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Diabetes and Triathlon
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First, let me start off by saying this post is NOT about Team Diabetes.

I am an insulin dependent diabetic of 24 years. I have been competing in sprint distance tris for about 3 years. I am considering doing longer distance tris, but am concerned about keeping my blood sugar levels up for that long. I read a book called "The Diabetic Athlete" but it dod not give me much specific information.

Any diabetic triathletes out there with experience or who know where I can get some better information on nutrition (before/during /after) and insulin dosing?
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Re: Diabetes and Triathlon [tri_bri2] [ In reply to ]
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There are so many variables, unfortunately there really can't be any specific information that would necessarily work for you. I have had type 1 diabetes for 36 years and trained/raced at various durations over the last 20 years and I don't think the adaptations required have stayed constant for more than 6 months the entire time.

Really the only way to figure it out is experimentation in training. Gradually rachet up the duration and then intensity to match the event you are doing and see what happens. Fortunately tris are time trials which makes it easier to calculate the caloric requirements.

Although you always have to take at least a couple units of longer acting insulin just to ensure you can properly metabolize your food intake, insulin requirements can approach zero as you get into the 5-6 hour range and higher intensity [pre insulin, extreme exercise and caloric restriction was the only "treatment"].

The best advice I can give is to take it step by step as systematically as possible and get each new level working right before adding another hour or whatever. There are somewhat conflicting goals with good control -minimizing variables - and proper training which precludes doing the same intensity every day. But try to be as consistent in daily training load as possible to keep things more predictable.

Nutritionally the only major difference is that pre-race or training meals have to be quite close to the start of the event. Otherwise to avoid a BG spike you have to take more insulin and there goes the benefit of the meal. So practicing stuffing yourself in training is a good idea to train your body to deal with the added stress and learn not to route blood away from the stomach when exercise commences.

Good luck, take it slow and keep your BG controlled. If you think there is no info for type 1 diabetes, try finding some on ironman level training with a kidney transplant. :-)
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Re: Diabetes and Triathlon [tri_bri2] [ In reply to ]
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First off.....awesome. I like it when people don't just roll over and give up.

I've only been in the club for 3 and a half years now, but I consider myself a fairly quick learner. That being said, I think the best thing I ever did was to get an Insulin Pump. I obviously have no way of knowing what type of regimen you're on, but for me, the pump is perfect. While I was still on injections I could never really get my numbers to line up quite the way I wanted them to... Now, its a different story. I can vary dosages on the fly depending on what type of workout the cook has planned for the day and life is generally much easier.

So, that would be my suggestion. If you're not on a pump, what are you waiting for.....If you are, make it your best friend. I wish I had info on nutrition for long duration races/workouts, but unfortunately I've been scouring anything I can find looking for the same stuff.....

Good luck..
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Re: Diabetes and Triathlon [usna00] [ In reply to ]
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Thanks both for the advice and words of encouragement--same to you both. If I find any better published info, I will post it here.
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Re: Diabetes and Triathlon [tri_bri2] [ In reply to ]
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Mises and usna00--Did either of you read the article in the Swimsuit Edition about the diabetic Ironman? What do you think of not eating before a race? I don't think that would work. Have you tried it? I usually eat a little more than my normal breakfast and take a little less quick acting insulin before a race. Then, if it has been a while since breakfast, I might pop some energy gel right before the swim. This seems to work well in the sprint distance.
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Re: Diabetes and Triathlon [tri_bri2] [ In reply to ]
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Hey Tri Bri2. I have had Diabetes for about 4 years now. I was originally on pills to help control it but I started racing as a means to help me control it. Since then I have lost over 40 pounds and no longer require medication to control it.

I've raced a half IM at Buff Springs last year and felt great. I was worried about what my blood sugar level would do, but overall I finished it ok. Since I am not insulin dependant our situations are different. The only time I really notice when my blood sugar level is dropping way too much is during sprint races. The longer races I prepare for eating and drinking plenty of carbs during the race. I experimented in training just how much my blood sugar would drop. I would actually test during longer runs and rides. It is kinda cumbersome but that is the only way you will know for sure how your body will react. I backed that up with a visit to my doctor before the race and he gave me the "go for it" after I showed him the data I collected and showed him my nutirion plan. One important thing to remember is that the longer races are more aerobic in nature rather than anerobic. When you are aerobic your primary fuel is fat while you are anerobic or just below your primary fuel is sugar. Train your body accordinigly.

