Diabetes & Sports Nutrition

As an athlete and a type 1 diabetic nutrition forms a very important part of my life. In terms of sports nutrition I have to think as an athlete first and then as a diabetic to ensure I am fuelling my body adequately. This is easier said than done and trying to get in all the nutrition that an endurance athlete needs whilst also trying to get insulin doses right and manage blood glucose levels (BGLs) is very challenging. Maintaining stable BGLs is critical for me to be able to train/race effectively and also get all of the nutrition in which my body requires for recovery, fuel and everyday life.

The amount of carbohydrates (CHO), protein and fats required by athletes is pretty well understood along with the timing of nutrient intake around training, recovery and racing. Although there are many diet variations and everybody (especially diabetics) has a different approach, I require an amount of CHO in my diet. As CHO consumption directly relates to insulin requirements I do manage the amount of CHO I consume so that I do not need too higher dose of insulin which would increase my risk of hypoglycaemia. This is by no means a LCHF diet that I follow but I would be consuming on average only 300 grams of CHO daily as oppose to the 500 grams plus which may be recommended by sports dieticians for someone training as much as I do.

I find that the biggest challenge nutritionally as a T1D is that you cannot just eat whenever you want and everything needs to be specifically planned for including timing of meals and snacks, timing of training, BGLs and insulin doses (insulin on board). This planning can be 2hrs before a session or 12hrs before a race and the impact of poor BGL control can last for 24hrs as the body recovers from high BGLs or missed fuelling. It goes without saying that keeping BGLs stable and within a good range it critically import to achieving your best athletic performance. My focus and often stress is on this point in particular but I have figure out how I can best manage all of these aspects and get it right, most of the time.

Some things that I try to maintain from a nutritional point of view include:

  • Consume majority of CHO before, during and after (around) training sessions as this is when less insulin is required to process CHO due to the physical activity and I am still able to fuel my body
  • Eat my main meals within 1 hour of training sessions to avoid having to have a post session snack (with insulin) and then another meal (with more insulin) within a short time. This meal timing also always me to get sufficient recovery nutrition in and reduce the hypo risk.
  • Consume low CHO snacks between meals which do not require additional insulin doses (this is along the lines a low carb high fat diet with a focus on protein and good fats)
  • Maintain a low GI diet which I find assists with keeping BGLs stable. This generally involves including low GI CHO in my meals and also adding protein to assist with BGL stability
  • Understand everything that I eat and matching my insulin doses accordingly – how much CHO, how much protein and what type of fat
  • I generally do not have more than 50 grams of CHO in a single meal as any greater than this increases my insulin dose to a level that I find creates BGL instability
  • I always have two hydration sources with me when I train – one is a 6% CHO mix and the other is a no sugar mix so that I can choose which one I consume based on my BGLs and also maintain adequate hydration
  • During race’s I generally consume about 30-50 grams of CHO per hour and include some protein to assist with slowing the processing/glucose release. This can both be from solid food s and liquids. As the duration of an event extends I am able to consume more CHO per hour.

These points are easy to put down on paper but definitely not easy to get right every day. I’ll be the first to acknowledge that type 1 diabetes is difficult but if you put in the effort you can achieve great results.

**All information in this post is from the authors own experience and does not represent professional medical advice. Please refer to disclaimer.

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T&D 7 Feb

Race week turned out to be a real challenge and ended with a DNF in my first race of 2016. With my diabetes not as controlled as I would like in the past two weeks and physically not being 100% I struggled with my preparation. I was also mentally struggling coming into an event not been 100% ready. It was a challenging week but having gotten through it I have learnt a lot and I think that I will be much better from the experience.

Geelong 70-3 2016 (4) Geelong 70-3 2016 (2)

Although my race didn’t go to plan on reflection I was happy to get through to the 10km mark of the run leg and I was able to test myself during all legs and take away some positives which I can build on for this next training block. I’ll be posting a full race report in the coming days but here a a few of the major things I’ve learnt from the week.

