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The Official Diabetic Triathlete Thread
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I thought this could be a place to post whats working and not working with other Tri Diabetics out there.

A brief self intro

Post your training and race results/reports here. The more detailed info you share the more it could help others.

Or try and get a question answered here.

PS This is for Type 1, Type 2 Diabetics or any other type, lets not discriminate ;)



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Type 1, diagnosed Aug 14th, 2013

Insulin pen 10 units Lantus daily, 1 unit Humalog per 20 g carb

No pump, no CGM

Completed 3 Ironman, most recently B2B on Oct 26th and hope to get a full detail race report up soon



"Keep those feet moving!" Me
Last edited by: runnerwv: Nov 3, 13 16:44
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Type 1, diagnosed 1991 - at a swim meet when I was 12.

Lantus 8 units daily, 1 unit humalog per 20g carbs or so also, but varies depending on training.

Most recent race result was 40th World Age Group Champs, London, in 35-39 age group.

Have completed 3 ironmans
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Re: The Official Diabetic Triathlete Thread [fulla] [ In reply to ]
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Do you use a pump? I'm guessing no..



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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runnerwv wrote:
I thought this could be a place to post whats working and not working with other Tri Diabetics out there.

A brief self intro

Post your training and race results/reports here. The more detailed info you share the more it could help others.

Or try and get a question answered here.

PS This is for Type 1, Type 2 Diabetics or any other type, lets not discriminate ;)



Type 2, diagnosed 1998
No meds....struggle taking on carbs during races
Mostly doing 70.3
Last 3 70.3 : Miami (4th) last weekend, 70.3 Tremblant (8th) June 2013, 70.3 Muskoka (1st) Sept 2012 50-54AG
Last edited by: marcag: Nov 3, 13 16:51
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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runnerwv wrote:
Do you use a pump? I'm guessing no..


No pump - I don't like the thought of having something attached to me on the outside of my body. Had a CGM once and didn't really like the experience! I just have to be REAL strict about what I eat in terms of matching quantity of Carbs to insulin.
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Type 1, diagnosed 1981 at 6yrs old, current A1c of 7.1., use a pump and a CGM during racing and race week.

-Couple short course races
-4 70.3's
-3 Ironmans:
-Signed up for IMCanada for 2014

IMLP 2011: 11:47 - Race report
IMLP 2012: 12:12 - Race report
IMLP 2013: 10:52 - Race report

-First race was a crap shoot. Basically worked out but I got pretty low at the end.
-Second race I struggled. Misjudged a high out of the swim and messed up my ride.
-Third IM I had a solid insulin plan and adjusted my start nutrition. I highly recommend my coach Cliff Scherb, a type 1 diabetic and successful(KQ) IM athlete.

The main lesson I learned after IMLP this year was that I need to use insulin via a syringe before the swim and in T1, and that breakfast should be fast acting carbs rather than something fatty like PB that will mess with insulin absorption.
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Type 1 diagnosed officially 11th Jan 2012, i was 31.
A1c tests of 5.7, 5.5, 5.5
Lantus: 8 units
Novorapid: 1 unit per 20gms

Was diagnosed during my second tri season when i got the usually symptoms- i used to cramp up even in super sprint club races and didnt know why. Then the blurred vision came, weight loss etc. Managed one or two races late in the second season.
This year is my 3rd year of racing, but really my second as the latter was interrupted a fair bit!

I tend to do a lot of club races, super sprints, sprints a few olys. Even a few team 70.3's. Have done busselton 70.3 in May just gone, im doing Mandurah 70.3 on Sunday.
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Re: The Official Diabetic Triathlete Thread [amclean] [ In reply to ]
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Can i ask why you use insulin during a race? Would you just have the basal on board, bolus for breakfast but add a little extra carbs for a small peak before your wave start? Having fresh insulin in your systel do you go through a lot of carbs to avoid the lows? Or does your body react in a way in which adrenaline kicks in and creates a hyper which your body doesnt want to bring down?
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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You can't use the carbs you're consuming unless you take insulin to turn it into a fuel source your body can use. Your caloric needs are not different as a diabetic athlete. Your body's response is though. I definitely do get an adrenal spike, but that will eventually fall.

I'm not consuming tons of calories to avoid lows, I'm consuming lots of calories because you need to in order to finish an IM bike and set yourself up for a good run. By the time I get to the run I slowly dial back my basal until it's basically zero at 13 miles into the run.
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Re: The Official Diabetic Triathlete Thread [amclean] [ In reply to ]
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Your muscles can use glucose independant of insulin. Im not saying to race with no insulin on board, but there are athletes who do ironmans, ultras etc without injecting/pumping any insulin. I did a half with just basal insulin on board. Im not having a go or anything, i find these things interesting is all.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Ah. Perhaps I misunderstood what you were asking.
When I'm riding I don't bolus for the fuel I am consuming. I depend on my basal insulin pattern which changes during the day.
Just like you adjust your basal pattern with your doctor for how your normal day works out.
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Re: The Official Diabetic Triathlete Thread [amclean] [ In reply to ]
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It is the stopping in T1 to inject insulin i dont understand? Or do you mean you just adjust the pump's basal pattern?
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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It sounds like you've only been type 1 for a year. What I'm saying is I consider my IM day as not much different than any other day as a diabetic. You go to your doctor and figure out a basal insulin pattern for your day.

Doc: "When do you plan to eat breakfast, lunch, dinner?"
Me: "X, Y, Z"

And he helps me figure out an appropriate series of patterns. After you've been diabetic long enough you basically figure out how to adjust that pattern yourself with the occasional sanity check with an Endo(cronologist).
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Re: The Official Diabetic Triathlete Thread [amclean] [ In reply to ]
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Yeh i have only had a dud pancreas for a few years now :(

I understand what your saying- i have a pattern too but let me explain:

I Usually bolus 1 unit in morning, 1 unit at lunch and 3 for dinner with 8 units of lantus running in the background. When i do a 70.3 i have my breakfast and bolus the unit to cover it. Prior to the gun going off I pop a gel to create a blood sugar spike. During the race i add a gel/glucose tablets/jelly beans etc to not only fuel me, but to avoid a hypo. Im usually done around lunchish. My question, if this was you, would you have any more bolus insulin during the race? OR is it because its a full ironman that you actually do in reality, you dont think you can race on a basal insulin?
Sorry im not trying to flog a dead horse, I just dont understand having injections during the race UNLESS your talking about manipulating your pumps basal.
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Re: The Official Diabetic Triathlete Thread [amclean] [ In reply to ]
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amclean wrote:
You can't use the carbs you're consuming unless you take insulin to turn it into a fuel source your body can use. Your caloric needs are not different as a diabetic athlete. Your body's response is though. I definitely do get an adrenal spike, but that will eventually fall.

I'm not consuming tons of calories to avoid lows, I'm consuming lots of calories because you need to in order to finish an IM bike and set yourself up for a good run. By the time I get to the run I slowly dial back my basal until it's basically zero at 13 miles into the run.

The carbs I use during training and racing are pretty much used up as fast as they are absorbed....because I'm exercising.

At one stage a while back I didn't have to use any long acting in the morning (when I was on twice daily shots of long acting) if I had a big day of training ahead.

Every diabetic is different and it is sometimes a matter of trial and error until you get the right formula. I know that my diabetes can sometimes react totally differently to exercise in the space of less than a week. Racing is also different to training.

The reason you need to consume lots of calories (or to put it better, carbs) as a diabetic to finish an IM bike split is to ensure your blood sugar levels are steady.
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Re: The Official Diabetic Triathlete Thread [fulla] [ In reply to ]
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Type 1 Diabetic, diagnosed September 2012, age 27.

20 units of Levemir daily, 1 unit of Apidra for every 15g of carbs, less during training.

I haven't done any long races since I was diagnosed, but I do have a couple of Dus and short road races since then. I have long term plans on an IM, but I have Noooooo idea how to handle nutrition for that. It is going to take a lot of work beyond the training to get there.

Does anyone race IMs without a pump these days? It seems like the pump is great for day to day, but huge for distance racing.
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Type 2 here, or as my endo likes to call me, a Type 1.5.

Diagnosed in Dec 2008 during a routine physical. I didn't think there was anything wrong with me (I didn't know the typical symptoms at the time, frequent urination and always thirsty), and was surprised when I was told I was diabetic. I wasn't overly out of shape, overweight or anything. My A1C was 11.1 and my BG was 370 or so from my first glucose test.
I'm currently at 5.9 and typically stay around there. My C-peptide test is getting worse though, as my pancreas is producing less and less insulin. So its only a matter of time before I'll have to inject.

I've done three 70.3s, a handful of Olys and a bunch of sprints. The past few years I really got into running ultras and marathons as well. This upcoming season I may do more cycling. I can never decide on any one thing.

Keep all the stories coming. I love hearing about diabetics doing their thing and not letting the disease stop them from reaching their goals.

ETA: I was diagnosed at age 31, and currently take oral meds.

@davempratt
Last edited by: djastroman: Nov 4, 13 18:28
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Re: The Official Diabetic Triathlete Thread [RFXCrunner] [ In reply to ]
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I do not use a pump, straight injections. I just did140.6 without it. Not saying I won't use one in the future. I would prefer a cgm over a pump I think



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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I was diagnosed with Type 1 in November of 2009 at the age of 34. I use a pump and my insulin is Apidra. I do not wear my pump while training/racing.

Since my diagnosis:

2010
Florida 70.3 My carb mix that worked well in the northeast did not work well in the heat and humidity (if only the race was a day earlier). Everything was great until the run (or in my case, walk). I did Musselman later that summer with more success after finally getting my nutrition dialed in (24 oz bottle with one scoop of carbo pro and one scoop of EFS every 30-45 min). I was scheduled to do Syracuse, but just didn't feel right later that summer.

2011
I was not able to race because of shingles and then a lower leg injury

2012
More lower leg issues (left calf strain/Achilles tendinitis) but I was able to do the Aquabike at Keuka Lake.

2013
I did the Keuka Aquabike, a bunch of time trials, and was FINALLY able to get back to triathlon at the Cortland Sprint Tri!
Last edited by: shade: Nov 5, 13 19:08
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Diagnosed December 1985 when I was 4 years old.

I owe my parents everything, they never made excuses for me and kept me in great health until I was old enough to take care of myself.

I race the 70.3 distance and working hard for a very strong 2014! I had a great 2013 and I am always working on dialing nutrition. I used to be scared to bolus during a race but it's helped me to go much faster!

I'm on a pump and maintain a low 5 a1c, can't wait to get a cgm!

During a 70.3 I reduce basil to 20% of my normal delivery and bolus 1 unit per 40 grams of carbs during the race. I have yet to have a bad low. I usually start the race at 150 and end near 100.

I use Carbo Pro and whatever GUs the race provides.

Awesome thread!
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Re: The Official Diabetic Triathlete Thread [shade] [ In reply to ]
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So if you don't wear a pump for race/train, do you bolus?
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Re: The Official Diabetic Triathlete Thread [noxious] [ In reply to ]
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see this is what im failing to understand, as before? Why would you bolus during a race? If muscle contraction in itself is enough to absorb blood glucose, why would you bolus? Arent you just increasing the risk of a hypo?
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Re: The Official Diabetic Triathlete Thread [RFXCrunner] [ In reply to ]
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RFXCruner, for me, it's no pump, no bolus. I also have to be careful when I give myself a bolus prior to exercise or I'll go hypo very quickly.
Last edited by: shade: Nov 6, 13 3:50
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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I dunno, I have had issues with high blood glucose after hard interval workouts that required a bolus when I tested afterwards. Granted, this could be becasue of what I ate beforehand, and it could also be that interval workouts don't usually last all that long, so there wasn't enough time to process the glucose.

I'm still waiting on the results of my C-peptide test, so I don't know if I still have any endogenous insulin or not. If not, I'm going to talk to my doctor about getting on a pump. My A1C is... well, not great. My BG seems to fly up really quickly, even if I am bolusing right, and I wake up most mornings at 160+
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Re: The Official Diabetic Triathlete Thread [RFXCrunner] [ In reply to ]
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T1D since 2000, diagnosed at age 17. Managed to go pretty fast at tris, 8h50 IM PB and qualified for Kona in 07, still stands as the fastest diabetic IM time.

Followed the conventional advice but never got my A1C at normal levels, would celebrate a 6.9% but the norm back in the heavy training days were 8%, until I found about Dr Bernstein book and that was a slap in my face. Dropped from 7% to 5.8% in 7 weeks, that was 1 year ago and been testing every 2 months since, lowest was 5.3% and highest 5.8%. My experience is explained in the article below. These days I find it just impossible to have normal levels on a high carb diet. The T1D here that can maintain mid 5's A1C on a medium to high carb diet are nothing short of amazing, I wish I could do that.

http://www.ironguides.net/...w-carb-high-fat-diet

I still have to take small amounts of insulin before high intensity training (ie, 1/2 oe 1u before to keep it 100-120mg presuming a 85mg/dl start) and large amounts before races and during races (2-3 pre race, plus 1-2 during, that for sprints, IM more during.). Mostly to cover adrenalin and in training liver release of glucose.

Vinnie

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [RFXCrunner] [ In reply to ]
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I think I'm producing less insulin too, honeymoon will be over at some point. I am seeing less lows and higher highs. Tested this morning before breakfast at 143 and yesterday at 132. Guessing I need more Lantus? I have an endo appointment this month so will see what she says. My first A1c was 8.0



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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coates_hbk wrote:
see this is what im failing to understand, as before? Why would you bolus during a race? If muscle contraction in itself is enough to absorb blood glucose, why would you bolus? Arent you just increasing the risk of a hypo?


There are two ways the Glut 4 receptors in your cells are activated to take the sugar off your blood, one is with insulin and the other is with physical activity. Insulin (for me) is more efficient than physical activity.

Because the physical activity during a race is not enough to absorb all the sugar I take in through the race I also need to bolus. I would normally take 1 unit of insulin per 15 grams of carbs on a regular work day, but during a race I take 1 unit per 40 grams of carbs due to the physical activity helping with the Glut 4 activation in my cells.

If I didn’t bolus during the race I would not get the full benefit of my nutrition and I would be finishing my races with high blood sugars.

Obviously this is an overly simplified explanation and it takes time and practice to find what works for you!

I wanted to add the following

I’m sure it is possible for some diabetics to not need a bolus and completely rely on the physical activity alone to keep the blood glucose in check, for me though that is not the case as I take in a lot of calories/carbs during a 70.3.
Last edited by: noxious: Nov 6, 13 7:29
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Type 1 - Diagnosed in 1993 at 24 years of age. 30 plus marathons, ultras & 13 IM's...racing triathlons since 1991.

Insulin: Lantus & Humalog
CGM: Dexcom G4 Platinum

2014 Races: Boston Marathon, Challenge AC, IM Chattanooga
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Re: The Official Diabetic Triathlete Thread [noxious] [ In reply to ]
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What is your BG range during races?



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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On average I start at 150-180 and finish right around 100, I have finished above 200 on rare occasions.
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Re: The Official Diabetic Triathlete Thread [noxious] [ In reply to ]
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Mine is similar, at least for now.

Around 120-140 in the morning, food and a gel push it up around 180 at the start. When I finished B2B full a couple weeks ago I was at 125 when I tested at the finish. I had no idea on my BG was going to respond during the run but it held steady just like training. Did go low afterwards either.



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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runnerwv wrote:
Mine is similar, at least for now.

Around 120-140 in the morning, food and a gel push it up around 180 at the start. When I finished B2B full a couple weeks ago I was at 125 when I tested at the finish. I had no idea on my BG was going to respond during the run but it held steady just like training. Did go low afterwards either.

Are you testing during races? For this 2013 season I would test before and after only, I am trying now to get insurance to pay for a dexcom but that is proving to be a pain!
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Type 1 Diabetic diagnosed at 14 in 1999. It was a very slow road to feeling comfortable with doing anything in the realm of tri's (and I wasn't a runner and even less of a swimmer), but I did my first sprint in 2006 and have been hooked ever since.

I slowly built my way in distance, doing sprints for a couple of years, olympics for a couple of years, 70.3's for a few years, and finally completed IMLP this past summer (that was more of a life-timing thing than knowing I could do it at this point though).

I've used Lantus and Humalog since they were developed (shout out to everyone who used to struggle through NPH and Regular, ha!) mainly because I've had A1C's in the low-6 to high-5 range and don't really want to have the pump on me 24/7 (though I have heard it's a wonderful thing). My doses during IM training this year were 20-21 units Lantus before bed and about 31-35 of Humalog each day. Now, in the off-season I'm up to 26 Lantus and about the same Humalog (but I eat less now).

For any race up to 70.3, I'll dial back my Lantus (down to around 14-15 for 70.3 and less for shorter) and do not require any bolus. For IMLP, I had my Humalog in my bike bag on the bike and attached my meter to my aero bars. I tested every hour, and had to take 3 units of Humalog at about mile 70 on the bike. My plan for the run was to have my wife have another meter and Humalog and we had set up places for her to be on the course that I would test and bolus if needed. Turned out that my parents and her parents were with her and were worried about missing the finish of the race, so I only saw them at miles 3 and 11. At 3, I had just tested in transition so didn't need to test. At 11 I was at 160, and figured I'd test again when I saw her at mile 15 and probably take a bolus at that point. Well, I never saw her at 15, or anywhere else along the course. I felt like my blood sugar was high but couldn't confirm, so I barely took in any carbs after special needs and tried to only drink water. My mouth would get dry about 30 seconds after I passed through an aid station and I felt quite dehydrated. After crossing the finish line I think I was down to 90, so I think I may have been high for a while, but did eventually bring it down towards the end of the run. Lesson learned: if I ever do IM again, I have to have a meter and insulin with ME for the flexibility to test when I need to test.
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Re: The Official Diabetic Triathlete Thread [noxious] [ In reply to ]
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Yes I test during but I have only raced once since I was diagnosed (aug 14th). I tested every bike aid station so 6-7 times . Tested several times before the swim and a handful on the run.

No pump for me...yet. I do like the idea of a CGM, thinking dexcom G4. I see no downside to a CGM



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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runnerwv wrote:
Yes I test during but I have only raced once since I was diagnosed (aug 14th). I tested every bike aid station so 6-7 times . Tested several times before the swim and a handful on the run.

No pump for me...yet. I do like the idea of a CGM, thinking dexcom G4. I see no downside to a CGM

Every diabetic on a pump that I talk to says it is the best decision they have ever made, and Im sure you have heard the same. Ill be honest with you though! I had great control with injections and sometimes I think about going back but I do get more flexibility with the pump. For example if I test 80 an hour before a long or hard run I can simply reduce my basil and let my sugars come up without eating, you can’t do this on a long lasting injection you took hours ago.

With that said I hate, hate, hate having the pump attached to me, I never really felt like a diabetic until I started wearing a pump. That might sound a little weird but as soon as I was done with an injection I had nothing that made me think about being a diabetic, with the pump I have to manage the tubing and where I store the device and sleeping with the thing is a total nightmare!

Ill be on the pump for the foreseeable future but I do have my gripes!
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Honeymoon may not be over yet, but you may be seeing "dawn phenomenon" with your morning BGs. It happens naturally for everybody, but we diabetics "see" it because it's when hormones tell the body/liver "Hey, you're going to wake up soon. You're going to need some energy. Put some sugar out." Your endo will probably tell you to take a bit more Lantus at night to cover for it.

While we're talking about diabetes, I highly recommend seeing if you can be involved in any clinical trials going on. I know that for the newly diagnosed, there are a lot of trials going on that are studying ways to slow down beta cell death and prolong the "honeymoon phase". Follow this link here: http://www.diabetestrialnet.org/
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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And for the self intro-
Diagnosed in April 2006, just before high school graduation. I was a cross country runner in HS, but it took me a few years to get back into it after diagnosis.

I had a lot of issues with lows during exercise while on MDI. I just couldn't get the routine right on top of a college schedule. I went on the pump in 2008, and it has made all the difference - namely, I don't have to figure out what physical activity I'm going to do 24 hours ahead of time and adjust Lantus dose.

I'm more of a runner than a triathlete, but I'm working on it. Done 5ks up to a 50k with Type 1. I do a fair amount of biking (by fair, I mean I live in Seattle and am a fair weather cyclist - you can decide what that means for yourself). I've ridden a century, albeit slowly and with many stops for food. I chronicle most of my adventures at lindsayonthego.com .
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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Vinnie I'm coming for that record.

Diagnosed at 17 im 28 now. A1c of 6.3. I do use a Pump of straight humalog and CGM. During a race I find the CGM doesnt work for the exact number you are at, but you can see if you are trending up or down. Raced only sprints and olympics moving up distance next year. I will be the fastest diabetic by 2015 no doubt if I can get sponsors.

I do fairly well on a lower carb diet for a better A1c, but I found I lacked that extra gear I needed for high instensity stuff. So I stick with medium carbs and try to get my body to mostly burn fat during normal training sessions.

As for taking insulin racing, If youre doing anything above olympic, I just dont see how you can run strictly off basal and consume that amount of calories and not go high. Unless maybe your just kicking it in zone 2 all day
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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type 1 diagnosed 2005

i've cycled all over the world, continental level so UCI races, i'm by no means a TDF winner but i can get out of my own way on a bike
I'm on levemir and novorapid and holes in my finger and on my bike a lot. I have used a CGM, it's too much diabetes and a bit of a waste of time, test lots in training and when you're racing just get on with it!

FWIW i don't think that, below 7.5 hba1c has that much meaning and some of the people i know who suffer most from diabetes do so in order to maintain a stupidly low a1c. the risk of complications comes at much higher a1c (above 8) (see below) and i don't believe a low carb diet is necessary or beneficial

i run a project workign with cycling and type 2 diabetes in a native American community in Tucson http://www.facebook.com/pascuayaquibike and i'm happy to help anyone who has any questions but don't you dare whine about your diabetes! if you're able to access the internet you're (on a global scale) pretty rich, people in sub saharan Africa die within 12 months of diagnosis, for them diabetes is a burden and a problem for us fortunate few it's a t most a hindrance and for me it's the reason i am able to maintain the (admittedly mediocre) career i've had at the top level of the sport.
Last edited by: jamesstout: Nov 6, 13 15:40
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Re: The Official Diabetic Triathlete Thread [jamesstout] [ In reply to ]
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I agree with jamesstout on his assessment of A1c. The curve for complications is not linear as many think it is (as shown by that chart). Exercise is the key to health, with and without diabetes, as you all obviously know on slowtwitch.

I've had diabetes for fourteen years since the age of twelve. I played college baseball and never let diabetes slow me down. I've completed many triathlons including an Ironman. I'm on levemir and take injections for meals with humalog. I use a Dexcom but still test a lot. I was also on a pump for about eleven years. I disagree that it's the answer to everything. No matter what anyone says do what works best for you! If that's a pump, do that. If that's injections, do that. A pump is only as good as the tube anyway.

To the low carb thing. That may make diabetes easier to control but it can also kill you instantly. Not driving a car will result in zero car accidents but how else are you going to get to work? Have a low blood sugar in your sleep and if your body has zero glycogen....that's it.

If you want anymore inspiration check out the video of Bill Carlson from 1983.

http://www.youtube.com/watch?v=qk_Kvjvje6U

He was a heretic then. Doctors told him it would kill him. I talk to him a lot now and he still has zero complications, eats a normal healthy diet, not low carb. Actually he'd beat anyone here on the bike besides jamesstout. When asked it's the exercise that has kept him so healthy.

Check out Insulindependence for more on diabetes and exercise.
http://www.insulindependence.org
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Re: The Official Diabetic Triathlete Thread [Delmonsta] [ In reply to ]
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I did a 4:55 70.3 which may not be fast ( was my first) but not 'zone 2'.... I test on the bike and run so I don't consume too many carbs. Not everyone experiences super highs from adrenaline or whatever so don't assume people are just winging their races if there blood sugar in check. Maybe if u ate less carbs u wouldn't need a bolus? But I suspect many go higher easier than others thus might need the bolus but I manage to stay sub 10 mmols throughout all my races and go ok
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Re: The Official Diabetic Triathlete Thread [mrbaseball0] [ In reply to ]
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Couldn't agree more! Bill is my hero and should be to any active person with diabetes. Insulindependence and their triabetes program have helped so many people with diabetes to find community and enjoy exercise. In my opinion The cure isn't something I worry about any more, exercise (along with education and supplies) makes my diabetes a non issue.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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I didnt assume anyone was "winging" their races. I already dont agree with anything you seem to post about diabetes so Im not even going to comment.
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Re: The Official Diabetic Triathlete Thread [Delmonsta] [ In reply to ]
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Well zone 2 isn't exactly racing ... Have a look at dr Sheri colburg... I concede everyone is different with the beetes so what works for one might not work for another
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Re: The Official Diabetic Triathlete Thread [mrbaseball0] [ In reply to ]
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Wow that's awesome! Not sure I had heard of Bill Carlson prior to this thread. What pioneer! I also like the fact that our first IM finish times as diabetics are nearly identical, within seconds.



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [lindsayonthego] [ In reply to ]
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lindsayonthego wrote:
Honeymoon may not be over yet, but you may be seeing "dawn phenomenon" with your morning BGs. It happens naturally for everybody, but we diabetics "see" it because it's when hormones tell the body/liver "Hey, you're going to wake up soon. You're going to need some energy. Put some sugar out." Your endo will probably tell you to take a bit more Lantus at night to cover for it.

While we're talking about diabetes, I highly recommend seeing if you can be involved in any clinical trials going on. I know that for the newly diagnosed, there are a lot of trials going on that are studying ways to slow down beta cell death and prolong the "honeymoon phase". Follow this link here: http://www.diabetestrialnet.org/

Thanks for the suggestion. It crossed my mind about the "dawn phenomenon". But the other reason I think I'm producing less is I'm seeing a little bit higher BG # throughout the day and seem to be more carb sensitive. Actually having to use Humalog 3 times a day now



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [Delmonsta] [ In reply to ]
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Delmonsta wrote:
Vinnie I'm coming for that record.

Diagnosed at 17 im 28 now. A1c of 6.3. I do use a Pump of straight humalog and CGM. During a race I find the CGM doesnt work for the exact number you are at, but you can see if you are trending up or down. Raced only sprints and olympics moving up distance next year. I will be the fastest diabetic by 2015 no doubt if I can get sponsors.

I do fairly well on a lower carb diet for a better A1c, but I found I lacked that extra gear I needed for high instensity stuff. So I stick with medium carbs and try to get my body to mostly burn fat during normal training sessions.

As for taking insulin racing, If youre doing anything above olympic, I just dont see how you can run strictly off basal and consume that amount of calories and not go high. Unless maybe your just kicking it in zone 2 all day

Response to Delmon:

Some diabetics can and do. I've had diabetes for 23 years and been involved with either swimming, rugby or triathlons for all of that time.

Only time I will go high when I am above 'zone 2' (whatever that means) is for either racing with its adrenaline (happens often) or really high intensity stuff in training where there is an adrenaline response (which rarely happens to me in training, never happened to me in swimming when we often did 25m sprints in training)..altho it can and does depends on the time of day, eg at night I don't need much if any carbs since my long acting is starting to run out.

Response in general:

I also do not really need to adjust my lantus for exercise that is to come (whereas for humulin n I did), rather I adjust it for what I have already done.

Diabetics are different in the way they respond to different things.

Also trying to get an awesome A1c carries with it a higher risk of a serious hypo...which can be a killer.
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Re: The Official Diabetic Triathlete Thread [jamesstout] [ In reply to ]
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Good graph and it does prove the point of "low is better" -- each to his own, but I would compromise certain foods and maybe some performance if that means I can cut in a FIFTH my chances of going blind by maintaining a 5.5% A1C compared to 7.5%, I will happily do that, thank you.

What I also find interesting is that most people here are opposite to very low carb without even trying! This part is beyong my understanding. The number of severe lows and shaking has dropped in my experience and others on a VLC that I talk to. Guys, I've done the other way, raced fast and trained hard on "higher" carbs (150g on an easy training day and 250+ on a tough training day)

In the end we are NOT healthy as people make it sound, this is a very, very serious and deadly disease, either you take full on control and bring your levels to normal, or wait a couple decades (at a best case scenario) and pay the price. If you want to speed the learning process go and see a dialisys clinic, every second person has diabetes, plus is the leading cause for blindness in the US among young people.

Take this serious, you can still race triathlon fast, but performance should be secondary to health.

Vinnie





jamesstout wrote:
type 1 diagnosed 2005

i've cycled all over the world, continental level so UCI races, i'm by no means a TDF winner but i can get out of my own way on a bike
I'm on levemir and novorapid and holes in my finger and on my bike a lot. I have used a CGM, it's too much diabetes and a bit of a waste of time, test lots in training and when you're racing just get on with it!

FWIW i don't think that, below 7.5 hba1c has that much meaning and some of the people i know who suffer most from diabetes do so in order to maintain a stupidly low a1c. the risk of complications comes at much higher a1c (above 8) (see below) and i don't believe a low carb diet is necessary or beneficial

i run a project workign with cycling and type 2 diabetes in a native American community in Tucson http://www.facebook.com/pascuayaquibike and i'm happy to help anyone who has any questions but don't you dare whine about your diabetes! if you're able to access the internet you're (on a global scale) pretty rich, people in sub saharan Africa die within 12 months of diagnosis, for them diabetes is a burden and a problem for us fortunate few it's a t most a hindrance and for me it's the reason i am able to maintain the (admittedly mediocre) career i've had at the top level of the sport.

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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I just wanted to thank all of you who answered. I am not diabetic but I have a friend who is (actually several) and I know he will find this thread very interesting.

John
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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Going low a lot has its own complications too, for your brain and if you're trying to obtain perfect levels all of the time, you increase the risk of a severe hypo causing death - the biggest complication of all.
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Re: The Official Diabetic Triathlete Thread [fulla] [ In reply to ]
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fulla wrote:
Going low a lot has its own complications too, for your brain and if you're trying to obtain perfect levels all of the time, you increase the risk of a severe hypo causing death - the biggest complication of all.

Have you tried going very low carb (<50g/day) for at least a few weeks straight?

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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No, I like carbs too much! I have tried going "low carb' at dinner for 3 months and it was horrible.

I can get really good levels so long as I measure all of the carbs I take in and am strict.What

What do you eat on the low carb diet? Just protein and fats?

Are you able to give an example of what you might eat in one day?
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Re: The Official Diabetic Triathlete Thread [fulla] [ In reply to ]
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fulla wrote:
No, I like carbs too much! I have tried going "low carb' at dinner for 3 months and it was horrible.

I can get really good levels so long as I measure all of the carbs I take in and am strict.What

What do you eat on the low carb diet? Just protein and fats?

Are you able to give an example of what you might eat in one day?


See. With all the respect, but you and others on this thread are against low carb and even say what happens on a low carb diet without trying it.

I knew you never tried it since you said "going low all the time" -- this DOESNT happen on a low carb due to the "Law of small numbers". Which one you think will keep the levels at a healthy range (70-90)

Option 1) You start at 85mg/dl. You have a meal with 15g of carbs (or 75mg/dl), requires 1u of insulin. (lets not talk gluconeogenisis via protein for now to keep it simple)

Option 2) You start at 85mg/dl. You have a meal with 75g of carbs, requires 5u of insulin.

Option 2 presents a much higher chance your carb counting won't go as planned, lets say there is a 20% error margin (aproved by FDA) for insulin dosage, the result will be:

1) 20% of 1u of insulin (0.2u), will take you from 85mg/dl to 70mg/dl if low or 100mg/dl if high
2) 20% of 15u of insulin (3u), will take you from 85mg/dl to 00mg/dl if low or 250+mg/dl if high

--

On the I like carbs too much!! True, we all do, but I'm happy enough to be able to have a healthy life and do other things that I like more than carbs. Plus, bacon, steak, butter and avocado are pretty good too ;-)

For the menu, there's a bunch of options out there, google ketogenic diet menu.

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
Last edited by: vinnie: Nov 6, 13 19:56
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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vinnie, I'm not sure where this FIFTH you speak of comes from going blind is a fairly extreme form of diabetic retinopathy (the blue line), the y axis represents relative risk and the x axis hba1c, a line drawn to meet the blue line from point 7.5 on the y axis would correlate to a relative risk of about 2.3, less than half of five.

I understand that you experience very little in the way of shaking, you will be familiar with the concept of hypoglycemic unawareness. just because you do not perceive symptoms does not mean you are not low, just that your body has become used to being that way. This in turn leads to a risk of nocturnal hypoglycemia which in an individual starved of glycogen can be extremely serious and fatal. perhaps this gives rise to your perception, which i do not share, that diabetes is so hazardous. Diabetes can, of course be deadly but i believe that this is only the case where there is a lack of understanding and / or a lack of supplies. The latter is thankfully less of an issue in the USA but the former is.


