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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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