  • Don’t change what works: With the issues that I have been having with my diabetes I have been changing things regularly to find some better stability. In doing this I ended up not really understanding where things were at and went into the race with a diabetes strategy that wasn’t 100%. In the end it was a technical issue with my CGM that led to my DNF but a sounder diabetes strategy would have been far less stressful.
  • Check BGLs at the first sign of something going wrong: Especially when racing I find it difficult to take a moment to assess how I am feeling and I usually just push on (struggle on). I was feeling average at around the 60km mark of the bike leg and I should have checked my BGLs then rather than waiting another 1.5hours when I was near collapse. I would have been able to stabilise my BGLs then and finish the race if I had only taken a minute to check earlier.
  • Trial everything, constantly: With the regular changes to my pump settings I haven’t had a chance to properly trial a race plan. This is critically important so that a plan can be setup and then you can trust it during the race. The added mental stress and guessing what was going to happen during the race was the result this poor preparation.
  • Look at the positives: As I walked back along the run course to withdraw from the race I was initially very disappointed, but as I walked the 1km back to the transition area I realised that there were some great positive to come out of the race. All considered I was actually in a pretty good place to continue to build from this performance. It’s a simple saying to look on the bright side but keeping that positive attitude really does bring the best results.
  • There is no substitute for hard work: Coming back from my broken collar bone things just haven’t been right and my training has been up and down. I know that I haven’t done the work on the track nor spent the time getting my diabetes plan right for this race. No excuses, put in the work, get the preparation right, and the results will come. Simple.

It is onwards and upward from here. I am taking the positives out of my performance yesterday and I know that I can identify and work on certain areas to make a big improvement in my performance. I want to be better and I am motivated to put in the hard work to achieve my goals. Some recovery and planning coming up this week.

  • Review where I am at and design my next training block with my coach; Ironman 70.3 Port Macquarie is my next goal race at the beginning of May
  • Review race weekend diabetes performance and look at how I can manage my BGLs better
  • Set some short-term goals for my next training block focussing on where I want to improve in my race performance
  • Complete a full recovery and sort out all body issues so that these do not hold me back during this next training block

T&D 31 Jan

It has been a good week of training! Energy levels are back up and I think that I have figured out my lack of power on the bike. One week until Geelong Ironman 70.3 and I am super excited to get back to racing 14 weeks after my last race and my broken collar bone.

Having really worked hard on my nutrition and recovery my energy levels have come back this week which was an enjoyable change from the fatigued state I’d been in for the last two weeks. On the bike I focused on a smooth pedal stroke rather than trying to push out power and amazingly I felt stronger on the bike and my power was actually up! Win win there.

My diabetes was pretty good this week with only one major uncontrollable high BGL incident and no significant hypo’s to mention (a small hypo prematurely ended my Saturday run resulting in a slow 3km walk home). The balance of training harder and also eating more balanced out my BGLs nicely. I was able to complete all of my planned sessions and  my afternoon session were especially satisfying as I’ve had difficulty keeping my BGLs up recently and have had many mid-session hypo’s. I have also picked up that I need to adjust my bolus doses when I adjust my basal rates to keep things level.

T&D Jan 30

This week was all about just doing what needed to be done and not being scared of my “perceived” consequences which aren’t always reality:

  • Pre-training bolus insulin dose; I have long been hesitant to bolus dose before a training session but I  need to eat before a session. In the past an increased basal insulin rate and the exercise would keep my BGLs stable, but not the case any more. I am working on a one-third bolus dose for the carbs consumed 30 minutes before a session and it is working well. During longer sessions (+1.5hrs) I also have to consume carbs during the session.
  • Post-training bolus insulin dose; I have a very strong BGL pull-down during my afternoon sessions and to counter this I need to reduce my normal basal rate by at least 50% for 1.5hrs before the session starts. I then have to consume carbs during the session to maintain stable BGLs. Unfortunately when I finish the session the low basal rate and carbs consumed pushes my BGLs up. To counter this I am now giving a small bolus dose immediately post the session to stop the BGL rise. A larger bolus dose is required if I am eating immediately following the session also.
  • Training hard means eating lots; Like a lot of endurance athletes the power-to-weight holy grail weighs on me heavily and I often do not eat enough for fear of putting on weight. The reality is though if you are training 15hrs per week you’re going to need to eat a lot to fuel up and recover. I really focussed on this over the last two weeks and the results have been excellent. This hasn’t meant that I am eating everything and anything in sight but I am just consuming more quality foods and feel better for it. An increase in carbs has also meant an increase in insulin at some meals and although I fear giving too greater dose, I have trusted my pump settings and my BGLs have been pretty stable.

