Maintaining blood sugars on a long haul – be it running, riding or whatever your favorite sport is, can be a challenge when living with Type 1 diabetes. In fact, one of the questions I’m most frequently asked is:
“How do you control your blood sugars when you exercise?”.
Shy of hauling a trailer full of food and diabetes supplies, one is faced with the complexities of choosing what makes the cut when packing for a long adventure. Granted, supplies will change depending upon the sport at hand but the basics remain the same. Intensity of the exercise and hours anticipated off-the-grid will dictate what gets shoved (literally) into pockets and bags.
Go For It!
I’ve been reading a lot of articles lately about nutrition before, during and after long bouts of exercise. Advice runs the gamut of course and there’s nothing cut and dry about how to eat or adjust insulin during heavy or sustained exercise. There isn’t a “cookie-cutter” easy-button solution that fits everyone unfortunately.
You need to be prepared, go after it and adjust as needed. This obviously means that you need to have a knowledge base of how to adjust basal rates (long-acting insulin) and also bolus doses (short-acting insulin) with a confident level of comfort and safety.
Slowly building up to longer bouts of exercise is an important step in training for everyone – even those living without diabetes. Run or ride where you have cell phone coverage and bring a friend for support. Don’t bite off more than you can chew, take notes and start making a plan that’s tailored for you.
Data from my my favorite tool after a 5 hour bike ride: Dexcom’s Continuous Glucose Monitor
Type 1 Diabetes Packing List
Trust me, I know it’s a task trying to wear everything you’re going to need on a long run or ride but it’s about prioritizing. Bringing extra is important; I feel like a packing failure if I don’t come home with extra food. It’s like a diabetic’s ‘spare tire’ – we always have extra carbs on hand.
Keep in mind, biking also requires its own set of stuff – pump, tube, tool, patch kit, etc. it’s a tight squeeze!
- Glucometer
- Continuous Glucose Monitor
- Glucagon
- Your phone
- Water
- Cash
- Diabetes identification – so you don’t get mistaken for a drunken cyclist.
- Good gear to carry stuff in – go shopping, outfit your bike or your back well.
- An extra insulin pump site if you’re prone to pulling them out
- Fast acting carbs: Clif Shot Bloks (my favorite), gummies, glucose tabs, raisins, dates, etc. (Juice boxes never make it into my bike jersey because they take up more space than their carb load is worthy of.)
- Power bars: My generic term for nutritional bars. Tons of options here, but I try to eat the ones that have 6 or less whole food ingredients. If the first ingredient is prunes, skip it – your gut will thank you later.
- Something salty: You’ll get sick of sweet, sweet, sweet on the saddle or in your shoes, it gets yucky over time. That’s why I drink water and no sports drinks. A nice packet of salt poured into your mouth half-way through a lengthy endeavor tastes amazing. Pack what you like: salty new baby new red potatoes, pretzels, jerky, almonds, or a salt packet.
- On race day I suggest sticking with your normal foods and supplementing with snacks they provide. Simply switching bars can mess things up with your blood sugars or your stomach for instance. It is nice to know you can chug some Gatorade or something if you need it though.
Free Carbs
Forget about “free love” – when it comes to living with diabetes, “free carbs” is where it’s it. What exactly is a free carb?
Eat carbs – don’t give insulin for them – repeat as necessary.
* You can do this prior to exercising knowing you will drop when you start.
* Try free carbs throughout your exercise stint, as long as your blood sugars are cooperating with the plan – be sure to check with your health care provider first!
What’s With All The Carb Pushing?
There’s an excellent article on Carbohydrates from Iowa State University which I recommend reading in full.
Here’s an except on the importance of carbs: “Carbohydrate spares the use of protein as an energy source. When carbohydrate consumption is inadequate, protein is broken down to make glucose to maintain a constant blood glucose level. However, when proteins are broken down they lose their primary role as building blocks for muscles. In addition, protein breakdown may result in an increased stress on the kidneys, where protein byproducts are excreted into the urine.”
Estimate your carbohydrate needs with this carbohydrate calculator.
How often do you eat?
This is a great question. I read an article in a Runner’s World magazine in which a person with T1D wrote asking for help with balancing Type 1 diabetes and running. This poor guy was eating a GU packet every 15 minutes; which is an awesome way to make yourself throw up.
GU packets are difficult to choke down once an hour, especially when running a marathon. If you do the math he’s eating 100 extra carbs/ hour to maintain his blood sugar. He’s in great need of insulin adjustments so he can run without eating the entire time – but, no one told him so. Kudos to him for running a half-marathon this way, he’s dedicated.
My Routine
My schtick is a personal compilation from trial and error over the years. Running and riding are very different beasts for me. I’m currently training for a 107 mile JDRF century “Ride for a Cure”: The Tour de Tucson in November 2014 – please consider making a donation on my behalf.
Given that most long distance athletes require 30-60 carbohydrates per hour to maintain blood sugars, you can do the math and figure out just how much food you will probably need to carry for yourself. Nothing beats experience though – it takes time to dial it all in.
- I eat the same breakfast and take my normal bolus for it.
- I eat a second breakfast prior to riding and don’t take insulin for it. Protein, carbohydrates and fat are key.
- I always exercise in the morning.
- I keep my continuous glucose monitor (CGM) close by and look as needed, I also check blood sugars and calibrate my CGM as needed.
- I can personally lower my basal rate on my pump to 60% of my normal doses and eat without giving myself insulin for carbohydrates during my long rides.
- Many people experience post ride high blood sugars which is temporary and often due to adrenaline, dehydration, lowering the basal rate too much or food eaten in the last hour of riding.
- I’m careful to give gentle bolus doses for meals the rest of the day if my mileage totals over 40.
- This is obviously MY Routine – you will need to find what works best for YOU under the guidance of a trained medical professional. I’m a health coach and would be happy to help you achieve your goals safely; please visit my coaching page.
Insulin Dosing
That being said, many people that are exercising for long periods at a time – ie: marathons, century bike rides, half or full iron-mans, etc. are very adept at adjusting their insulin doses by default from experience. Nine times out of ten, athletes know way more than their health care provider does about this process, which gives them the upper hand in slapping diabetes into submission. Many providers ask us for tips or refer other patients to us when they’re having issues managing blood sugars during physical activities.
Check in with InsulinDependence.org for their expert advice on exercising with Type 1 diabetes.
Don’t be surprised if your physician can’t tell you much about what to do or how to do it – it doesn’t mean you shouldn’t be doing it. Long or short, exercise is an integral piece of diabetes management. Seek guidance from knowledgeable people – start with your beloved providers, certified diabetes educators, dieticians, athletes, trainers and anyone else in the know.