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, Multisport Coach http://www.ironguides.net
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