I wonder how many people in dialysis clinics etc have had access to a good CDE who shares and understands their goals? As someone who works with diabetes in resource poor setting i have seen many of my participants drop A1C from above 15 to below 8 merely by including more exercise in their daily lives, the massively empowering effects of education and through peer group mentor-ship. At no point did i march any of them to a dialysis clinic because i hope they never have to attend one themselves.


Instead of taking my participants to a dialysis clinic i take them on a bike ride, i share the message that diabetes is only a limitation if you allow it to be one. If you fear your diabetes, you fear your body and you fear food you will never truly understand how these things interact and (in my opinion) will not realize personal or atheltic potential. The one thing my body does not produce is insulin, but i can take that from a syringe, once i have addressed that deficit there is NOTHING that i cannot do as well if not better than a non diabetic individual.


No i have not tried a low carb diet (for the reasons outlined here http://diets4diabetes.com/...eople-with-diabetes/ and also because i enjoy food, find VLCD to be socially restrictive and performance limiting) but then again i haven't tried crystal meth either. But people who use it tell me it's great
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Re: The Official Diabetic Triathlete Thread [jamesstout] [ In reply to ]
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i should add that i don't have a "dog in the race" here, i just care about other people,a bout their health and about their happiness. I work in non profit because it makes me very happy but I'm not invested in the whole JDRF scheme of making diabetes appear to be some kind of death sentence in order to get money from people. I want to empower people with what i do not enrich myself or anyone else.
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Re: The Official Diabetic Triathlete Thread [jamesstout] [ In reply to ]
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Hi James,

In the end we are all seeking for the same goal here, to be happy. And diabetes poses a big problem as the complications won't make life very enjoyable, at least in my view. As you said, I also like to ride my bike way too much to even think one day this activity may not happen due to one of the complications (problem with vision or neuropathy for example).

While I do understand that "you" or others are a lot more educated than "most" and "most" are the ones that get the complications, we have to stop with this idea of "you can live a normal life with diabetes", which is not true. If the trend goes to "control your blood sugar levels as close to normal as possible, you will stay out of complications", but then the first one is a lot more appealing and easy to sell, including for pharmaceutical companies and so on.

I've seen this first hand when my 2yo nephew was diagnosed with T1D a year ago. Rather than focusing on the treatment, the information was "how to use your pump to eat mcdonalds" and things like that.

Some other topics you mentioned below that I would like to express my view:

a) 80% of people with diabetes will develop Retinopathy by 20 years of the disease. Sure, there will be another 20 years of lasers treatments et all before vision loss happens (or partially) and even by then, there will be better treatments, etc, but I prefer to make my own luck. By age 55+ (40 years of T1D) I still want to be riding my bike.

b) People with pre-diabetes (A1C of 5.7-6.5%) have developed diabetes complications. Basically when your BG goes past 120mg/dl you are already kiling some beta cells.

c) Nocturnal hypos are not as severe on a VLCD due the law of small numbers as mentioned above. If you have barely any fast acting insulin on board, only your basal may take it down and you know how slow the act. This problem of nocturnal is actually dimished on a VLCD

d) Diabetes IS a limitation. I'm sorry to burst the bubble, but while a diabetic can have a pretty flexible and healthy lifestyle, certain activities or situations can be very, very troublesome for a diabetic and that includes elite athletic performance for some sports. If high performance training may not be healthy for a normal/healthy individual, much less for someone with a metabolic condition like diabetes. For one, while I think team type 1 (or novonordisk) is doing a great think, I personally do not believe their athletes can ride at a very world class level (Tour de France) WHILE maintaining a normal A1C and I will keep it flexible and say 5.5% which is normal high while a actual healthy A1C is sub 5% or in other words, they won't have a long lasting career without developing diabetes complications

e) The problems of a VLCD for diabetics from your link is basically the shift from NK (nutritional ketosis) are very different from DKA (diabetic ketoacidosis), your link also is from a non-medical website, although this isnt necessarely a problem since even ADA recommendations are killing people

Once again guys, you are against something you've never tried, while I'm trying to expose the benefits of it, as I've been on both sides of the fence. We are not arguing against who is right or wrong here, I'm only defending that THERE IS A GREAT OPTION to deal with diabetes and that is via very low card diet, but since the idea isn't well spread out there (yet), it sounds like the contrarian.

FWIW, the evidences are too strong VLC is the way to manage diabetes, and the pharma industry not getting on the way, it will be the recommended dietary guidelines very soon.

Vinnie

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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geez vinnie, arent you just a little ray of sunshine! im gonna go to the tour to prove you wrong. I will be the one getting my kit off and running 25m up a hill to try and cheers on wiggens. Will need a jellybean afterwards :)
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Hi I am not diabetic but I know Kris Freeman who is one of the top male US XC skiers and is Diabetic. He was told he would not be able to compete with the condition and has continued to do well. He has written written about it quite a bit on fasterskier blog. Google him and you will learn about him.
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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Vinnie, With all respect I do not need to try low carb. Frankly, I'm not willing to take the risk of a low overnight that will kill me. I've never tried drugs either and know many are bad.

You've ignored the Bill Carlson achievements of health. What about guys like him, Bill King and Steve Prosterman (google them if needed). Those guys have all had diabetes near 50 years or over, they're all extremely healthy and addicted to exercise. They come from the days of urinating on a stick to test blood sugar, basically doing diabetes blind. They don't have complications. They are my hero's with no extreme diets.
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Re: The Official Diabetic Triathlete Thread [mrbaseball0] [ In reply to ]
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mrbaseball0 wrote:
Vinnie, With all respect I do not need to try low carb. Frankly, I'm not willing to take the risk of a low overnight that will kill me. I've never tried drugs either and know many are bad.

You've ignored the Bill Carlson achievements of health. What about guys like him, Bill King and Steve Prosterman (google them if needed). Those guys have all had diabetes near 50 years or over, they're all extremely healthy and addicted to exercise. They come from the days of urinating on a stick to test blood sugar, basically doing diabetes blind. They don't have complications. They are my hero's with no extreme diets.

How do you know they are free of complications?Do they post their tests online? A friend of mine (T1D) has been on a ride with Bill and reported his BG were a mess, all over the place, he had to get some food from others, the usual roller coster scenario of a T1D on high carbs (been there many times before). I prefer to have Dr Bernstein as a role model and hero, 80yo, T1D since age 12, trains twice every day ;-) A1C in the 4's -- read his book, the best think you will ever do for your health, thats all I ask.

I'm sorry but once again you are blaming on something you haven't done. I respect your decision, I just wanted to be the "contrarian" on this thread to show others that there is another way other than taking industrial amounts of insulin, you CAN achieve normal blood levels, race fast and stay away from complications. The comment about going low during the night is again ignorant, since it doesnt happen as often as someone on a high carb diet (high insulin which means more hypos).

The analogy with drugs is out of place, and you can't argue with the results, there is a whole community of VLC (and Dr Bernstein followers) out there, they are all micromanaging their BG, most are sub 6, some are sub 4 while having a very flexible lifestyle, thats the part that most people don't get it since they are based off they current high carb routine.

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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I'll chime in to get things a little back on track.

I'm a T1D, diagnosed back in February of this year at age 33.

Currently on 8 units of Lantus (once per day) and Humalog at about 1 unit per 30 grams carbs.

I haven't done any Tri's this year, but did an 8 hour mountain bike race back in April and a few running races this year. I've found that for me by basal insulin takes care of me pretty well during excercise (Training), although I haven't raced enough this year to fully understand the impact that the race day adrenaline will have. Generally though, I like to make sure I don't have too much fast acting insulin on board before workouts and it seems like my body does a good job of processing the Glucose I take in for fueling.

I love this thread though, as so far we have had a lot of great information. Hopefully we can keep it going so that we all have the opportunity to learn from each other.
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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vinnie,
I've tried as hard as i can to make this as civil as possible but being rude about Bill who i consider a friend, who many consider a hero and to whom ANYONE including yourself who undertakes endurance sports as a a t1d owes a HUGE debt of gratitude is unacceptable. I dare say Bill, and many others, would suggest the same regarding your bloodsugars, your a1c and your approach.

I think the drugs analogy is entirely appropriate, you feel great, you tell other people how great you feel and then one day you aren't around any more. If you want o be sick, if you want to have a life threatening "disease" (ip refer the word condition) if you want to scare people and you want to dis-empower people these things are all available to you, by all means take that path.


I'm not about to engage in a1c "penis measuring" because it's contrary to my belief that lower isn't always better but you can rest assured that my A1c is likely lower than 75% of the posters on here, diabetic or not. You can also rest assured that I suffer from no complications and intend not to and that I rarely eat spoonfuls of coconut oil.


If you want a cause to be contrarian about and a ground on which to fight big pharma join us at 100campaign.org where we advocate for 100%access to insulin by the 100th anniversary of it's creation in a laboratory. Advocating for this cause will positively benefit the health of others, your stance WRT diet is, in my opinion and that of many others not only indicative of a flawed understanding but also dangerous.
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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vinnie wrote:
Good graph and it does prove the point of "low is better" -- each to his own, but I would compromise certain foods and maybe some performance if that means I can cut in a FIFTH my chances of going blind by maintaining a 5.5% A1C compared to 7.5%, I will happily do that, thank you.

What I also find interesting is that most people here are opposite to very low carb without even trying! This part is beyong my understanding. The number of severe lows and shaking has dropped in my experience and others on a VLC that I talk to. Guys, I've done the other way, raced fast and trained hard on "higher" carbs (150g on an easy training day and 250+ on a tough training day)

In the end we are NOT healthy as people make it sound, this is a very, very serious and deadly disease, either you take full on control and bring your levels to normal, or wait a couple decades (at a best case scenario) and pay the price. If you want to speed the learning process go and see a dialisys clinic, every second person has diabetes, plus is the leading cause for blindness in the US among young people.

Take this serious, you can still race triathlon fast, but performance should be secondary to health.

Vinnie

I would assume that "most" diabetics in dialisys clinic are not "fit" Ironman type 1 diabetics?

I would speculate that most people most on this thread are much healthier diabetics than most of your "average" American diabetics

No?




jamesstout wrote:
type 1 diagnosed 2005

i've cycled all over the world, continental level so UCI races, i'm by no means a TDF winner but i can get out of my own way on a bike
I'm on levemir and novorapid and holes in my finger and on my bike a lot. I have used a CGM, it's too much diabetes and a bit of a waste of time, test lots in training and when you're racing just get on with it!

FWIW i don't think that, below 7.5 hba1c has that much meaning and some of the people i know who suffer most from diabetes do so in order to maintain a stupidly low a1c. the risk of complications comes at much higher a1c (above 8) (see below) and i don't believe a low carb diet is necessary or beneficial

i run a project workign with cycling and type 2 diabetes in a native American community in Tucson http://www.facebook.com/pascuayaquibike and i'm happy to help anyone who has any questions but don't you dare whine about your diabetes! if you're able to access the internet you're (on a global scale) pretty rich, people in sub saharan Africa die within 12 months of diagnosis, for them diabetes is a burden and a problem for us fortunate few it's a t most a hindrance and for me it's the reason i am able to maintain the (admittedly mediocre) career i've had at the top level of the sport.



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Sorry to hijack this thread - I don't have diabetes, but my training partner was diagnosed with Type I in his late 20s (about 18 months ago).

It's interesting to read how some of you were diagnosed with Type I later in life. I'm curious - did any of you have an illness, or some other medical condition, that affected your insulin production relatively "later" in life (in terms of Type I). As a nurse, I've seen more and more instances of this.

Thanks! And I think you all are amazing to manage diabetes with a sport like triathlon!
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Re: The Official Diabetic Triathlete Thread [kristaae] [ In reply to ]
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Hi Kristaae,

I was diagnosed at 12, but almost exactly a year before I got diagnosed I had a bad case of mumps.
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Re: The Official Diabetic Triathlete Thread [kristaae] [ In reply to ]
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I was diagnosed on August 14th, 2013 at the age of 37. About two weeks prior to that I came down with a cold. Nothing crazy, just extremely tired and congested ect. Then the extreme thirst came, off the freagin chart thirst!!! Lost 15lbs, blurry vision ect



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [kristaae] [ In reply to ]
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kristaae wrote:
Sorry to hijack this thread - I don't have diabetes, but my training partner was diagnosed with Type I in his late 20s (about 18 months ago).

It's interesting to read how some of you were diagnosed with Type I later in life. I'm curious - did any of you have an illness, or some other medical condition, that affected your insulin production relatively "later" in life (in terms of Type I). As a nurse, I've seen more and more instances of this.

Thanks! And I think you all are amazing to manage diabetes with a sport like triathlon!

There is certainly a trend. I was diagnosed 12 months after Chicken Pox (agressive at an older age) and 3 months after Dengue Fever.

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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runnerwv wrote:
vinnie wrote:


Vinnie

I would assume that "most" diabetics in dialisys clinic are not "fit" Ironman type 1 diabetics?

I would speculate that most people most on this thread are much healthier diabetics than most of your "average" American diabetics

No?
[/quote]

Define "healthier".

To me, when it comes to T1D healthy means: Low A1C & No complications

I've trained full time for ironman races, putting in consistently 35h a week of training, and during these times I was running chronically, high, the usual roller coster of a T1D on high carbs. A1C's in the 8's, or mid 7's, celebrating a 6.9%.

On the other side, you have a "normal & active" individual, picture 5x1h per day. They are likely to have better A1Cs than the ironman athlete. In my view, as a T1D he is a healthier individual (not necessarely fitter much less faster, but the question wasnt about the finish line).

Low Carb allows ironman athletes the best of both worlds. They can sustain a much lower blood value while training (and definitely outside of training times) while still being able to perform reasonably well. I wish I had the time to put in the IM training again, but as a quick trial, I went 61min sprint distance tri on a ketogenic diet and tested 5.3% A1C a couple weeks after that.

I'm into this "race" for life. Triathlon lifestyle with a healthy body, and to me low carb is the easiest and better approach to follow. I wish I had this information back then and that's my goal here, to allow people decide a second path towards their T1D management and training/racing.

Vinnie

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
Last edited by: vinnie: Nov 7, 13 17:36
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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just curiously do you pump vinnie?

I wish asutralia subsidised CGM's, that would make racing so much easier to see trends.
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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By "healthier" I mean not fat and exercise and watch what you eat. Type 1 diabetics account for 5% off all diabetics. Guess my point is that diabetics on this thread are in a better overall state of health than most of the people you were referring to that are on dialysis.

I am do new to all this and am still learning. I think this will all make more sense once my pancreas totally ceases production



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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while it does get easier, you can honeymoon for quite some time. Im 2 years into this and taking less now than i ever have. Having said that, uou quickly learn how your body responds to the different diciplines and speeds/time etc
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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coates_hbk wrote:
just curiously do you pump vinnie?

I wish asutralia subsidised CGM's, that would make racing so much easier to see trends.


Not on a pump neither CGMs. Some people are going to laugh, but I'm about to try and follow Dr. B insulin regime and shift back to regulars + lantus. Reason is, as of now, I take about 1-2u of novorapid before most meals, but need another 0.5-1u or so 2-3h after I'm done to cover gluconegenesis (the protein that turns glucose). Regular covers that.

Would love to try CGM but hard access where I'm am, very pricey, cheaper to test blood 15+ a day which I have done many times before. These days I'm at 12 or so.

My 2yo nephew T1D is on a pump and my sister loves it, I can see it being a good deal in many situations but definitely not for all.

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
Last edited by: vinnie: Nov 7, 13 19:14
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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runnerwv wrote:
By "healthier" I mean not fat and exercise and watch what you eat. Type 1 diabetics account for 5% off all diabetics. Guess my point is that diabetics on this thread are in a better overall state of health than most of the people you were referring to that are on dialysis.

I am do new to all this and am still learning. I think this will all make more sense once my pancreas totally ceases production

You can actually be on honeymoon phase indefinitely if you shift to very low carb, if you don't mind how T1D it is now, you should do that. Once the honeymoon is over things gets way harder to control. I would barely take any insulin during my honeymoon. Read Dr Bernstein book as he explains this process of indefinitely honeymoon.

Our view on healthy is different at least when it comes to diabetes. While I do agree that not being overweight do help to stay away from complications due to lower blood pressure and better circulation, the fact you are exercising and watching what you eat can easily become insignificant by chronically high BG levels, for a T1D.

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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I have to admit my blood glucose levels are usually better when I am on a break as my routine is consistent day in day out - the exercise level doesn't change because I do none. But I'm not using a low carb diet then, just using a diet which sees me eat the same amounts of carbs at meals so that I'm not changing anything on a day to day basis.

Also in terms of the protein to glucose thing - I thought that didn't happen? It was something I was always told when I was diagnosed (we used to call 10 g of CHO and 7 g of protein, carbohydrate and protein "choices") but I thought that had been found to be scientifically inaccurate?
Last edited by: fulla: Nov 7, 13 19:50
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Re: The Official Diabetic Triathlete Thread [fulla] [ In reply to ]
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fulla wrote:
I have to admit my blood glucose levels are usually better when I am on a break as my routine is consistent day in day out - the exercise level doesn't change because I do none. But I'm not using a low carb diet then, just using a diet which sees me eat the same amounts of carbs at meals so that I'm not changing anything on a day to day basis.

Agreed 100% and I'm sure this is the case for all T1D. The more you train, the more of a "normal training plan" you follow, messier your levels will be.

Doing 5-7 days of 1h of running (or anything else) at the same time of the day is far superior to control BG levels rather than the usual training plan that shifts in between a long 4-7h day to 1h the day after.

I understand that there is more to life other than tight BG control, but its also important to adjust your training and routine around your diabetes rather than just say "we can have it normal like everyone else".

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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yep, that's why I try to have the same/similar type of workouts on the same day each week so that I can track trends etc. I'm a bit bad with sometimes choosing to eat more though, ice cream in particular!

have also found that chocolate milk has a tendency to enter my system VERY quickly after a workout, despite injections to offset its impact on blood glucose.

certain foods are also terrible - like large amounts of pizza, chinese takeaways, pasta...I can in fact go low from the 'slow absorbtion' but then will be in the 20s an hour to 4 hours later as the carbs get absorbed.
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Re: The Official Diabetic Triathlete Thread [fulla] [ In reply to ]
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fulla wrote:
yep, that's why I try to have the same/similar type of workouts on the same day each week so that I can track trends etc. I'm a bit bad with sometimes choosing to eat more though, ice cream in particular!

have also found that chocolate milk has a tendency to enter my system VERY quickly after a workout, despite injections to offset its impact on blood glucose.

certain foods are also terrible - like large amounts of pizza, chinese takeaways, pasta...I can in fact go low from the 'slow absorbtion' but then will be in the 20s an hour to 4 hours later as the carbs get absorbed.

Training a similar energy system same day is a good idea, I try and do that. Morning is usually a high aerobic intensity (call it threshold) and afternoons speed/strength work. But then even the discipline changes the impact on things.

Swimming is by far the most effective to control BG, during and after
Running spikes my BG during but makes it good to control after
Cycling doesnt spike during, but not as efficient to keep low BG after

A high fat diet has allowed be to eat smaller meals per meal, which facilitates the absorption rate of carbs and proteins. I also try to stay well fueled during long sessions to avoid feeling hungry and overeating once I'm done. On along ride will take cheese, nuts, coconutmilk+ucan and some bcaa, may need to bolus 2x0.5u, then eat as small as usual straight after.

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [fulla] [ In reply to ]
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the spike is likely to be due to the cortisol secreted post exercise

for me at least it's all about self experimentation. I agree a routine is easier, it would be easier to go shopping if you ate the same meal three times a day, dressing would be easier if you only had one outfit sometimes what's easier isn't what's desirable.


I think it all comes down to outlook, I want to achieve the most I can with my life, to see the world, to help people and to excel in my sport. I will make my diabetes fit with those goals. If above all things i wanted to maintain a lower a1c maybe i would approach life differently. Health has a mental component and giving up on your dreams and accepting diabetes as a limiter not only unnecessarily limits your goals it also negatively influences your relationship with your diabetes which could in turn upset your BG management, and make you sad enough to eat ice cream ;)


oh and the delayed pizza bolus is an art form, I'm also a big advocate of the pizza and beer combo, as the beer brings you down the pizza kicks in.
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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Hi everyone, timely thread for me. Very recent routine blood work indicated high sugars. I am still waiting for follow up and additional results. I am floored because I never had a bad diet and my numbers are all over the place without discernable rhyme or reason. Just wondering if anyone knows of a good reference book/ website / whatever particular to athletes. These numbers are driving me nuts and some info might help. Th.ank
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Re: The Official Diabetic Triathlete Thread [caffeinator] [ In reply to ]
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have you had type 1 sort of symptoms (eg thirst, weight loss, blurred vision etc)? or are you thinking type 2?
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Re: The Official Diabetic Triathlete Thread [caffeinator] [ In reply to ]
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caffeinator wrote:
Hi everyone, timely thread for me. Very recent routine blood work indicated high sugars. I am still waiting for follow up and additional results. I am floored because I never had a bad diet and my numbers are all over the place without discernable rhyme or reason. Just wondering if anyone knows of a good reference book/ website / whatever particular to athletes. These numbers are driving me nuts and some info might help. Th.ank

What are you seeing ? Low morning numbers ? All day ? How high, how low ?

How did they diagnose ? Morning fasting or A1C or OGTT test ?

I have 2 books from which I learned some stuff but a lot is trial and error and from fellow diabetics on the internet. I suspect several people on this thread can help you figure some stuff out.

Books I read

Diabetic Athlete's Handbook by Sheri Colberg
Diabetes Solutions by Dr Bernstein.

I am 50, type 2 since 1998.
BTW, finding a doctor that knew something about endurnace sports and diabetes was/is a real challenge for me,
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Hi all,

Paul Buchanan here, Founder of Team Blood Glucose.

dx Jan 28th 2012 at the age of 44

A1c on dx was 13.4% (in old money) fasting bloods were 17.6mmol/l

Started on 1 shot of levimir (24u) in the evening and fixed bolus of 6u per meal.

Self taught carb counting and by month 3 was MDI split levimir am/pm (8u/8u) and novorapid I:C 1:10 next A1c was 5.1%

In Sept 2012 did my first Olympic tri after doing a course on Sports & Exercise with Ian Gallen (Endo)/Carin Hume (Dietician) sponsored by Animas (pump makers) at Loughborough University.

Was quite proud of my 2:47:20 time!

March 2013 went onto pump - Animas Vibe & self fund Dexcom G4 CGM, also founded Team Blood Glucose (for all PWD).

2013 - Wellington Sprint Tri, BUPA 10k, Exmoor 70.3, 2,400km cycle from Brussels to Barcelona with Team Blood Glucose (TeamBG),

2014 - Half Marathon, Marathon, Exmoor 70.3, Zurich Ironman, another cycle from Barcelona to Vienna (EASD conference to conference tour), about 2,400km - route/event still being planned.

Have managed to maintain an A1c of c5% for the last 18mths - am a LowCarber except when exercising/training/eventing when I consume c 60g Carbs/hour at a HR of c130-150 which goes up to 90+ carbs/hour if HR above 160

When doing endurance training/events I reduce basal by 80-90% (or as low as the pump will allow) and do not bolus for any thing I eat during exercise.


Triathlete, wanna-be Ironman, sailor, cyclist, swimmer, runner and beekeeper (oh the sweet irony!)

Really keen to learn from and share with others how to live a healthier/stronger/safer life with diabetes

http://www.teambloodglucose.com
Empower:Connect:Support:Educate
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Re: The Official Diabetic Triathlete Thread [TeamBG] [ In reply to ]
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Hi Paul, love the team BG gear! Tri gear would be great!
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Re: The Official Diabetic Triathlete Thread [TeamBG] [ In reply to ]
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Paul - I've just looked up your website for Team Blood Glucose. Well done mate, you've done a great job there.

I was diagnosed in June this year having completed IM Wales last September. I've got Challenge Roth coming up next summer as well as a mountain marathon in the Autumn

I'm interested to know how you ended up with a pump. I asked my consultant about pumps and was told I don't meet the criteria as I'm controlling my b/s well with injections. Also, I see your CGM is self funded. How much did it set you back? Would you recommend them for races? I don't fancy stopping loads during an IM to test blood sugar levels...

Interesting to see how much you reduce your levemir and bolus during an event. I'm guessing you're not going hypo. However do you have any figures for how high your b/s gets if you're taking on 60g CHO per hr?

All information welcome as I'm going to be beginning my IM prep in the New Year.
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Re: The Official Diabetic Triathlete Thread [p206751] [ In reply to ]
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I consume about the same carb per hour, 50-75g, some times more. During b2b full a few weeks ago when I tested I ranged from 80-145 but most were in the 120's. Probably tested 10 times during the event

I used Perpetum on the bike(6 bottles YUCK) along with some Hammer gel and I also like to mix in GU gels because it has 15% simple sugar and caffeine.

Through lots and lots of testing I have learned that I need at least 25g carb every 20-30 min



"Keep those feet moving!" Me
Last edited by: runnerwv: Nov 8, 13 7:09
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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vinnie wrote:
Swimming is by far the most effective to control BG, during and after
Running spikes my BG during but makes it good to control after
Cycling doesnt spike during, but not as efficient to keep low BG after

A quick introduction about me. I'm 34. Was diagnosed almost exactly a year ago, type I - LADA. I've raced 3 IM in the past, more HIM than I can count, tons of endurance cycling etc. I'm racing my first diabetic IM next week in AZ and planning to use it as a learning experience.

I think it's great that resources such as this thread allow us all to find another and discuss these topics. It really is amazing the progress. I'm am incredible grateful for those who have tested the boundaries and been brave enough to achieve the success that they have had. Every diabetic is different, physically and mentally. Hell, I'm different depending on the day - but that said I'm also going to vouch for Vinnie and the benefits of being low carb and ketogenic adapted.

I have also been pursuing this strategy, admitted I'm new to the scene so I know my place. However, how I choose to care for myself is my decision. I'm not here to pressure anyone else to do things my way, but it works for me. My goal is to try to preserve my beta cells - hell I'll openly admit that I'd love to reverse this thing. Even if that's an unrealistic or unobtainable goal it still leaves me with my health.

I'm not saying it's unhealthy to treat your diabetes in the traditional manner, but for me I want to pay due respects to the 80 year old future me. I don't want to (in my opinion) risk my long-term healthy by exercising with BG's in the 140's. I am able to train in the 80-100 range very well. I do not experience any rapid hypos, and if I do ever go low I can just stop or slow down and my body will auto-correct. Vinnie's comments about the law of small numbers is only part of the benefit. The real benefit in my view is that being adapted to burning ketones as a primary fuel source means that my body can handle them and actually use them.

There is more to it than just 'low carb'. I've trained by body to burn fat (in the form beta-hydroxybutyrate). So not only do I not get high BGs from food, although high intensity intervals do cause a bump, I'm protected from lows. I guess I can't prove this, but I am putting my life on the line that I am more protected from lows. I haven't ever been low to a point where I haven't been able to think clearly and care for myself (again, this is year 1 so knock on wood) It's not a hypo unawareness issue, it's that my brain and body aren't choked off from their only fuel source. There was an interesting study I read about in "Good Calories, Bad Calories" where they took patients who they ketoadapted through starvation for a couple weeks and then administered enough insulin to take their BG's below 20, and they apparently suffered no neurological deficit - I think this was in the 1930's since you can't fund that study these days! Not that it's my goal to ever go that low, but if I do I'd rather not go into a coma.

My blood ketones are consistently in the 0.5-2.5mM range, no where near the 15mM DKA risk category. I feel better and perform better at 80 than over 140. I get stronger as a workout duration increases - I feel like a big diesel engine. Admittedly I'm probably a small portion of my anaerobic metabolism, but I've also upregulated my aerobic (just through diet!). I should do a VO2 max test and measure my respiratory quotient - been wating on that since the first year of diagnosis is $$$. But I can tell I'm more aerobic while swimming and require less air, etc.

A note about CGM's. I use a dexcom G4, but it doesn't seem to tell me much. My theory is that this could be unique to the whole ketoadapted thing. It's great when sedentary, but once I'm 40 minutes into cycling workout the CGM shows that I've dropped below 50 while blood values show me still in the 100's. This could be related to my ketoadaptation, either way it doesn't tell me what I need to know for it to be a reliable tool during exercise. Maybe my interstitial glucose values really are 40's, but I was knocking out killer hill repeats feeling very strong the last time that occurred.

Other benefits beyond and up-regulated aerobic capacity is that I'm noticeably less inflamed now. No more allergies - I can breath though both nostrils at the same time! My flexibility increased which I thought was crazy (I got better at yoga while not actually practicing?! ), my energy is very steady - I can miss a meal and not be hungry and have stable BG values, I could fast for a day and train just fine.

Now again, I'm not forgetting that I'm still new at this. I was likely honeymooning a bit, and hopefully I still am and will continue to for the rest of my life. Right now I'm using an OmniPod (no tubes!) and run a 0.4U/hr basal. I set a temp basal of 0.15u/hr for aerobic efforts. I turn that temp basal on 30-45 minutes pre-workout before swim and bike, but time it at the start for runs. I experience similar BG effect that I quoted from Vinnie above. For high intensity workouts or short runs I don't reduce a temp basal.

With my first diabetic ironman next week I did 4400 swim yesterday. By swimming a comfortable easy pace my BG dropped from 90 to 70 and my splits where nice and consistent. Normally I'd do that distance in about 65 minutes - but yesterday's pace time was 75 minutes. Then for shits and giggles I did a hard anaerobict 200yd effort to finish my workout. By the time I was dressed I was back up to 90 from the intensity. That's pretty cool in my mind. (using my own glucagon rather than injecting).

As for losing 10 minutes in my swim - I don't care. I'll be stopping to test on the bike. I'll be happy with a 6hr+ split (where as I know I could probably ride sub 5:15, at least I could pre-diagnosis). And I'll just be happy to finish the run.

Its funny how I feel a little pressure to prove that this strategy works by actually going all out, but it's not worth the risk to me. I have a much longer term vision. Maybe I'll go harder in IMWI'15. There is hopefully going to be a big group participating.

Oh, and more details. My A1C after my first year is down to 5.6%. I eat mostly fat. Typical meals: Breakfast is either bacon and eggs with kale in coconut oil or lard. Lunch (if I need it) is a salad with olive oil and vinegar dressing perhaps with avocado and sardines on top. Dinner is usually a home-made soup from bone broth with non starchy veggies, maybe 6-8oz of pork, fish, or steak (sometime liver). Snacks are almonds, macademia nuts, or a spoonful of coconut oil with nutbutter and/or chia. Dessert is coconut milk chia seed pudding with cinnamon and cocoa powder mixed in. And I admit to putting kerry gold butter in my coffee if I'm in a hurry.

Sorry for the length of my post. Again, I think it's amazing that we can all share this info. I'm so happy to read what Vinnie has posted because it reflects what I too have learned and experienced. We all have a choice in how we care for ourselves. And even if you choose the HCLF strategy, your better off than someone who chooses no strategy and doesn't exercise. We are all doing the best we can. I'm just glad to have the choice. It was hard for me to find info on choosing this method so hopefully my words (and Vinnie's) will help explain this option to anyone else that might be interested.

If you sadistically want to read more about me I do write a blog at koryseder.blogspot.com. I think I'm just going to post this as a blog as well - wholly manifesto!

I'm not on ST much anymore, just happened to check in for info on AZ (water temps, etc), but I'll follow this thread - good timing I guess! And from my blog address I'm easy to find on FB. Good luck everyone! I know how afraid I was a year ago - and it's due to the work of all of you that I have the confidence to continue on in the sport that I love, hopefully for a long time to come.
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Re: The Official Diabetic Triathlete Thread [p206751] [ In reply to ]
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Type 1 diabetic Diagnosed at 36 in 2004.
Currently using a pump and occasional CGM. I initially got both fully funded in the UK (yay NHS!) but have been living in Australia for the last 3 years so have had to self fund my CGM during that time :-( Back in the UK now and have my first endo appointment in a couple of weeks so maybe I'll be able to get the CGM again.

Did Strongman Japan on MDI, done numerous running events from half marathons up to 60km on both MDI and pump. Find that for me, I need to drop my basal levels during events, the shorter the event, the more I need to reduce the basal level - intensity related I guess.

CGM is a godsend for marathons and anything greater. I make sure that I have it inserted a couple of days prior to the event so that I can be sure that it is properly calibrated and then I can monitor and adjust levels during a race without testing.

I have dropped low in marathons and still been able to finish in a good time. Once (pre pump) I found I was at 1.9 (that's 35 in US numbers) at the 25km point during London Marathon but taking on board a good amount of carbs at the aid station was still able to finish about 3:40. Not something to recommend though!

I was living in Japan at the time of diagnosis. My wife thinks it was doing Marathon des Sables 6 months earlier that triggered the T1, I think I picked up something from all the mossie bites I was getting over the Japanese summer. In the end, we are unlikely to ever know the cause, we just need to live with the results.
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Re: The Official Diabetic Triathlete Thread [non_sequitur] [ In reply to ]
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How much carb do you consume during activity? And what do you consume?

