Wednesday, June 22, 2011

Adjusting Type 1 Diabetes to Racing Tour of America's Dairyland

Often when I travel, it seems like I need to increase my insulin basal rates; but racing this week in Wisconsin has required a surprisingly large adjustment.  Leading up to the start of the series for me, I had my basal rates on increased, "taper" mode, which is what I try to remember to use when I have a rest week in my training, or am tapering my training before a race.  (With a decreased training load, I will need more insulin.)  After arriving in Wisconsin for my first race (Friday),  I turned on my "race day" basal rate profile.  This profile has an approximate 30% increase an hour before my planned breakfast and throughout my races, which are all 30-40 minutes in length, beginning sometime between 11:20 and 11:50 AM.  At other times, the basal rate profile uses my normal rates.  At my race Sunday in Waukesha, my BG started around 190 and ended up around 300 forty minutes later.  I don't necessarily expect to have a flat line (BG-wise) during a race, so my goal is to start lower so that I don't finish the race quite so high.

Aside from the race-related BG spikes, I have had overall higher BGs, frustratingly resistant to multiple corrections.  Leaving my race day basal rate profile on constantly was still not bringing my BGs down so yesterday afternoon I just decided to increase my basal rates by another 30% or so.  Overnight, things were a bit better and this morning, I programmed a new basal rate profile that is 30% higher than my already high, "taper" profile.  I looked back and saw that, instead of my typical total daily insulin dose of 20-32 units, I was needing more than 40 units for consecutive days, which is very much outside the norm for me.  Since I had been staying high after meals and my corrections were not working well, I also reprogrammed my carb ratios from 15 g/U to 11 g/U and lowered all of my correction factors by 10 mg/dL/U.

It has seemed a bit paradoxical that during an 10-day race series (with 8 races), I would need so much more insulin.  But, perhaps it makes sense.  Although I am racing almost daily, the races are short & intense.  My blood sugar always goes up during 30-40 min crits, which are high-adrenalin events.  The common thought is that, with high intensity activities, adrenalin is released, causing the liver to release glucose from glycogen stores; for someone with diabetes, the lack of a normal insulin response can easily leave the blood sugar high.  Furthermore, the short duration of these crits means that my overall exercise volume is much lower.  And to compound that, we spend most of the rest of race days resting or doing light activity, which is in contrast to a more typical day of traveling (by foot or bike) to and from work, working a full day, etc.

So far, during our rest day today, I have only had a couple brief excursions over 200, which is a huge improvement over the past few days.  It is always nerve-wracking to take so much more insulin, but it seems to be working well so far.  But really--since when did I have to take 1.4 units for an apple?  We will resume racing tomorrow and continue through Sunday if all goes well, and I fully expect that I will have to make more adjustments.  Diabetes is always a work-in-progress!

Total daily rapid-acting insulin using Omnipod
June 12--end of 18-hr training week; June 13--begin taper; 
June 17--daily racing begins; June 20--no race

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