Body feeling better, diabetes under control and I am on track to race next weekend. Some nerves to overcome during the week but I know that I only need to focus on getting through the race and using it as a test and platform for the rest of my season. I’d like to swim comfortably without any shoulder issues, feel strong and smooth on the bike and then push the run hard to really see where I am at. Forget times and places, this is a race against myself and an important learning experience after the disaster of 3 months ago.

Some further race prep planned for this week along with recovery and fuelling to be tip top for next Sunday. Game time!

2016 Here I Come!

2015 was a big year for me. Diabetes, sporting and personal events, milestones and achievements all contributed to a fantastic year. Plenty of challenges and a setback or two (crashed bike,broken collar bone, pump issues) all added to the mix.

A couple of things that I was particularly proud of were:

  • 20 years with type 1 diabetes and no complications to report to date
  • Maintained HbA1c under 6.5 and under 7.0 for the past three years
  • Achieved better control on insulin pump and using continuous glucose monitor (changed from injections in October 2014)
  • Completed my first Ironman in under 10hrs and without any diabetes issues
  • Started Type1Athletic and begun blogging about my diabetes experiences
  • Found a loving and supportive partner whom I could not have achieved all of this without
IM Melb Finish

Finishing 2015 Ironman Melbourne – 9hrs 32mins

So what’s to come in 2016? There are so many things that I would love to be doing and after the reality of day to day life I’ll be working hard to achieve as many of them as possible. In the end this is meant to be fun and I want to get the most enjoyment out of my passion for exercise, racing and talking to people about type 1 diabetes.

Some of my aims and goals for 2016 include:

  • Qualify and race at the Ironman 70.3 World Championships on the Sunshine Coast
  • Complete some races with my partner; triathlons, mountain bike or cycling events
  • Continue to build content on Type1Athletic including more diabetes specific posts, reviews and video content
  • Connect with more type 1 diabetics including athletes who are facing similar challenges; there are groups around the world doing similar things and there’s a massive opportunity to build our collective knowledge base here
  • Take more photo’s of where I am and what I am doing; this is more about slowing down and enjoying the moment which I’m not very good at
  • Get more involved with the local diabetes community and attend more sessions with support groups, product seminars and diabetes events
  • Build my diabetes and exercise knowledge, especially the connection between the two, to better understand why things happen and how glucose levels can be maintained at the most stable level
  • Design some Type1Athletic sporting kit which may include running and cycling gear

Although Type1Athletic is still in its infancy and I am learning a lot about blogging, social media and online content, I have really enjoy working on this. Documenting my experiences with diabetes and exercise has allowed me to reflect on what I have achieved and also provided the best education for me as I review what I have done and why certain things have happened. I have also found countless other resources to follow and these have provided the most positive impact for me just by knowing that I am not experiences this alone.

I am looking forward to another fantastic year and absolutely pumped to get started achieving my goals. I really want to connect with more type 1 diabetics and work with other diabetic athletes. I’ll be seeking you out but please get in touch, hashtag your posts as you achieve your goals. Bring on 2016.

Pump Down!

After completing a short pool swim a couple of days ago I was rinsing my insulin pump (chlorine not great for plastics) when I got a black screen (of death) followed by the pump vibrating non-stop. There was no response when I pushed buttons and it was immediately apparent the there was something seriously wrong with the pump. This was confirmed when I got back to my car and using a 10 cent piece undid the battery cover (to disable the pump and stop the vibrating) and brownish liquid came out of the battery slot (all over my tan work pants).

IMG_20151212_102442

Possible leak into battery leading to pump failure, rusty battery pictured

In a situation like this it is important not to use the pump. We become accustomed to these units and can forget that they are a medical device which need to be treated with the utmost caution and respect. The pump went straight in my bag and I was on the phone to the Animas distributor in Australia immediately.

The service from AMSL Diabetes was fantastic and although I felt completely in control and able to quickly change back on to insulin pens, their knowledge and support over the phone made me feel safe and confident. A replacement pump was sent out the next day and had it not been for the weekend (bad timing) I would have had the replacement pump within 24hrs. Including the weekend I had the new pump within 3 days.

The reason for the failure, unknown at this time but suspected to be a hairline crack in the pump casing which may have allowed water to seep into the pump. Having changed the battery cap about 4 months ago and the battery a couple of months ago it may have been seeping in for some time. You don’t want to think about the possibilities of the pump failing whilst connected to you but as I survived for several months without issue there must be some good fail safes within these devices.

So back on the pump and back to training. Also very happy to get my CGM back!