I think its wise you are planning on taking it "easy" at IMAZ and testing frequently

I just did B2B full Oct 26 less than 3 months after being diagnosed. I took a very easy and relaxed approach and finished 13:21. No issues.

I am almost done with my race report. Its taken forever(5 pages) because I'm trying to be detailed on what I did nutritionally and testing in hopes it can help other diabetics in some way.



"Keep those feet moving!" Me
Last edited by: runnerwv: Nov 9, 13 4:23
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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runnerwv wrote:
How much carb do you consume during activity? And what do you consume?

I think its wise you are planning on taking it "easy" at IMAZ and testing frequently

I just did B2B full Oct 26 less than 3 months after being diagnosed. I took a very easy and relaxed approach and finished 13:21. No issues.

I am almost done with my race report. Its taken forever(5 pages) because I'm trying to be detailed on what I did nutritionally and testing in hopes it can help other diabetics in some way.


So far I've only consumed minimal carbs during training, but most of my training has been at a very relaxed pace as well. I plan to use UCAN during the race and have tested that a couple of times such as during the Horribly Hilly Hundreds 200km ride (also ate two 4oz packets of wholly guacomole,) and a 2.4 mile practice swim at a faster pace. I did a 150 mile training ride on nothing but some almonds at the halfway point and then I sucked on a date or two every hour.

I'll have my bacon and eggs for breakfast and then have 2 servings of UCAN early on the bike depending on how my body reacts to the swim. I'll carry extra UCAN in powder, and planning on another 2 servings of UCAN at halfway. I'll maintain an emergency supply of a couple of Bonk Breakers on me at all times, but I'll only use them as needed, further reducing my basal if I trend low.

Since bike to run transition causes a bump of about 30-40 points I'm hoping to target 80-90 mg/dL at the 90-100 mile mark at which I'll cancel my temp basal (currently 0.4U/hr) for about 90 minutes. Once my body begins to settle in to running (about mile 3 or 4), I'll hope to turn the temp basal back down to about 0.1U/hr, knock back more UCAN and then carry on.

This 'plan' isn't set in stone. The only way for me to know a good plan would be to have done this before. I have an outline and the plan is to adjust. During training my body has had the ability to compensate to produce or access it's own carbs whether it's the muscle glycogen, or liver glycogen from gluconeogenisis. I'm aware that it could theoretically run out of these limited reserves, it just hasn't happened to me yet, in part do to increase metabolic efficiency and all the other compensatory factors of being ketoadapted.

My longest training run was 16 miles. I consumed only water (and electrolytes) during all training runs, even on an 80-12 brick. I understand things will probably be different for the full 26 after the swim and bike. So I'll likely consume at least two more servings of UCAN on the run, and carry a bonk breaker at all times.

That's why this one is considered research. Adding in the UCAN shouldn't bother my stomach. I've had an iron stomach in the past and used to be able to play soccer on taco night with little issue. The bit that I have tested UCAN was enough to confirm that I don't have any issues with that either. I'm a proponent of not doing anything new on Ironman day, but I'm comfortable with UCAN and it's very low osmolarity shouldn't cause any issues.

I'm usually about an 11hr finisher (pre-diagnosis and one while un-diagnosed), but I'm okay if this one takes 14 or more. A relaxed approach can actually be pretty fast since it usually leads to great pacing.
Last edited by: non_sequitur: Nov 9, 13 5:45
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Re: The Official Diabetic Triathlete Thread [non_sequitur] [ In reply to ]
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I miss the days where I could workout and only take in water.
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Re: The Official Diabetic Triathlete Thread [amclean] [ In reply to ]
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Thanks Alan,

Hello ST, Coach Cliff Scherb here. My first post...ever and a long time coming but a long time ST reader and fan. Since this is T1 family here I thought I would finally chime in.

About me: Founder of TriStarAthletes.com, T1 Athlete and Coach, 9:07 IM PR, 4:16HIM, 17X IM finisher, Kona 2X.... Coached 100's of athletes, coached for Team Type 1 and Triabetes.... live the endurance diabetic life day in day out.

A little bit more about me…. some of you may know some of this already......as a life long athlete, I have been testing different insulin strategies for racing at the elite level as a triathlete/diabetic. My day job is a triathlon coach/athlete and founder of TriStar Athletes LLC. (A coaching company for athletes) . I work out of our training Lab in Connecticut, creating insulin training plans based on my experiences for my athletes with metabolic cart testing. To date all athletes have seen better A1C's as well as less lows-highs and variability during training and racing.

I have codified exercise and carbohydrate demands to the highest degree; from my early days using syringes, to a more precise approach with a pump regimen. The templates and algorithms I have been using are tested on myself and my athletes. At its core, the testing and modeling takes into consideration, weight, age, heart rate, and insulin to carbohydrate ratios. Behind this data is also a methodology and practice that helps tie in insulin and activity. (I currently am a consultant to several insulin pump companies.)

With this tool I have been able to give precise recommendations to athletes of any ability and in any dimension of activity. (I create individual race/event insulin plans based on intensity, distance, metabolic efficiency, and experience. See sample plan)

Diabetic Coaching Site:

Diabetes and Exercise Conference Video - "Go Go Gadgets" (2013 San Diego Insulindependence Seminar)

Video of T1 Consulting

Currently, we are in the the long term process of getting real time app functionality for closed loop technology. (artificial pancreas) Someday your Garmin/Training Peaks/Insulin pump, CGM will all talk in real time with the cloud and control your pump..... until that day, I hope I can help!

~Cliff Scherb

&#9733;&#9733;&#9733;TriStarAthletes.com
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Karma. I was beaten around the head with it today. Did Mandurah 70.3 and had had trouble with my blood sugars. First time in a long time, i didnt have enough insulin on board. Had my normal 8 units of Lantus, 1 unit Novorapid to cover breakfast. Prior to start the nervousness etc got me to 9.7mmols. Swim went ok but i fell to peices on the bike. Throughout the whole ride i only required 4 jelly beans to keep my bsugar up. To me, that is unheard of. I was seeing readings in the 11mmols, which i really dont race well on. I even began to throw up mid ride but thats prob not diabetic related. Jumped off the bike into the run and quads cramped straight away. I knew that feeling. I was well hydrated, but it was that 'glucose cant get in' feeling. I had to pull out.
Im at a bit of a loss. I did a super-sprint race last week which only lasted 45 mins, but did quite well. Same insulin regime. Last year i did busselton 70.3 and was taking more insulin at that time. 10 units of lantus and 3 bolus units in the morn. I raced a good race on that.
So my question to my type 1 homies. Why can i race like a demon on the short stuff with my current insulin regime and do a 70.3 on 10 units of lantus and 3 bolus units. But fail miserably with 8 lantus units and 1 bolus? Didnt think it was that much difference (insulin amount)? Maybe i just had a shit day with the beetes?
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Just a follow up on this I'm very insulin resistant today despite pulling at the run. I feel like I have done a full ironman, like a truck has run me over. I am jabbing myself like crazy, having a shit of a time trying to bring blood sugars down, this is unusual after the swim and bike leg of a 70.3
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Re: The Official Diabetic Triathlete Thread [marcag] [ In reply to ]
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Thanks for the references, need to check them out.

Thinking maybe I do need a doc who know a little something about endurance sports. Mine has really given me no guidance, just a referral.

My fasting glucose is usually off the wall high, then drops quite significantly throughout the day, especially if I get busy at work and skimp on lunch. I have never really been one to train with food and fluids other than water before so I'm even more puzzled as to handle workouts. Without nutrition on a ride/ run my sugar will be in the low 100's starting out, spike wicked high and then crash me through the floor. Well I am a newbie waiting for an appointment, this will all get figured out in time.

I wish I could find a pattern and fix it, I suppose the specialist will have other ideas though.
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Re: The Official Diabetic Triathlete Thread [caffeinator] [ In reply to ]
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How high is it spiking on run/bike?

How much insulin? What kind and how often?

When I was first given insulin I was going low all the time! I was taking too much insulin



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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coates_hbk wrote:
Karma. I was beaten around the head with it today. Did Mandurah 70.3 and had had trouble with my blood sugars. First time in a long time, i didnt have enough insulin on board. Had my normal 8 units of Lantus, 1 unit Novorapid to cover breakfast. Prior to start the nervousness etc got me to 9.7mmols. Swim went ok but i fell to peices on the bike. Throughout the whole ride i only required 4 jelly beans to keep my bsugar up. To me, that is unheard of. I was seeing readings in the 11mmols, which i really dont race well on. I even began to throw up mid ride but thats prob not diabetic related. Jumped off the bike into the run and quads cramped straight away. I knew that feeling. I was well hydrated, but it was that 'glucose cant get in' feeling. I had to pull out.
Im at a bit of a loss. I did a super-sprint race last week which only lasted 45 mins, but did quite well. Same insulin regime. Last year i did busselton 70.3 and was taking more insulin at that time. 10 units of lantus and 3 bolus units in the morn. I raced a good race on that.
So my question to my type 1 homies. Why can i race like a demon on the short stuff with my current insulin regime and do a 70.3 on 10 units of lantus and 3 bolus units. But fail miserably with 8 lantus units and 1 bolus? Didnt think it was that much difference (insulin amount)? Maybe i just had a shit day with the beetes?

this days is behind me now, and for some reason im still having trouble bringing my blood sugars down. I dont feel sick or anything, but sheesh im hitting the needle like a junkie. Even if i had insulin on me during the race, i dont think it would have helped. I can see why perhaps people do race and inject at the same time now i guess. Im a bit beat up about this, very much at a loss why all of a sudden i have become an insulin whore on race day.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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What was BG #'s during the race?

Sorry you had a bad day

My friend and I ran a marathon yesterday and her BG was acting up. She started in the 300's, it went up into the 400's before coming down to 150ish

She said she was due for a a crappy day

I'm on 10 U Lantus per day as well and have opted to not take Lantus on race days. At least at this point



"Keep those feet moving!" Me
Last edited by: runnerwv: Nov 11, 13 4:35
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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started at 9.6mmols right before the swim. Had 1 bolus unit in the background pretty much cleared out. 8 units of lantus on board. Swam and felt ok, ran to transition with legs like lead. I knew something wasnt right. I could hardly run. Checked my bsugar and after a 30 odd minute swim i was at 6.5mmols. So the numbers were reading ok, but i really had no power on the bike. I just had no energy and was zapped. I had 1 jellybean and that took my bsugar from 6.5mmols to 11. Crazy from a single jelly bean. I was thirsty as hell too. Signs pointed to ketoacidosis, however my numbers werent off the charts high. I dont know, i dont get it. I was well rested, tapered (didnt up my lantus dose during taper when i probably could have by 1 or 2 units) and raring to go. The swim itself was fine. My legs were just shot. I hopped off the bike in T2 to see if i could run and i had really bad quad cramps. I ambled for a km. It took me over 6 minutes. It was a familiar feeling. Cramping because i couldnt get glucose into my muscles. I didnt have enough insulin on board it felt like. I was really nauses on the bike aswell. As mentioned before, i have raced a half on 10 units of lantus and nothing else and blitzed it. No go this time. Such a shit disease where you analyze everything when it goes wrong and still leaves you guessing


Edit: i was very insulin resistant that day and today too. You would think after doing such exercise you would need less insulin. But i have trippled my bolus dosage these past two days because my readings are all way too high. Im going to adjust my basal up a little bit too
Last edited by: coates_hbk: Nov 11, 13 4:43
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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coates_hbk wrote:
started at 9.6mmols right before the swim. Had 1 bolus unit in the background pretty much cleared out. 8 units of lantus on board. Swam and felt ok, ran to transition with legs like lead. I knew something wasnt right. I could hardly run. Checked my bsugar and after a 30 odd minute swim i was at 6.5mmols. So the numbers were reading ok, but i really had no power on the bike. I just had no energy and was zapped. I had 1 jellybean and that took my bsugar from 6.5mmols to 11. Crazy from a single jelly bean. I was thirsty as hell too. Signs pointed to ketoacidosis, however my numbers werent off the charts high. I dont know, i dont get it. I was well rested, tapered (didnt up my lantus dose during taper when i probably could have by 1 or 2 units) and raring to go. The swim itself was fine. My legs were just shot. I hopped off the bike in T2 to see if i could run and i had really bad quad cramps. I ambled for a km. It took me over 6 minutes. It was a familiar feeling. Cramping because i couldnt get glucose into my muscles. I didnt have enough insulin on board it felt like. I was really nauses on the bike aswell. As mentioned before, i have raced a half on 10 units of lantus and nothing else and blitzed it. No go this time. Such a shit disease where you analyze everything when it goes wrong and still leaves you guessing

Forgive me, but do you know what that converts to in the US? I have no idea what that means



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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I looked it up, and have the conversion table



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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I have no ideas but your race sounds just like my friends day. Really nothing she did worked!



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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yep, i guess there are days like that. Just annoying when you pay $320 to even race! The conversion is x18 from memory. 172mg/dl and saw a few 200's. Have raced with that high before, but the body didnt want to know yesterday.
Hows your friend? A bit beat up about it all?
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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A DNF does indeed suck! I hate that for you or anyone!


I am still new to diabetes and trying to figure out what works and what is safe.

Do you use a CGM?

At the marathon yesterday my BG was way high out of bed. Think 10.6 mmol, I have been higher out of bed lately but its usually 8.5-9.5 out of bed.

Took no insulin. I usually take my Lantus about 10am anyways and then 1 u Humalog per 20g carb

Tested 15 min before race at about 8.3 which is where I found I usually want to be because I drop fast, usually. I tested once during the race at around 17 mile mark at 6.7 and then again at the finish at 7.8 Ran a 3:45 , not bad after doing a full IM 2 weeks ago! And just getting this diabetes stuff 3 months ago. Its a work in progress for me. I have to pound the carbs right now, 1 gel every 30 minutes or at least I think I do!?

This is my friends post from FB regarding the race :

MU Half: Today was a very tough. My diabetes decided to act-up. In my Garmin, you can see its effects on my performance. I felt like hell, the entire time, but finished. I have also included my BGs to show not only the time taken from testing, bolusing, and later eating, but also in time. Despite the knowledge/education and training, some days--for no reason--it allows me to remember its presence and vulnerability, which I respect and accept--- it is what it is. I finished, and although I am on the rollercoaster of BGs, I'll be fine and ready to race again next weekend.

BGs:

Last Night 2am (I always due this prior to big runs)- 251, correction dose of insulin
5am (no food or anything)- 439, correction dose of insulin, ate an egg.
7am- Race Time- 341
7:30- 299, no food, pump running
7:45 314, no food, pump running
8:00- 446, no food pump running, 4 units added
8:10- 463, no food, pump running
8:40- 170, no food, suspended pump
8:50- 150, ate 15 grams of carbs.
9:00- 146, finished.

At home, around 10:00--BGs= 57







"Keep those feet moving!" Me
Last edited by: runnerwv: Nov 11, 13 5:08
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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3:45 nice work! your doing really well only 3 months in.

RE: your friend, their blood sugar was through the roof! At 439 (24mmols!!) i wouldnt even attempt exercise. They would have had to have ketones present surely?! They would have needed more than an egg for energy too! By the time they added 4 units and it got them down to 170 it was unfortunately too late by the sounds of it. They had a massive spike from 7:45 (314) to 8 (446). Not enough insulin in their system it seems like. Some crazy high numbers there!
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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coates_hbk wrote:
3:45 nice work! your doing really well only 3 months in.

RE: your friend, their blood sugar was through the roof! At 439 (24mmols!!) i wouldnt even attempt exercise. They would have had to have ketones present surely?! They would have needed more than an egg for energy too! By the time they added 4 units and it got them down to 170 it was unfortunately too late by the sounds of it. They had a massive spike from 7:45 (314) to 8 (446). Not enough insulin in their system it seems like. Some crazy high numbers there!

Thanks! I thought I could do around 3:35 but decided after a few miles that wasn't going to happen and backed the pace down and just ran a steady pace. No real issues, there were a few times I thought I was getting lowish but other than that it went well I think. It was my hardest effort since being diagnosed as far as heart rate. I was a concerned how my body and BG would react if I ran all out marathon so I played conservative.

I don't think those are normal BG #'s for her. I passed her around the 3-4 mile mark(she did half) I could tell something was wrong. I know she likes to keep her BG on the high side while racing. Pretty sure she usually starts in the 300's



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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coates_hbk wrote:
3:45 nice work! your doing really well only 3 months in.

RE: your friend, their blood sugar was through the roof! At 439 (24mmols!!) i wouldnt even attempt exercise. They would have had to have ketones present surely?! They would have needed more than an egg for energy too! By the time they added 4 units and it got them down to 170 it was unfortunately too late by the sounds of it. They had a massive spike from 7:45 (314) to 8 (446). Not enough insulin in their system it seems like. Some crazy high numbers there!

Most of my races have been done in the high teens for blood sugars and sometimes I've hit 20 and above. Last time I did an ironman I was 20 after the bike so injected and then went low...Lately with lantus though I've found that I can get my blood sugars more steady.

11 and 9.6 are perfect for racing imo, as going high isn't going to destroy your race, but going low will...gives you a bit of a cushion.
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Re: The Official Diabetic Triathlete Thread [fulla] [ In reply to ]
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fulla wrote:
11 and 9.6 are perfect for racing imo, as going high isn't going to destroy your race, but going low will...gives you a bit of a cushion.

I tend to race around the 11-13 mark also for the longer races. For the short stuff, I want to eat a lot more at the start because I find the intense activity drops my bg too rapidly.
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Re: The Official Diabetic Triathlete Thread [davet] [ In reply to ]
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Got my A1C done today as we are 2 days out from World Diabetes day result is 5.4%, getting more consistent to the low 5%, which is good. Goal is to break 5% consistently. T1D for almost 14 years now and first time I'm seeing these levels, for the last year was all sub 6%

https://www.facebook.com/...p;type=1&theater

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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I did a 3 stage trail race this weekend, here is a quick writeup. I was racing the full series, and placing is determined by total cumulative time.

Stage 1, Saturday 9AM- 3 mile TT, ~550 ft of elevation gained (according to Garmin). Just an absolutely ridiculous, hilly course, lots of twisty, rooty descents and sharp, steep climbs. Finished in 22:07 for 2nd overall.

BG was high when I went to bed, 238, and was still a little high when I woke up, 198. 1/2 serving of Gu Chomps before, stomach wouldn't let me get breakfast down. Took 10 units of levemir. Post race, I had a cinnamon roll and some pancakes (terrible, I know, but it was that or nothing, all they had at the race). BG registered 221 about 20 minutes after eating. Not a good day so far, took a correction dose, but only had about 90 minutes before the next race, so it was only 2 units (which would normally get me down around 140 after 75 minutes).


Stage 2, Saturday 1 PM- 4.7 miles, ~500ft of elevation. 34:26 for 2nd again. Showed up VERY late, didn't test beforehand. Took a vanilla Gu on the start line. This stage started out on easier trails, rolling grass, more like XC than a trail race. About 1.5 miles in, we hit the first hard climb, and the guys in 1st and 4th place overall missed a turn right over the top of the hill. I was running about 150 yards behind them with the guy who won the race last year, and we ended up running in the whole way together. Two very hard up and down sections with some easier trails in between. Oh, and some knee deep bog. Yuck. The last .05 miles climbed 60 ft, Finished in second again, but with the previous leader taking a wrong turn, I ended up in the overall lead by 1:35 over the winner from last year.

BG was 58 right afterwards, had an egg mcmuffin, some leftovers, and a bunch of other little things throughout the afternoon, no big meals. BG was 60 before dinner, and I was hurting from hunger, so my lady and I made biscuits and gravy, a big bowl of broccoli/caoluflower/peas/carrots, and roasted a chicken. It was glorious, and I ate like a total pig. BG was 145 before bed. I was dosing about 2/3 of what I would normally use throughout the afternoon and evening, and it seemed to be holding me pretty level- apparently my body really responds to doubles.


Stage 3, Sunday 9AM- 10.5 miles, ~1000 ft of elevation. 1:17:01 for 4th on the stage.

This stage was absolutely ridiculous, it hit the hardest sections of both of the previous day's courses, plus two new difficult sections that I had never seen before. I had 1:35 on the guy who was 2nd overall, but he put a little 15 foot gap on me about 3.5 miles in up a long grinding uphill that I chose to hike (trying to keep my HR down). I managed to keep him within about 20 seconds of me for the next 5 miles until I lost sight of him after climbing what I can only describe as a 50 foot high wall. After running the whole second stage with him the day before, I knew that if he was putting time on me, he was really, really stretching himself to do so, so by the time I lost him, I figured he was about 40 second up on me. The last difficult section involved climbing the same two hills twice on different trails, with steep descents and rolling, twisty trails between them. The RD was perched on top of one of the hills, and told me that I was running about 45 seconds behind, and that I had better get moving on the last section or I was going to lose it. Looping down and around the base of the hill a mile later, I faintly heard him shouting "30 seconds!". Crap, I was losing time fast, The legs were completely shot, and I could climb no more. Fortunately, the last 1.2 miles were on flat, muddy path, and I managed to get back into something resembling a rhythm. I even clipped off a 6:10 mile somewhere in there, I guess because the flatland muscles hadn't really been used all day. The finish line is perched on top of one last steep grassy hill, so I threw down what little finish I had and damn near tipped over. Two of the guys who finished already were waiting for me, and given how quick they were to congratulate me, I gathered that I had won. In the end, I pulled back a little time and maintained my lead by 40 seconds.


BG was 118 at 7:30AM, breakfast was coffee and a vanilla gu right before the race. I took 10 units of levemir at ~7:30 AM. Took a salted carmel Gu about 40 minutes into the race, no other nutrition (no time for it either). Tested at 143 right afterwards, so I was very happy with that. Now, if I had only done the Sunday race, it probably would have been much higher, but at least when my body is exercise-stressed, it does seem at least a little bit able to soak up glucose with relatively minimal dosing.

On the whole, my body felt pretty wrecked afterwards, but I'm already bouncing back a little. I even managed a little 5k shuffle yesterday afternoon.
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Re: The Official Diabetic Triathlete Thread [RFXCrunner] [ In reply to ]
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Great Job!

I did the Marshall University Marathon this past weekend. I was interested to see how it would go since I just did B2B Full Iron two weeks ago.

Race Day

Tested out of bed(3:45am) at 191, way high for me, usually around 100-140 out of bed. I ate pizza later than normal, so I think thats the likely reason. I took my 10 U Lantus @ 10 am Saturday, no insulin taken before the the 7 am start(or humalog).

Tested again before eating breakfast 4:22am 174

I ate my normal breakfast for race day, mulitgrain english muffins. I was out of peanut butter so I had to eat them plain, yuck.

Tested 15 minutes before the start at about 150ish, ate 1 Gu gel

I had hoped to try and run a sub 3:35 but knew that was ambishious so I started a little more conservative and I'm glad I did. I knew within the first couple of miles that sub 3:35 would've been very difficult.

So I backed off the pace and just tried to keep it easy and conservative, pretty much going off heart rate.

For nutrition I planned to take a Hammer Gel or Gu Gel every 30 minutes. I was also carrying a camelbak 21 bottle with 2.5 scoops or approx60g carbs. My plan was to drink two of those. I carry own portions in a small running packback along with necessary diabetic supplies.

I only tested once during the race around the 16-17 mile mark and it read 125. I probably should've tested more but it cold and I didn't want to take my gloves off or break pace. The wind was knarely, gusts of 20mph and sustained 10-15mph. This was a flat, double loop course so the wind was a factor. I also had to stop and hit the porta johns 2 times

Splits

13.1 miles 1:49 8:23
19 miles 2:41 8:29
finish 3:45 8:37

Garmin file http://connect.garmin.com/activity/402518024

I tested 145 about 10 minutes after finishing and 185 20 minutes later. My BG was all over the place later in the day. Heres a list of BG tests after the marathon:

12:18 BG 77 Before lunch
12:54 BG 86 After Lunch
1:39 BG 174
3:43 BG 115
5:22 BG 90 (ate a bunch of chips and nacho dip, oops)
5:57 BG 127
7:50 BG 209 Before dinner 5u Humalog 5 u lantus
8:39 BG 200 After dinner ( Giant burrito)
9:33 BG 122
10:33 BG 84

Race went well, especially considering I just did 140.6 two weeks ago. This was more of a test to see how my body responds to carbs and insulin during a "harder" effort. I was concerned that "racing" a marathon I would be more likely to go low both during and after the race. It appears going low wasn't an issue though so thats good to know for the next race. I will be more likely to push that effort harder.



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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It looks like you're chasing your BG a little bit , especially looking at your dinnertime high. You ate a bunch of chips, tested high later on, and then took insulin. If you took insulin with the chips, you might have avoided that high in the first place. My doctor told me very early on (only 15 months, so take that for what you will) that I have to think like a pancreas.
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Re: The Official Diabetic Triathlete Thread [RFXCrunner] [ In reply to ]
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Any other day I would have taken insulin, I didn't take insulin because I was worried about it BG going low due to the race. I'm about 3 months into this diabetic thing, and was very insulin sensitive early on. Next time I race I won't be as concerned about going low and will take my insulin as usual. Like I said this race and B2B was pretty much an experiment. I'm also aware my BG won't always react the same but now I have a better idea of what it might do



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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I had a similar experience when I was first diagnosed. I would take 3 units on insulin for a huge pasta dinner and still end up going a little hypo. That all stopped the first time I got sick- it wasn't that bad of a cold, but it caused real issues with my BG. After I recovered, I had to totally re-learn how to dose insulin. I went from 1 unit/40g carbs to 1 unit/15g in the period of 2 weeks. It has held steady since then.


Speaking of sickness, does anyone have any pointers on how to handle BG while sick? I have only had two colds since I was diagnosed, but both times have been very difficult to control things short of taking boatloads of insulin.
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Re: The Official Diabetic Triathlete Thread [RFXCrunner] [ In reply to ]
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My insulin insulin sensitivity changed about a month ago. I went about 2 months without really having to take humalog at all because I was going llw like crazy. Now I take humalog with every meal, 1 u for 20g carb.

I dont worry as much about going low now.

Also interested to see how my bg responds to anaerobic workouts as I will start working on my ftp soon

Interested to see responses on bg and sickness because I hear it can be bad!!



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [RFXCrunner] [ In reply to ]
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RFXCrunner wrote:
I had a similar experience when I was first diagnosed. I would take 3 units on insulin for a huge pasta dinner and still end up going a little hypo. That all stopped the first time I got sick- it wasn't that bad of a cold, but it caused real issues with my BG. After I recovered, I had to totally re-learn how to dose insulin. I went from 1 unit/40g carbs to 1 unit/15g in the period of 2 weeks. It has held steady since then.


Speaking of sickness, does anyone have any pointers on how to handle BG while sick? I have only had two colds since I was diagnosed, but both times have been very difficult to control things short of taking boatloads of insulin.

Sickness (and stress!) really messes with blood sugar,not much you can do but what your doing. I believe your liver dumps glucose into your blood to create energy to fight infection. Having no insulin means we go high obviously. Hence the boatloads of insulin.

Im finding a few days after a 70.3, despite pulling out on the run, my legs are very sore and as a result im very insulin resistant at the moment. I too am taking boatloads more than normal even post race. You would think it would be the opposite, and we would run into lows. Im not 100% sure why this is, im thinking the body produces glucose to feed into muscles for repair? I actually worry about putting on weight when you have to increase insulin dosage. Im not fat by any means, but increasing insulin dosages always makes me think of it
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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glad to see this thread continuing and people helping each other. I'm not a big fan of a1c penis measuring as, much like the analogy it's not about numbers but about what you do with it and how you get there!

WRT your friend do remember that pumps can have site issues, the insulin could be not clearing from the site and thus the BG remains high. One of the nice things about MDI is the ability to change site with each injection. This isn't an occlusion, the insulin is leaving the pump tube just not being absorbed.


On the off chance anyone is in AZ for IMAZ and still around for El tour we are having a fundraiser, i'd love to have more people from this thread attend (a few already are) and have this conversation over dinner not the internet!


http://volunteers.ayudainc.net/...Detail&id=101041
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Re: The Official Diabetic Triathlete Thread [jamesstout] [ In reply to ]
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jamesstout wrote:
WRT your friend do remember that pumps can have site issues, the insulin could be not clearing from the site and thus the BG remains high. One of the nice things about MDI is the ability to change site with each injection. This isn't an occlusion, the insulin is leaving the pump tube just not being absorbed.

This is often mentioned with a pump but I wonder how frequently it is a problem. I have been pumping for 4 years and never once had a problem with occulsions or significantly altered absorption rates. I have had times that I needed a lot more insulin but that was due to what I ate.

The canula gets moved every 3-4 days. After several years, I do find that some places are harder to insert the needle than before (feels like a rubbery membrane under the skin) but once it is inserted, I don't believe it has significantly altered the absorption.
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Just sidetracking for a bit.

Has any of you type 1's struggle with weight or notice they put it on quite easily? Im 71kgs at 5'10 but i did get up to 75 easily at one stage. I asked my GP if more insulin = weight gain. He said flat out 'yes'. My endo said 'not necessarily'. I understand insulin, in part, is a storage hormone. However, as mentioned previously, what about the times when one is sick? Or goes through a taper and insulin needs increase? Does anyone hate having to up their insulin because they think its 'going to their thighs'? or am i just being a little bitch.

Or, are we governed by the same rules of calories in vs calories out, even if it was all carbs and a lot of insulin to cover?
Last edited by: coates_hbk: Nov 12, 13 22:09
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Hi Folks - great thread. Type1 diagnosed 3 yrs ago. Playing at Triathlon and have done a few marathons.

I find the same happens after a long endurance race. I recently ran Chicago marathon and for a week afterwards my blood sugars were elevated, not dramatically, but certainly a bit higher than normal. The main cause of this is inflammation & stress on the body which increases the amount of cortisol & other stress hormones being released as they help to reduce inflammation. This floods the muscles it with glucose (from liver), to supply an immediate energy source to aid recovery. Also, its worth noting that Cortisol also suppresses the immune system which can cause an increased susceptibility to colds and other illnesses. I've found that a good way to minimize the impacts of this are to take a good Omega-3 Fish Oil supplement to help reduce inflammation, and take a combination of an Immune Boosting Multi-Vitamin Supplement and high dose Vitamin C to help the immune system. Its worth considering doing same during high mileage training weeks before the race.

Wrt to weight gain, Cortisol is a definite driver of fat storage , even in non-diabetics - primarily by driving hyperinsulinemia. Overall for weight management minimizing insulin levels as much as possible are a good thing, through both reduction in stress (mental & physical) and through use of appropriate nutrition as outlined by Vinnie. High levels of insulin are BAD. The last thing we want to becomes is insulin resistant & Type1 diabetics. I'm not going to kick off the Ketogenic debate again - but I've definitely seen huge benefits in from a low(er) carb nutrient dense way of eating. Better recovery, stable weight, good energy levels & improved cholesterol profile.
Last edited by: bmac78: Nov 13, 13 4:21
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Re: The Official Diabetic Triathlete Thread [TriStarAthletes] [ In reply to ]
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Hello, ST

I am posting / giving back a schedule I use with my athletes, mainly to advertise my diabetic coaching services and reach a greater audience of T1 athletes. This is my full time job and what better way to interest new athletes by giving away some of the "secret sauce"!

Here are fueling suggestions for you to try out if you are using an insulin pump. Please keep in mind these are NOT the same as raceday. (A completely different metabolic state) Also keep in mind that insulin on board and types of carbs consumed (slow vs fast) can have a great impact on how things play out prior to exercise and during. To learn more about the decision support system I use with my athletes day to day and on raceday please contact me directly. (Cliff@tristarathlete.com)



TIME 3+ HOURS OUT
FUELING 3+HOURS OUT FROM WORKOUT
  • BOLUS AT 100%
  • LEAVE BASAL RATE ON AT SUGGESTED NORMAL RATE.
  • DETERMINE FUEL STRATEGY DURING WORKOUT AS DESCRIBED IN "O HOURS" OUT STRATEGY BELOW.





TIME -2 HOURS OUT

FUELING 2HRS PRIOR TO WORKOUT

  • BOLUS AT 100% 2HRS PRIOR
  • LEAVE BASAL RATE ON UNTIL START OF EXERCISE, THEN TURN BASAL OFF AT START OF EXERCISE.
  • CONSUME 30G OF CARB AT START OF ACTIVITY (NO BOLUS TO COVER FOR THIS)
  • BOLUS SCHEDULE WHEN BASAL IS OFF……..
  • CONSUME 30G OF CARB AT 45MIN AND ADDITIONALLY 30G EVERY 30-45MIN WITHOUT A BOLUS TO COVER)
  • AFTER 2HRS OF ACTIVITY - DURING THE THIRD HOUR BOLUS AS FOLLOWS…..
  • 3RD HOUR AT 30% FOR "X" CARBS
  • 4TH HOUR AT 20 % FOR "X" CARBS
  • 5TH HOUR AT 10% FOR "X" CARBS
  • 6TH HOUR + AT 10% FOR "X" CARBS
  • ABOVE ASSUMES CONTINUOUS ENDURANCE SUSTAINED ACTIVITY.




