Thursday, June 30, 2011

Exercising Post Breakfast

While there has been some press lately on how exercising before versus after a meal may affect calories burned and weight management, people with diabetes have additional considerations.  For me, I have generally avoided exercising soon after a meal simply because I'd rather not deal with the conundrum of either taking my normal bolus and crashing from the insulin once it becomes super-active during exercise or underbolusing and then going high early on.  This was especially noticeable with running, and I tried to never have more than 1 U of insulin floating around when I went out the door.  For races or other times when I want to have a meal beforehand, I try to bolus & eat about 3 hours prior to starting to exercise.  Then, I am able to take a full bolus that is pretty much gone by the time I start.

But today, for various, uninteresting reasons, I wanted to eat before my 1-hour easy ride.  So I thought I would experiment a little.  I took my full bolus and ate my normal breakfast.  But when I took my bolus I also shut my pump off for an hour.  Hmm, maybe it was 90 minutes.  At any rate, by the time I started my ride, my pump had been off for 45 to 60 minutes; although I had a full bolus still peaking.  My BG was somewhere in the low 100s and rose up a bit; I checked about 40 minutes in and it was starting to fall, so I ate a 20g gel.  By the time I finished, I was 160; I took a correction bolus and settled in nicely in the low 100s.

I still prefer to exercise with just a snack versus a whole meal, but it was nice to figure out a way to sneak in a ride post meal in case I need to do that again.  I think if it had been a much harder ride, I may have had a bit of trouble.  Also, since I don't normally shut my pump off (or even modify basal rates) during exercise, I have some room to play with my basal rates.  I guess, in the past, I have used this method if I had to take a correction bolus close to exercising; although usually I just take a smaller correction than I might have otherwise done.

Saturday, June 25, 2011

ISCorp Downer Classic

We are off to Madison early in the morning, but I thought I'd update quickly on my blood glucose victory in today's race.  Yesterday, I came down a bit low after breakfast, and then turned my basal rate down to +15% (vs +30%), and ate a gel on the line, and finished around 300.  Today I tried the same thing but was able to head off the low with a granola bar and a few Dex 4 tabs, and then left my basal rates at +30%.  I hesitated but decided to go ahead with the gel again, about 10 minutes before the race start.  This race was a fun course, with a sharp turn at corner 2 but two long straightaways which helped me to move around more.  I spent some time at the front and also too much time in the wind again, but was felt more comfortable overall adjusting to stuff in the pack and was able to test out my sprint at the end.  Following our 30-minute race, I checked the Dexcom and saw 110 with a steady arrow.  I had gone up a bit from my pre-race 140 but settled down during the course of the race.  Victory!  So for the record, today I had my basals up 30% all morning (1 hour before breakfast onwards) and changed my carb ratio from 1:15 to 1:11 and my correction factors by 10 points.  I rode around a lot more today and hence had a couple bad lows in the evening.  I also did an easy ride yesterday late afternoon, so perhaps that also had an effect.

I stuck around to watch the rest of my team race in the P1/2/3 race in the afternoon, and enjoyed cycling a bit along Lake Michigan.  The atmosphere at the race today was downright festive, with lots of local people filling the, sidewalks.

Friday, June 24, 2011

Fond du Lac at Tour of America's Dairyland

On day 2 of my diabetes revamp, I seemed to have a bit too much insulin on board.  I had a horrible high that kept me up for an hour overnight--I think it was related to the infusion site--but had settled down nicely by breakfast.  Eating the same meal as yesterday, I rose up but came down a bit low, 58 right before I planned to warm up for the race in Fond du Lac.  (My theory is that since we had such a relaxed conversation on our long drive before the race, I was less nervous than usual. Maybe??)  I ate a granola bar plus a handful of Dex 4 glucose tabs, and turned my pump down so it was only +15% over normal.  My BG was 166 the last time I checked, and was just barely starting to fall again; unfortunately, my CGM stopped working on the line of the race, and since I was feeling sort of lowish, I decided to eat a gel just in case.  The race started and I went to the front and stayed with the pack.  I have been working on staying in the pack, towards the front, without doing a crazy amount of work.  (My average watts in these races have been high which is mostly reflective of me staying in the wind too much.)  I felt like there were some improvements and that my comfort level was much greater.   I could feel that racing feeling coming back at last.  I enjoyed racing with Erin Ball, my teammate on Team Type 1, and was happy to see her right in the mix; plus she went for a prime and nearly got it. Very cool! It has also been great racing with my friend Katie Styer from the Early Bird Women's team, which I was part of for 2 years--she is a very positive person to have around and she helped rein me in from the wind a few times.  After the race, my BG was up to 300 but came down to 224 after 15 minutes of easy riding.  Overall, I felt better even though my BG ended up a bit high.  We have two more races to go--tomorrow in Milwaukee and Sunday in Madison, where I am looking forward to meeting up with some great friends and supporters of Team Type 1. Yay!