Afternoon session blues

Trying to get back from my broken collar bone at the moment and although the break and shoulder are healing ahead of schedule I am having great difficultly getting my blood sugar levels right for my afternoon/post work sessions. At the moment this is just cycling on the trainer or running but in both cases I can’t seem to keep my levels stable and over 30 minutes my levels are dropping 10-12 mmol/L to 4-5 mmol/L and then continuing to drop.

This is obviously super frustrating and yesterday I ended up having to walk nearly 4 kilometers back to my car when my levels dropped half way through my run! Not fun but on the plus side it a good time to think about things on the 30 minute walk back.

So what am I doing about this? Firstly I am trying not to stress about it and I am making sure that I am getting the most out of my morning sessions when my levels are stable. Secondly I am trying different insulin and CHO combinations including lower basal rate, increase CHO before session and increased CHO during session. The issue I am having with the first change is that my levels are then rising too much prior to the session, and with the second it is difficult to consume enough CHO prior to and during the session without feeling ill.

An individual issue which I have and which is especially prevalent in the afternoon is the very strong pull-down effect exercise has on by sugar levels. Even with a low basal does, no bolus insulin on board and having consume a prescribe amount of CHO my levels can drop between 5-10 mmol/L within 20 minutes. I do not seem to have this issue in the morning but it is a real challenge in the afternoon.

To help me get my training done at the moment I am now working on the following to manage my program.

  1. Putting all of my priority 1 sessions in the morning (and some priority 2 sessions) so I can get the maximum benefit from these
  2. Doing all of my run sessions in the morning; I have found trying to run in the after the most challenging with respect to my sugar levels
  3. Putting swim, strength and recovery sessions in the afternoon; I have previously been able to maintain more stable sugar levels when swimming in the afternoon which may be due to being able to sip on a high CHO drink (Gatorade) more easily during the session

As I am still in a recovery phase this is the perfect opportunity to get this right so that when I am fully recovered I can get the most out of my training immediately. With about 10 weeks until my next Ironman 70.3 event I have not time to waste.

**All details noted in this post are from the authors personal experience and should not be used as a treatment guide. See Disclaimer.

HbA1c Victory

Another visit to the Endocrinologist yesterday and another HbA1c result in the bank on my diabetes journey. A fantastic 6.4 result after 1 year on the pump!

Mention HbA1c to any type 1 diabetic and it’ll bring many responses and emotions. As an indication of the most recent 3 months blood glucose levels this single figure is meant to provide you and your doctor an indication of how your blood glucose levels have been controlled. This number is not a true indicator of your control as high and low levels can average out to give a good results but from poor control. In Australia the target range is 6.5-7 (source: DA).

I generally have a HbA1c blood test every 6 months when I see my Endo. I have never really thought a lot about the result or worried about it but it is always good to keep it within the prescribed range and also when I have achieve a lower results than previously. Early on in the T1D life this was especially important and satisfying as my early results were in the 8-10 range.

Over the past 3 years my HbA1c has been fairly stable: 6.4, 6.5, 7.2, 6.5, 6.7 and 6.3. For the past year I have been using an insulin pump after transitioning from injections. I made this transition to help me better manage my blood glucose levels around my training and achieve more stable levels overnight. This has been a highly successful change resulting in my HbA1c dropping from 7.2 to 6.4 over the past year. Not that my previous results were bad but they may have been influences my the averaging effect mentioned previously.

I have been told by my Endocrinologist that after 20 years with diabetes and consistent HbA1c results under 7.0 that my risk of complications from diabetes has been reduced significantly. That is not to say that I can now relax and let this result slide up as the risk of complications will always remain.

It is a good feeling to know that through my hard work and diligence I have achieved these good results and not only are my risks of complications reduced but my good control has meant that my diabetes has not negatively impact my life. Happy with that!

Blood Glucose Battles Continue

Having crashed badly during my last Ironman 70.3 event 4 weeks ago I have been focusing on my recovery which has been going really well but has meant very little physical activity. As all diabetics would know this means that I’ve needed to adjust my insulin regime, increasing my insulin doses and also reducing how much I am eating on account of being inactive. Now that I am 50% of the way to a full recovery I am starting to get back into training which means that I also need to adjust my insulin regime again to allow me to train (without hypo-ing).