TIME -1.5 HOURS OUT

FUELING 1.5HRS PRIOR TO WORKOUT (ALLOWS FOR FUELING OF 150CALS PRIOR, ~300CALS AT START,
  • BOLUS 100% FOR 'X' CARBS, (NO MORE THAN 150 CALS OF CARB (~<1.5U)
  • CONSUME "X" CALS AT 1.5HRS PRIOR.
  • LEAVE BASAL PROGRAM ON UNTIL STARTING WORKOUT THEN TURN BASAL OFF
  • CONSUME ["X" x 2] CAL AT START OF WORKOUT. (BASICALLY DOUBLE WHAT YOU ATE 1.5HRS AGO.)
  • HIGH BG CORRECTIONS (BOLUS AT 40% OF SUGGESTED CORRECTION PRIOR TO START OF EXERCISE)
  • 1HR INTO WORKOUT - CONSUME ONE GEL.
  • EVERY 30MIN OF ADDITIONAL ACTIVITY CONSUME ["X CARBS" x 1/3 OF STARTING CARBS] ( ex: 100CAL OF CARB FROM 300CALS AT START).
  • NEED MORE CALORIES AT 1.5HORUS PRIOR TO WORKOUT? CONSUME PROTEIN OR GOOD FATS.

TIME 0.0 HOURS OUT

FUELING AT START OF WORKOUT (5-10MIN PRIOR)
  • BOLUS AT 40% OF "X" CARBS 5-10MIN PRIOR TO EXERCISE. (MAX CARB TO INTAKE AT START = < 300CALS CARB.
  • TURN PUMP OFF.
  • AFTER 1ST HOUR CONSUME 1 GEL EVERY 30MIN.
  • HIGH BG CORRECTIONS (BOLUS AT 40% OF SUGGESTED CORRECTION PRIOR TO START OF EXERCISE)
  • BOLUS SCHEDULE WHEN BASAL IS OFF……..
  • 1ST HOUR AT 40% FOR "X" CARBS
  • 2ND HOUR AT 35% FOR "X" CARBS
  • 3RD HOUR AT 30% FOR "X" CARBS
  • 4TH HOUR AT 20 % FOR "X" CARBS
  • 5TH HOUR AT 10% FOR "X" CARBS
  • 6TH HOUR + AT 10% FOR "X" CARBS


HOW TO MANAGE DIABETES DURING EXERCISE?, ITS ALL ABOUT “TIMING”.

Prior to Exercise
Prior to activity there can be a mental gymnastics to determine the right amount of insulin and carbohydrate necessary to fuel the body but at the same time prevent low blood sugars or highs. The question that needs to be asked is where am I now and where am I going? If you are going to drive the car just down the block and back, you probably don’t need to fill up the gas tank to full. However, if you were to drive out of state you certainly would not leave home with the light on “empty”. The next thought is how much do I need to stay fueled up and sustain during my activity, and how long and hard is that activity?

As a diabetic, you must ask these questions but also at the same time know the answer to the question of how much carbohydrate do I need to offset current insulin on board. Depending on when your last bolus was (one or more and how many corrections + current basal rate), this for a diabetic determines how much you will need to put into the tank, besides needing gas to go for a drive.

The following paragraphs provide guidelines for how to fuel or not fuel prior to a workout from different time points out from your intended exercise. Options will be provided for fueling up and not fueling up based on goals. I decided to provide this information as well, as more times than not diabetic athletes or those simply wanting to do safe exercise are forced to eat when they do not want to. This can make it difficult to maintain weight and also capture the benefits of key workouts or activities.

Three hours before a workout

Three hours before your workout is a fairly long time away from the actual workout itself. Any insulin you take at this point will have minimal impact on your actual workout or activity planned. The duration of activity of most insulins are between 3.5 and 4hours. (Most rapid acting insulins) Insulin takes time to get rolling, and in the first 15minutes the action on blood sugar will be very little. Novolog, Humalog and Apidra have similar curves where the peak is approximately 50-70min post bolus. From there the insulin falls off rapidly and has a tail of “lowering action” for up to 3.5-4 hours.
At this time you can take a full bolus amount and eat normally. The food choices here should be a combination of short acting and slow burning carbohydrate. The proportion may be 80% slow burning or low glycemic in nature while 20% may be fast acting or high glycemic. As an example, a cup of steel cut oatmeal (Slow burning) and quarter cup of raisins (fast acting) with two tablespoons of agave nectar would suffice for a morning breakfast pre workout. To add additional calories for a longer effort, add a quarter cup of almonds and quarter cup of protein powder.

Three hours later at the start of your workout you would then have the option of a “bolus exercise strategy” or “basal exercise strategy” for the intended activity. (Explained in the upcoming sections below.)

3 hours Before workout Recommendation Summary
  • Bolus normally
  • Fueling Up: Consume a meal with 80% slow burning carbohydrate with 20% slow. A protein component or good fat component may also be added to the meal.
  • Keep baseline basal rates running normally at this time up and to activity.
  • Fueling Down: Consume no food, no adjustment needed prior to exercise. (Note 3 hours is a long time prior to activity)
  • Prior to exercise select a basal or bolus exercise strategy.



Two hours prior to exercise

Two hours prior to exercise is still considered a fairly long amount of time. The reason being is that the food you would be consuming and insulin as well would be mostly cleared prior to activity. However, compared to 3 hours prior, the insulin would now have a direct impact on exercise when you start.

Many diabetic athletes (From now on you will all be called diabetic athletes, since you are at the highest levels of diabetes exercise management)! ......will be tempted to take less of a bolus resulting in somewhat high blood sugars for 90min prior to activity. I believe this is less than optimal strategy as high blood sugar dehydrates the body and also forces the body to urinate out the precious electrolytes and carbohydrate consumed prior to exercise, rather defeating the purpose. Raising the basal rate may be another option but not a great one. Given the amount of increased basal, it will not be enough to cover the food from the meal but enough to cause a low BG during exercise. The result is a high prior to exercise and a low during activity within the first 30-60minutes.

Its at this point that a little math comes into play and some exercising diabetic rules that can be applied each time you bolus or use basal within the 2 hours prior to activity. Many pumps can calculate the insulin on board from basal, bolus and any corrections for highs. This information is valuable as the total amount of insulin on board prior to activity has a direct amount of carbohydrate that must be coming in to prevent a low blood sugar. I sometimes refer to it as the Insulin on board to carb on board ratio. (IOB :COB)

The strategy below is for all activities that are non racing scenarios (ie not a 5K or triathlon race) but rather a level of sustained aerobic activity. For race specific insulin plans and day to day management, the strategy is distance dependent, and heart rate driven as well. Contact me directly for specific race insulin plans or global insulin strategies. The plans are as unique to each sport as they are unique to your own physiology! (Ie no quick math ; )

The relationship is as follows; to prevent hyperglycemia, the total insulin on board must have two times the amount of carbohydrate consumed at the start of activity. At this time a temporary exercise basal of no insulin is selected for the duration of activity.

Total IOB (Insulin On Board, at time of start of activity, including all boluses, current basal rate and any corrections for highs.)

I:C (Insulin to Carbohydrate Ratio, where 1u covers X amount of carbohydrate. Common calculation needed for all pump bolus calculations.)

Ex: (Total IOB) X (Grams Covered by 1u) = carbohydrate to be consumed prior to exercise.

2.4u X 16g = 38.4grams X 2 = 76.8grams (Simultaneously at start of exercise, consume 76.8grams of insulin and apply a temp basal rate of zero units per hour or “OFF” or lowest setting for duration of exercise.

Fueling options two hours prior to exercise are still the same as three-hour recommendations. No adjustments are necessary only the impact the bolus and basals have prior to the start of exercise. You may want to slightly reduce the amount of good fats at this time from your meal so as not to delay the absorption of carbohydrate in the stomach. (Heavy fat meals tend to slow carbohydrate absorption rates and can cause high blood sugar hours after a bolus. Protein has a similar effect except somewhat less pronounced depending on the nutrients in the gut)

At this point you may or may not have realized that there is a maximum amount of insulin on board that you could have at any given time… In general, most GI systems (ie your stomach) can only absorb between ~200-375 calories per hour of carbohydrate. Small individuals may be less and larger individuals more.

Interestingly, this means that the total amount of insulin that someone could have on board would be limited to this bottleneck of carb ingestion. By way of example, if I were to have 4u on board at the start of exercise I would need to consume 128g of carbohydrate or 580 calories. (which may be possible but certainly would not feel very good or allow for performance!) This would cause a low blood sugar for sure.

Therefore based on the examples above, I should not undertake exercise with >=3u on board. Instead I should wait until some of the insulin has passed from my system before exercising.

One hour before a workout (The Insulin “blackout period”)


Getting closer to the time you will exercise, any injections and corrections at this point will have an increased effect on blood sugar lowering. The reason being is that insulin taken < = 90minutes prior to activity will have a greater lowering effect due to its peak effect at ~60minutes from a bolus or correction.

The goal should be to not take any insulin during this time and sustain or fuel yourself with alternate foods that are not carbohydrate based. A source of protein and good fats to satiate you would be best. Examples would be lean turkey meat, egg white, low carb or no carb protein bar, low fat cottage cheese for protein and avocado, almonds, almond butter, and flax seeds. The impact of these foods is little to no raising of blood sugar and no supplemental insulin is needed prior to a workout or activity. When < 90minutes and > 60minutes prior to exercise approximately 50-400 calories of good fats or proteins is possible depending on how hungry you are and the duration of your intended activity.

The reality of diabetes and working out is that “life” happens in a much less structured way. Its quite hard to always start and stop a workout when you want to and its more about fitting in workouts when and where you can. For this reason, there may be times when you are in the 60-90minutes window and you are carb deficient. For whatever reason, lunch was lighter on carbs, or you are just plain hungry and need carbs for energy; what can you do?
Your options are;
  1. Take a small shot to cover a smaller amount of carbohydrate (Ideally < 30g, since you will need 60g to start your activity. This based on keeping 2 x the carbohydrate on board to insulin on board as previously discussed. Any more than this may cause GI distress. Note you are not discounting the bolus in any way but keeping the IC ratio substantially constant.)
  2. Consume a VERY slow burning carbohydrate. In my experience, one such carb that would qualify for this would be UCAN. This product is a powder that can be mixed with water and has the ability to be absorbed over 2 hours. This delay is enough time that no insulin is needed prior to working out. Ucan can be ingested anytime prior to exercise, ~60minutes and less. (The insulin strategy would be take no bolus and leave basal rate “on” until just prior to the workout and then turn the basal rate to “0” or “OFF”.) Based on the fact that most cardiovascular activity that you will be doing will be less than two hours, a consideration for how much carbohydrate on board must be determined. Meaning, at the end of the workout how much carbohydrate is still yet to be digested. This carbohydrate would need to be accounted for and an appropriate bolus taken.
  3. Take no insulin and consume lean proteins and good fats to satiate as desired for the current level of hunger and or upcoming duration of activity. (This in my opinion is the most “easy” way to entertain the 90-60minutes window)

The third option also has better metabolic benefits if the intensity levels are low (Fat burning is going to be higher since less insulin is on board).
The third option can also provide much needed flexibility to when you start your workout. Rarely does it happen that we say we will workout at 5pm on the dot and it does. A phone call comes in, work, chore, or a closed pool?! ....can lead to disruption in a workout and its timing. If you use option #3, if you need to change the start time there is not pressure to do so. Contrast this with the other options where you are consuming more rapidly absorbed (simple carbs) and blood sugar is sure to rise with every minute that passes.
In option three, since you are simply turning your basal rate off when you begin exercise, you can do so with some timing flexibility since there are little to no carbohydrates entering the blood stream.
Option #1 may be a better option for someone who is highly active, and is considering being active two or more times in one day. This will help keep fueling up so that you dont “bonk” during a workout.

To learn more, please visit us : ) or contact me directly.

Cliff@TriStarAthlete.com
&#9733;&#9733;&#9733;TriStarAthletes.com



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Re: The Official Diabetic Triathlete Thread [TriStarAthletes] [ In reply to ]
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would love to see something like this written for MDI folk!
Cliff, you mention not to take any insulin around 1hr before a workout. I agree and dont take insulin during training at all.
Would you take insulin during a race? At what distances?
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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this looked good .....





And then you tagged Ben Greenfield in your Facebook post............
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Thanks! Tri gear being designed and will be available for 2014 !!

http://www.teambloodglucose.com
Empower:Connect:Support:Educate
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Just wondering how people go with CGM's in tri's? are they helpful at all? how long is the delay? Thinking of getting one and taping it to the bike so i dont have to keep pricking my fingers mid ride, and then peeling it off and taking it on the run portion in a spi belt. I am in australia and these are NOT covered by any insurance, so im talking 1500 bucks to pony up. Are they worth it?

As an aside, how do you pumpers race with those things attached? especiialy in a wettie? very curious about where you put them in a wettie, on the bike etc?
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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i found a CGM to be "too much" diabetes, it's delayed which makes it pretty meaningless in terms of alerting you to potential hypos and looking at it rarley told me what i didn't know. Sometimes you'll be high, or low and you don't need a little vibrating box to remind you of it you just need to HTFU and pedal!
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Re: The Official Diabetic Triathlete Thread [jamesstout] [ In reply to ]
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hey James, cheers mate. Thats what i was curious about re: the delay. I understand the dexcom 4 platinum is 5 minutes, i guess my plan was to stop testing and pricking my fingers all the time from the bike onwards and just attach this to the bike and run with it in a belt. Its all about the trends i guess, to keep it in that 'sweet spot'.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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I don't think the monitor is waterproof so most people sync the sensor and the monitor out of the water...I think.

I don't see how it could hurt to have a CGM like Dexcom G4, especially for racing and training. I think the sensors is where you will see biggest cost, pretty sure a monthly supply is about $300

I am likely going to get one in 2014...ironically my deductible is $1500 and so is the unit...so I will be shelling out $1500 either way but at least if its 2014 it will satisfy my deductible as well



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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oh ok. So you cant sync the sensor and place it on your bike in T1, then go swim and it 'detects' it when your in range?
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Re: The Official Diabetic Triathlete Thread [jamesstout] [ In reply to ]
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I think that my Dexcom has been a tremendous benefit when racing. I have it attached to the top of my stem and can view it easily between my arms when aero. I agree that many of us can use our experience to know what our BS is currently, but 20+ years after diagnosis and still I can't accurately predict with consistency which direction I'm trending, and that's where the CGM earns it's keep! - KP
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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There's a sensor that secures to you. YouTube it, looks kinda painful but hear it's not. The sensor is attached by some sort of adhesive patch your the abdomen (or possibly other areas). The sensor is waterproof (I believe) w dexcom G4. The monitor unit is not water pproof. Think the range is like 10th or something between monitor and sensor. So I think most folk just sync the monitor and sensor in to a bond attached the monitor to the bike



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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I've been using Dexcom for a few years now, so I'm experienced with it. The new G4 Platinum has a range of about 20 feet. The sensors are designed to last 7 days and the adhesive they use is good, but depending on your skin, it may not last the full 7 days. My race routine is this: I put on a new sensor two days prior to race day (Sunday race = new sensor on Friday). As a general rule, you should calibrate at least twice per day, which requires nothing more than using a standard monitor and entering the result into your Dexcom. On race morning, I wait until the last moment before transition closes and then test with a monitor, enter the result and then attach my Dexcom to my bike. I put it in a snack sized zip lock back and it stays dry. After the swim, it takes about 5 minutes for the receiver to connect with your sensor...after that, you have your Dexcom with you for the duration. In T2, I simply pull the Dexcom receiver off my bike and stuff it into the pocket of my jersey (still in the zip lock bag).
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Re: The Official Diabetic Triathlete Thread [KP-NJ] [ In reply to ]
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I see . So when ur in T1 do u have to recalibrate or anything or it just takes 5 mins to pick it up with nothing else to do?
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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I basically do the same with my medtronic cgm. Calibration is every 12 hours so I make sure I calibrate fairly close to the start of the event. I'm wanting to do a finger prick then anyway so no problem. Then I remove the pump at the last minute before the start.

the sensor will hold about 20 mins data before dropping so if you are doing a short swim you are back in time and the sensor and pump will rejoin without doing anything. Longer than 20 mins and I need to do a calibration in T1 to get them back together.

Some people disconnect the pump and put it in a plastic bag inside their wetsuit so that the sensor and pump are always in contact - I haven't been game enough to try that yet.
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Re: The Official Diabetic Triathlete Thread [davet] [ In reply to ]
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wow. Does it take you ages to put the pump back on? Do you run into trouble with longer swim events taking the pump off?
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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coates_hbk wrote:
wow. Does it take you ages to put the pump back on? Do you run into trouble with longer swim events taking the pump off?

Pump only takes seconds to disconnect/reconnect. The canula has a quick release attachment so you leave the canula inserted and just disconnect the tubing from it.

Never had problems with having the pump disconnnected (or connected but turned off) on longer events.
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Re: The Official Diabetic Triathlete Thread [davet] [ In reply to ]
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awesome. I do think about getting one quite a bit. Feels like kind of a big step. I hear people put on quite a bit of weight when they get on a pump. Plus there is trying to learn basal/bolus routines all over again whilst trying to exercise at the same time. I probably will one day. The dexcom seems quite valuable too, but again i guess it depends on that lag. Trending data is good though.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Medtronic makes a pump/cgm combo

Theres another pump that is actually waterproof(omipod I think) but it has no CGM

I'm going to try and go without a pump and just do injections with a CGM.

Wouldnt a CGM basically give you the same data as a pump?



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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runnerwv wrote:

I'm going to try and go without a pump and just do injections with a CGM.

Wouldnt a CGM basically give you the same data as a pump?

The CGM is doing data collection. The pump enables you to change to smaller doses. They are separate functions and there is no need to have them together.

If you are doing fingerprick tests you are getting maybe 10-15 data points a day, which means that there can be long periods where your BG is fluctuating without you realising. With a CGM you are getting 288 data points per day (every 5 minutes). This gives you much better analysis. And you don't need to have a cgm on all the time to get the benefits. At the moment I tend to put on in for a couple of weeks every 2 months, normally when I have a big event coming up or a significant change in my life (travel, food, exercise program etc). The CGM helps me track how those changes are affecting my body.

The pump allows you to switch from having long acting basal in your system to being able to microcontrol your base insulin levels. You have different basal needs throughout the day and the pump allows you to set a dosing schedule to match that. Also for longer events, being able to reduce basal levels is great. You can have fine control of your bolus with MDI but a pump gives you the ability to fine control your basal also.

There are advantages to having both - if you can see how your BG levels are moving about every few minutes you can adjust the amount of insulin to match, but you can use either independently.
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Post deleted by oceanlife [ In reply to ]
Re: The Official Diabetic Triathlete Thread [davet] [ In reply to ]
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How about some Turkey Trot race reports?

I did a local 10k. I've been a little ill over the last week, so my hopes weren't high for a great race. My mother was doing her first 10k ever, and there was a fastest mother/son category, so I figured I'd give it a shot.

BG was 136 when I woke up, better than normal. Breakfast was about 2 hours before the race, a small bowl of raisin bran, taken with 2 units of Apidra and 10 units of Levemir.

Warmup was... minimal. Less than 2 minutes of jogging. It was about 18 degrees out, so I didn't want to spend too much time outside before the race. The field was fairly competitive, lost of sub-36 guys toeing the line. The course is shaped like a P, with the first 5k mostly downhill and second 5k rolling and then uphill on the way back. Went out just a little bit too hard, 5:35, and slowed back just a little bit to come through 5k in 17:40 or so. Next two miles were a little tough with a couple of rollers, and I ended up being caught up by a couple of guys who I didn't recognize. Making the final turn, I was running just off the shoulder of a guy in a Boston Marathon shirt with another guy just off of my shoulder. Just after the 5th mile, I noticed my legs starting to get a little heavy just as Boston man made a little push up a slight hill. I hung in there, and just as I pulled even, the second guy made a harder move and dropped the pace down in the 5:15 range. Boston guy dropped off, and the pace eased up slightly. Up the road, I could see the police car blocking off traffic where we turn into the finish, and I estimated we had about 3/4 mile to go. I didn't think I would have much of a kick from my legs being heavy, so after a minute of futzing, I broke for home and dropped the pace back down again and put in a good burst for a minute. I managed to create a little gap and I held it all the way into the finish. Crossed the line at 36:06, so a pretty healthy positive split, wah wah :(

11th place overall, and my Mother finished in 58:30, top 25% of her age group in her first race over 5k! To top it off, we won the Mother/Son division by over 5 minutes :)

Tested my BG after the race, and it rang up at 253. I have to imagine that contributed to my heavy leggedness, as well as racing in a trainer instead of a racing flat.


How about you guys? Any Turkey Day reports?
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Re: The Official Diabetic Triathlete Thread [RFXCrunner] [ In reply to ]
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Nice job! Thats great both you and your mom raced!!

I had planned on a 5k pushing my 18 month old but it was too cold so I stayed home and rode an 1:30 on the trainer

I hear lots of folks say their BG goes up when going anarobic. I am just now starting to test the anarobic waters.

On Friday I planned a 13 mile run but ended up having to cut it short due to low bg. I screwed up at lunch, took 2 units Humalog which is fine unless Im going to run. Just poor planning on my part.



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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So now that winter is here I have my bike set up on trainer and using trainer road.

I am now some anarobic work on the bike and will be starting on the run soon.

Just curious how anarobic work effects your bg? I hear folks say by goes up during anarobic work



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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everyones a bit different, but most people find the bursts type of workouts raise blood sugar, atleast for a while. I sometimes find during TR workouts that have VO2 max intervals, that my bs will be trending down during the easy cycling parts, but will shoot through the roof when i do even a few minutes of over threshold stuff.
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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runnerwv wrote:
So now that winter is here I have my bike set up on trainer and using trainer road.

I am now some anarobic work on the bike and will be starting on the run soon.

Just curious how anarobic work effects your bg? I hear folks say by goes up during anarobic work

My understanding is that anaerobic work can
a) trigger the liver to produce glucose to satisfy the need for energy
b) trigger the production of hormones that will increase insulin resistance

My BG definitely goes up. I am T2 so don't have the ability to cover with insulin. Given insulin resistance possibilities I am not sure how T1s handle this.

When racing 10k to HM, my BG is always through the roof at the end of the event, and I take 0 carbs many hours before.
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Did a sprint tri last weekend, so ill post up a bit of a report, albeit short.

Pre-race I was around 6mmols (108) after bolusing 2units for breakfast (i normally have 1 unit, but had 2 to counteract those pesky adrenaline highs) and most of the insulin was out of my system. I had my normal 9 units of lantus on board. The race was a sprint distance, so much of this was going to be a crap-shoot. I had 3/4 of a powerbar gel prior to the swim.
Swim: 160/286 (20/30 in age group). I have swim issues obviously. Believe it or not i was very much back of pack at one stage of my tri life, but made a bit of an effort with my swimming, hence am about middle of the road. The swim itself was rather uneventful except for large swell and rolling waves with the usual elbow's here and there.
T1: had my accuchek mobile glucometer there which makes testing pretty quick. Did this while i got out of my wettie etc, and i was 6.5mmols (117). jumped on my bike and away i went
Bike: 31/286 (3/30 in age group) Had a decent bike. Being in the second last wave and a slow swimmer meant noone passed me on the bike and i passed a fair few. As for blood sugar, i just had a glucose tab every 10 mins. Biking doesnt smash my blood sugar too much at that intensity.
T2: After finding my stuff in which i ran past (first time i couldnt find my belongings in transition!), I grabbed my glucometer and a gel and was off for the run. Tested while running and leaving T2. I was 6.5mmols again which is great!
Run: 51/286 (6/30 age group). Run time for me wasnt great. Im usually a better runner and actually ran just over 4mins per km which i wasnt pleased about. I had half of that gel i carried with me at the turn around point 2.5kms in.
I came 61st/286 and 8th in my age group.
When i finished my bsugar was 6mmols, but 20 mins later it peaked at 12 mmols (216) so i prob over compensated with the gel, but my numbers were stable during the race and not peaking high or low. I find i need more sugar during swimming than anything. In 70.3 and olys i put a gel in my cap or up my sleeve and stop about 3/4 into the swim to suck one back. In fact olys i might now be able to get away with one gel prior to starting because im a bit better swimmer than before.

I have a few olys coming up in the next 6 weeks, as well as a 70.3 in may. Im going to experiment giving myself a quick bolus of 1 unit during 70.3 bike training to see how it effects me.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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You should be very happy with those blood sugar levels. I've had diabetes for 23 years and wish my levels were like that all of the time in races!

I'd probably be scared if I started the swim with a 6.0 though...I like to give myself a bit of a cushion on the swim,

How did you find testing during the race?
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Re: The Official Diabetic Triathlete Thread [fulla] [ In reply to ]
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It would be a nightmare normally, but my glucose monitor is an accuchek mobile , it's 50 tests on a type of tape- I push back the cover and a test strip appears, no unwrapping single strips and inserting etc. the 'pricker' is attached to the unit as well. They are good for sport because they don't take much time to suss it out. I test on the aerobar a etc in long races and keep it in my bento.
I normally wouldn't swim with 6 mmols either hence the gel, plus I know nerves etc hold me steady for a bit. If I start the swim too frantically I can blow my race though and my bsugar skyrockets towards 13mmols plus. If I start out easy, bilateral breathe and relaxed, my bs behaves a bit better. It costs me a bit of time on the swim coz I'm faster swimming breathing every second stroke etc, but I swear the intensity isn't good for blood sugar!
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Congrats. That's very well managed. I love reading what works for everyone and how each of us has to get to know our bodies so much more than non-diabetics. I like the look of your accuchek mobile, the preloaded coil of strips is a good idea. For my last race I kept the meter velcro'd to my stem and then had my stabber and strips on tethered lines, but stored in my bento box. I've often wondered why more units are designed with built in stabber jabbers and strip dispensers.
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Re: The Official Diabetic Triathlete Thread [non_sequitur] [ In reply to ]
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its funny how we manage blood sugar on things like bikes. I remember in an oly once, i passed one of my friends while i was stabbing my finger and fiddling around with the accuchek. He thought i was texting someone during a race haha.
Like yourself, im looking into buying a dexcom 4, and am trying to figure out the most 'aero' ways of storing it on my bike (similar to your meter velcro'd to your bike). We have to pay out of pocket for these in Australia, so im not sure if they can be something i can substitute for a glucose monitor in a race. Some people give feedback that they are great because there is only a 5 minute lag, some say they are horrible for sport when blood sugar doesnt 'match' interstatiol (spelling?) fluid. Im trying to set up a loan one to use during a race and see how it goes. I guess the unit could be stored in the bento and i can just bring it out every now and again to glance at, but it would be great if it was something i can just look at it like my garmin. Again, i would have to have trust in it too, so thats another thing.

Im really keen to hear from people who race with CGM's, particularly this model mentioned, to see if they are worth it.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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I've found the Dexcom G4 to be accurate for non-exercise, but considering my numbers are rather rock solid I don't gain much from it other than having one more device to distract me from real life. I wish interstitial values trended more precisely with my blood values. I've already learned to trust my feelings and senses over what the CGM says.

I feel the devices are still of great value and will probably be giving mine to my mother who rarely tests BG more than twice daily. She could benefit from seeing more of a trend and perhaps be able to connect what she eats to what that line does. If she doesn't want it maybe I'll put it on the classifieds.

There was a young girls blog that I stumbled across this year - she titled it "Texting my pancreas". I thought that was clever.

Where in Australia are you? (Just curious since it's -4 degrees F in Madison, Wisconsin)
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Re: The Official Diabetic Triathlete Thread [non_sequitur] [ In reply to ]
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Just perused this thread, kudos to all of you!

On a related a note, I'm curious if anyone has participated in the Tour de Cure New England or has any insight into it. Specifically, the 550 miler. I've decided to switch to touring in 2014 and, as I know my share of people affected by diabetes, this appeals to me.

Thanks in advance. I don't mean to intrude on the thread but at a minimum perhaps can raise awareness of the event:
http://main.diabetes.org/...id=9340&pg=entry
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Re: The Official Diabetic Triathlete Thread [non_sequitur] [ In reply to ]
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Sorry i didnt see your reply!
Im in Perth, WA....so we have been hitting near 40 degrees (celcius) here. So you dont find your interstatial values match your bsugar values?

Anyway, another small race report: West Aust. state championships, sprint distance.
Conditions: Hot. Bloody hot. Non-wetsuit and the water temp wasnt even taken- it was this way purely because of the outside temp. My wave was at 9pm which is late aswell.

118 males 30-34 age group
26th overall

Swim: 16:xx (67th)
Im a MOP swimmer WITH my floaties, so without my wettie i expected to struggle. The distance was slightly longer, but it mattered little. 2hrs prior i noticed my usual bolus wasnt bringing me below 7.5mmols, so i had 1 unit and that only got me to 6. Damn nerves/adrenaline. Before swim start i had a powergel. I suck at swimming.
T2: check bs and i was 9.8mmols. Didnt need nutrition obviously anyway, so all good as long as i dont go higher. My T2 time suffers a little because of testing etc and it costs me places, but im not kona bound here.
Bike: 31:xx (7th)
I rocked that beotch. Very happy on my trusty steed. Course wasnt too hard, some small rises/hot wind one way, but cant complain. I took 2 jelly beans, maybe twice throughout the ride. Didnt test on bike at this distance/speed.
T2: took my glucometer with me and tested while i trotted out of transition. 9.8mmols. No more nutrition needed for me here on out.
Run: 22:xx (32)
a Slow run for me but coming in 32nd out of my age group probably means everyone was suffering in the heat on the run. Some slight rises etc, nothing serious, again it was just the heat and hot wind.
Finished with 1:14, which isnt a fast time, but it got me 26th which suggests we were prob all struggling a bit. BS at the end was 5.3mmols, so landed perfectly.

Question time!
1) I can get away with sprints with minimal nutrition and assume most can and do. Does anyone jab themselves (bolus) in transition at short events due to the rises?
2) Do your blood sugars behave the same with 70.3's and sprints/olys? Or do the latter tend to spike your blood sugar more due to the intensity?
3) Anyone bolus during a 70.3 or even olympic? When and do you have to do it more than once? I think if i have another race where im hitting 9.8mmols in an olympic as an example, i cant trust muscle contraction/exertion to bring my blood sugar down naturally. I have been doing a lot of sprint type tri's lately and noticing that if i had to keep going, i wouldnt be able to take in nutrition without a bolus. But then i think on the flip side, if doing a 70.3, your intensity is lessened and blood sugar may behave and come down 'naturally' so i wouldnt need a bolus.
Im going to have to test in training, but i would love to hear from those who bolus during events, with how often, their regimine etc?
Cheers
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Well i just got hooked up on a trial for 2 weeks on a dexcom G4. Sensor is firmly in my upper ass cheek! I calibrated, had trending arrows and then decided i would put it to the test for an hour run. Well it didnt go well. I had a powergel before i left and it took 20 mins before little dexy even registered a rise in bs. I figured i would roll with it and just keep going because the gel had caffeine in it, so maybe i am staying higher for longer. Wish i had my glucometer on me. Anyway, running along, i lose my trend arrows. I start to feel a bit woozy, not too bad, but dexy says 8.5mmols. I have a couple of glucose tabs because i dont trust it thus far. 15 mins later the readings start to rise again right u to 11.7mmols. I tested at this point because i finished my run and i was 3.9mmols. And now i have been given the ??? marks of doom. How annoying!

Its now working again, however had me steady at 4.8mmols, then a small rise to 5.4mmols over about 15 mins....i checked with my glucometer and im 3.8mmols. This thing not only missed a minor low, it was actually trending the other way. So far, these things are pretty shithouse.
How do people race with these things? The lag on them must be annoying? Do you lose trending arrows?
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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There is a difference in physiology between blood and interstitial fluid. Not only do you have to calibrate the unit, I think it helps to recalibrate during any period of differing physiological demand. (if that makes sense). The Dexcom reads accurately when I'm standing around doing very little, but once I start exercising I have to recalibrate. Now the trick is that whenever you recalibrate you should be in a steady state (not trending up or down). I found it frustrating as well and have decided it's just not worth it to me. I'd rather learn to trust my own senses. I'll keep playing around with it in the future. I'm wondering how successful other people are.
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Re: The Official Diabetic Triathlete Thread [non_sequitur] [ In reply to ]
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im starting to think it isnt worth it either, especially considering we have to pay for it here in Australia (its $1800 all up). As i type this, its buzzing at me to treat a low of 2.3mmols, when im actually 5.7....yes thanks for 20mins ago as well as another recalibration inbetween dexy :|

Unless it improves to that 5 minute mark, this thing is crap for exercise for me. False trending and the lag is rediculous. Ill stick to the trusty accuchek mobile i think, and just keep testing on the bike and run.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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So I have done a couple of HARD anarobic rides in this week, the first since my T1 diagnosis in August. It does appear that going anarobic makes my bg go up.

