Thursday, May 2, 2019

Bit of an update; diabetes, carbs and running

I have been in a good run with my diabetes of late. There have been some unexpected spikes but the biggest change has been my overnight sugars and the changes I have made to achieve this. This post will be validated or blown out of the water on Wednesday when I get my blood test results and the all import HbA1c number. 

At the time of my last check up I was struggling with blood sugars overnight. Too high as evidenced by waking levels of regularly >10mmol and in reality an average of around 12mmol. These days it has been much more between 5-8mmol. A significant change borne of two main changes that are wholly related. I now trust my going to be blood sugar levels and can do this as I am eating a lower carb meal in the evening.

Previously I would test my blood sugars before going to bed and if it were less than 7mmol I would worry then eat something without insulin and then wake up with a high reading in the 10-12mmol range. What I do now is trust the levels as I understand them better. The understanding and trusting the insulin on board calculation. If my blood sugars are 6mmol but with no IOB at bedtime then I trust that and go to bed. When  wake my blood sugar levels are similar.

I have been able to achieve this through eating a lower carb evening meal and doing this much earlier in the evening. The last point being particularly important as I tend to be an early to bed early to rise kind of guy. My evening meal now comprises around 20-30g of carbs and does not include anything remotely related to bread, pasta or rice. While I am not low carb (I am  a long way from sub 50g of carbs a day) this small change has made such a difference that it is something I will be extending to my lunchtime meal. I just need to figure out how to transport salad in a rucksack when I run to work so that it is still edible at lunchtime!

The bread, pasta, rice thing is very interesting and has been a source of problems for me. This is as it relates to the evening meal specifically. If I were to eat pizza or rice my blood sugars would spike significantly later on the same night. I have counted the carbs and tried various combinations of extending the insulin delivery (a feature of the OmniPod) by an hour or two except that this resulted in high sugars followed by  a significant drop. It’s just been easier (and I feel better for it) to not eat those foods at night.

The other aspect of my blood sugar control I have gotten a grip on has been the use of the temp basal feature. As someone that run-commutes I have struggled with afternoon blood sugar drops. I could be at 8mmol leaving the office at around 5pm and after an easy 30minutes of running my blood sugars would be sub-4mmol. I have started the temp basal reduction earlier in the day and also worked to not have any insulin on board from lunchtime or afternoon snacks. Oe of the issues here is that I can only do a temp basal reduction of 50%. The pump cannot accommodate a greater reduction as my insulin levels are so low. I have experimented with suspending insulin but this makes me nervous and I am unsure of how long to reasonably do this. Should I start this an hour before I am due to be exerting myself or just for the period of exertion?

This is where a feature of scheduling on the OmniPod would be awesome. The features to reduce insulin delivery for time periods is great and what would be even better would be a facility to schedule the reduction. I have given this some thought and think something like the following would work incredibly well for me. On an assumption that I will be running at 5pm I would look to do the following.

3pm :: Temp basal reduction of -50% (this being the current pump limit. If this could be smaller I would do a -50% for 3-4pm then -80% from 4-6pm)
5pm :: run home (I would want my blood sugars to be around 7/8mmol and have no insulin on board. I may also need to eat something (around 15g of carbs) before leaving.
6pm :: the temp basal of -80% would finish
6pm-9pm :: I would look to have a -25% temp basal reduction and depending on the intensity of the 5pm run may even extend this to a 4-5hr period

I did this, sort of, just last night. On Wednesdays I run with Bath Road Beers Run Club.  We set off for the club run at 7pm. Earlier in the day, at 4:30pm, I applied a temp basal reduction of -50% for 4 hours. At 1800hrs my blood sugars were 8.2mmol. I ate around 25g of carbs without insulin. I ran a pretty hard 6miles and when I tested my sugars at just after 8pm, when I got home, they were 4.2mmol. I had an evening meal quite a bit later than normal that was around 45g of carbs (a little higher than normal as I had a vegan protein shake with it). When I went to bed at 10’ish my blood sugars were 12mmol. I had insulin on board and new that I had the effects of the run still in me. I set up a temp basal of -25% at 9pm for 5hrs to cope with this as I have had situations where I have gone low over night.

When I got up this morning my blood sugars were 8.8mmol. A little high but, I think, managed quite well with lots of variables to contend with.

As I mention above the impact of low carb in evening meals has been incredibly significant and something I want to explore further. My reticence only being that I train a lot and while I never feel under powered (my April numbers have been really good; 151 miles run at an average of 7:52 per mile and an average run length of 7.22miles) I am a way off being a fat adapted runner and this takes time to achieve. Something I am not sure I have the patience for. It’s also worth noting that my weight has been pretty stable for the last couple of years at around 150lbs. A weight I am comfortable with. It had though, recently started to creep up and only a couple of weeks ago I was at 156lbs. Still not massive but the wrong trajectory.  Three weeks on lower carb evening meals and I am back to 151lbs. I need to make sure it doesn’t go too far the other way now but as an experiment of 1 it shows that this works.

It's funny as I have always thought of myself as a good diabetic. Recently I have felt much less like that and struggled a bit with the emotions that throws up. I want to keep the OmniPod and that was at risk following my last appointment as my blood sugars were not showing an improvement that warranted the investment that having this device comes with. I am hoping for an improvement on my HbA1c numbers as having to give it up will be a very bad situation to find myself in. Fingers crossed!