Wednesday, March 14, 2018

How a new activity affected my blood sugars

I have been struggling of late with an ITB issue in my left leg. It's always my left leg. Any issues I have had in past 2-3 years have been my left leg. It's frustrating, monotonous and a bit boring. More than a bit boring it's a pattern.

Get fit, feel great then as i start to progress towards my goals something breaks down.

You could argue I need different goals and you might be right but as of now I don't know what they could be. Right now what I do know is the goal is the South Downs Way 100 miler on June 7th.

This post isn't meant to be about that or me moaning about yet another injury setback. It's about what I have been doing in the absence of being able to run and the significant impact this has had on my diabetes.

On Saturday I went to the gym, I have been increasing my gym time to help with my leg. Strength training really helps to keep this all at bay and my focus to upper body is a contributor towards this. Saturday, I decided to go on the rowing machine, a good all body workout. I rowed 5km in a little over 21 minutes. Pride dented slightly as I used to be able to do that in less than 19 but that was probably 5-6 or even more years ago and I am 47 and not a rower! After that I did 20 minutes on the treadmill at a really easy pace and then some strength work.

For the rest of the day my blood sugars were down. I used a -80% setting for my basal during the exercise session (this was around and hour and 20 minutes total) and continued for a further 2hrs or so afterwards. I ended up extending this -80% for nearly 4 hours post workout such was the impact. It seemed that each time I tested I was at 3-point-something. It was exhausting.

When this low blood sugar cycle happens I always go back over the day and previous days to see what was different and the answer was very little. I eat more or less the same food, drink the same amount of coffee, water and tea and exercise a lot. I always do. The only thing that was different was the actual exercise I did.

Could it be that the 21 minute row had that much of an impact?

I can only assume that yes it did. A different type of exercise and different intensity and one that uses a lot more of the body than just running does for example. I eventually got things under control by evening, where i was running a little higher at around 9mmol, and took the opportunity for an early night. A day of up and down blood sugars really leaving me drained.

The lesson learned is that different exercise can have a profoundly different effect. This got me to thinking that when you start exercise as a diabetic you really need to be careful and test regularly during the effort to understand what is going on and what affect it has. I have been running for so many years that my body is used to that, throw a random-row in and I am right back at the beginning of the journey. Learning what it does to my body and how my body needs to get used to it and adapt to it.

When someone with diabetes says they are struggling to exercise this may be part of it. Don't judge them or think that they are looking for excuses not to do it; they really aren't. It's difficult and they need more time to understand what's going on and how it affects them.

Exercise is the simplest thing right? You put on your kit and you go. Now imagine that every step or pedal stroke or pull on the rower that you are worried about your blood sugars going low. That you need a strategy for this if you feel it. That you have to carry more kit to test, that you need to stop and test. It's frustrating and difficult but persevere. I learned so much about my diabetes through running and the benefits to me in terms of blood sugar control and overall health are massive.

Now i just need to get my 5km row time down again! 

Thursday, February 15, 2018

Countdown to my first 100 miler

My ultra running journey started some years ago in, of all places, Telford.

I can be even more specific than that, it was in Costa Coffee in the precinct and followed a visit to Waterstones. 

I had heard of the book Ultramarathon Man by Dean Karnazes a few times on a couple of podcasts. I had looked online at the book and for some reason had not bought it. In the Telford Waterstones they had a copy. I saw it a couple of times and then decided, one day, to just buy it. I then went direct to Costa, bought some lunch and started to read.

I could not put it down and given the opportunity of taking the rest of the day off to continue reading would have done so.

It opened my eyes to the world of possibility. Much in the way that Dean’s own eyes had been opened, something he has described on a number of podcast interviews. Reading voraciously it appeared to me that the only limit on human performance was sleep. We need to sleep to recover not only physically but also mentally and that was a limiting factor to what we could achieve athletically.

I read about his 50, 100 and then 200 mile races where he fell asleep running!

That was it for me, I wanted to try this myself. I wanted to see what I could do. The thought of running 100 miles felt something that was simultaneously beyond me and yet something I could aim for. Why not? Some rudimentary research shows plenty of runners just like me  have achieved this. Not to say it’s easy, far from it, but that with the right dedication, training approach and mindset it can be achieved.

Since then I have run a few 50’s and always stopped shy of making the next step. This has been due to a healthy fear and respect for what it would entail. I am naturally cautious, something I only realised while reflecting on this recently, and there’s always been a reason not to enter a 100 miler. The main one being how to be ready for it. Then I realised that you are never really ready for that. You are as ready as you can be.  At the end of last year I put my name on the wait list for the Centurion Events South Downs Way 100

From Winchester to Eastbourne along the South Downs Way footpath. Being on the wait list is one thing but when you get the email saying a space has become available and you are in well that’s a different feeling altogether.