Start ride at 160 and finished at 227.

It would appear I don't need carb intake for these short anarobic workouts since it pushes bg high.



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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yep this happens a lot and can be a pain in the ass. When racing, you can add adrenaline to the list and all of a sudden your blood sugar skyrockets. You have to be careful not to get too high. Some people can race upwards of 13mmols, but i find i really become lethargic above 11ish. Sprint distance racing you may not need much carbs.



Took the dexcom out again today on an easy ride. Started at 10mmols and spent 20mins in an upper tempo type of pace and i checked my meter and it said 4 mmols (tail end of insulin still on board) where the dex had 6.4mmol and dropping. I can forgive that due to lag obviously. Later on though im treating a 3.8mmols (glucometer reading) where dex says im 7.4 and rising. I envy the people who this device actually works for and race with. Day 2 for my trial, and its still shithouse
Last edited by: coates_hbk: Dec 20, 13 19:14
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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My pump is now due for replacement and I have been offered the option of either a new Medtronic or an Omnipod. Anyone got any recommendations?

If I chose the Omnipod
- Waterproof
- No tubing
- Can insert anywhere I can reach with one hand

If I chose the Medtronic
- All the controls are on the pump, no need to carry an additional device
- integrated CGM

Having everything in the pump might be the key point for me. When I am doing something long, it's great to be able to just look at the pump, see which way I am trending and make adjustments. If I was running a marathon for example, I am not carrying my meter but I still have control over my pump. I think that might be a problem with the Omnipod as I would need to carry the controller as well.

I know some of you have an Omnipod - what do you do?
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Re: The Official Diabetic Triathlete Thread [davet] [ In reply to ]
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I dont have a pump but have looked into the medtronic and know a bit about the omnipod.
Firstly, the medtronic's CGM system is rather inferior to the Dexcom- in fact the lag time to match blood sugar is around 20-30mins. Useless in a race. I personally found the Dexcom's lag of 5mins useless. A lot can happen in 5 mins and thats assuming the trending data is accurate. I seriously wouldnt use the CGM as a selling point, particularly from medtronic.

Are you able to test drive a pump? They have programs here in Aus atleast where you can trial one for a while. If it was me i would go the Omnipod. Tubeless, waterproof, good times.
You may have better luck with CGM's than i did, but for our sport, it didnt work for me. Blood sugar changes too rapidly for it to keep up and the medtronic would be worse in that regard.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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coates_hbk wrote:
I dont have a pump but have looked into the medtronic and know a bit about the omnipod.
Firstly, the medtronic's CGM system is rather inferior to the Dexcom- in fact the lag time to match blood sugar is around 20-30mins. Useless in a race. I personally found the Dexcom's lag of 5mins useless. A lot can happen in 5 mins and thats assuming the trending data is accurate. I seriously wouldnt use the CGM as a selling point, particularly from medtronic.

Are you able to test drive a pump? They have programs here in Aus atleast where you can trial one for a while. If it was me i would go the Omnipod. Tubeless, waterproof, good times.
You may have better luck with CGM's than i did, but for our sport, it didnt work for me. Blood sugar changes too rapidly for it to keep up and the medtronic would be worse in that regard.

Actually I have been using an medtronic for 4 years and a CGM for most of that. Once you know what you are doing with calibration you should not have any worries about accuracy and I have it pretty much dialed in now. I found the CGM to be very useful in races that are longer than 3 hours. Trying to do a fingerprick in the middle of a trail ultra pretty much requires you to stop, but a quick look at the CGM lets me know how my BG is trending and if I need to eat or dial back the dosing.

I used to live in Sydney, but I am back in the UK now so I'm getting the replacement pump on the NHS which is nice. Good point about test driving the Omnipod, might see if I can do that and if having the separate component is a pain.
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Re: The Official Diabetic Triathlete Thread [davet] [ In reply to ]
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ahhh you have had the medtronic before, ok cool. Im glad the cgm works for you, it was a real pain for me. I only trialled it once, and it was all over the place. Telling me im over 7mmols trending up yet my bsugar is 3.8. Tonnes of false hypo alerts, it was just a pain. Im fortunate that i dont have to stop to test, i use the accucheck mobile glucometer, it has 50 strips on a tape which circles around itself. Has the finger pricker attached to it. Its not ideal in that i prick on my aerobars and blood can splatter on bumps or i get an error message from not enough blood etc, but i dont have to unwrap a single strip and insert it into a machine and so on.
I hear great things about the omnipod, hopefully your local rep will sort out a trial one for a month or so
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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It took a few sensors before I got the technique right but since I was getting the sensors free (again, yay NHS) it didn't matter. By the time I got to Sydney and was paying for them myself I knew what I was doing. If people are starting off with cgm then some guidance would be useful.

I used to use the old accuchek mobile for testing on the bike but don't use it as my everyday meter due to the noise. Even using that one is a pain compared to a correctly calibrated cgm. I'm a meter kleptomanic so I might contact roche and see if I can score a free one and see if the new one is any better.

If I am running a marathon, I carry nothing extra, not even a meter. For shorter races it doesn't matter, for longer races I have a backpack and carrying a meter is not too much of a problem and a few seconds to test isn't a big deal either.
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Re: The Official Diabetic Triathlete Thread [davet] [ In reply to ]
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i have a feeling i would rob need a few goes at the CGM. The educator basically stuck it in my upper ass and put some special clear tape over the top- of which i bought some fixamol aswell to cover. I had to download the info from dexcoms website to see how it all went. The educator said i am the first person she has seen that this has given bad readings for and been inaccurate. Maybe it was a dodgy site. Im allowed to have another go, maybe i should put it on my stomach or tricep. The educator tells me they are selling like hot cakes to athletes in general. Who knows. I found it a big let down, as like you, i was hoping i could race with it without the need for the mobile accucheck glucometer. Your right too, it is a noisy thing haha. I was testing on the bike and went past one of my mates on a tri one day. He yelled out 'whats so important that your texting during a race?!!'.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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I've never had anyone else insert a canula or sensor for me - I have always done them myself. This means that I do all my insertions into my abdomen as I need both hands. that's one of the things that I see as an advantage with the Omnipod - I will be able to insert in a wider variety of locations.

Anyway, I believe that other people on this site use Dexcom so they should be able to give you some tips on how to get the best results. Once you see the results of a properly working cgm, you will be reluctant to go without it.
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Re: The Official Diabetic Triathlete Thread [davet] [ In reply to ]
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Am I the only one that doesn't use a pump or take insulin at all during a race?



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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I did a 50k trail race(Frozen Sasquatch) on Saturday, my first ultra run. WOW, what an experience. I didn't really train for this beast and was just doing it because a T1 friend of mine challenged me.

My BG was 165 @ 6am(dawn effect) and down to 125 by 8am start. No insulin other than the Lantus I took at 11am the previous day. Breakfast was 3 boiled eggs and I had one Gu gel 10 minutes before the start.

A cold front came through overnight so the 8am starting temp was 9 degrees and even colder on the snow covered trails! BRRRRRR!!! This is was a 2 loop hilly course, total elevation was 5000ft of climbing.

I was so cold at the start it was unreal, my hands were stinging and going numb. But I quickly warmed up once we hit the first climb. It was beautiful out there, everything snow covered and peaceful. No real goal in mind, I just wanted to take it easy so I figured 6ish hours.

Nutrition plan was one bottle of Hammer Perpetum(2scoops) every hour plus Gu gel when needed. I carry a small backpack so I can stash my own supplies. So for the first loop I carried 3 pre measured sandwich bags of Perpetum(I always have one extra) plus 4 Gu gels. I refilled my bottle approx every hour at the 3 aid stations spread along the 15 mile course.

Things went pretty good on the first loop, made it through the check point around 3:06, not bad. Stopped at my car and put my supplies in my back then tested BG, it was 95 a little lower than I would like. I try and stay around 120-140.

Going into the 2nd loop I had a lot of dread as I wasn't really looking forward to running another 15miles and 2500ft of climbing! The 2nd loop was without a doubt one of most mentally challenging things of my endurance career. On the 2nd loop I saw only one other runner as I was in no mans land. It was mental HELL!! I tried to keep positive but it was difficult at times. But I kept moving and crossed the line in 6:38 and I was VERY happy to stop running!

BG at finsh was 115

Kudos to all you ultra folks, that was without a doubt one of the most difficult races I have every done! (and probably last ultra!).

PS- I ran an 8k race yesterday :)



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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I've got a question for any of you that have CGM's. I just got my Dexcom today and started using it, so I'm really curious how others are using them during training. I'm looking forward to having it in my jersey pocket while cycling, but I'm a bit undecided on how I'll use it during runs. I'm thinking it'll be great to have with me on treadmill runs, but not so sure I'm gonna want to take it with my on outside runs. I have a thing about running with a lot of crap on me, it just doesn't feel right. Usually I'll bring a gel or two and thats it.

I'm also looking for any tips or advice, different sensor locations, how long your getting sensors to last or any other good tricks or tips.

Thanks
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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Hi folks, I haven't been on this thread for a while, and my apologies to those who kindly answered my question a few months ago. Its just that this is new, and I still am having a hard time accepting all of this. I've been in tri since 1990, always ate super healthy; rarely ate processed carbs/ sweets ...

Anyway here I am.

Don't have dexcom yet, trying to get but that might be a while.

Race and workout blood sugars range from 40 to 275 so need to check.

What's the easiest glucometer to carry for that purpose? I need something quick and easy, drives me crazy to see other people going by during a race while I fiddle with my usual device wrapped in a ziplock and strips in the little cannister?
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Re: The Official Diabetic Triathlete Thread [caffeinator] [ In reply to ]
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certainly changes everything, I will show you what I ALWAYS carrying with me on nearly every run/ride

-I use the Aphimpod belt to carry my GM,lancer and test strips http://www.amphipod.com/...cs/airflow-endurance
-I use the glucose meter because its small and fits easily in my belt http://www.medicalsupplycorner.com/...ite=pricegrabber.com
-I also almost always take this small backpack to carry gels and supplies as well http://gomotiongear.com/...o&products_id=17



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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runnerwv wrote:
Am I the only one that doesn't use a pump or take insulin at all during a race?

I don't take insulin during a race or use a pump. I did a half ironman yesterday and my levels were 15.6 prior and 13.8 after...sorry not sure what equivalent is in the american etc measurement. Happy enough with those blood test results, prob drank too much coke on the run
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Re: The Official Diabetic Triathlete Thread [non_sequitur] [ In reply to ]
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Thanks for the info on the Bayer glucometer. It looks a lot easier to to carry than what I have now. As long as its accurate I'm going to get this model. Thanks so much for the tip.
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Re: The Official Diabetic Triathlete Thread [fulla] [ In reply to ]
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fulla wrote:
runnerwv wrote:
Am I the only one that doesn't use a pump or take insulin at all during a race?


I don't take insulin during a race or use a pump. I did a half ironman yesterday and my levels were 15.6 prior and 13.8 after...sorry not sure what equivalent is in the american etc measurement. Happy enough with those blood test results, prob drank too much coke on the run

Can u race well at those figures? its funny how individual this can be, i find anything kind of over 13 and im a slug
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Re: The Official Diabetic Triathlete Thread [Cppike79] [ In reply to ]
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Cppike79 wrote:
I've got a question for any of you that have CGM's. I just got my Dexcom today and started using it, so I'm really curious how others are using them during training. I'm looking forward to having it in my jersey pocket while cycling, but I'm a bit undecided on how I'll use it during runs. I'm thinking it'll be great to have with me on treadmill runs, but not so sure I'm gonna want to take it with my on outside runs. I have a thing about running with a lot of crap on me, it just doesn't feel right. Usually I'll bring a gel or two and thats it.

I'm on a medtronic pump so the CGM is no additional equipment other than the sensor. it didn't take long to get used to the pump being on my belt during an event.

For anything under 10km, just wear the pump/cgm. I don't carry a meter.
For 21-42km I may carry a meter in a spi belt but don't expect to use it.
Over 42km I am carrying a small pack anyway so carrying a meter as well doesn't matter.

I have the bayer meter (actually the newer model but the same size) and also the freestyle lite, both of which are quite small. Meter, lancet and a couple of test strips into a ziplock and into the spi-belt and I don't even notice it is there. the spi is also my race number belt.
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Locally, in the last month two teenagers have died from DKA and a friend of mine(and endurace athlete) was in ICU for DKA. I'm not sure I have my head wrapped around this thing

Have any of you gone DKA?

How common is this in Type1?



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Had the state oly distance champs today in West Australia. 106 males in my age group.

Swim: about 5 minutes. Funny. The current in the estuary waters was a thousand miles an hour. After witnessing the kids tri and enticers, they decided to change the swim course because people were swimming in one spot. To how far? About 200m give or take. With the current. Awesome sauce. It took me 5 mins including the decent run back to transition. Now THATS how you do an oly swim leg!

Was at 7mmols and had a gel before hitting the water to carry me through to the bike leg

Bike: 1:04, 19th/106
Not too bad, cross winds were up and about. Pretty flat ride. Felt good in that i had lungs, was breathing well, cadence was averaging 96rpm.

Early second lap i had 3 large jellybeans and a glucose tablet. Checked my blood sugar during the end of the second lap (of 3) and i was 14.8!! shit, too high for me. Usually when i hit this high, its as if my body goes into ketosis. Does it actually? dont know. Its that sluggish feeling you get, body turns to body fat for fuel, your out of energy and nothing goes right. If i had my needle i seriously would contemplated injecting. Except this time i was able to put the power down still which is unusual. I felt like i was 7mmols.

T2: checked my blood sugar before the run and it was 9.8mmols. Thats about as high as i normally like to be.

Run: 51mins 70th/106.
Fuck. Familiar story? I didnt FEEL like i cooked the bike. I could have gone harder. I felt like i was at that 90% FTP. Anyway, started well, i have run just under 40mins for an open 10, so wanted to do sub 4:20 min kms as a 'safe bet'. First km felt good, running tall etc. Lungs were good. During the second km my left quad locked up like anything. I mean couldnt walk locked up. I had no choice but to stop and stretch it. Cmon man, i was thinking. At this point lungs etc were still good. Ran another 100m and it locked up again. This time stopped, stretched, massaged it etc.... Pissed off. Head space wasnt good now. I continued to run, but after a while i started to blow up. The stopping and starting really got to me and i had to continue to do so throughout the run leg. By this time i was starting to feel physically spent aswell. Most (all?) signs point to biking too hard for my run abilities.
Im not sure what affect a) stopping and restarting does to you and b) the effects of hitting 14.8mmols did and i would be curious to find out.

Could the hitting of high bs numbers cause the cramps and me to stop? Or was it biking too hard? I felt fine until i did have to stop and then it just went to shit.

Anyway i had 1.5 gels on the run, one at about 4kms into it and half at about 7. I finished on 10mmols. In hindsight i should have just swam without a gel ingested and at 7mmols- because this is what rocketed me up to 14.8mmols.

Think i might start racing longer stuff with a needle in my bento box.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Im not sure if anyone reads these anymore since im replying to myself! but alas....
After a bit of a review of the day im pretty sure my dip into the 15mmol territory and no insulin did my run in. I used to be able to get away with this, as evidence by my earlier replies. Not anymore! I can do a sprint sans insulin, but not an oly or more. I am going to have to experiment with injections on the bike etc during training. I have no idea if you should inject every time you eat, or maybe once an hour or so, who knows. But i cant race without insulin it seems (basal is not enough).
Anyway i am sick of pulling out my glucometer from my bento- so i retrofitted it to my bars. My arms sit on top, and my hands wrap underneath the garmin. It doesnt look all that aero from the front view, but my hands actually shield a fair bit of it. Anyway this makes testing much easier as i just slide the little door down and the test tape rolls around on a tape. It may cost me 20 seconds over an oly or something because its not exactly sleek, but if im going to inject during the race with a needle (which will also be interesting to do that on the fly), i want to be able to test often. It wont be able to hold up to rain, but the xlab doesnt splash thankfully either. If anyone has any more suggestions to make this thing easier to test without coming off the bars im all ears!




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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Sucks man! Has your BG been trending higher during non activity? I'm dreading that day.

I like the setup!

I have no idea how to inject on the bike, that seems like it could be a bad idea and has distaster written all over it!

When I did B2B full in October I stopped at every aid station to refill my bottles and test. I carried my own nutrition, Hammer Perpetum.



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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I received a letter in the mail yesterday from my insurance notifying me it will not longer cover my Bayer Contour Test Strips.

I have to choose either Accucheck or One Touch..... Sugguestion on these?



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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I find the ultra one touch mini to be both accurate and portable, am happy with it so far. Now if I can only figure out how to mount iron my Aero bar too I will be all set.
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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actually i have noticed some days my bs has been trending upwards when i have no bolus insulin in. What was covering me and keeping the number in check was the exercise effect as well as the bolus. But on lighter days, my blood has been trending up slightly, which means im thin on the basal. I injected 12 units of lantus last night instead of 10 and woke up 4.2mmols which was good. A little low, but better than the 7's i have been getting intermittently. It takes a few days to build up the basal i believe, so i will continue with 12 units.

As for the moniitors i cant help you there since ours here in aus are different, but you prob cant go wrong with either.

Injecting on the bike i would only do if my blood sugar is too high and not trending down fast enough for any nutrition i want to consume. Due to nerves/adrenaline/any taper as well as morning insulin resistance, means im not trending down enough via my basal alone. I perhaps would only need to do it once early on in the bike, as time goes on i imagine people get more insulin sensitive in exercise, and thus i could feed the basal. I understand its dangers, hence the ease of which i can now test on my bars because it something i would want to really keep an eye on.

I never used to be this way, as suggested by earlier posts. I could do any race on basal in the background. But for oly's its a nightmare. Sprints i can prob just rely on the basal as i dont really need much nutrition, if any, thus only have to compete with adrenaline highs which dont take me too high (over 10mmols). A gel + adrenaline is not good though! Basal wont take care of it, and neither does intense racing.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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I just completed the Tour of Sufferlandria which is mostly anarobic Vo2max work, unchartered territory for me. Since being diagonsed in August I had pretty much done longer steady efforts. I was interested to see what the VO2max would do to my BG. In most cases it didn't spike high which I expected it to do. I have to take in a lot of carb for workouts



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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When at home training I find the same but in competition/racing its a different ball game
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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There is some great stuff in this thread thank you all for participating.
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Well, got an OD race this weekend and will be stating to taper fairly soon. My nightly lantus will no doubt increase from 10 units probably to about 12 in this time. Im planning, for the first time ever, to inject a bolus in T1 due to the frustration of highs. I know i have talked about it before, but anyone who has to increase their insulin/inject mid race, i would love to hear from you, as this is going to be new for me. Adrenaline/glucose raising hormones are killing my races. I will have a glucometer attached to my bike so i can keep an eye on it closely without getting off my bars. I will run with a spibelt with another glucometer in it. Small time penalties from these im sure but such is life. Infact we have limited transition timing mats thus once over the T1 mat to record a swim time, the bike leg time starts straight away, so i will lose time here having to drag out a needle from my bento and inject.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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I had a bit of a mare at National Oly Distance Champs yesterday as far as blood sugars go. Was 24.6 post race after 1 gel and about 2/3 to 3/4 bottle of sports drink. Having said that, I did get 4th in my age group (20secs behind 3rd), so having high blood sugar issues does not mean the end of racing - just that you can feel a bit lethargic and dry come the run when you can't drink as much.
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Re: The Official Diabetic Triathlete Thread [fulla] [ In reply to ]
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i wish i could race that high! i swear my blood sugar sees a 12 and decides im going keto. I tehn begin to drink like a camel and turn to mush.
Adrenaline is a killer isnt it?
Im hoping my plan will work out ok. My plan is maybe 1 jellybean pre-race, the swim is two laps where you have to get out of the water and run around a cone, so i will have a gel when starting the second loop. Inject 1 unit in T1 which should see me through with basal in the background, fingers crossed.
Fulla 24.6 is insane, that was more than my diagnosis number haha
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Seems like you're having some real issues with your bg's during racing. I've been fortunate to where mine stay fairly steady during excercise with Basal alone and a constant intake of carbs. I love the set up with the glucometer on the bars, but that also seems like a lot of work and somewhat dangerous. I know it's not a possibility for everyone. but have you looked into cgm's? I've been using a Dexcom for the last 3 months and couldn't imagine excercising without it now. The information it gives might lag a bit behind real time numbers, but the trend info is really invaluable to me.
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Re: The Official Diabetic Triathlete Thread [Cppike79] [ In reply to ]
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yeh i had a trial of one, the dexcom g4. The site was in my upper glute. It was horribly way out of wack for 4 full days. Wasnt even documenting trends correctly. I was a bit pissed off that this happened because i hear so many good things about them. But it was waking me up with hypo alerts when i was well and truley fine, its application in exercise i found to be very poor and not quick enough for the few times it was correct.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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So I've had a chance to experiment with a few different site locations and I'm a bit surprised that they had you try the upper glute area for the trial unit (unless you chose that location on your own). I'm on the thin side 6'1" and weigh 172 or so and I really haven't had much success with alternative sites. That said, if I keep it on the sides of my abdomen it's been very accurate and very consistent. It might be worth it for you to get another trial and see how one of the "approved" sites might work for you.
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Re: The Official Diabetic Triathlete Thread [Cppike79] [ In reply to ]
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your probably right i should give it another try. The site was chosen by the diabetic educator, she rekons she has more success with it there. I was pretty dissapointed considering the hype though. The eductor was suprised i had a bad experience with it, unfortunately i was the 'first' who had.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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For me, when I tried that location I felt like I just didn't have enough fat in that area. The wrong movements would continuously make it feel like my glute muscle was pushing into the sensor wire. I would get discomfort and terrible readings.
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Re: The Official Diabetic Triathlete Thread [Cppike79] [ In reply to ]
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This is a great thread.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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My most recent A1C came in at 6.1 down from 8.0 a couple months after my diagnosis. Hoping to stay in that ballpark. Fighting a cold right now that's messing with my bg

Over the winter been averaging a solid 10 hour week of activity and rebuilt my FTP to a PR of 330. Now I should probably start swimming some :)



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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funny you mention a cold....
Did my olympic distance triathlon and had a bit of a fail. The week leading up to it i tapered (about 6 days) and got a cold from my lovely son! bah! so not only did my insulin needs increase from not exercising as much with the taper, but im basically a human pin cushion being sick aswell. I tell you what, it is much harder to control diabetes without exercise.

Anyway, in the morning of the race, my bolus was done and dusted and i climbed from 7mmols to 9.4mmols from pre race nerves alone. I didnt need to eat anything. The 1500m swim was two laps of a large triangle. On 1/4 way through my second lap i gulped half a gel mid swim. Got to my bike and i was stuffed. My legs were like lead and i had no energy. I even had to sit down i felt dizzy. This was the effects of the cold probably. Anyway, blood sugar was 7.4mmols. Good times. I had a unit of insulin and 2 jellybeans and jumped on my bike to see if i could get my legs turning. I did half a lap and they still werent co-operating and my blood sugar was now 10.4....crap! I dont race well over 10ish usually anyway. End of lap 1 on the bike i was 12.4 despite 1 unit taken and a meagre 2 jellybeans. I bailed. Legs werent kicking, blood sugar way too high. I dont get passed much on the bike, its my favourtie leg, but i was the guy getting passed by road bikes when im on a tri bike with disc wheel, aero helmet etc like a douche. Oh well. So i have had a very light week in training from taper and sickness and i just could not get going. Seems too much taper reducing my insulin sensitivity does not bode well (as well as sickness!)
Got busso 70.3 in 3 weeks, need to bring things back up to normal in this time!

edit: it took me 4 units to get back to normal range and i have been yo-yoing all day, high/low its been a nightmare. Sickness aside, i dont think a major taper where insulin sensitivity is lost does me any good!
Last edited by: coates_hbk: Apr 13, 14 0:45
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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This was my first cold season as T1D and I have a 2 year old.....I was sick quite a few times. It almost seems as though my insulin didn't even work while sick. It really messed with my bg thats for sure!

Sorry about the race, that sucks!

Are you pretty carb sensitive? What is the purpose of two jellybeans? I ask because I can't imagine that serving any real value to you (unless your low). Simple sugar, all it's going to do is cause a big spike then crash. I stay away from all simple sugar, especially training and racing. Have you tried Hammer Nutrition? It's 100% complex, I see less spikes and crashes.

Totally agree regarding exercise, it is key for anyone that's a diabetic, T1 or T2. If I am running on the high side after a meal, a quick 15 minute walk will reduce my bg 50 points or so. I exercise more since being diagnosed for that very reason. I'm pretty consistent with 7 days a week, sometimes I will take a day off if needed. But I think more exercise has helped me control my bg

Be sure to post your 70.3 race details



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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i guess the two beans were a little insurance. I have never injected during a race i was a bit worried. It didnt do anything, because as you mentioned, insulin doesnt seem to work when your sick!
Do you find Hammer products keep you 'up' for longer? All gels etc i have tried inevitably come with a spike and eventual fall. Some spike more than others, but they all wear out similar. I always figured this was an unavoidable thing.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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I use two products, Hammer and Gu Gel

With Hammer I use Heed and Perpetum (powder mix). It its a workout less than 2 hours I use Heed, if its over Perpetum.

For EVERY run I consume carb in liquid form. I carry it in a camelpak quickgrip http://www.runningwarehouse.com/...escpage-CAMQG12.html

I'm not a fan of the Hammer Gel although I do use it some. When I feel I'm getting low I pop a Gu Gel, it's an 85% complex 15% simple, it has just enough to bring me up without causing a big spike.

A typical run would be 1-2 scoops of Heed depending on how my bg is doing for the day. Generally I can get through a one hour run with just 1-2 scoops of Heed.

Today is long run day about a 2 hour run. I will start with 2 scoops of Heed for the first hour. Second hour I will dump Perpetum in the bottle. I will carry 2-3 Gu gels(just in case I need it) and my Perpetum powder In a sandwich bag. Takes a some planning, but its a necessity for me.

I carry my own supplies for every workout and race. It adds weight and cost me some time but it's worth it to me.



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Hammer does a good job keeping you "Stable" during and after a workout. I have had zero issues going low after a workout or race.

Look at the sugar/carb ratio of Hammer product, it's pretty amazing

I actually used Hammer products before I was diagnosed but now I actually know what all that nutrition stuff means haha



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Does anyone INCREASE their basal for events? Really struggling with highs during events, more so by the time i get on the bike and ride for up to an hour my bs is sky rocketing.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Colds mess me up big time. I've missed races because of the havoc they've wreaked on my bg.
Just curious, Do you normally take in a gel during your swims?
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Re: The Official Diabetic Triathlete Thread [shade] [ In reply to ]
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longer swims yeah coz i suck at them. Going in highish at 9.8 in a 1500 and having a gel midway and coming out 7.8 keeps me where i need to be. BUT i think i prob dont need to because i skyrocket once im on the bike. Im not sure if this is the bike itself (i have a feeling it prob is) or the gel still kicking in a bit. Its probably both.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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If your bg is high, will it not come down if you ride for 30 min w no carb intake?



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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training yep....racing not really, no. Eventually it prob would but not before i would need to ingest something again. Doesnt come down all that quick i have found.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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I suspect the distance of the race and the race effort plays a role as well.

I figure sprint and oly races can push bg high because its more anarobic...?

Longer races 70.3/140.6 will push bg low due to the steady effort?

I have found that my bg doesnt spike crazy high on Vo2max efforts but I know folks that will go into the 300s on a 5k

We are all different in how our bg responds to stuff, its just plain crazy!



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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coates_hbk wrote:
Does anyone INCREASE their basal for events? Really struggling with highs during events, more so by the time i get on the bike and ride for up to an hour my bs is sky rocketing.

DEFINITELY increase my basal for events. Also need to take industrial doses of fast-acting insulin on the morning of the event and also on T1. And still most short course races I finish in the 200's. I remember taking 7 units (!!!) on T1 during Ironmans, haven't done one in a while, last one was Kona '07. The amount of insulin I take the morning of a race these days is more than I take during a whole day on a normal day. The good news is that the high BG levels doesnt really impair performance as you may think. I've seen non-diabetics into the 200's and most people are in the mid 100's, post race. Prof Tim Noakes says this is a sign of T2D, but thats another thread.

Anyone doing relatively high hours of training at decent intensity that tapers, will likely deal with it due to adrenalin releasing your liver's glycogen to your bloodstream.

I find racing very difficult and stressful and had to develop a smooth carb-load protocol, while training due to a low carb approach is easy. A1C's sitting in the mid 5's, lowest 5.3, T1D for 14 years.

Good luck

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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interesting and good to know! being on lantus injections, is it something you need to start, say 5 days out, or the night before should be fine? i just remember reading that when changing basals, one needs to do this over the course of several days to 'build up' the basal to notice change. I could be wrong though.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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coates_hbk wrote:
interesting and good to know! being on lantus injections, is it something you need to start, say 5 days out, or the night before should be fine? i just remember reading that when changing basals, one needs to do this over the course of several days to 'build up' the basal to notice change. I could be wrong though.

Correct, you may need to slowly add up 2-3 days before, I used to do that when racing for performance. But is a roller coaster and you have to be careful otherwise may put on weight easily.

These days I'm willing to trade performance for BG control so keep insulin dosage normal up to day before when I may need to add 10-20% or so to Basal then race morning same and add more fast-acting.

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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I take 10units of Lantus once a day

I did a 140.6 less than 3 months being diagnosed and was advised to not take my Lantus the day before so I didnt. BG was fine, no real highs or lows.

For my races this year I will probably take it as I normally do. Hopefully my training will give me an idea



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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you were prob still producing a fair bit of insulin only 3 months in, hence no need for basal. Awesome work doing an IM only 3 months post diagnosis.
I usually take 10 units myself, but since i had the cold, im sitting on 13 units and things are only now starting to come back to normal after 1.5weeks with the illness. It may stay at 13 units, im not sure. If it does, i will prob inject 15 units 3 days leading up to the race.

I find i race pretty flat with a larger taper too and that the taper itself can cause a bit of a nightmare with insulin. My plan for this 70.3 is to not taper so aggressively that it changes my insulin needs so dramatically.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Thanks, it was scary! I will post my race report on here

I agree regarding the taper. Diabetes seems to like routine so I try and be as routine as possible. Fortunately I am a ver y routine(boring) person. I can do and eat the same stuff over and over and over. So I average about 10 hours a week of workouts and that will go up for race training.

The big D still throws me curves though...its frustrating and confusing at times.



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Speaking of bg, today is a bit of a head scratcher.

151 before breakfast, took 3u humalog. After breakfast was at 166. Before lunch just now was at 177!? Took 4 units of Humalog and sit at 191 after lunch.

These are about 30-50 higher than normal. Think my sickness is mostly over.

ugh



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Haha exactly I eat near the same shit day in and day out purely for ease of bolusing. Diabetes does like routine. So you don't taper much either?
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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After I posted I went for a 15 minute walk, tested and got 85!? Home from work at 5pm tested 123, 5:40 before run 98. 95 before dinner, 105 after

Weird day, I think it was nerves from work that contributed

I haven't really had a whole lot of experience so far. I was dx 8-14-13 and have done one full IM, one full marathon and a 50k ultra run. I suspect though that tapering could cause my bg to bounce around more.

Before I was dx I usually rested at least one day a week (usually monday) but since dx I do something everyday. There is no doubt that exercise controls bg levels. This is why I don't use a pump. Not saying I never would but the way my body reacts now I feel its not needed

I think my next big taper would still have some easy stuff every day. Besides I actually enjoy training for the most part

Is your race this weekend?



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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May 3rd. Since my last half I have crashed from diabetic complications on another half aswell as 2 olys. All from being too high. I plan to not taper as much and be more aggressive with insulin this time round
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Are you going high during your training workouts?



"Keep those feet moving!" Me
Last edited by: runnerwv: Apr 16, 14 18:51
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Nope not at all. Adrenaline etc kills me. As soon as I get in that bike it shoots up like crazy, wether I have a gel in me or not. I must be an excitable lil fella : D
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Haha I can understand

Man that's wild. In training have you done a swim(ows) , then bike like race day? To see how it responds?

At the 70.3 I would try a couple of things out of the water into and out of t1. Walk and take your time. Keep your hr low. Then for first 15 minutes on bike pedal easy.

In some of my past races I have seen my highest hr of the day out of the water running into t1. That adrenaline might very well be pushing bg up. If you can control your hr and stay in "zen" state that might help?

Walking plus an easy 15 minute pedal will cost you a few minutes overall but it's better than a dnf



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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vinnie wrote:
coates_hbk wrote:
Does anyone INCREASE their basal for events? Really struggling with highs during events, more so by the time i get on the bike and ride for up to an hour my bs is sky rocketing.


