Training Variations & T1D Management

For the last couple of years my training has been very focused on Ironman and 70.3 triathlons with a couple of cycling and marathon events thrown in for something different. In training for these events I have learnt how to manage my diabetes and keep my BGLs very stable. Basal rates, when and what to eat and how my BGLs fluctuate depending on the intensity and duration of the session have all been figured out. My training sessions have generally been specific to a program including swimming, cycling, running, strength and recovery. In most cases the longest of these session was a 3hr cycling session but each different session, duration/intensity requires a specific plan for my diabetes. Although everyone manages their type 1 diabetes differently, I think that it is beneficial to look at the variations we all experience.

Below I have noted the way in which I have to manage me diabetes, nutrition and hydration for various cycling sessions. I have reviewed this recently as my training focus has changed to building endurance for my JDRF One Ride cycling fundraising and 1,000km ride from Melbourne to Adelaide coming up in May 2017.

Recovery (Zone 1)

  • Low heart rate, low power and high cadence
  • Aerobic nature of this exercise has a strong pull down on my BGLs
  • Require a lower basal rate to avoid a hypo (-20% for a morning session and -60% for an afternoon session
  • I use a drink with carbohydrates in it to assist maintaining BGLs and also good hydration, approx 30gr of carb for a 1 hour session

Aerobic (Zone 2-3)

  • Medium heart rate and power (as determined by FTP) and smooth pedal stroke/cadence with medium-long intervals
  • Aerobic nature of this exercise does pull down my BGLs but this does not occur until about 1.5hrs into the session
  • For morning session my basal rate remains the same as normal, but for afternoon sessions I need to reduce this rate by -60%
  • During these session I need to eat at the 1-1.5hr point of the session and then every 30 minutes after that. Depending on the session I need about 25gr of carb each time I eat and I eat a low-GI food for its slow release
  • I use a zero carb hydration formula for these session and try to consume 500ml per hour. I use a zero carb formula so that I can also drink without working about any carb intake.

Anaerobic (Zone 4-5)

  • High heart rate, high power and maintaining smooth pedal stroke with short-medium intervals
  • During these more “effort”session I need to increase my basal rate as the effort forces my body to release glycogen as I am pushing my threshold. I only do these sessions in the morning as I have been unable to maintain stable BGLs in the afternoon with this type of exercise
  • These sessions are usually around 1hr and with the rise in my BGLs I do not consume any carbs during the session. A post session meal is very important for recovery from these efforts.
  • I again use a zero sugar hydration formula and consume closer to 1L of fluid for the hour session

Like with anything to do with type 1 diabetes there are variations within variations which need to be managed as they occur. Always carrying high and low GI carbohydrates is critically important along with being willing to change your session if things don’t go to plan. If thing do run smoothly then my insulin and carb requirements run as per the chart below with insulin requirements dropping linearly and carb requirements increasing more exponentially as the length of the session increases. Being fat adapted I generally require lower carb intake early on in the session and then increase this intake as the time goes on. My basal rate drops to around 50% of normal around the 4hr mark but to maintain stable BGLs I do need to consume about 75gr carbs per hour, at this point through my body needs this to continue training.

graph

Chart shown the decrease in insulin requirements and increase in carbohydrates required over training session duration (note: active basal is 1.5-2hrs post the basal rate setting/time)

So the important things that I now work on (for my diabetes) to get through my cycling training sessions are:

Short Rides (1-3hrs)

  • Set adjusted basal rates 2hrs before starting including switching back to normal rate somewhere in the last 30 minutes of the ride
  • Carry  1 x gel (high GI) and 1-3 x bars (75-100gr of low GI carbs)
  • Adequate hydration and mixed formula (carry sachets to refill bottles)
  • Know the turn-around points where I can assess how I am feeling and turn-around if things aren’t tracking well

Long Rides (3-6hrs)

  • Set adjusted basal rates 2hrs before starting and maintaining a lower basal rate for a couple of hours after the ride to avoid a delayed hypo
  • Carry  2 x gels (high GI) and 3-4 x bars (low GI carbs)
  • Adequate hydration and mixed formula (carry sachets to refill bottles)
  • Have a route planned out and stick to it
  • Know stopping points where food and water will be available including at around 3 hours when some more solid food will be good to consume (bakery is a favourite for this stop)
  • Have a plan in place is things do not go to plan, this can include turn-around points, someone to come pick me up or public transport to get back home
  • These rides are safer to do with other people

Day Rides (6hrs+)

  • Set adjusted basal rates 2hrs before starting; it is very important to understand how long I will be riding for and lowering my basal rate accordingly
  • Carry  4 x gels (high GI) and 4-6 x bars (low GI carbs)
  • Adequate hydration and mixed formula (carry sachets to refill bottles)
  • Depending on the ride I sometimes use a small backpack to carry all of the supplies which may be required for a long day in the saddle
  • Have the route planned out which you’ve checked thoroughly and let someone know where you are going
  • Maintain communication with someone during the day so that they know you are alright
  • Know stopping points where food and water will be available which should include places to get more substantial food (service stations don’t count)
  • Have a plan in place is things do not go to plan, this can include turn-around points, someone to come pick me up or public transport to get back home
  • These rides should be done with other people
jdrf-ride-3

Long days in the saddle are much easier and safer with a group

There are a lot of things noted above and they certainly don’t cover all of the ways that diabetes and BGLs can vary. Overall I find that longer rides are easier for my diabetes management as any fluctuations in my BGLs can be adjusted  more smoothly over the longer time. I also take the opportunity to consume a few extra calories (and treats) which on a normal day I wouldn’t be able to for fear of wild BGL swings. Most importantly, preparation/planning is key, regularly checking your BGLs is critical and then making adjustments (insulin, crabs, route, etc.) well before you get into trouble will ensure the safest and most enjoyable time on the road!

I am cycling to raise money for JDRF and type 1 diabetes research. I am riding 1,000’s of kilometres every month and will be riding from Melbourne to Adelaide in May 2017 to raise awareness of type 1 diabetes and show people that although living with type 1 diabetes is challenging, anything is achievable! Please donate to make a difference Donate Here!

All information provided in this piece is from the authors own experience and does not represent medical advice. See Disclaimer

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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.