Thursday, June 23, 2011

Sheboygan BGs--Update on My Insulin Tweaks

Dexcom readings around Sheboygan crit

(Update on BGs after major insulin adjustments described in my last post.)  

After a bit of a low BG before going to bed last night, I shut off my pump for an hour, which allowed my BGs to creep up to around 200.  The increased basal rates were a bit too much from about midnight until I woke up, as evidenced by a steady but slow drop between those times; but fortunately I landed in a nice spot this morning, right around 100.  I lowered the early morning basal by 0.1 U/hr so hopefully tonight will be better.

For the rest of the day, things have worked out pretty well.  The first bump on the Dexcom shown here is my breakfast spike, which came down after about a 20 minute warmup.  I saw "86" with a slight downward trend about an hour before the race start, and still had my basals cranked up, so ate a granola bar.  I warmed up a little longer and then headed for the car once it started raining about 40 minutes before the start.  My last BG check before the race showed about 135 and the Dexcom showed a flat trend at 120.  Finally things seemed to be where I wanted them!  I was a little anxious, actually, about having a normal BG, and popped a couple Dex 4 glucose tabs just in case.

The rain began in a complete downpour and I was soaked just waiting on the line. The field quickly became strung out and I was somewhere in the middle (I think), tucking in behind people when I could.  One of the biggest puddles on the course was right in the corner, but I actually enjoyed plowing through the water--at least it wasn't cold!  After the race, I was elated to learn that my teammate, Becca Schepps, had won the race!  I knew she was strong enough and had the tactical skills to do it, so was glad that it worked out! Very exciting.

Once I had changed out of my sopping clothes, I checked my BG and came in at 115, although I felt more like 60.  If the race had been much longer, I think I would have gone low (perhaps)? I think that I might either bring my race basal down a little, or eat a little more before if I find myself in the same position tomorrow.  I'd rather be up a little at the finish just to be on the safe side. I bolused a huge amount (compared to normal) for lunch and then corrected for the high (seen as the excursion above the line) and have been satisfied with how things are continuing to work out.

Although this game never ends, I am glad to have tamped down some of the constant highs and BG spikes.  Tomorrow we race in Fond du Lac, and I am hoping for similarly good BGs but a race without rain!

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

Tuesday, June 21, 2011

Mid-tour in America's Dairyland with the Team Type 1 Women

I am starting to lose track of time after multiple days of racing here in Wisconsin. Today is Tuesday I think?  So far our team has raced in Shorewood, Thiensville, Grafton, Waukesha, and Milwaukee; we have upcoming races in Sheboygan (Thurs), Fond du Lac (Fri), Milwaukee (Sat) and finally Madison (Sun).  We also had the pleasure of riding in the American Diabetes Association Tour de Cure in Grafton before our race there, and spent another day sharing our experiences with exercise and diabetes with local health care providers.  We have been taking turns writing up reports, which are posted at the Team Type 1 website here.  If you are in the area, we would love to have you come out for a race!  Please come find us and say hello.  We have women racing in both women's races, typically starting at 11:20 AM (Women's Category 3/4) and 3 PM (Women's Pro 1/2/3).  The daily schedule is located at the Tour of America's Dairyland website here.

So far, I have learned an incredible amount both during the races but also in our frequent discussions together off the bike, and have had a lot of fun getting to know my teammates.  What an incredible and fun group of women!  We are very fortunate to have Kori Seehafer--with her enthusiasm and expertise--directing us each day; managing the logistics of 7 people racing day after day, as well as directing tactics and strategies, AND racing each day is a big undertaking!

It's surprising how much energy even a 30-40 minute race takes after several days, so I will write up more when I have had a chance to rest up a bit.  But I will say that I am looking forward to the rest of the series and to racing with my teammates at future events.

Also, I wanted to say thank you to Sanofi-aventis for sponsoring our team, which makes this all possible.  I am truly grateful to be able to help spread the message of the importance of exercise in the management of diabetes, and that we can reach for our goals regardless of having type 1 diabetes.  Sanofi-aventis is not only helping to bring athletes with type 1 diabetes to the top levels of the sport but is also helping us share this message with the diabetes community and beyond!