DEFINITELY increase my basal for events. Also need to take industrial doses of fast-acting insulin on the morning of the event and also on T1. And still most short course races I finish in the 200's. I remember taking 7 units (!!!) on T1 during Ironmans, haven't done one in a while, last one was Kona '07. The amount of insulin I take the morning of a race these days is more than I take during a whole day on a normal day. The good news is that the high BG levels doesnt really impair performance as you may think. I've seen non-diabetics into the 200's and most people are in the mid 100's, post race. Prof Tim Noakes says this is a sign of T2D, but thats another thread.

Anyone doing relatively high hours of training at decent intensity that tapers, will likely deal with it due to adrenalin releasing your liver's glycogen to your bloodstream.

I find racing very difficult and stressful and had to develop a smooth carb-load protocol, while training due to a low carb approach is easy. A1C's sitting in the mid 5's, lowest 5.3, T1D for 14 years.

Good luck


Ever since I've done triathlons, I've had issues with high blood sugars during races, and had reasonable results most of the time (always wish I could do better but yeah heh). When I get it right I feel so much better during the race (having the dry mouth whilst running hard is horrid), but don't think I am going faster at all, if that counts.

Anyway, I have been thinking about doing the high fat low carb thing you suggested but after my next race (ironman cairns). However, I have a bit of a sensitive stomach (irritable bowel syndrome) so was just wondering if your stomach got upset at all when you switched it.
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Your prob right getting in to t1 to just take it easy ...it's gonna be a crapshoot to know how much to bolus in t1 coz I will still get high if I don't bolus...we will find out! Prob 2 units and just track the trends closely
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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vinnie wrote:
coates_hbk wrote:
interesting and good to know! being on lantus injections, is it something you need to start, say 5 days out, or the night before should be fine? i just remember reading that when changing basals, one needs to do this over the course of several days to 'build up' the basal to notice change. I could be wrong though.


Correct, you may need to slowly add up 2-3 days before, I used to do that when racing for performance. But is a roller coaster and you have to be careful otherwise may put on weight easily.

These days I'm willing to trade performance for BG control so keep insulin dosage normal up to day before when I may need to add 10-20% or so to Basal then race morning same and add more fast-acting.

Hey Vinnie, went and saw my daibetes educator this morning. She reccomended taking an additional 4 units of lantus about 2-3 hrs before the rrace. Interestingly she said Lantus doesnt need to 'build up' in the system and that one extra shot should help? I, like yourself, always thought basal took time to build up in the system somewhat?
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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coates_hbk wrote:

Hey Vinnie, went and saw my daibetes educator this morning. She reccomended taking an additional 4 units of lantus about 2-3 hrs before the rrace. Interestingly she said Lantus doesnt need to 'build up' in the system and that one extra shot should help? I, like yourself, always thought basal took time to build up in the system somewhat?

I'm not sure what information you provided to the educator, but this strategy wouldn't help at all the adrenalin spik I (we) get on race start and on T2, I also get another spike when running fast. Novorapid/Humalog is strong enough to hold the BG at decent levels. Lantus won't help IMO but give it a go and report back to her until you guys find a solution.

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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vinnie wrote:
coates_hbk wrote:


Hey Vinnie, went and saw my daibetes educator this morning. She reccomended taking an additional 4 units of lantus about 2-3 hrs before the rrace. Interestingly she said Lantus doesnt need to 'build up' in the system and that one extra shot should help? I, like yourself, always thought basal took time to build up in the system somewhat?


I'm not sure what information you provided to the educator, but this strategy wouldn't help at all the adrenalin spik I (we) get on race start and on T2, I also get another spike when running fast. Novorapid/Humalog is strong enough to hold the BG at decent levels. Lantus won't help IMO but give it a go and report back to her until you guys find a solution.

Oh i still expect to inject, but i guess the premise is trying to give a higher basal, i may be able to feed the basal rather than inject for everything. It wasnt a cure to the spike but may help minimise it a bit. T2 i will no doubt inject extra and monitor on the bike.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Higher Basal + Bolus Pre/During race = Better levels during the event

That said don't expect to hit it perfectly, just by having some more insulin on board you are way ahead of the game than before.

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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Yeh it can be a bit of a crapshoot I know... Sprint races are much easier to manage when you don't need nutrition. I can get over the highs during those!
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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vinnie wrote:
Higher Basal + Bolus Pre/During race = Better levels during the event

That said don't expect to hit it perfectly, just by having some more insulin on board you are way ahead of the game than before.

So, as a coach, do you think the extra 4 basal units (1/3 of my normal basal dose) a few hours before the race will help (with injections) rather than running a normal basal + bolus? Im really hoping that after a T1 bolus of a unit or two (depending on bs level) the exercise + basal may take over a bit more, things will settle and i will be able to just feed the basal. I doubt that will happen, but thats a dream tri for me.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Sounds like a reasonable plan. I would only take an emergency flask with extra calories on the run (and another on Special Needs) just in case that extra 4u of Lantus "bites you back" once you become too insulin sensitive.

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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excellent, thanks for your help with all this. I run with a spibelt with a glucometer and gels/etc so hopefully should be good
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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My concern taking extra 4 units of Lantus is the peak. For me Lantus peaks about 6 hours after injection. I inject at 11 am 10u everyday and hit my low (usually) at 5pm on the nose. Could be coincidence but I figure its the Lantus peaking.

I think I would rather take the humalog as needed to cover vs more Lantus

Only one way to find out what works though....experiment



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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coates_hbk wrote:
vinnie wrote:
Higher Basal + Bolus Pre/During race = Better levels during the event

That said don't expect to hit it perfectly, just by having some more insulin on board you are way ahead of the game than before.


So, as a coach, do you think the extra 4 basal units (1/3 of my normal basal dose) a few hours before the race will help (with injections) rather than running a normal basal + bolus? Im really hoping that after a T1 bolus of a unit or two (depending on bs level) the exercise + basal may take over a bit more, things will settle and i will be able to just feed the basal. I doubt that will happen, but thats a dream tri for me.

After your bike race this weekend, considering changing to LCHF, the below podcast explains some of the benefits for sports performance, but the biggest ones are definitely for Diabetics:

http://www.innerfight.com/podcast107

Less lows, less insulin, normal BG levels, steadier energy flow.

Have a good race presuming you are doing IMOZ!

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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70.3 busso, wont catch me doing ironmans, training for 70.3's is long enough!....a tad nervous dosing an extra hit of lantus in the morning but ill know ill need it
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Good Luck this weekend! Be sure to let us know how the race goes!

BTW- I am seeing a tad bit higher bg #'s in the evening and overnight into the morning....trying to figure it out.



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Shot race slower than last year! Anyway... Usual 12 units lantus night before and woke up with good levels... Bolused normal amount to cover food aswell as extra 4 units of lantus...start line was 8mmols.

Swim of 35mins which is 6 minutes quicker than last year... Had a gel midway through swim, checked blood in t1, bang, 3.4mmols... Crap! Sucked another gel and 2 jellybeans for something tasty:)... Now I took my needle with me and I needed to bolus on the bike twice to bring higher sugars down more quickly and allow me to eat. The problem was my legs just weren't on as soon as I mounted the bike...not sure if I was tapered enough or not who knows.

Bike was 2:32, 3 mins slower than last year all similar conditions...
I pushed hard on the bike to force the legs to wake up but cooked them and ran a slow 1:49, some cramp issues but now some GI issues starting to come into it.
Didn't need insulin on the run but had to have about 5 gels and a bit of coke every now and again (which wasn't flat!!).. Ran a 1:38 last year.
Total if 5:04 with a long t1 and t2 time, last year was 4:55.... Bs was 7.4mmol at finish

What I learned- I'm a much better sprinter than longer stuff but on the diabetic side-pumps are easier I would say!!

Increasing basal works but hits me viciously in the swim so I would need to spike before swimming as well as mid swim if I want to dose up basal. The bike needs insulin because my bs takes too long to come back down- it needs a bit of help as well as the nutrition need. The run, by that time, I can feed the basal... Also I need to look at my taper better i think, I did a bit too much running leading up.. Looking at my logs I ran sat, sun,mon,tue and wed for a sat race, every though they were easy paces (bar one) and range from 8-12kms in length... I was trying to avoid messing up bs from a lack of exercise but it seemed I went in a bit too cooked
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Thanks for sharing your race report! The low after the swim would have slowed me a bit. It's possible it took a bit out of your legs on the bike and run.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Congrats man, thats a solid time!!

Looks like a little slower than previous year but hey, they can't all be PR's!

Would you do Lantus before race again?

I think I would rather run a little on the high side vs the low side. All in all looks like bg did pretty good, especially from last race!?



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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i think the lantus came into its own during the run. I didnt need any jabbing at all then. The problems i encountered was that swimming smashes my blood sugar the most, so the lantus aided this more so, hence the low. To counteract i can gel pre-race AND during the latter half of the swim. I didnt have anything pre-race for the 70.3, if i did im sure i wouldnt have gotten low.
Anyway, I would get onto the bike and see if these gels start to gang up on me, in which case i would shoot a unit. If they dont then i have another 45 mins roughly before i need any more nutrition so hopefully the lantus plus exercise would start bringing them down naturally.
Its funny, biking in races requires a bolus or several even.
The thing is, if i didnt have the lantus extra on board, i may have had to jab a lot more frequently for bolusing for food, even maybe on the run. I simply dont know how much i would have to bolus if i just had my normal basal in.
If i had a pump this wouldnt be an issue. But since i have to coast and inject while riding, its a pain in the ass and i didnt want to inject while running as well. The only negative is by the run your feeding yourself quite a bit to feed the extra basal. I had about 5 gels, coke etc on the run. In fact i dont know how my guts didnt explode. Again, an advantage in having a pump. Doing this on needles blows.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Finally got my B2B race report from October posted

I caught cold at the end of July that sidelined me for about week. Nothing serious, just felt extremely tired. This derailed my training plan as I was supposed to start training for B2B August 1st, that didn’t happen. The cold went away after a week or so but it left me with extreme dry/cotton mouth, bad enough I had decided to go to the doctor. I was also having some vision issues and had lost 15lbs over a 10 days, I knew it was something serious. I thought I was dying!
August 13th I was registering for B2B full but something was telling not to do it, something just didn’t feel right. I went ahead and submitted and signed up because there were only a few spots left. The next day (Aug 14th) I went to the doctor with my symptoms, he pricks my finger and takes a small blood sample that says 360, proceeds to tell me I am diabetic. My eyes are swelling with tears as I am in complete shock, he is telling me stuff but all I hear is BLAH BLAH BLAH. So he sends me out with a bag of needles and insulin I have no idea how to use. I am 37, fit and do endurance races, how is this possible?
I pretty much figured my fall 140.6 was history since I couldn’t run 30 minutes without my blood sugar going low and nearly passing out. I actually withdrew from B2B. My blood work confirmed as suspected that I am Type 1 diabetic, an autoimmune disease where your body kills your pancreas requiring insulin injections. Over the next few weeks I slowly began to gain weight as my body recovered and I was getting the hang of the insulin/carb ratios. It was a lot of trial and error. I am proud to say I swam, biked or ran every day since being diagnosed August 14th. Most of it was really really slow but at least I was moving. My run pace was reduced to 10-11 minute miles and my bike FTP totally plunged as I just couldn’t produce any power. The more I experimented the more confident I got and the further/faster I could go.
I saw my endocrinologist on August 28th , she isn’t an endurance athlete but understands what I like to do and she gave me the okay to do the full 140.6! She reduced my Lantus to 10 units a day, Humalog to 1 unit per 20g carb. Now I had two problems, 1) I had withdrawn from the race 2) I was very concerned about the swim in open water. I contacted Jeremy the race director, told him my story and he let me back in the race and gave ok for me to bring my own kayak support in case I got into serious trouble. So I started training.
When diagnosed on August 14th I was put on 20 units of Lantus and Humalog as needed via sliding scale. I quickly learned I was very insulin sensitive. Taking insulin along with me still producing was causing me to go low real fast. I was testing every 15 minutes running and having to consume carb every 15-20 minutes to keep from going low. It was crazy! I used to go for a 1 hour run and not take any calories with me. So carrying gels an HEED (sports drink) for a 30min run was an adjustment.
Exercising was scary! While running I started with half mile out and backs. I was going low so fast I didn’t want to be far from my car. As I steadily gained my weight back and figuring out how my blood sugar was reacting I started running further and further. I got back on the bike but started on the trainer and my power had dropped significantly. It was about a month before I rode outside. The bike was a little scarier than running. I thought it was harder get a feel for where my sugar was and where it was trending. But eventually I figured it out. The bike was really no different than running, I needed at least 25g carbs every 30 minutes to keep my BG in the 100-140 range. For bike nutrition I was taking Hammer Perpetum for my long rides of 3 hours or more and would pop a Hammer gel periodically. Swim training was the scariest! I expected my BG to stay steady while swimming, but it didn’t. I tested frequently in the pool and learned that I needed the same amount of carb swimming as I did running and biking. How in heck was I going to swim 2.4 miles in open water without testing and carrying gels?
For running and biking I carry an Amphipod belt that I can stash my BG meter, test strips and lancer. It works perfectly! I also use a small backpack that allows me to stash additional items, gels, insulin and needles ect. I feel its very important to carry testing supplies and test frequently. As I got better feel for my BG I would test less and less while running and biking.
Race Week
I was feeling pretty good coming into race week having completed several 4-5 hour bike rides and maxing out my long run at 21 miles. The swim was still my biggest concern because I didn’t have good swim fitness. My longest swim was 3,000m, two times and average 6,000-7,000k meters per week in the two months prior to race day. I knew I couldn’t improve my swim much in two months anyways so I just tried to do what I could. The swim is my biggest weakness, especially open water swimming. Add diabetic concerns to an already anxious swimmer and you have one paranoid triathlete.
My main goal was to simply finish the race but I did have an expected range of 12-14 hours I felt I was capable of from training. I expected the swim to take an estimated 1:30-40, bike 6:00-6:30 and run was kind of up in the air but I was targeting 4:22 (10 min pace). Transitions I knew would be extra slow due to having to test my BG.
As luck (bad luck) would have it an arctic low was moving through the night before the race that would push temperatures into mid to low 30’s. Not really what you want to see when swimming 2.4 miles in open water. The expected water temperature was hovering around 70 degrees (supposedly).
Friday October 25th was mandatory bike check in along with our T2 (transition) bag. While putting my bike together before checkin I bent the valve while inflating my rear wheel ( used a wheel cover). I opted to not change it hoping it wouldn’t leak. In hindsight this was a bad decision. Got the bike set up and dropped at T1 and dropped my T2 bag at the convention center during the mandatory prerace meeting. The convention was the T2 site. Bags are all packed up and ready to race.

Race Day
Didn’t sleep well which is typical. Woke up around 3:30 and got up at 3:45. First thing I did was check my BG, I was very interested to see what it would be given race day nerves. Pricked my finger and see 125mg, sweet! That’s very normal for me to see in the morning. I was expecting to see a much higher number. I made some coffee and ate two multigrain English muffins with peanut butter just as I did for all my long training. I triple checked all my bags to make sure I had everything and my dad picked up at 5:30am to drop me at T1. This race is point to point so it makes for some logistic problems. My dad was serving as my personal Kayak support to make sure I didn’t get into any trouble on the swim course. I was so happy to have him (and my stepmom Paula) there, a huge confidence boost.
They drop me off at T1 and it is COLD and dark. I was wearing my full sleeve wetsuit and already had it on along with wearing a garbage bag to stay warm. I rush over to my bike to check the rear wheel and sure enough its LOW!! I should’ve changed that tube. Anyways I inflate it, drop my T1 bag and get on the shuttle to the swim start.
The plan was for Paula to drop my dad and the Canoe at the swim start and then drive to the swim finish. But she stayed at the start which meant me and my dad could sit in the nice warm car instead of standing around outside for an hour + waiting on the start of the race 7:30am. That was some VIP stuff right there! Thanks Paula!
I check my BG about 10 minutes before the start and I’m sitting at 180 after hitting a GU gel about 10 minutes prior. That’s exactly where I wanted to be starting the swim. 160-180 is where I started most of my early morning swims in the pool and I knew training I needed to consume approx 1 GU gel at LEAST every 30 minutes, for open water probably more frequently. I set my Garmin 910 alarm to beep every 25 minutes in the water. I was wearing a full sleeve wetsuit with GU gel stashed in my right sleeve, both ankles and neck. A total of 4 gels for the swim.
Beach2Battleship is known for one thing, the current aided swim. It starts in a channel Masonboro Inlet at Wrightsville Beach. This was a year with little or no tide assistance. Typically the swim has a wicked fast current pushing athletes to the end of the point to point swim. You can usually count on a FAST swim split, 2013 is a rare year with little to no tide assistance. The race started during a slack period of no incoming tide. So I knew my swim time would suffer more than I had hoped.
7:30am the cannon goes off and the race is under way. My dad and I were actually loading the canoe in the water when the cannon went off. I wasn’t in a huge hurry though, just took my time. I was probably next to last to enter the water. As I entered the water reality set in and it was scary. The water was chilly as it tricked up my back in the wetsuit. I put my face down and tried to take off but panicked within 30 seconds. This is very common for me to do historically speaking. I flipped over on my back and proceeded to backstroke. My dad was following me closely from behind. It was comforting having him there. My initial reaction to the water was “This sucks, get the heck out”. I’m glad I didn’t
As I was backstroking I could see the starting area getting further and further away. I thought I could feel a little bit of a push from the tide. Time seems to go by very slow during the open water swim for me, especially when I’m staring up at the sky! I was very nervous/anxious in the water. After 15 minutes I was still having anxiety and knew it was going to be a mental struggle the rest of the way. I took my gels every 25ish minutes just as I did in training but the longer I was in the water the more tired I got. Backstroking was wearing me down big time! I would occasionally flip over and freestyle for a few minutes then back to the backstroke. The water was also very choppy once I had the turn buoy in sight. The choppy water was rolling right over my face and I was taking in LOTS of water. It was a struggle at that point to keep going and I had to stop several times. I was tired and wasn’t sure if it was from my BG going low or just physical exertion. My dad kept telling me I was doing great, and to keep going. In reality I knew I was sucking ass but it was also somewhat expected. I finally made it through the turn buoy and across the windy, choppy channel. Now I knew I was going to finish the swim. Finally I reached the ladders to get out of that damn water. I gave my dad a shout out as I slowed moved up the ladder. I’m finally on the dock and walking, look at my watch and it says 1:35. I was very eager to test my BG to see where it was.
Swim time 1:38 479/499
T1 (Swim to Bike Transition)
To get to T1 it required us to run about 400 yards which usually isn’t an issue. However most of this was on a pavement surface. I may as well have been running on hot coals! The pavement was COLD and combined with wet feet made for misery! I went to pick up my bike bag and it was one of a handful left. Not surprising, I was one of the last ones out of the water. First thing I did was find my BG monitor and test at 125, great! That’s about where I was hoping to be. I took my time and dried off thoroughly. With the temps being rather chilly I decided to wear my Gore Windstopper Jacket (sleeves zip off), gloves, craft windstopper baselayer, calf sleeves, socks, toe warmers and aero helmet. I made sure I had all of my nutrition in my little backpack because I planned to use my own on course.
T1 Time 21:09 455/499
Bike
The sun was shining bright as I set off on the bike. I didn’t really know what to expect on the bike since I didn’t have the base I had in the two previous years. My plan was simple, take it easyish and test my BG at every aid station. I made it out of Wrightsville Beach Area with no issues. The first 3-5 miles was pretty slow and my heart rate was high given my output. One interesting thing about this bike course, there’s a 12 mile stretch of the bike on the interstate. Riding on the interstate is sketchy for a couple of reasons. 1) The half and full are all riding together 2) We ride in the left lane with cones between the lanes. The issue with the cones is they are easy to hit. I saw one lady hit a cone and go down. I made it off that stretch without incident.
I kept looking down at my rear wheel thinking the tire looked low but just shrugged it off as paranoia. Once the half and full bike course split it was much safer. But one disadvantages with the races splitting apart is you get left in no mans land. I could go miles and miles without seeing a bike and we are in the middle of nowhere! My legs started start to tire, butt was hurting and then the negative voices start talking in my head. I also seemed to have an annoying headwind all damn day, we never seemed to pick up a tailwind. I think around 70-80 mile mark I really lost it mentally and was questioning if I could finish the bike. I was hurting, bad! At mile 90 I stopped to check my tire, it was damn near flat!! The valve had leaked, slowly. I had stopped enough already and didn’t want to waste more time changing a tube I should’ve already changed. So I just reinflated it with a CO2 and hoped it would hold for the next 22 miles.
At this point my avg speed is much slower than I expected so that was a little disappointing. I do ride with power but had opted to try and not ride a power # and simply go off heart rate. Tried to keep my heart rate in the 140’s and I did just that. Those last 22 miles were brutal. By this point my shoulders were so sore I couldn’t even ride in the aerobars. I kept telling trying to tell myself to get to the run. I was pretty confident I biked easy enough that I could run. Man was I happy to cross over the bridge and see the convention center. I finally made it to T2. Bike data. Avg Power 133 NP 145 Avg Heart Rate 138. My power in training was 180ish avg For nutrition I drank approx 6 bottles of Hammer Perpetum, one every hour and also GU Gel here and there as needed and also ate one English muffin.
Bike Time 6:32 280/499
T2 15:57 462/499
I arrived at the convention center and dismounted. Volunteers grabbed my bike and took it, I just walked and took my time as another volunteer brought me my T2 bag. Tested my BG and it was 120ish, perfect! I didn’t have to change much other than shedding my jacket. In my T2 bag I had my shoes, arm warmers for the run, my camelbak bottle and my Go Lite backpack I used on the bike. Hit the bathroom, took a gel and I was off. My nutrition plan for the run was 1 bottle of perpetum per hour. So I had 4 bags portioned and stashed 3 of them in my backpack. However the thought of drinking more perpetum made me gag. So I decided to try on course Heed and hammer gels. Instead of Perpetum I would drink 4 bottles of Heed(refilling at aid stations) and one gel approx every 30 minutes.
Run
My two previous Ironman races resulted in complete blowups on the run leg. I really wanted together a good run, while I was content with my swim and bike splits they were slower than I would’ve liked. My goal for the run was just try and be consistent and run the entire time. So I set off and tried to settle into an easy 10ish minute per mile pace. The run course was a double out and back. I really enjoy this run course. It takes you through the waterfront of downtown Wilmington, past many old historic homes and really nice park. The spectators, volunteers and aid stations are all amazing!
The miles were flying by and I was feeling great! My heart rate was staying low and my legs left good as I was finished my first 13.1 loop. I stopped at run special needs and picked up some Gu gel and my light that clips to my hat because I knew I would be running at dark. My mile splits were fairly consistent only stopping to refill my bottle and hit the porta johns.
The bad part of a double out and back run course is passing the finish line and seeing people cross the line knowing you have another lap left. I stopped at run special needs and picked my light that clips to my hat and arm warmers because I knew darkness coming. It gets very dark( and chilly) on the run course in parts so it’s very helpful to have some visibility. I was taking a Hammer gel every 30 minutes and 1 bottle of Heed per hour. This seemed to be working as my blood sugar seemed stable and I was still moving a long at 10ish pace.
As I approached the last turn-around I knew I was going to finish and I was pumped! However, my quads were now feeling the full effect of the day. My pace began to slow a bit but I didn’t care, I kept plugging along. My brain was telling me to stop at this point but I had two things keeping my feet moving. 1) If I walked the rest of the way that would put me at the finish line after my son’s bedtime and I didn’t want that to happen. 2) The longer I was out on the course the higher the chance of having bg issues. So I kept going!
Now I’m in the home stretch, less than a mile to go. All smiles and high fives from here on in!! The spectators are amazing in the final stretch of this race. The folks of Wilmington really embrace this race! I can now see the finish chute and the music is pumping, I slow my pace and soak it up, giving high fives all the way across the finish line. I actually set a PR on the run (for 140.6 run) with a 4:32 run split. I was Sooooo stoaked about my run! Finish 13:21, not to shabby!
Run Time 4:32 176/499
Overall 13:21 281/499
Now the scary part, the unknown of how my bg will react now that the race is over. Once I crossed the line I’m asked how I feel, I say pretty good but I’m a diabetic and I’m not sure what’s going to happen to me now. The volunteer kind of panics and immediately sends me to the finish tent to be evaluated. They didn’t have anything to test blood (which was odd), luckily I had my supplies. I was so nervous! First test was 130’s, I will take it! I was expecting my bg to take a big drop but it never did. It pretty much stayed around 130-150 through the night and following day.
This was my most emotional finish and the most prized accomplishment in my endurance career. I just proved Diabetes CAN”T & WON”T stop me from doing anything I want to do.



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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So I did twoindividual time trials this past weekend. Each was 7.1 miles, one aero and one merx. Got some interesting bg data.

First the aero race went great! Did 17:25 24.5 MPH @ 323 avg watts. I have gained all of the power I lost at dx back. Finished 4th overall

Merx was 19:04 @ 306 avg watts good for 1st in age group

What I found interesting is my bg went up during these events. Started aero @ 131mg tested 190 after. I don't believe it affected my performance though



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Did my first tri of the year this past Saturday. Went well all things considered. 1000m swim, 26 mile bike, 4 mile run. Finish time was 2:21. Swim was not great, 24ish minutes. It was very foggy and hard to sight. Bike was good, very hilly course with 2000ft of climbing, 1:21. Not a suitable course for me on a tri bike with all the decending, avg power was 240, not bad. Run was great, 27 minutes.

Bg did well, no real issues other than seeing some highs at the start.

Was 200 right before swim start.

167 into T1
140 into T2
162 at finish

That's higher than I expected but learned a lot about my bg on race morning. I don't need nearly as much carb



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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haha yep! Hormones etc are a bitch at times. Much different to training. You may find on longer stuff (70.3) you may need to inject insulin?

Anyway how much/what did you supplement during the race?

I did a bike race yesterday - 52kms total. I managed to win, but for the 1hr20mins it took i only at 3 jelly beans. I started at 8.5mmols (153) and finished on 11.2 (201). For oly's and above im now having to inject to get that glucose working better and intot he muscles more efficiently than muscle contraction alone.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Great question

Your right, my bg is much different while training vs race. I am finding I need way less carb on race day but I have done only one triathlon this year and a handful of running races.

Also, most of my workouts are in the PM not AM and my bg is a totally different in morning vs evening. This is because of my Lantus which I take around 11am. Maybe I need revisit that plan. I am higher in the AM than the PM and need more carb in the PM.

I have a 15 mile running race this weekend and should get some good data from it.

Also doing a HIM sept 28th. Will be interesting to see how bg does. I "think" I can control it without injecting during the race.

My bg has been all over the map since my saturday long run. I got crushed but some nasty humidity. Dehydrtated and think its causing some instability



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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So I did the 15 Mile running race, The Charleston Distance Run this past weekend.

Had some crazy bg issues.

Start out of bed at 187mg, ate one cup of greek yogurt and had one english muffin no insulin

Tested about about 5 minutes before the start and bg was 279! Yikes! That's the highest I have ever seen before, during or after any workout! Didn't really know what to do at that point other than just run and hope to burn some of that off.

My nutrition play was the same as training. One bottle of Hammer Heed per hour, with about 1.5 scoops=40g carb. I carry my own nutrition with me.

It was hot, 72 degrees at the 7:30am start with 100% humidity. I do not function well in humid conditions as I really sweat a lot. I knew when I took my first step out the door that my goal time of 2 hours was probably not going to happen. This is a very hilly course.

I tested my bg about halfway point of race because I was feeling crappy it bg was 226mg, yikes! Way high for me, never seen this before. I didn't really now what to do other than totally scrap my nutrition plan and just drink water so that's what I did.

Finished the race in 2:07, not bad all things considered.

Bg at finish was 187.

I believe I will need to adjust when I take my Lantus especially on race day



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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runnerwv wrote:
So I did the 15 Mile running race, The Charleston Distance Run this past weekend.

Had some crazy bg issues.

Start out of bed at 187mg, ate one cup of greek yogurt and had one english muffin no insulin

Tested about about 5 minutes before the start and bg was 279! Yikes! That's the highest I have ever seen before, during or after any workout! Didn't really know what to do at that point other than just run and hope to burn some of that off.

My nutrition play was the same as training. One bottle of Hammer Heed per hour, with about 1.5 scoops=40g carb. I carry my own nutrition with me.

It was hot, 72 degrees at the 7:30am start with 100% humidity. I do not function well in humid conditions as I really sweat a lot. I knew when I took my first step out the door that my goal time of 2 hours was probably not going to happen. This is a very hilly course.

I tested my bg about halfway point of race because I was feeling crappy it bg was 226mg, yikes! Way high for me, never seen this before. I didn't really now what to do other than totally scrap my nutrition plan and just drink water so that's what I did.

Finished the race in 2:07, not bad all things considered.

Bg at finish was 187.

I believe I will need to adjust when I take my Lantus especially on race day

starting out of bed you were high, i would have had insulin to cover the yoghurt and muffin- that way you would have started the race at a similar BS to when you woke up. 279 is maybe getting into ketone territory. The fact it got to 226 after around 7 or 8 miles of running sounds too me as though you were lean on insulin. Racing is much different to training- i am finiding i (and many others) could once get away with the regimine you outlined. Allow physical activity to bring sugas down on their own. But training aside, this is hard to do for races over an hour or so, simply because the bsugar just wont come down without assistance of insulin. Note i say over an hour, simply because races that last less than that are usually intense (such as sprint tri's), which often sends the bsugar up on their own. Nutrition not needed.
This is why pumps are handy i guess. Press of a button, inject a bit, and your gold.
During my last 70.3 despite coming out of the water at 3.4mmols (64), i took 1 gel in T1 and jumped on my bike. It shot up to 12mmols (216) in a flash and was holding, it wouldnt drop and i needed nutrition. Whipped out my needle, coasted and injected in my tummy. That got me to 6mmol (108) which was great. Fortunately i only had to inject twice on the bike and that was it.

I think it was amclean who wrote a great report on injecting insulin in T1 prior to the bike.

In any event, 2:07 is nothing to sneeze at!
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Yea, hindsight I would've definately covered the food with insulin. This race made clear a trend I had already been seeing over the last 2-3 weeks which is higher morning bg and more carb sensitive(in the mornings).

I take 10u of Lantus at 11am dailey. It appears I need to bump that Lantus up as I am getting a big liver dump in the morning. Seems to be wearing off faster. Either increase Lantus dose or take some before bed?

I have not had high morning bg issues until the last 2-3 weeks. So something has changed, maybe I'm producing less insulin? IDK

I think if I had taken insuling to cover on race day that I would've still trended up instead of down or stable based on what I have been seeing in the morning.



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Read all these pages...There is some good stuff... I just found out I have type 1 about 6 weeks ago at the age of 35. My first ever A1c that day was 13.7. I have gotten my BG under control and have read pretty much everything I can find. I have a question that I need help on. I check my BG at least a dozen times a day. The last week I have not gone higher than 130 and usually am between 90 and 110....I ordered some ketone strips and when they arrived I tested myself. There are "small" ketones. Everything I have read online say call my doctor. I eat low carb am not sick or don't think I am stressed. My BG is not out of control...I am just looking for OPINIONS and Slowtwitch has no shortage of those. I am not concerned with small ketones...is this a mistake?
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Re: The Official Diabetic Triathlete Thread [nicholasJ] [ In reply to ]
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i wouldnt stress it too much- i believe you only check ketones when your super high or sick. If your numbers are fine, you cant really do much, adding insulin will only make you go low. Kudos to your control, especially 6 weeks in.
Welcome to the d club!
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Re: The Official Diabetic Triathlete Thread [nicholasJ] [ In reply to ]
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Gnerally, you are going to be concerned about the ketones is your BG has not been well controlled. Ketones are produced when your body burns fat for energy, which typically happens when you don't have enough insulin in your system to cover your metabolic needs. Unless you have gone away from carbs almost completely and are starving yourself of carbohydrates, ketones shouldn't be a big concern.

On the other hand, a T1 diabetic with an average BG between 90-130 means that you probably shouldn't see any ketones. I don't think ketones are going to stick around for 6+ weeks in your system, so they have to be coming from somewhere. It might be worth a call to your doctor just to see if he/she is concerned too. They're here to help us, after all...
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Re: The Official Diabetic Triathlete Thread [nicholasJ] [ In reply to ]
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Welcome to the T1D club

I was dx 8-14-13 so I'm fairly new to this as well. My A1C was 8ish when tested a month after dx. Now 6.2

Couple of things I suspect. You are probably in the "honeymoon" phase, very common. Did Dr do Cpeptide test? If not, request it. That will tell you if your still producing insulin and how much.

If your still showing keytones signs I figure it could be residual from the highs you were experiencing before dx. In general keytones are only present when bg is running high.



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [nicholasJ] [ In reply to ]
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been away for a while but i thought i would stop back in and report on an interesting t1d experience at crusher in the Tushar.

