Evening Training Highs & Hypos

I have always had a lot of trouble maintaining my BGLs when I am training in the afternoon. No matter how much I lower my basal insulin or how many carbs I consume, I always seem to end up having a sharp BGL drop during the session and if not that, then I end up with stomach issues from eating too much before/during the session. The combination of consuming carbs before/during a 1-1.5hr session and also reducing basal insulin, ultimately leads to a spike in BGLs after the session. Adding all of this up it’s 4hrs of worrying about BGLs every afternoon as I prepare, train and then recover.

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Getting levels stable can be very challenging, trying to balance; insulin, carbs and session duration is all important. Sometimes I do manage to get it close enough right though!

Especially with triathlon training where you need to squeeze in swim, ride and run sessions along with strength and recovery, you need to utilise all available sessions which including afternoons/evenings. With my challenges training in the afternoon I try to plan my sessions to get the most important ones in the morning (run and bike) and do other sessions in the evening (strength, swim plus lighter runs/rides). It takes some effort to get my planning right needing to consider; diabetes (am/pm), session requirements (hard/easy/length), pool availability, recovery time between sessions, weather and other personal commitments. Even so, but with a little stress, I manage to get 15 hours of training in most weeks.

So even though it’s a real challenge, I prepare myself most afternoons to head out and complete a training session know full well that there’s a high chance I’ll have a hypo. Recently I have had some success, my BGLs have been fairly stable and I’ve been able to complete some really good afternoon running sessions. The things which I am doing at the moment to give myself the best chance to complete these sessions include:

  • Reduce basal insulin 2 hours before training session and maintain reduced basal for first half of session. I need to reduce my basal rate by 70% for swimming and running session, and 50% for bike sessions in the afternoon. I do not require a reduction for strength sessions.
  • I do not start my session until after 2 hours post reducing my basal insulin rate to ensure that insulin levels in my system are reduced.
  • I try to start my sessions with BGLs around 10.0 mmol/l knowing that they will drop within the first 15 minutes
  • Consume between 20 and 40 grams of carbs about 30 minutes before the start of the session. This will usually be a supplement like Endura Optimizer or Hammer Recoverite mixed with water. I find that I respond well to these carb sources and they do no upset my stomach.
  • During a 1 hour session I will consume 25 grams of carbs at around the 30 minutes and this is usually a sports gel. It is important that whatever I consume does not upset my stomach and I also need to be able to carry it when running. When swimming or riding liquid carb sources are also an option.
  • I check my levels every 15 minutes during the session to make sure my levels are tracking OK and I can adjust things if needed. This does seem like a lot of testing but my levels are drop very quickly and when  you are covering a kilometre in around 4 minutes it can be a long walk home if you’ve missed a hypo!
  • I plan my sessions so that if something does go wrong, most likely a hypo and needing to walk back to the start, I am not too far away. A 20 minute loop is a good option and also provide for keeping provisions in your car for easy access.

I really work hard to get the most out of all of my training sessions and I do get upset when things don’t go to plan. I try to not let these incidents get to me but when you are trying your best and things still go wrong it is challenging to remain positive. Nevertheless, after many many incidents I continue to train and continue to work to get my diabetes management as close to perfect as possible. I know from experience that this will never be possible but the most important thing is to continue to strive to be better and in the end be healthy. Two afternoon run sessions week, one successful and one included a 20 minute walk back to the car in the rain, luckily I’m running first thing in the morning tomorrow!

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Learning to Run

After my last Ironman race in June I took a couple of weeks completely away from any training and enjoyed what many would call a “normal” life. I am always active so there was plenty of time spent outdoors with my girlfriend and also plenty of social rides with a focus on coffee and donuts! Being active is such an important part of my life so I’ll always be doing something, but more importantly it forms a really important part of my diabetes management. During this time where I was less active it did have an impact on my diabetes and I did have to increase my insulin doses to account for this and monitor things a lot more closely to ensure my levels stayed stable.

MelbMara

There are only so many coffee shops you can ride to until you realise that you need a new goal and new challenge. For me, the triathlon season was a long way off and I needed a local event to train for between now and then (later in the year). The Melbourne Marathon is in October so the timing was good and I knew when I started thinking about racing the marathon and it made me a little nervous that it was a great challenge and goal. With running being the weakest of my triathlon disciplines, and understanding the physical toll which long run training takes on my body, this was going to be serious!

So back to some more structure training sessions and back to the same old diabetes issues; getting BGLs right for training, being able to get enough fuel and recovery food in and managing stress levels trying to get all of this right. A real positive from my break was that I have learnt to stress a little less about my BGLs when I am exercising and allow things to stabilise more steadily while continuing with my activity. Although erratic levels do hamper performance, you can work through them calmly and sensibly.

So to some of those challenges which I am looking forward to overcoming:

Physical challenges of running

  • Running is hard; no question about this
  • Extra stresses on the lower body from the high impact resulting is many combinations of muscle, tendon and joint soreness
  • Managing inflammation which can be one of the complications of diabetes; I usually require double the recovery time from any soft tissue injury than a non-T1D
  • There are no free kilometres like when cycling, you have “run” every kilometre and there a plenty of those

Diabetes challenges of running

  • For me, running has the biggest pull-down effect on my BGLs and this can occur very quickly
  • The need to keep BGL stable for 1.5 to 3hr sessions
  • Eating while running which is especially important for runs over 1hr and during afternoon/evening sessions
  • Carrying everything that I “may” need; BGL tester (Freestyle Libre at the moment), insulin pump, food (usually 2 x gels – approx.. 50gr carbs), phone and credit card/money (for emergencies)

I have had many annoying experiences when running due to my diabetes all of which have involved a hypo and then trying to get home; walking in the rain, taxi/uber, public transport without a ticket and even getting a dink from a cyclist. All of these are even more enjoyable at 5:30am in the morning or when I’ve heading into some remote location! Never-the-less I continue to head-off and challenge myself, and then have plenty of time to reassess when I am walking home (take 4-5 minutes to run a kilometre and 10-12 minutes to walk).

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My expressionless running face: not thinking about the pain, just ticking off the kilometres

Through social media and the great promotion which T1Ds are doing I have been able to meet some great people and new running buddies. From a performance perspective training with people at a similar level is great and being able to train with people at a higher level provide some fantastic benefits and improvements. Not only that, but training with people who also have and understand T1D is a new and enlightening experience. I recently had my first stop mid-session to allow my training partner to check their BGL and then have something to eat because they were trending low. Something that I do all the time but have never seen it form the other person point of view.

As my running has progressed I am enjoying it and feeling good when running. As expected my legs are feeling the sting after my longer runs and I’m having to put a lot of work in to strengthen and maintain good feeling in my legs. This is definitely a work in progress and I’ve got to watch that I don’t push things to hard and cause an injury. I’m lucky to have some great people to help me and bounce ideas off including Shaun Forrest (Elite marathoner and T1D). Unfortunately, there are some realities of running; it’s hard and there’s not cheating the kilometres! Fun times to come.