puffy fingers after running for 6+ hours, it’s because I have taken more than enough salts or electrolyte. This is confirmed to me by the fact that if I then tun on just water and non-electrolyte nutrition for about 40min to an hour they return to normal size.
        4. Caffeine is strong stuff. Make sure to have a depth charge ready for the no-holds-barred final 15km but otherwise use it strategically and in small doses. If you caffeinate at 11pm, the cola you have at 2am might not do what you need it to.
        5. Stay hydrated but don’t get obsessed. As long as your pee isn’t dark and you’re not dizzy and you’re not thirsty, it’s probably all good. A regular pre-race ritual is to drink about a litre of coconut water a day for about 5 days before a proper long run, and also to have some 250mL containers in drop bags on course for variety and a quick fluid hit before heading back out. Works for Jess, she put me on to it. Seems pretty good for cramping prevention/reduction too.

        Final thoughts – you will want savoury/salty/solid at some point so give yourself some simple options in your drop bags. Do NOT over-feed/over-hydrate. It might feel good while you’re doing it, but then you’ll spend the next 3-5 hours feeling like crap as you hold back your running so that you don’t hurl. Keeping food types separate is a good idea I think too. If you’re having potato chips, for example, keep them half an hour at least apart from your watermelon, or cola, or ice-block.

        Hope this helps. What race?

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