I won't bore you with the details but i neded up off the front early in a group of 4 - Dopey the Dwarf came across a 4:30 gap (fuelled by EPO, Ego and the crushed dreams of more principled athletes) . We said nasty things to him, he dropped us. I descended irresponsibly. I got a flat, co2 and a tube fixed it. I chased hard, i got a flat.... and so on. 4 flats later i thought i was done, took some lantus and waited for the voiture balai . As it turned out this was a LONG way behind me already. Some guy snapped his carbon bars and very kindly gave me thre emore tubes, so i decided to push on. Obviously at this point i had extra IOB , I was at altitude, I was climbing a very steep and sandy climb so i was forced into sever medicinal cokes and gels. I couldn't maintain a decent BG that way so i resorted to my first ever twinkie (thank you twinkie hand up man) . That worked a bit, as did a snickers (thank you random Utah lady who had no idea what was going on and had nothing to do with the event).

that worked for about an hour but i started to feel sick with all the food, came across an ambulance and they kindly mixed me up some glucagon, i took a mini glucagon shot (just under 1 unit IM) and that got me through the race feeling MUCH stronger. However i did vomit several times afterwards, have high blood glucose all day despite a 3500 kj ride and feel godawful for the next 48 hours.

Has anyone else used glucagon in an event? any n=1 anecdotes regarding this?
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Re: The Official Diabetic Triathlete Thread [jamesstout] [ In reply to ]
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Wow! That's a helleva race report!

I have never needed glucagon, well to this point anyway. Although I do keep a pen in case of emergency.

How was bg afterwards.?



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [jamesstout] [ In reply to ]
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Hardcore... Why lantus anyway? Why not a bolus? Just curious how others do things...I would have given up after 3 flats haha, u really wanted to gut that one out!
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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It was pretty much NOT GOING below 200 all day despite 3500kj out on the bike and not eating a lot.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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i use levemir not lantus, i rum a lower basal to race, even lower at altitude (because, y'know it's what Science and non diabetic bodies do) and eat plenty of carbs in the race. If i stop i'm just going to creep up so i took basal to set myself straight for what i thought would be a long wait as every single person in the race passed me and i waited for th broom wagon
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Re: The Official Diabetic Triathlete Thread [jamesstout] [ In reply to ]
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I started keto about a week ago. What it has done to my blood sugar is remarkable. I have been able to lower my basal and bolus...my question is when training what about going hypo? Obviously you don't want to take carbs...I am wondering if I maybe ran too soon after a bolus, thinking this is most likely since I ran and biked numerous other times in the last week with no issues. I don't need to hear any negative comments from people who have never tried this diet but know a guy that knows a guy. I have spent hours reading on the net but a lot of the keto and training is not people with type 1 for obvious reasons.

And no I haven't consulted my dr who pretty said eat what you want and cover with insulin
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Re: The Official Diabetic Triathlete Thread [nicholasJ] [ In reply to ]
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Congrats, I wish I would have found out about VLC diet straight after my diagnosis like happened with you. You are blessed and this has literally saved your life and made diabetes very easy to deal with.

As you antecipated, be ready for some attacks of people that never tried Keto and don't know how it feels for a T1D. Ignore it. Can't blame your doctor as thats what its taught on Med School still, but yes, criminal information. I believe you also read Dr Bernstain 'Diabetes Solution'?

On your questions:

a) my question is when training what about going hypo? Obviously you don't want to take carbs.

As you are likely still on honeymoon, you may be still producing insulin (keto will prolong this for a long, long time, more than 6 months likely, you can test it). For now, aim to train when you have zero bolus insulin on board, best time would be before main meals. o h

Dont be afraid of taking small amounts of carbs if that gives you a little cushion. Another option is protein, as gluconeogenesis will act like a very slow carb. My favorite snack if I'm at normal levels (70-90) and want to stay there during an aerobic training is a pack of nuts or a couple boiled eggs. Just enough to hold it in place.

b) I am wondering if I maybe ran too soon after a bolus, thinking this is most likely since I ran and biked numerous other times in the last week with no issues.

Yes, training and bolus combined can be a very powerful tool to drop your BG levels. Best to change the time you train or the time you eat.

Personally I do my training first thing in the morning on a cup of 'bullet proof' coffee and couple eggs or before lunch/dinner when there is minimal insulin on board.

Formore info, I've put on a basic article on tri-training and LCHF with diabetes T1: http://www.ironguides.net/...-carb-high-fat-diet/

Vinnie

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Race report from 70.3 last month

Deer Creek Fall Challenge 9/28/2014

This race had a 9:16am start time so I got to sleep in until 6am, yay! Woke and check blood sugar, it was 157mg. Not awful, not great but about what I expected. My bg tends to rise pretty high out of bed due to the dawn phenomon. Made some coffee and tried to eat two English muffins with peanut butter and 3 units of bolus (Humalog). The insulin was pretty much ineffective at keeping my bg from trending upwards. Adrenaline can cause bg to rise and this happens to me at every race.
I tested my bg 8 times before the start, it was as high as 243 and last test before the start was 203. I typically burn off the high when swimming in the morning so I was pretty confident I could swim for around 45 minutes with no carbs and come out of the water within a normal range.

The race start late, my age group started at 9:37, over 20 minutes late. I had a horrible swim and I’m not sure why. I swam for 10 minutes the day before with no issues so I was feeling pretty excited. However, once I was in the water I was freezing! I had opted to wear my sleeveless wetsuit, maybe it was a bad idea. I did a lot of backstroking on the swim. One funny comment a lifeguard made to me “most people can’t swim straight backstroking”, well at least I have that going for me. So finally I was out of the water, nearly dead last. Oh well, get to T1, test bg and start biking! Swim time was 43 minutes
Got to T1 and tested my bg, 116mg, nice! I decided to take 4 units Lantus to keep from going high. I felt kind of hungry so I ate one Hammer Gel. Got all my crap together and off I went. T1 Time-6:13

I carry my own nutrition. For this race I had one bottle on the front with 1 scoop of Heed and another bottle with Hammer Perpetum. I also had 4 Gu gels on my bike and 2 sandwich bags with 1.5 scoops of Perpetum in them. The bike course was three loops, mostly flat with a few rollers and 2 small climbs. So as I got started on the bike I noticed my Garmin 510 wasn’t picking up my heart race, cadence or power. Not sure what happened but I powered it off and back on then it picked up the data, weird. On my bike I was running a 44mm carbon front and wheelcover on the back with my LG Vorritice helmet.

The bike course was pancake flat for the first 10-12 miles with rollers and one small climb at the end of each loop. I was feeling pretty good on the bike. Power was hovering around 180-200 avg which put me right around 20mph, much faster than I had anticipated. I was watching power but decided to go off heart rate data instead of power. Finished the first lap in 55 minutes and change, avg power was 179 np 193 avg hr 147. Stopped at the aid station, check bg and was 200mg, yikes! Refilled one bottle and dumped my bag of perpetum in it and also grabbed a bottle of just water. Now the plan was to drink water only for about 30 minutes to bring down the high.
Felt pretty good on the second loop. The sun was out and the wind was light. I wanted to ride a bit faster but decided to maintain current effort. I finished the second lap in about 55 minutes, the same as the first. This time I didn’t stop to test bg, grabbed another bottle of water and kept on going. Second lap data, avg power 188, np 197, avg hr 146.

Just a few minutes into the 3rd and final lap I managed to knock my Garmin 510 off and it went rolling down the road behind. I looked back and see a car run right over the top of it but didn’t hit. I about had a stroke. Turned around and quickly picked it up. I was starting to get a little fatigued and was ready to get off the bike. 3rd lap data, was 54 minutes and change, avg power 184, np 194 avg hr 152. Overall bike data 2:50 19.73 mph avg, avg power 183, np 194, avg hr 148. Very pleased with the bike split.
Tested bg in T2 and was around 120. Grabbed my running stuff and was off. T2 4:02

I carry my own nutrition for running as well. For this race I had 3 or 4 gu gels on me along with perpetum in my camelback quikdraw. Run legs felt really good, like I could go faster. It was really warm and all sun at this point in the day so I decided to stay conservative and keep heart rate under control which was around 8:30-9:00 minute pace. I was just hoping for 2 hours. The run was a double out and back on mostly pavement and nowhere to hide from the sun. Every aid station I grabbed water and ice and dumped in over my head and chest to try and keep my core cool. I did stop once to check my bg it was 90 which is a little lower than I like but nothing to be too concerned about. One thing that frustrated me, I forgot to turn off auto pause. So when I stopped to check my bg my run time stopped on my Garmin 910, no biggie though.

The run was pretty boring in the middle of nowhere surrounded by cornfields. One thing I do well at long course triathlon is keep moving when my brain is telling me to stop. Sometimes it’s difficult to stay motivated out there. Also want to set a good example for other T1D out there. So I was finally in the home stretch and new it wasn’t going to be my fastest 70.3 and I had no idea what my overall time was at this point. Suspected I was around 5:50 thanks to all of stoppages. I crossed the finish line and new my run was under 2 hours so I was pleased with that. 1:57 offically

One of my tri buddies went to get my final finish time ticket from the timers and brought it to me. To my surprise it was 5:41! I was very pleased with the finish time. However I was very disappointed with my swim time/effort. Stoppages cost me at least 5-6 minutes overall and had a few silly mistakes but hey, that’s how long course goes. I have lots to learn about long course and being T1D but I know I can be much more efficient. Just need to do more racing. My bg was steady the rest of the evening. No issues with highs or lows.



"Keep those feet moving!" Me
Last edited by: runnerwv: Oct 22, 14 8:46
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Re: The Official Diabetic Triathlete Thread [jamesstout] [ In reply to ]
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Lanuts patent is expiring in early 2015 woot woot, going to save some $$$



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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I have yet another question for you guys this one regarding dawn phenomenon....I usually work out before work and after the kids are in bed. So usually at 4AM and after 8PM....For the last 3 weeks I have been getting up at 4AM to work out because I have to be to work at 6. Since I have been doing this I have had no high readings. I get up and it is between 80-100. It would shoot up a little after breakfast but since I have started keto it doesn't. It seems I am beating the dawn phenomenon to the punch. Any one have this experience?
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Re: The Official Diabetic Triathlete Thread [nicholasJ] [ In reply to ]
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Perhaps

In my experience, the more I hit snooze and try and get out of bed the higher my bg goes. I never wake up in the 80-100 range, its usually 115-170.

Have you had ceptide tested to see if you're still producing insulin? I have mine tested with a1c

Maybe your liver stores less sugar in keto?



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [nicholasJ] [ In reply to ]
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Also, I tend to be more insulin resistant and carb sensitive in the mornings



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [jamesstout] [ In reply to ]
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i have asked Del this question but i may as well ask you guys as well

Theoretically, should we be ale to race spprint tri's with just basal in the background? Im assuming the body has enough energy in muscle glycogen for this distance is this correct?
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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You're not accounting for the glucogen dump and this glucose surge caused by the adrenalin of shorter aerobic events such as a sprint tri. That is why I tend to bolus for events like that (crits in my case) and then if I need to eat, I do. Not so much for fuel but to prevent hyper or hypo glycaemia
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Re: The Official Diabetic Triathlete Thread [jamesstout] [ In reply to ]
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This is true, but I thought the dump didn't matter if the glucose stored in the muscle itself is enough to get us through ? Don't we have enough 'power' for about 80 mins before nutrition needed and thus a bolus?

Edit- with that glucose dump I think we all get it, but my understanding was it isn't something needed to bolus for because we had enough energy stored to go on with anyway?
Last edited by: coates_hbk: Nov 9, 14 19:58
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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you have enough stored energy yes, but the issue is that hyperglycaemia (high blood glucose) has negative health and performance consequences. As i said above I don't see this as a "fuel" issue but rather an optional performance issue
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Re: The Official Diabetic Triathlete Thread [jamesstout] [ In reply to ]
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Ahhh I see... So it's more of a problem if ur seeing numbers like 250 or something instead of, say, 180? ... Where the high starts to interfere with performance (sluggish etc)?
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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coates_hbk wrote:
Ahhh I see... So it's more of a problem if ur seeing numbers like 250 or something instead of, say, 180? ... Where the high starts to interfere with performance (sluggish etc)?
exactly yes. Much above 200 and you'll see a drop in high level output . Try it in training (you'll do so eventually wether you want To or not !)
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Re: The Official Diabetic Triathlete Thread [jamesstout] [ In reply to ]
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I've done quite a few races where I've been over 20 (360 mg/dL), whilst my performances might have been affected, I haven't done horrendously being that high.

Sprint races, I can get by on just a sports drink or perhaps even water (yet to try). I just sip to thirst.

I think 200 is a pretty ok level to have whilst racing as it lessens the risk of going low, which is going to be a real performance killer. I've been above 20 and gone low in the same race, after injecting myself after the high.

Racing is a whole different kettle of fish to training when it comes to managing blood glucose levels.
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Re: The Official Diabetic Triathlete Thread [fulla] [ In reply to ]
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definitely...i have been getting by with sprint races with basal in the background, but since the bike sends me so high, i wondered if there is any advantage in me bolusing a unit or two in T1. I dont go any higher than, say, 13mmols (234)...but if 2 units kept me to 9mmols (162), would i be faster, all things equal?

I guess the question becomes ' how high is too high before sporting performance is impaired?'

Oly's and above, definitely needing insulin of that bit i know....i did a 70.3 on the weekend and should have front loaded a stack of insulin in T1...instead i spent my bike leg not really racing but trying to get nutrition in while injecting to bring down the highs. I injected myself 7 fuckin times on the bike. Sit up, coast, inject repeat. I was mostly 11-14mmols except the last 1/4 of the bike in which time i could finally feed the blood sugar drops. It was a very very hot day, i didnt push the bike, but was gone when i got off of it. Hell, in training i was doing 210NP for 2 x 1 hr blocks...i did 184np for the race i was just chasing blood sugar...it was a 2 lap bike, my first lap power was ok, i didnt feel fatigued nor was i burning matches.....but the second lap, wether it was just me or chasing the highs and getting no nutrition in through to the muscles, it musnt have been working. I think i ran out of muscle glycogen, and by the time i finally got my blood sugar down in the second lap, it was too late.
Cramped to shit. I shuffled the run but ofcourse needed to snort every gel known to man at every aid station, coz hooray, now insulin decides to work.
A big F you to hormones that cause hyperglycemia
Last edited by: coates_hbk: Nov 10, 14 5:22
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Re: The Official Diabetic Triathlete Thread [jamesstout] [ In reply to ]
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i managed to have a look at my glucometer post 70.3
Full basal on board during the race, fully tapered.


1/2cup oats with protein shake for breakfast. Normal bolus to cover all about 2.5hrs before event.
No nutrition pre-swim, was 9mmols (162). Had a Gel halfway through swim as swimming drops me low in racing and training.

T1 = 5.5mmols, ate 2 gluogel jelly beans (15cals per bean, 4gms carbs mix of glucose/malto) - i wasnt expecting the reaction below!
7mins into ride = 10.1mmols (180) – injected a unit
+17mins = 14.4mmols (260) – from memory may have injected 2 units here
+25mins = 14mmols (252)
+32mins = 13.9mmol (250) – had a gel here with maybe 3 units? I know I injected again
+38mins = 16.4mmols (295)
+48mins = 12.3mmols (221)
+58mins = 12.7mmols (228) – may have had more nutrition here with more insulin
+1hr05 = 13.4mmols (241)
+1hr15 = 14.4mmols (260) – injected more

+1hr25 = 7.9mmols (142) and the rest of the ride AND run between 4-8mmols.
At a guess I took about 7 units of insulin during my ride, unfortunatley i cant remember how much but it was a shit tonne.

It took me 1hr25mins to bring blood sugar down on the bike. No wonder I had a good first lap, I was perhaps cycling on stored glycogen in muscle? but ran out of gas and cramped badly just when my sugars were good again in the latter part of the ride and run.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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I also used to get high on the first hour in the bike, between 200-300, but I realized that after that my sugar went down pretty fast, to the point that eating tons of gels did not keep it high enough. Now I take 4units less of lantus (12 instead of 16) before races, at t1 I measure my bg and if im high I get a "regular" corrective dose. After I just ride "by feeling" and measure again at t2, which usually has me at 100-120. I get around 1200kcal on the bike (2.30h bike leg usually). I have a glucometer on my bike with an apidra pen, but i only use it if i feel something's wrong. Next HIM will be my first time using power on a race and I will try to pace it evenly at 240-270NP (0.8-0.9IF). Last simulation I did was a 1.5h bike @270AP, started at 250, got 2units, took 400kcal during bike and at the end i was at 56 (did not reduce my basal that day), took 10min to feel normal again and ran a 40min 10km, but at the end I was feeling empty, so now I might try upping my calories a little bit and maybe just reducing one lantus unit on competition. You know, as diabetic, I am (we should be) used to make many trial and error tests, with food, exercise, alcohol, emotions.

Hope you have better luck next time! It takes time but you will dial it for sure!


Stefano
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Hey all, I'm a newly diagnosed type 2 diabetic. Raced my first 70.3 In September. Didn't know I was diabetic at the time. Had a bad race, despite being well hydrated and really taking it easy early in the race my lower body started to cramp severely. I was only about 90 mins into the race when this happened. Don't even know if cramping can come from diabetes side effects but I never once cramped in practice ever.

So the very next day after my race I started getting very thirsty, sudden urges to pee. Fast forward 2 weeks and I had felt exhausted the past 2 weeks, so I thought maybe its lack of training. So i tried to go out and run and barely made it a mile before having to walk. Couple days later my eyesight went. Everything was blurry. I had started my training 9 months ago at 175lbs. I got down to 160lbs for my race........ 1 month later with no exercise at all I had dropped to 143lbs.

Doc gave me my A1C results which were 13.6. I was put on metformin and taking classes right now. Weird thing is, I fell into NONE of the categories of people who should get diabetes. No family history, not obese, good diet, exercise 6 times a week, just turned 41yrs old, and there are a few more, but I don't fit any of the mold. This was truly a shock to me.

My eyesight has gotten worse. I have to wear +3.25 reading glasses to see anything at all. I am trying to learn about nutrition thru taking classes and seeing an endo specialist. I just started walking and jogging again a few days ago. Seems like it might be a long road back. Hoping things clear up soon. I've really been down in the dumps and frustrated the past few weeks. Trying to turn my attitude around now. No need to feel sorry for myself. Time to get things right.

Just want to share my story. I will be going back and reading this thread from start to finish.

-------------------------------------------------------
I quit school because of recess........ I don't play
Last edited by: spiderjunior: Nov 11, 14 9:42
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Re: The Official Diabetic Triathlete Thread [Stefano] [ In reply to ]
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Stefano wrote:
I also used to get high on the first hour in the bike, between 200-300, but I realized that after that my sugar went down pretty fast, to the point that eating tons of gels did not keep it high enough. Now I take 4units less of lantus (12 instead of 16) before races, at t1 I measure my bg and if im high I get a "regular" corrective dose. After I just ride "by feeling" and measure again at t2, which usually has me at 100-120. I get around 1200kcal on the bike (2.30h bike leg usually). I have a glucometer on my bike with an apidra pen, but i only use it if i feel something's wrong. Next HIM will be my first time using power on a race and I will try to pace it evenly at 240-270NP (0.8-0.9IF). Last simulation I did was a 1.5h bike @270AP, started at 250, got 2units, took 400kcal during bike and at the end i was at 56 (did not reduce my basal that day), took 10min to feel normal again and ran a 40min 10km, but at the end I was feeling empty, so now I might try upping my calories a little bit and maybe just reducing one lantus unit on competition. You know, as diabetic, I am (we should be) used to make many trial and error tests, with food, exercise, alcohol, emotions.

Hope you have better luck next time! It takes time but you will dial it for sure!


Stefano

do you find an hour or so riding that high cramps you up etc? i cramp so bad if i spend a significant amount of time with high blood sugar
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Re: The Official Diabetic Triathlete Thread [spiderjunior] [ In reply to ]
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Most of us are very aware of those symptoms, I recall it very well.

It sucks right now but keep your head up. It gets better and easier. If you're Type 2 you can likely control it with a pill.

Keep exercising and a good diet and your A1C will drop.

I had a buddy dx as type 2 about 3-4 months ago. He was way overweight and didnt exercise at all. Depressed, drinking ect ect.

Woke up one day with all the symptoms...type 2. Had to end up going on insulin because the pill wasn't working. He is now a machine. Walking, jogging, clean diet.

In his case diabetes probably saved his life. This was the kick in the ass he needed to make the change and he's hell bent on it.

Keep your head up! Nothing to sulk about. You will get better



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [spiderjunior] [ In reply to ]
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Metformin?
I'm going to recommend they test your GAD antibodies as it sounds like latent auto immune diabetes of adults LADA.
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Resurrecting this thread:

70.3 strategies on mdi and tapered

- what works for you? How do u settle those highs? Inject before the swim ? In t1? Reduce ur basal the night before?

Tired of the bike portion sending me high that it ruins the rest of my races. Injecting 7 units on the first 40 kms of a bike leg is racing blood sugar not the race and not my idea of fun
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Maybe not cramp but I used to bonk, like if I had already been riding for many more hours.

I got to make a PR on my 70.3. I was at 143 at T1 and 147 at T2. Took 700kcal during the bike (supposed to be 1000, but I did not finish my bottle of malt dextrin). During the last loop if the run I kind of bonked, I felt slightly low. Managed to finish with 112, so maybe I was low during a part. I took one gel each 15min during the run and took water and sports drink 4 times per 7-km loop. I reduced my basal by 10% the night before. Rode at 250W (0.83 IF).

Managed to finish on 4.32 (27/2.23:/1:36 T1+T2=6), my PR by 26 min.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Background I have had T1 for 39years (43 now) and have played outside all my adult life (mountaineering, trail running, biking, x-country & back country skiing plus a few tri's).

Reading your race the Insulin that you took at the beginning of the bike if it was (Humalog or Humulin) both start to react in ~20min's but do not reach there peak effectiveness until just under an <1hr.
So as you said for the first half of the bike you were just chasing the high. (Done that in one 1/2IM and I did not like it)

But others have commented adrenalane(epinephrine) at the start of the race can & does cause a high loading & converting of glucagon to glucose.
But since you become a bit low during the swim, in your case is the glucagon being released &/or converted more slowly?
So like everything else with diabetes it is trial & error.
But in my case I would give myself a small Bolus at the start of the swim and have an extra gel or two in the wetsuit in case.

Plus if you are using a pump and it is not on for the swim you are missing a small amount of insulin during the swim.



i managed to have a look at my glucometer post 70.3
Full basal on board during the race, fully tapered.


1/2cup oats with protein shake for breakfast. Normal bolus to cover all about 2.5hrs before event.
No nutrition pre-swim, was 9mmols (162). Had a Gel halfway through swim as swimming drops me low in racing and training.

T1 = 5.5mmols, ate 2 gluogel jelly beans (15cals per bean, 4gms carbs mix of glucose/malto) - i wasnt expecting the reaction below!
7mins into ride = 10.1mmols (180) – injected a unit
+17mins = 14.4mmols (260) – from memory may have injected 2 units here
+25mins = 14mmols (252)
+32mins = 13.9mmol (250) – had a gel here with maybe 3 units? I know I injected again
+38mins = 16.4mmols (295)
+48mins = 12.3mmols (221)
+58mins = 12.7mmols (228) – may have had more nutrition here with more insulin
+1hr05 = 13.4mmols (241)
+1hr15 = 14.4mmols (260) – injected more

+1hr25 = 7.9mmols (142) and the rest of the ride AND run between 4-8mmols.
At a guess I took about 7 units of insulin during my ride, unfortunatley i cant remember how much but it was a shit tonne.

It took me 1hr25mins to bring blood sugar down on the bike. No wonder I had a good first lap, I was perhaps cycling on stored glycogen in muscle? but ran out of gas and cramped badly just when my sugars were good again in the latter part of the ride and run.


coates_hbk wrote:
Resurrecting this thread:

70.3 strategies on mdi and tapered

- what works for you? How do u settle those highs? Inject before the swim ? In t1? Reduce ur basal the night before?

Tired of the bike portion sending me high that it ruins the rest of my races. Injecting 7 units on the first 40 kms of a bike leg is racing blood sugar not the race and not my idea of fun
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Re: The Official Diabetic Triathlete Thread [kwallis] [ In reply to ]
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kwallis wrote:
Background I have had T1 for 39years (43 now) and have played outside all my adult life (mountaineering, trail running, biking, x-country & back country skiing plus a few tri's).

Reading your race the Insulin that you took at the beginning of the bike if it was (Humalog or Humulin) both start to react in ~20min's but do not reach there peak effectiveness until just under an <1hr.
So as you said for the first half of the bike you were just chasing the high. (Done that in one 1/2IM and I did not like it)

But others have commented adrenalane(epinephrine) at the start of the race can & does cause a high loading & converting of glucagon to glucose.
But since you become a bit low during the swim, in your case is the glucagon being released &/or converted more slowly?
So like everything else with diabetes it is trial & error.
But in my case I would give myself a small Bolus at the start of the swim and have an extra gel or two in the wetsuit in case.

Plus if you are using a pump and it is not on for the swim you are missing a small amount of insulin during the swim.

Im on shots, i have a meeting with a pump rep on wednesday.

I take novorapid- pretty much humalog equivalant. The low in the swim is simply because im not a good swimmer lol. Seriously, it drops me no matter what i do, racing/training etc. Im thinking your right, i will need a bolus before the swim start. However that leaves the question, what do i dow itht he basal the night before? keep it as is? Im thinking gel and 2 units before swim, and keep a gel tucked in wetsuit sleeve. I would prob have to pop it mid swim if i have basal and a bolus on board.
A coach reccomended that all basal be cleared out of my system by the start line and bolus before the swim. Scary shit



i managed to have a look at my glucometer post 70.3
Full basal on board during the race, fully tapered.


1/2cup oats with protein shake for breakfast. Normal bolus to cover all about 2.5hrs before event.
No nutrition pre-swim, was 9mmols (162). Had a Gel halfway through swim as swimming drops me low in racing and training.

T1 = 5.5mmols, ate 2 gluogel jelly beans (15cals per bean, 4gms carbs mix of glucose/malto) - i wasnt expecting the reaction below!
7mins into ride = 10.1mmols (180) – injected a unit
+17mins = 14.4mmols (260) – from memory may have injected 2 units here
+25mins = 14mmols (252)
+32mins = 13.9mmol (250) – had a gel here with maybe 3 units? I know I injected again
+38mins = 16.4mmols (295)
+48mins = 12.3mmols (221)
+58mins = 12.7mmols (228) – may have had more nutrition here with more insulin
+1hr05 = 13.4mmols (241)
+1hr15 = 14.4mmols (260) – injected more

+1hr25 = 7.9mmols (142) and the rest of the ride AND run between 4-8mmols.
At a guess I took about 7 units of insulin during my ride, unfortunatley i cant remember how much but it was a shit tonne.

It took me 1hr25mins to bring blood sugar down on the bike. No wonder I had a good first lap, I was perhaps cycling on stored glycogen in muscle? but ran out of gas and cramped badly just when my sugars were good again in the latter part of the ride and run.


coates_hbk wrote:
Resurrecting this thread:

70.3 strategies on mdi and tapered

- what works for you? How do u settle those highs? Inject before the swim ? In t1? Reduce ur basal the night before?

Tired of the bike portion sending me high that it ruins the rest of my races. Injecting 7 units on the first 40 kms of a bike leg is racing blood sugar not the race and not my idea of fun
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Re: The Official Diabetic Triathlete Thread [kwallis] [ In reply to ]
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sorry, re-post to make it a bit easier to read:

Im on shots, i have a meeting with a pump rep on wednesday.

I take novorapid- pretty much humalog equivalant. The low in the swim is simply because im not a good swimmer lol. Seriously, it drops me no matter what i do, racing/training etc. Im thinking your right, i will need a bolus before the swim start. However that leaves the question, what do i do with the basal the night before? keep it as is? Im thinking gel and 2 units before swim, and keep a gel tucked in wetsuit sleeve. I would prob have to pop it mid swim if i have basal and a bolus on board.
A coach reccomended that all basal be cleared out of my system by the start line and bolus before the swim. A 70.3 with no basal at all from the start?
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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I'm on MDI as well, currently Lantus and Humalog pens although insurance is requiring me to change from Humalog to Nova.

I would disagree with the no basal on board, especially for a 70.3. Perhaps if your still honeymooning, yes.

But in your situation(and mine), you're going low in the water then rebounding out of the water and onto the bike.

I think that's the liver dump. Two theories I have for race day highs. 1) early start coinciding with the dawn phenom 2) Adreneline

At my 70.3 in Sept I took 4 units of Lantus in T1. I typically take 12 units at 8am. I was above 200 at swim start and around 100 out of the water (no carb). Was high on the bike. Took too much carb during the bike. Burned that off though, run was good stayed around 100-140.

I don't understand the logic of no Basal on board? I would imagine that would send your baseline bg # high. It would for me



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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You may be right, but im going to try this, on sunday. Have an oly to do. According to diabetic coach: basal to end as the gun goes off. Inject 2.5units bolus pre-swim with a gel. This should help fight the highs from getting onto the bike. The lack of any basal on board does concern me though you are right. But Cliff Scherb is apparently good with diabetic triathletes, so we will see how i go.
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Good luck!

I got a Dexcom cgm about a month ago and have learned alot about my bg and have already made adjustments to better control bg.

First thing the data showed me was my basal (lantus) wasn't lasting 24 hours. I would trending upwards overnight which results in the high in the morning. This also makes a bolus more difficult to bring down the high on me.

So, I have split my basal into two doses. 8 units at 8am, 8units at 8pm. I was taking 15 at 8 am.

This adjustment seems to be keeping me steady. Not waking up highs very often now and should also help the race morning highs I had been experiencing.

I'm still tinkering with the proper dosing as I have had more lows than highs. Today I dosed 7 units Lantus at 8am in hopes to stave off lows throughout the day.



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [KP-NJ] [ In reply to ]
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Hi, I do long distance and just invested in a G4 Platinum. have you any advice about swimming please? Do you cover the sensor with anything? Also how have you fixed the Dexcom to your bike?

Thanks
In Reply To:
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Re: The Official Diabetic Triathlete Thread [Rhino007] [ In reply to ]
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I use the Dexcom G4 Platinum as well...no need to cover your sensor while swimming. As for the bike, I use that little belt clip thing that they have. I simply put my Dexcom in a ziplock bag, put it in the belt clip and then Velcro that to my stem. Very easy to get readings while riding. I put it on the bike before the swim and do one final calibration with my regular meter. As I hop off my bike in T2, I pull it off my stem and put it in the pocket of my jersey. I've done this for multiple IM's and I've never had an issue.
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Hi,
35 year type 1 here (diagnosed at age 11) over the past few years I've developed a frozen shoulder. After 2 manipulations, the last one being in November. I have not been able to get my full range of motion (especially the external rotation). This ultimately makes my swim slow as I cannot get a decent catch and pull. Curious if there are any other T1's that are also struggling with this?
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Re: The Official Diabetic Triathlete Thread [SWBK44] [ In reply to ]
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I haven't sufered from frozen shoulders but worries me (among others) as its a typical complication of T1D, I'm into 15y of T1D so just curious to learn about them all. I'm wondering what sort of A1C you've held for both the past few years? Any other problems you've suffered that hindered your performance?

Other than of course target as low as possible A1C (hovering in the mid 5's) I just aim to focus a lot more on recovery than your typical non-D triathlete. Weekly massages, plenty of sleep for hormonal balance and of course a very strict diet with no cheat days ;-)

Vinnie

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [KP-NJ] [ In reply to ]
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How accurate do you find the dexcom in trending when racing? I think my blood would change too rapidly for the dex to keep up
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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For me, the Dexcom is very accurate. I hear mixed reviews on it's accuracy, but maybe that has something to do with individual body chemistry or something; I'm not a scientist or a doctor though, so I have nothing to back that up. It's not unusual for my finger stick readings to be within +/- 5 points of my Dexcom on a regular basis. When racing, I will test in T2 and at the finish and still routinely fall within the range I mentioned...I'm not trying to say that I have perfect control, I'm just saying that my Dexcom readings are comparable to those of my regular meter. I guess the best idea is to do some serious testing in training to see if Dexcom readings are reliable enough for you to base a blood sugar correction on.
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Re: The Official Diabetic Triathlete Thread [KP-NJ] [ In reply to ]
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Anyone using one of those closed loop systems? Seems like a lot of work, and a fair amount of risk involved. But I would love to get some help making my decisions regarding insulin delivery.

OpenAPS.org – #WeAreNotWaiting to reduce the burden of ...
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Re: The Official Diabetic Triathlete Thread [coates_hbk] [ In reply to ]
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Hey guys, I have a question for you all. I'm looking into getting an insulin pump for the first time (diagnosed ~3.5 years ago), and my Endocrine MD is recommending a pump with a CGM because I have semi-frequent lows. I had a 72 hour trial with a CGM, and I had all sorts of trouble keeping it fixed in place.