The wait list is easy, just a name and an email address.

You then get THE email and it’s real, there’s the financial commitment (obviously) but more than that I now know that all things being equal on June 7th I will be on a start line and when the whistle or gun or whatever it is goes I will probably be on my feet for around 24hrs. No sleep. That’s a little scary, I would be inhuman if it weren’t but it’s also hugely exciting. The realisation of a dream concocted in Costa coffee, Telford.

One of the reasons for my reluctance to push myself to enter a 100 miler is that what then? When I started out I wanted to run a 100. Assuming I finish and achieve that then what next? More 100’s?  A 200? Or a different sport? I really don’t know how I will feel after that as haven’t ever really set myself a goal that was that big before. I have run for many years, dabbled in triathlon (Olympic distance) and even done a marathon swim (6.5 miles) but these were goals that were set with little thought. While I wanted to do triathlon I knew I wouldn’t do Ironman distance – it just doesn’t interest me enough. Similarly with the swimming; I did that as I was waiting for an ACL operation in my left knee and rather than do nothing I trained through swimming. It wasn’t a dream to do a swim like that and I’ve not looked at doing another once since. But with ultra running the goal has always been there.

From where I sit now there’s little point thinking about what happens after 7th June as there's a lot that can happen up to that day and certainly on that day. For now what next will take care of itself.

Differing insulin requirements at different times of day

Not the catchiest title for a blog post I grant you but hopefully something worth reading if you are a runner with type 1 diabetes..

I often run twice a day and this would normally be anything from 4-5 miles in the morning and maybe 3-4 in the evening. Not fast or too excitable, just ticking over around 7:45 pace. While the distances and double days are not a problem the insulin requirements could not be more different.

In the morning I run fasted as much as possible, if my blood sugar is around 5-6mmol then I will normally have a small bite to eat with no bolus being delivered. I also reduce my basal by 80%. This very morning my blood sugar was 6.7mmol on waking and because of the weather conditions being pretty awful I knew I’d be working harder. I reduced my basal by 80% and ate around 20g of carbs giving myself 0.5 units of bolus which was around a quarter of what I would normally use if I wasn’t running. When I finished my run, 4.4 miles in around 32 minutes my blood sugar was 7.8mmol. A normal breakfast followed (40g of carbs) with normal bolus (4.5 units to include a small correction) and with the -80% basal still running (I have this set for 3hours) my blood sugar is stable until lunchtime.

Contrast with the afternoon….

I eat my lunch at midday most days and it’s normally the same or similar food. A pitta with some vegetables in it and some fruit. Around 40gs of carbohydrates. My ratio sees 2.5 units on bolus delivered. My basal chugs along and normally there’s balance. But something happens towards the end of the day and my blood sugar starts to drop. This is only around 4-6pm that it occurs (I think this is the case). I know it happens as when I ready myself to run home I need to eat to get my blood sugar up otherwise it does not last. Even a relatively short run home of say 25 minutes has seen my blood sugar go from 14mmol to 2.9mmol in that period. This is combined with an 80% reduction in basal for the same period.

This is not sustainable so recently, and I mean just this week, what I have started doing is suspending all insulin about 30 minutes before I head out the door that sees a reduction in insulin in my system covers the period I am on the move. I did this yesterday and my blood sugar went from 11mmol to 6.7mmol over a 30 minute period. When I get home I resume insulin delivery but at -80% of the normal basal rate.

What is interesting is that this does not happen if I am running an ultra. When I ran in November (my last 50 miler) I had insulin with breakfast and then ran on a -80% basal which until the time the pump failed was working. My blood sugar did drop a little but I would expect that for the effort I was putting in and the demands being made on me. Where I have had a normal day with normal insulin it seems to me that I get a build up or a cumulative effect. Almost like the insulin profiles don’t really apply. Today I also reduced my afternoon basal by 20% while at work to start the reduction process. This has had a positive impact meaning I have had to eat less so there’s maybe a tweak to my basal to be factored in there to.

I am sure I am not the only diabetic to experience this so hopefully this helps, or if someone has a better way of managing get in touch with me!

What this has got me thinking is that the Omnipod is a wonderful piece of kit, after reticence using a pump I am totally sold on it now. It would be even better if you could program fluctuating basal rates without having to create the profile to do it. The profiles work where things are consistent but I don’t always run at the same time, or leave work at the same time. If I could at 3pm think I will probably be leaving at 5:30 and then set a programme to reduce basal by 20% for an hour (1500-1600hrs), then 60% for the next hour (1600-1700hrs) then from 1700hrs to suspend for an hour and a half before resuming at -80% for 2.5hours. That would be awesome!