For those who don't live with diabetes, here are some reminders:
basal rate = background insulin, usually fast-acting, delivered 24/7 by an insulin pump
bolus = equivalent of an injection of insulin, usually rapid-acting
CGM = continuous glucose monitor, which gives glucose readings every 1 to 5 minutes
BG = blood glucose, measured by a BG meter; aka "blood sugar." Normal is 70 to ~120 depending on various conditions. BG is affected by insulin concentration, stress, exercise, food, illness,...
insulin = hormone that facilitates movement of BG from blood to cells; fast-acting insulin starts working fairly quickly, peaks in about an hour or so, and sticks around for 3-4+ hours (for me). Exercise makes insulin much, much more potent.
The other night, I woke up around 1 AM feeling weak and hungry, as if I had low blood sugar. I checked and it was okay at 100. Not sure if my BG was rising or falling, since I am not, sadly, using a CGM right now, I ate half of a gel--about 10-15 g carbs--and went back to sleep. When I checked again before starting a morning swim, I was startled to see 279 on the meter. If anything, I have been waking up low in the morning recently since I significantly increased my basal rates. I was about to hop in the pool and figured leaving my basal rate at 100%, instead of reducing by 20-30%, plus skipping a pre-exercise snack, would help knock it down. Although I might typically give a little insulin to get things started, I decided to forgo it because of my elevated basal rate. I started my swim with a big set of 50's and felt thirsty and lethargic. I kept going, realizing that some days are better than others for a variety of reasons; still, I was having to work really hard to make intervals that were manageable the week before. After 45 minutes, I checked my BG, which had risen to a sticky 316. Ugh! No wonder I felt horrible. I gave a 1.2-unit bolus, drank some more water, and got back in the pool. A little disconcerted, I checked again about 20 minutes later and saw that I had already fallen to 262, and following my swim I had settled down to 122. There were many moments during the first half of this swim where I wanted to call it a day. While I am obviously a big fan of exercise, I do it for health benefits and for my enjoyment; it is not required to be an act of heroics! But sometimes, it sort of feels that way. Once I could see that my blood sugar was falling, I felt comfortable from past experience that things would improve. Throughout the day, I still felt off, and wonder if my probable prolonged overnight high BG had taken a toll.
My blood sugars were pretty oscillatory for the day and I had a late lunch/snack around 4 PM, requiring about 6 units of insulin, which is a lot considering my daily insulin is anywhere from 20 to 35 units. I was supposed to run after work, but had not been looking forward to it during the day. With my IT band troubles as of late, I haven't been able to really enjoy running, with each run ending in pain and frustration. Maybe I subconsciously ate late so I could use a massive bolus-on-board as an excuse? It's possible. For some reason, though, taking a lot of insulin made me feel a little better and I started to think that maybe I would run after all. So, about 45 minutes before I started running, I knocked my basal rate down by 90%, meaning I was basically taking little to no insulin. I didn't really think this would work, but had plenty of back-up GU handy. At 6:30, I started my run; I decided to run on the track in case I had to bail early. My BG was at about 120 and I decided I would just run and see how it fared. I just didn't want to eat more calories if I could help it. About 30 minutes into it, I had that sudden realization, "I'm low." I was at 74 and ate one gel and kept going. My blood sugar came back up nicely and I was able to finish my 50-minute run without any BG or IT band catastrophes.
In retrospect, it would have worked better to take a little insulin before my swim, and check partway through. If I needed to eat at that point, I could have. Also, during my run, I felt like it was likely that I would drop, so it might have been better to eat before I got started, rather than waiting until I was low. (Well, in the first place, it would have been better to not take 6 units of insulin that close to exercise.) In both cases, I was motivated by trying to avoid eating extra calories. I had to eat the calories anyway for the run, and getting my BG down sooner during my swim would have led to a more productive, healthier workout. And I was definitely hungry in the pool, so being able to eat a gel might have helped me swim stronger.
In the end, I was happy that I was able to get through both workouts, although the mental struggle in getting through them (and even starting them) was tough. I do love exercise, but that doesn't mean I love every workout. Anyway, Ironman Arizona is coming up quickly and at this point, each workout is key and will make a difference in how I feel race day. I am hoping that a little pain now will make race day a little less painful; I'd like to keep my focus on the wonderful experience of racing with my Triabetes team and watching out for my Triabuddy Elisa and other friends and family along the course!
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