For those of you using pumps with infusion sets and CGMs, how do you keep them fixed in place so you don't have to baby em all of the time?

The NP told me they could be worn without extra cover, but I feel like I'd pull it out too easy. MD didn't recommend an omnipod (I asked) mainly because he insisted on the CGM. I had BG <40 twice during the four days I had the monitor on, so I'm inclined to agree...
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Re: The Official Diabetic Triathlete Thread [RFXCrunner] [ In reply to ]
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Given the 72 hour time frame and the issues with keeping the sensor attached, it sounds like you were on the Medtronic system? If so, I had the same issues, and that was one of the main reasons I made the switch to the Animas pump + Dexcom. Initially I had the 2 separate devices, but now have the Vibe system which has the CGM integrated into the pump, which is awesome.

As for keeping the sites in place, it's not bad once you find a location that works. I primarily use my abdomen for pump sites, and my Dexcom sensors are almost always on the back of my arm (tricep area), as I've found I get good accuracy there and it doesn't get in the way during swimming, biking, or running. During summer when I sweat a lot (or when I'm actually doing swim training, unlike now) the adhesive on the sensors/infusion sets tends to not last as long, but there's an additional product called Skin-Tac that helps greatly in that regard. For IM I started the day with an extra infusion site already inserted, just in case something happened to the "primary" one.

I think you'd see a huge benefit to using both the pump and the CGM. The pump makes it super easy to turn down basals during exercise without screwing up the rest of your day, and it's much easier to fine-tune dosage compared to the long-acting injections. I've been without my CGM for over a week now (waiting on insurance issues) and frankly it's driving me nuts not having that info. Being able to see whether your BG is trending up/down before or during workouts is huge, and it helps you be able to prevent extreme highs or lows rather than trying to fight them when it's too late.
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Re: The Official Diabetic Triathlete Thread [harryt] [ In reply to ]
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Yes, it was the Medtronic system I was trialing, mostly because it can be programmed to shut off if the CGM senses a critical low, and I was told that it's the only current system that does.

The issue I'm hoping tonavoid is that I'm pretty lean, not many good spots to put an infusion set or CGM, so it sounds like I'll need to spend some time finding the right setup and sensor placement. I'm looking forward to getting on the pump, but its definitely going to be a whole new learning curve.
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Re: The Official Diabetic Triathlete Thread [RFXCrunner] [ In reply to ]
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I really like the omnipod for triathlon. I've found a good place for it on my inner thigh. It needs to be far enough from the crotch so that it clear the saddle while pedaling, but I like keeping it covered in my tri-shorts. (not a speedo guy). The reason I keep it somewhat medial is so that my ribs don't contact it while in my aerobars. (It's also a good place for other exercise, such as yoga).
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Re: The Official Diabetic Triathlete Thread [RFXCrunner] [ In reply to ]
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I'll second the Animas/Dexcom combination found in the Animas Vibe pump. I've used the Minimed CGM and Dexcom's and there is no comparison. Dexcom is much more accurate. If Minimed was the only CGM option, I would actually pass on it to be honest.

I like the Omnipod option as well, but it does not integrate directly with Dexcom. You could easily have an Omnipod and Dexcom though.

There are some folks that use an app on the new Garmin 920 that will show your Dexcom blood sugar reading on the watch.

Good luck on moving forward.
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Re: The Official Diabetic Triathlete Thread [brrit] [ In reply to ]
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I usually shave the area first, helps keep it on during sweat fests.
I switched from minimed/dexcom to omnipod/dexcom, i'm really enjoying the benefits of not having a tube.
I've also got a pebble watch where I can see my CGM data, this has been a game changer for me with workouts and especially daily life; highly recommend it.
Last edited by: willbarfield: Apr 29, 16 10:44
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Re: The Official Diabetic Triathlete Thread [willbarfield] [ In reply to ]
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Has anyone else had problems with their Dexcom reading accurately during workouts- specifically in aero?

The Dexcom is reading 30-40+ lower than the glucose meter. It is kind of hard to concentrate or get in a decent workout when the meter is beeping and sending urgent alerts that my levels are 50 and below. When I check my glucose the levels during the wkt they are in the 70- 80's. The readings on the Dexcom also go up immediately as soon as I get off the bike. I spoke to Dexcom today and one thing that might be causing the problem could be compression from being aero or bent over? I'm pretty lean and have the sensor inserted into a higher fat area 2 inches to the left/right of my navel.
I'm currently in the long process of being tested for an insulinoma. The Dexcom is accurate within a few points when I run and or in daily life with the glucose meter.

Have you found the Dexcom to be accurate during heavy training?
Is there another site that you have found for sensor placement that works well?
Last edited by: milesaway: Oct 27, 16 19:11
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Re: The Official Diabetic Triathlete Thread [milesaway] [ In reply to ]
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I usually wear my sensor on the outside of my upper arm...I find I get pretty accurate results there and it stays out of the way for most workouts (although if I'm swimming a lot, the adhesive doesn't last as long there as in other spots). I've had the same issues on occasion with abdomen sites, but I don't really have a scientific explanation for it...I mean I guess that area is moving less when you're on the bike, but that may or may not be related.
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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runnerwv wrote:
I thought this could be a place to post what's working and not working with other Tri Diabetics out there.

Thought I'd revive this thread, as the topic has become personally relevant...

Intro/context: former IM distance, road racing and ultra runner; joined here back in '99 but been away for a decade+ due to serious health conditions; recovered (more or less) and coming back to endurance sports as another "1.5 diabetic," diagnosed 40+ on insulin; now aiming at 70.3's as my sweet spot; injections, not pump.

Meds stats: Lantus 30, Humalog 1/10.

Lots to parse out of the historical content here, but have a few questions/comments to start:

a) I get the common logic that insulin is required to utilize nutritional inputs and convert carbs to energy. It seems that many people in this thread are on low doses of <10 Lantus and not much Humalog with meals. As someone who requires higher doses of both, I'm trying to get some sense of how to adjust and decrease my basal and bolus for long-distance training and racing.

Also, if I was doing short races, I know that I could bolus at the start and be done before my peak, so there isn't much to manage. For distance, I'm trying to figure out if I take Humalog at the start of a race and account for eating 3 times within my bolus window (I peak around 3-hours, plus), measure and eat accordingly and then either bolus again for the next eating window, or top-up if going low?

Also, because there's more insulin in my system, I find that the drops come fast and hard when they do happen and can change depending on things like heat, etc. So even though I've been testing and learning as much as I can, I'm not landing on trends, etc to develop guidelines of insulin to carb - especially when the intake is of "fast-acting" food and drink that's burned-off quickly. I'm concerned about taking a bolus of 3 Humalog for a water bottle of Gatorade when I don't know my prope ratio for exertion.

b) I'm looking for a sports-focused endocrinologist in the Greater Toronto Area to get a referral for. My GP won't even consider the question and believes that I should "maybe find another hobby," and my present endo won't entertain questions beyond my A1C, kidneys, blood pressure, etc. Likewise, the nutirtionist on my care team isn't an athlete, so we're speaking two different languages.

c) Prior to diabetes, I never had issues with cramping, even at the IM distance. Now though, I find that I am cramping regularly, even for rides under 40-50km. Have tried Gatorade Zero, but no difference. Any insights or recommendations?

Many thanks. Hopefully this thread kick-starts again...
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Re: The Official Diabetic Triathlete Thread [insulinpower] [ In reply to ]
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My suggestions below. Trying to help as a T1D since 2000, with plenty of racing (from junior to Kona pro) and coaching experience


a) I get the common logic that insulin is required to utilize nutritional inputs and convert carbs to energy. It seems that many people in this thread are on low doses of <10 Lantus and not much Humalog with meals. As someone who requires higher doses of both, I'm trying to get some sense of how to adjust and decrease my basal and bolus for long-distance training and racing.

>>> I would suggest reading Dr Bernstein `Diabetes Solution` he teaches how to find the optimal basal, among other benefits of his approach which Ive been following and improved my A1C now in the mid 5s.


Also, if I was doing short races, I know that I could bolus at the start and be done before my peak, so there isn't much to manage. For distance, I'm trying to figure out if I take Humalog at the start of a race and account for eating 3 times within my bolus window (I peak around 3-hours, plus), measure and eat accordingly and then either bolus again for the next eating window, or top-up if going low?

>>> Careful with Humalog, it acts much faster than that. Bolus pre-race has the main goal of keeping the levels steady to counteract against adrenalin flushing glucose from your liver into your system after a `mini taper, mini carboloading`. Very easy to spike on race day for those reasons


Also, because there's more insulin in my system, I find that the drops come fast and hard when they do happen and can change depending on things like heat, etc. So even though I've been testing and learning as much as I can, I'm not landing on trends, etc to develop guidelines of insulin to carb - especially when the intake is of "fast-acting" food and drink that's burned-off quickly. I'm concerned about taking a bolus of 3 Humalog for a water bottle of Gatorade when I don't know my prope ratio for exertion.

>>> Correct, I would avoid the big numbers of humalog as if they crash you its game over. In the book recommended above, learn about the `rule of small numbers`, small inputs, means small margin for error. The less insulin you take, less crashes. Keep carb consumption during and outside of racing to the minimum needed. You can perform well on low carb. Ive blogged about my experience here https://www.ironguides.net/...-carb-high-fat-diet/


b) I'm looking for a sports-focused endocrinologist in the Greater Toronto Area to get a referral for. My GP won't even consider the question and believes that I should "maybe find another hobby," and my present endo won't entertain questions beyond my A1C, kidneys, blood pressure, etc. Likewise, the nutirtionist on my care team isn't an athlete, so we're speaking two different languages.

>>> I hear your frustration, most GPs are just relaying the information they have been trained with and there's also the liability issue that they are protected by following the standard guidelines which is not to adapt to triathlon racing/training. You may need to take your own decisions here, study on your own and experiment with different approaches


c) Prior to diabetes, I never had issues with cramping, even at the IM distance. Now though, I find that I am cramping regularly, even for rides under 40-50km. Have tried Gatorade Zero, but no difference. Any insights or recommendations?

>>> If you are running chronically high, which can be normal as you lean, you are also chronically dehydrated and with electrolyte imbalance. You need to supplement across the board with extra electrolytes, especially if you go the low carb route (that drops Blood Pressure so the salts brings it up again)

Hope this helps.
Vinnie Santana

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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Hey Vinnie,

Thanks very much for taking the time to provide such a detailed reply. Your advice is really succinct, practical and actionable. Ordering that book right now and will check out your blog. Great to know there's a T1D coach out there as well!

One real eye opener for me is your comment about sugars increasing as you lean. That was counterintuitive for me and is what I'm struggling with most right now. Lots of high numbers as I've been increasing mileage and intensity, as well as losing weight (and I have "lot" to lose). Especially my waking numbers, which had been very consistent pre-exercise.

I was increasing my basal to try and counteract that but then found I was going low more often during the day, so it was a real head-scratcher. That insight is a game changer.

Will read your resources and figure out a new test and learn strategy. Luckily my spouse is an insulin-dependent nurse, so the conversation in this house is focused on hacks and learning.

Cheers/
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Re: The Official Diabetic Triathlete Thread [insulinpower] [ In reply to ]
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The ratio of Lantus:Humalog is a bit off in my opinion. It looks like Lantus is being used to lower glucose when it should be used only to cover the liver dumping glucose. a 50:50% or thereabouts is more appropriate. Personally Im on 1:1.5-2 if you count regular as a meal based insulin. Keep on lowering the lantus and add more basal to cover the spikes.

I also presume you are on MDI so consider adding R for protein, just be careful as its a potent dose and can last ~8h so avoid taking 1 meal before training (ie, if you use for lunch and train in the evening you will crash).

Good luck, its a bit of a trial and error and Im still learning after 20y of T1D but its sort of becomes a fun after a while once you can figure out the outcome most of the time ;-)

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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Really good stuff and really appreciated. Thank you again.

Yes, the ratios are all off right now. I've decreased my Lantus from 64 to 30 over the course of a few months due to recent positive health and activity changes and simultaneous addition of Jardiance. So everything's kind of upturned at the same time that I adding in distance/intensity, etc.

Not sure what MDI or R is.

Thanks for your input though. Your notes and this thread is providing useful talking points for an appointment with my sports physician next week to see if he knows an endo to refer me to.

Enjoy your weekend!
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Re: The Official Diabetic Triathlete Thread [insulinpower] [ In reply to ]
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Just diagnosed as a type 1 diabetic. Setting up an apt with endo this week.
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Re: The Official Diabetic Triathlete Thread [TNTRI] [ In reply to ]
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Without sounding flippant about your life change, welcome to the family. Was it a surprise thing, or migration from T2 to T1? Best wishes on your journey.
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Re: The Official Diabetic Triathlete Thread [insulinpower] [ In reply to ]
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Thanks for reviving this thread!

Do you have a CGM?

I would be very cautious of taking bolus for any race but especially longer distances. If you do take a bolus I would greatly reduce what you normally would take. If I have a bolus in my system, I will crash, fast.

Everyone is different with how their bodies react because of different dosages ect. While I don't race 140.6 anymore, I still do marathons and long rides/runs. I don't really adjust my basal for it. I take 27 units of Tresiba.

Gadgets I'm using to make my life easier, DexG6, iPhone XR, Apple Watch which I always wear to more easily display my BG and AirPods! AirPods for workouts are amazing because I can just say " hey Seri what's my glucose" and I get the number without taking out my phone or tapping my watch.



"Keep those feet moving!" Me
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Just passing this along, Kris Freeman who was a 3x Olympic nordic skier and also T1 is transitioning to Triathlon for his retirement. He posts a lot about training and racing with T1 on his facebook page Kris Freeman Fortitude.
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Re: The Official Diabetic Triathlete Thread [endosch2] [ In reply to ]
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endosch2 wrote:
Just passing this along, Kris Freeman who was a 3x Olympic nordic skier and also T1 is transitioning to Triathlon for his retirement. He posts a lot about training and racing with T1 on his facebook page Kris Freeman Fortitude.


That’s an awesome resource. Thank you. I’m trying to compile a list of T1’s to follow for inspiration and whatever insights they might have. Will check him out.
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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runnerwv wrote:
Thanks for reviving this thread!

Do you have a CGM?

I would be very cautious of taking bolus for any race but especially longer distances. If you do take a bolus I would greatly reduce what you normally would take. If I have a bolus in my system, I will crash, fast.

Everyone is different with how their bodies react because of different dosages ect. While I don't race 140.6 anymore, I still do marathons and long rides/runs. I don't really adjust my basal for it. I take 27 units of Tresiba.

Gadgets I'm using to make my life easier, DexG6, iPhone XR, Apple Watch which I always wear to more easily display my BG and AirPods! AirPods for workouts are amazing because I can just say " hey Seri what's my glucose" and I get the number without taking out my phone or tapping my watch.

No GSM, just injections. With public health here it’s a process and I’ve had too much endo turnover to have the consistent 3-year run required to get one...

Yes the inconsistencies are maddening. For now I’m starting intentionally quite high, without bolus, to give myself some buffer and test reactions. But results are way off.

Eg. Friday I did a 16k racewalk and dropped 8+ points. Yesterday I did a 3-hour bike ride and dropped 2+ points. Same time of day. Same heat.

Madness.
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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Quick question - any insulin-dependent diabetics out there also doing 70.3+ tri's, or marathons/ultras on a plant-based diet? If so, how's it going? Learnings?

The excercise and other diet changes have already dropped my basal Lantus 36 units/day in the last 4-6 months. Wondering if changing to plant-based would show additional benefits...

Cheers.
Last edited by: insulinpower: Jul 19, 20 10:18
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Re: The Official Diabetic Triathlete Thread [insulinpower] [ In reply to ]
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Never received a notification about this response. Was told I was T2 in high school and now 15 years later its been decided its T1 instead. Now on Novolog, Tresiba, and Metformin. Switching to an insulin pump soon. Having bad drops in sugar levels so havent had much success lately in working out. Hoping to get it stabilized and get back into shape.
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Re: The Official Diabetic Triathlete Thread [TNTRI] [ In reply to ]
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Sorry to hear about your tribulations. The lows on insulin can get scary quickly, so I empathize with you. Have a similar situation now as body and dosages change, creating wild unpredictbility. Having to take so many sugar sources, etc. on every bike and run now it's ridiculous. I look like that one guy you always see at marathons who's carrying a backpack full of food and drinks as if they're on an expedition, lol...

Do you find the lows are the same intensity or different compared to your previous meds? Are you new to the Metformin? I was doing the Metformain/insulin speedball as well. How's your stomach handling it? I couldn't take it and got switched to Jardiance with great results.

Good luck out there!
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Re: The Official Diabetic Triathlete Thread [insulinpower] [ In reply to ]
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I am having some stomach issues. Nothing major but def 1-2 times a week I have some vowel issues. Yeah I feel the same way when I do go for a ride. Packed out with sugar to make sure I make it fine.
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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I got on Afrezza, the inhaled insulin, 2 years ago and it has changed everything as far as training and racing. It starts working very quickly in your system (peaks in 15 min) and leaves rapidly too. It is almost out of the system in 1.5 hours. I can start a training session 1.5 hours after eating and taking Afrezza and I will not come crashing down like with novolog/humalog, which takes longer to start working and it’s in your body much longer, 4 hours or more. I still use the pump for the basal rate and I still bolus. But if I have a 250-300 BG I can take some Afrezza and have less than a 120 BG in 30-40 min. Then I can start a session with the insulin peak long gone within the hour. I had to cancel so many training sessions because of a 250 BG. I would inject, then an hour later, nothing. Then I would inject again ( stacking insulin) and come crashing down 2 hours later and I would get 50s during a training session. I am sure everyone can relate.

I was worried about "inhaled" insulin because I am an athlete. However, no residual respiratory side effects after two years of use.
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Re: The Official Diabetic Triathlete Thread [insulinpower] [ In reply to ]
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At first I never imagined steady BG on a plant diet was possible, but I can see it happening unless you are putting out more than 20h of training per week, sure not as easy as when adding some animal protein as that just kills hunger and you need less volume of food, but if you are OK with adding some eggs (very little gluconeogenesis) then I imagine is possible to be plant based and maintain an A1C of sub 6%.

-Daily avocados
-Coconut & Olive Oil (potentially butter)
-All the slow carbs veggies
-Coconut milk
-Nuts in moderation
-Eggs x3 a day

For the previous posts, Im also on metformin, 2x500mg (10am, 5pm), my insulin requirements is very low, I do R insulin before high protein meals (0.5-1u), Lantus 2x a day (2-2u) and Novorapid ~3x a day 1-2u. Total insulin intake is around 10u.

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
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Re: The Official Diabetic Triathlete Thread [Jimbotri] [ In reply to ]
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Thanks for the post. This is very interesting to me. Never heard of it before. I got a referral to an endo in my city who is apparently "performance-focused" so will ask them about it. I find Humalog surges late and with varying intensity for me (around 3-hours), depending on other factors, so finding it hard to guage. Would rather have something like you're describing.

The drug companies are missing an opportunity to jump into the conversation on this forum. If their marketers were aware of the conversations about their brands through social media listening and really are interested in leveraging the "active lifestyle" angle, then it would be great to get them weighing-in. The bike and equipment manufacturers have already figured that out and they have a lot less money than Lilly, et al...
Last edited by: insulinpower: Jul 22, 20 6:26
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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Thanks for that. Agree about the need to "feel full." Nothing does that for me quite like meat. On my 2nd bowl of chick pea, cauliflower and tofu curry right now actually and still not feeling like I've had a meal yet, no matter how "rich and thick" I made the sauce, lol.

Reminds me of one the lines in a Michael Arnstein (the Fruitarin ultra guy) video about, "If you have to eat 9 or 10 bananas to feel full before going to bed at night..." Yikes.

Yes, I'm open to "meat/protein cheats" and love eggs. Eat a lot of egg whites already. Not looking at plant-based as a hardcore, long term lifestyle change, or as a philosophical decision, so won't be semantic about boundaries and adherences. This is more of a test & learn thing to see if it will help me cut weight and insulin requirements faster in the short term. I've posted elsewhere that I've cut my basal from 64 units/day to 28 units/day in a few months from just excercise and weight loss. In the week that I've been experimenting with non-meat meals I find I'm already "running hot" on my insulin and so probably going to drop it even more.

Would like to see what happens over a 90-day test period...
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Anybody here on the Freestyle Libre system and if so, how are you finding longevity for the sensors and any hacks to share?

I've been using them since they became available here in Canada and have to admit the product and customer experience more like supporting a "necessary evil" than something I'm thrilled about. The ease of use is great, but finding issues with accuracy in general and sensor life and just keeping the darn thing in with training activities.

Find that the sensor will overheat (giving me a "sensor too hot" error message, or just crap out entirely (too much sweat maybe...?), or dislodge. I have it applied by a nurse (my partner), under 2 Tegaderm dressings and have it re-dressed when it starts to peel, so it's securely held in place and protected from elements. Doesn't seem to help. Have had them rendered useless in as little as 2-days. Given the cost, it's a little frustrating (yes, I know that you can call their help line for replacement, but here in Canada, the customer service is shambolic. Truly :( Gave up on bothering with that a long time ago...

I'm particularly wary about how it's going to fare under a wetsuit. Any thoughts?

Likewise, where have you found effective placements on your body and what are you doing for taking readings on race day? Carrying your phone with you to tap? Not sure if I want to be schlepping my phone with me through a 70.3+...

Cheers.
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Re: The Official Diabetic Triathlete Thread [insulinpower] [ In reply to ]
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I've been using FreeStyle Libre for a few months and haven't really had any issues yet. The biggest problem is just being aware that it is there and making sure not to brush up against a door frame, etc, to dislodge it, which I did with the first one. Luckily I only had another day to go with that sensor. I've been out training quite a bit (I live in the Canary Islands), running/biking in the heat, swimming in the ocean both with and without a wetsuit, and I haven't yet had a problem with it coming lose, or with getting a reading. My doctor put on the first one, but I've been doing it since then and no issues, just watching myself in the mirror for the application, switching arms each time. The biggest issue is actually getting the sensors delivered, but it is the same with all deliveries here in Gran Canaria so you get used to the wait.

I was diagnosed with T2 back in 2012 while living in Montreal, so a longtime metformin then janumet user, but confinement here in Spain led to an intense episode that put me in the hospital, where I was rediagnosed with LADA and have since started using insulin. Now doing janumet & 2u apidra before breakfast, jardiance before lunch, another janumet before dinner, then 8u teojou after 10pm. Along with daily training things are going well with this setup.

Drew

---------------------------------------
I am a living animal, tied to a dying soul. -PKD

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Re: The Official Diabetic Triathlete Thread [TNTRI] [ In reply to ]
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So I was diagnosed a few months ago as type 1. I have been having a really hard time finding a balance with insulin and keeping my sugar levels where they need to be to safely exercise. I use a CGM and went for a one hour ride today. At the start of my ride my BG was reading close to 150. By about 30 minutes in it was showing that my BG was 70 which is when it alerts me that its getting low. I consumed a Clif gel and continued to ride. I get a reading every 5 minutes and for the continuation of my ride my reading kept reading lower and lower actually staying in the 40s. I ate 2 more times consuming small packs of welchs fruit snacks. I made it home and drank about 3oz of hot coca cola and finally after being home for about 10 minutes my numbers started slowly rising back up. I havent eaten or drank anything else except water since then and its been about an hour and a half since i rode. My BG has now shot up and is reading 248. Anyone else experiencing these kind of issues? Am I just not processing the carbs at a normal pace and my body is taking longer to get them into my system?
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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Hi vinnie and others -

Has anyone found tapers don’t work so well with long course with type 1? Had my usually 10 day taper for a half. Reduced volume a touch and from 7 days brought it down to half volume but maintained intensity but even the day before the race I was concerned. I was sweating bullets on a 30 min ride, like my body has gone into full recovery mode and had no sharpness and power.
Race day I was plagued with cramps. Coming out of the swim my legs were locked. It’s as if they had no power and was asking too much of them and they were seizing from very early on? Again I had enough intensity in my taper to try keep sharp. I was well hydrated in the lead up even had pickle juice and crampfix and couldn’t get rid of them. I had zero power and just had to finish with a shit time. My vmo in particular was going mental with cramp.
Looking back I always seem to race better with less rest but A touch more fatigue and buzz in the legs. Too much taper (for me) and my legs are flat and blood is all over the place.
Is anyone else similar ? Could there be any reason behind this from a diabetic point of view ? Or is this just individual ?
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Re: The Official Diabetic Triathlete Thread [IamSpartacus] [ In reply to ]
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How were your blood sugars on race day? I used to have massive cramp problems in longer races, especially when I was high. I changed my drink and hardly ever get them these days.
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Re: The Official Diabetic Triathlete Thread [fulla] [ In reply to ]
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i actually had to have a gel pre swim. I overbolused breakfast so had to bring them back up. On the bike i was trending low when i normally need insulin from adrenaline highs. I needed a 360 cal bottle of Torq as well as 6 or 7 GU gels to stay afloat on the bike alone. rode 15mins slower than normal for 2:40 ride. Had a gel mid swim too. It was ridiculous. I was a sugar pig. Had no power at all. Got to the run and didnt bring needle with me, and low and behold blood went up to 13 over the distance with just elecrolytes, 1 swig of coke and about 5 lollies for the entire 21kms. Was shuffling 5:25km pace doing my best to fight cramps.
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Re: The Official Diabetic Triathlete Thread [IamSpartacus] [ In reply to ]
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Yes, I recommend Tapering a little different, if you spend several months training XX hours a week, then race week sub 50% of that, is not going end up well in terms of BG levels, insulin requirements. I recommend something along the lines of

Do a freshen (~3 days long) ~2 weeks out just to get rid of that deep fatigue. A day off and a couple very easy days
Then back into a semi-normal week (say 75% of the volume, tad less intensity, dont redline, aim to maintain fitness)
Pull back on the intensity days leading into the race, some volume ok

Dont try to carb load much, liver will be topped off with glycogen anyways from reduced training load. You may need to increase basal insulin amount to cover that. And by no means try to 'water load'

--
Vinnie Santana, Multisport Coach
http://www.ironguides.net
* * * Your best is our business. * * *
Last edited by: vinnie: Oct 18, 20 0:46
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Re: The Official Diabetic Triathlete Thread [TNTRI] [ In reply to ]
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TNTRI wrote:
So I was diagnosed a few months ago as type 1. I have been having a really hard time finding a balance with insulin and keeping my sugar levels where they need to be to safely exercise. I use a CGM and went for a one hour ride today. At the start of my ride my BG was reading close to 150. By about 30 minutes in it was showing that my BG was 70 which is when it alerts me that its getting low. I consumed a Clif gel and continued to ride. I get a reading every 5 minutes and for the continuation of my ride my reading kept reading lower and lower actually staying in the 40s. I ate 2 more times consuming small packs of welchs fruit snacks. I made it home and drank about 3oz of hot coca cola and finally after being home for about 10 minutes my numbers started slowly rising back up. I havent eaten or drank anything else except water since then and its been about an hour and a half since i rode. My BG has now shot up and is reading 248. Anyone else experiencing these kind of issues? Am I just not processing the carbs at a normal pace and my body is taking longer to get them into my system?

Where is your CGM placed? I had some issues with compression lows with my Dexcom when riding in aero. It's obviously easier to check this when you're on the trainer against your regular meter to see if your numbers are accurate on the CGM. After moving the CGM a little higher on my abdomen up the numbers stabilized out more. Just something to consider.
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Re: The Official Diabetic Triathlete Thread [vinnie] [ In reply to ]
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vinnie wrote:
Yes, I recommend Tapering a little different, if you spend several months training XX hours a week, then race week sub 50% of that, is not going end up well in terms of BG levels, insulin requirements. I recommend something along the lines of

Do a freshen (~3 days long) ~2 weeks out just to get rid of that deep fatigue. A day off and a couple very easy days
Then back into a semi-normal week (say 75% of the volume, tad less intensity, dont redline, aim to maintain fitness)
Pull back on the intensity days leading into the race, some volume ok

Dont try to carb load much, liver will be topped off with glycogen anyways from reduced training load. You may need to increase basal insulin amount to cover that. And by no means try to 'water load'

Gonna save this Info, much appreciated !
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Re: The Official Diabetic Triathlete Thread [TNTRI] [ In reply to ]
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Hi TNTRI!

Yes, I have experienced what you are describing many times on the bike, run and swim - BGs running low during the exercise, but then spiking up as soon as I stop, especially if I've eaten a lot of food toward the end of the workout. One endocrinologist told me it was because the body slows down digesting food during exercise, as part of the fight or flight response, and then starts up again when you stop working out. This doesn't make a ton of sense to me, because our body is obviously able to metabolize gels and sugars pretty quickly while exercising, but I'm not an expert.

Some tips on how to prevent the situation you described: To start, I would avoid the big plummet in your BGs which caused you to eat a bunch of food during the ride. Even though your blood sugar was 150 at the start of the ride, you probably had a decent amount of insulin on board either from your basal or a recent bolus, that caused you to plummet so fast. My BG also plummets very quickly whenever I start biking, so I avoid it by turning down my basal rate down by 60-80% an hour or two before my ride, which helps smooth out the drop. If you aren't on an insulin pump yet, the best solution is probably to eat a gel or bar 5-10 mins before your ride, so that it starts digesting and just barely begins bringing up your BG, but doesn't have time to spike it up super high before you get on the bike.

I would also recommend setting your CGM to alarm whenever you start to drop, so that you can eat something on the bike before your blood sugars get to 70 or lower. I have found that when I am dropping on the bike and I don't eat before I am below 90, its already too late and I'm going to get low and have to stop. And if you are getting low readings on the bike, its best to stop for 5-10 mins and wait for your sugars to come back up before getting back on, because continuing to cycle will just keep driving them down.

I hope this helps, good luck! It gets easier as you learn how your body reacts to exercise!
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Re: The Official Diabetic Triathlete Thread [runningchunk] [ In reply to ]
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Hey thanks for the response. Since writing that post I have gotten switched to an insulin pump. I’ve only ridden a handful of times since then cause I actually ordered a new bike and sold my old one am still waiting on the new bike to arrive so I haven’t tested things out yet. I have ran a handful of times recently though and am still experiencing the same issues. I make sure the numbers look good before starting. I have even taken a gel and then started. Switch the pump into sport mode and then go for a leisurely 3 mile run. Typically by the time I am done it has already dropped.
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Re: The Official Diabetic Triathlete Thread [TNTRI] [ In reply to ]
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Insulin typically takes 15 minutes to start working in the body, but hangs around for another 2-3 hours. I would try turning your basal rate down an hour or two before you run. Switching into sport mode right before you start running won't affect your BGs during the run because the higher rate of insulin you've been getting for the past few hours is still acting in your body. I generally notice that any basal changes take at least an hour to make a difference in my blood sugar. I would even try just completely shutting off your pump for two hours, then having a gel and going for a run to be extra cautious. Then you can experiment with a shorter time or smaller % reduction once you stop seeing the drop.
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Re: The Official Diabetic Triathlete Thread [runnerwv] [ In reply to ]
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Just got diagnosed as Type 1 last week at the age of 39. My C peptide was .2 but my antibodies came back negative. My Dr. Was stumped and ordered a CT scan for tomorrow but a Dr. friend said this is one of the four types of Type one and looking online the WHO says type 1b is something to be aware of. Anyone have any experience with this?
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Re: The Official Diabetic Triathlete Thread [Spacemoonman] [ In reply to ]
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I’m sorry to hear that!
You don’t meet the typical diagnosis criteria for LADA or MODY, those are two of the more common “other types” of diabetes.
Overall the management is typically the same.

If you have any questions send me your email via DM.

I’m Type 1, a dietitian and former diabetes educator.
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Re: The Official Diabetic Triathlete Thread [ProActiveNW] [ In reply to ]
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ProActiveNW wrote:
I’m sorry to hear that!
You don’t meet the typical diagnosis criteria for LADA or MODY, those are two of the more common “other types” of diabetes.
Overall the management is typically the same.

If you have any questions send me your email via DM.

I’m Type 1, a dietitian and former diabetes educator.

Do you mind if I ask U a query via pm? T1 myself
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Re: The Official Diabetic Triathlete Thread [IamSpartacus] [ In reply to ]
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Wow the timing of this thread....I was just diagnosted as Type 2 two weeks ago. a1c results was 13.6%. I always thought I had a pretty decent diet, but could have a sweet tooth at times (apparently a lot). Moving forward, my eating is much more strict which has already began to pay dividends with my current BG levels. I havent had the time to read through all 14 pages of this thread, but am looking forward to so I can gain any knowledge I can. One huge concern of mine is, do I need to change my fueling stratgies at all or should I continue to use what works for me and just monitor my BG on my long training days?
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Re: The Official Diabetic Triathlete Thread [IamSpartacus] [ In reply to ]
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Not at all. I sent you a PM
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