I find this really challenging and super frustrating as I try to balance enough insulin to keep my blood sugar levels within a good range but also not too much insulin that I end up going low during my training sessions. Training in the morning and the afternoon means that I am trying to get this right twice a day. The training also impacts how my blood sugar levels track during the day and overnight which then means further changes to my basal insulin pattern.

BGBC Image

Summary of a day when my BSL’s just didn’t stick to the plan. I was new on the pump so there are a few basic errors i made and learnt from.

Over the last week I have been trying to increase my sessions on the bike (indoor trainer) and also include some jogging. My morning sessions have been relatively successful in terms of getting through the session but my levels have risen which has required a bolus dose post session and then careful consideration of my breakfast bolus doses shortly afterwards to avoid a hypo later in the morning.  My evening sessions have been a disaster! Trying to reduce my basal rate during the afternoon to allow me to train for 30 minutes to 1hr has led to late afternoon high levels which have required a bolus dose. This bolus dose has then lead to a hypo during my session. On other occasions I have had too much basal insulin in my system and I have also hypo’d during the training session.

Making these adjustments is a real balancing act and they do take time to get right. It is very frustrating when things don’t go to plan as I cannot train or a session ends without completing it, and then I have to manage the subsequent high or low blood sugars. This does get me a little depressed and wishing that it was easier but it does not stop me trying again the next day. Every diabetics management is different and trialing what works for you is the best way to figure out how you can get the most out of your activity.

I guess the purpose of this post is to acknowledge that managing diabetes and exercise/sport is difficult and sometimes it just does not work out as you planned. It doesn’t matter who you are or how long you have had diabetes for the challenges are the same for every one of us. Don’t let this stop you getting active because after these short moments of frustration the rewards when you get it right are massive for your diabetes, your body and your mental health.

Diabetes Tips #1

I have had type 1 diabetes for nearly 20 years and I’ve faced many challenges over this time and learnt plenty about how to manage my diabetes in my everyday life. My passion for health and fitness has most recently made me adapt my diabetes control so that I can consistently train and race just as a non-diabetic would. Although the requirements to train 15-20hrs per week and race for up to 10hrs are particularly rigorous, the basics are simple and applicable to all diabetics.

I apply many little “rules” to my everyday diabetes life to help me keep my blood sugar levels stable but some of these “rules” are a little OCD! For everyone else I’ve broadly summarised these in the points below which can be applied to your everyday diabetes management.

  1. Test your bloody frequently – it is critical to know where your blood sugar levels are to effectively keep them stable throughout the day and especially when eating, insulin dosing and exercising. The use of a continuous glucose monitor provides an excellent monitoring tool and I find this to improve blood glucose control significantly.
  2. Don’t overreact to high and low blood sugar levels – it is important not to give too much insulin when treating high blood sugar levels as this increases the risk of stacking insulin and hypo-ing. You must give an insulin dose sufficient time to work (can be 1-2 hrs). Equally it is important to treat low blood sugar levels correctly and not over eat/drink (the dreaded hypo munchies) which then cause’s higher blood sugar levels.
  3. Maintain a consistent routine – I find that keeping a consistent routine really helps my diabetes control; meal timing would be the most important but when you sleep and when you exercise also impacts your insulin regime and thus your blood sugar levels.
  4. Avoid refined sugars and simple carbohydrates – If you can, just don’t eat refined sugars as they are not only more difficult to match with an insulin dose but they are not good for your general health and well being. Sugars are contained in many foods and drinks so you need to be really vigilant to avoid these, but the results are significant for your blood glucose control.
  5. Include low GI carbohydrates in your diet – Low GI carbohydrates form a large part of my diet and due to their longer absorption time which greatly assist with maintaining stable blood sugars post meals.
  6. Use exercise as part of your diabetes management – exercise is an excellent way to keep healthy and regular exercise may allow you to reduce your total daily insulin requirements which then reduces the risks of hypoglycemia by having less insulin in your system.
  7. Always be prepared – it doesn’t matter what you are doing you’ve always got to be diabetes prepared; blood testing kit, insulin, snacks and mobile phone are things I carry with me everywhere. Carrying these things  can be annoying, especially when training, but it’s a small price to pay for being safe and able to look after yourself if something goes wrong which always happens at the worst time and place.

Although these are only simple tips they do have a big impact on my diabetes control and I hope they can provide similar positive responses for you.

These tips can also be found on the Tips Page for your future reference.

**The advice and information provided in this post is from the authors experience only and should not be used as medical treatment without consulting your doctor. Please refer to disclaimer.