Good luck and Race Hard

Rusty

"Strategy? The strategy was in the preparation" - Lance Armstrong after winning 2000 TDF
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Re: Diabetes and Triathlon [tri_bri2] [ In reply to ]
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There was an article in one of the tri mags this month about a triathlete who races iron man distance races... perhaps you could try to get in touch with him. He seems to have a very elaborate system that works for him...
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Re: Diabetes and Triathlon [tri_bri2] [ In reply to ]
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I didn't see the article - I can see skipping breakfast working ok for a type II. For type I with a pump it could work too since you could start with minimal insulin and come up later if necessary. Anything approaching science reporting in the press is of dubious quality so who knows what the real story is.

For me, I would be SOL within 20 minutes. I've always been very insulin sensitive and in my better years I only used 2 NPH a.m for 5-6+ hours exercise even eating 1500 - 2000 calories for breakfast. Now that I am out of shape it's not so extreme, but I still need only a couple units of R to cover everything. Doesn't leave much room to adjust downward in either case so my only choice is to eat.
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Re: Diabetes and Triathlon [tri_bri2] [ In reply to ]
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Sorry, I didn't happen to catch the article.

Hmm, not eating before the race. Two things:

1) If I were on injections I would either have to:a) alter my injection the night before (something I didn't like doing because longterm planning (12-18 hours out) and me never lined up quite right; it was always a recipe for disaster, or b) have the ambulance wait for me a few miles out on the course.

2) Now that I'm on a pump I still don't like not eating just because I know how fast my sugar drops once I start anything of intensity. I do lower the basal rate for longer duration races/workouts, but I still don't like to start myself in the gutter. I know that I'm going to need to eat sometime, and its much easier for me to eat when I'm comfortable (not just the heavy breathing, but more like normal sugar) rather than when I have that 'need sugar now' feeling.

I won't say any more about not eating before the race since I didn't read the article, but I'll try to catch it then I can comment later.

For me what works best is to eat a little before a race and then to make sure I eat during the race before I get that feeling (and you know the one I'm talking about) because if you wait until that feeling comes you're going to be in the hole for a solid 20 minutes waiting for the food to come around. Its just like staying hydrated: by the time you feel the need for it, its already too late.

I'll look through my stuff because a while back I found a few interesting articles by a doctor in England doing research on endurance athletes. I don't want to misquote things so I'll go find it, then post the address for you to read.....

Best of luck!
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Re: Diabetes and Triathlon [usna00] [ In reply to ]
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Ok, so it took a bit of searching but I've got the link to the article I was talking about. I still have to read it a few more times to fully digest the meaning, but from what I understand so far it seems quite helpful. I'd appreciate any interpretations of what's presented in the article so as to help in finding the full meaning.

The link is in reference to an article out of the British Journal of Sports Medicine. It is:

http://www.idea2000.org/...nd-Exercise-1999.pdf

Let me know what you all think.

All the best..
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Re: Diabetes and Triathlon [usna00] [ In reply to ]
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Thanks--good article. Fairly easy to understand even for a business major like me. Sounds like my plan should be to slowly build up distances keeping good track of insulin, food, test results, distances/times, etc. Then, during competition, also do periodic checks.

BTW, did you attend the boat school?
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Re: Diabetes and Triathlon [usna00] [ In reply to ]
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I wish that article was available 20 years ago, it would have saved me a lot of trial and error.

The units of insulin/kg guidelines for different exercise intensities seem pretty accurate to me. The lowest (.2/kg) even comes close to my extreme case.

For anything much above 1 hour of exercise I have never had a post exercise increase in BG levels, except when sick. Weight training and calisthenics however seem to cause BG increases almost every time.

Time off from the training routine as it mentions is a problem. An occasional week off has always been the hardest to control for me. It generally takes 4 - 5 days for my insulin levels to max out in the absence of exercise, but how it gets there has always been variable.

As it demonstrates in the article, being as calculating as possible with insulin, diet, training loads is the key. Maintaining good control is about identifying and eliminating variables and that's even more true in the abnormal metabolic conditions produced in endurance sports.

Testing during exercise should get easier in a couple years since there are several compact non-invasive (no lancets) BG measurement devices being developed and are getting close to final approval.
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Re: Diabetes and Triathlon [tri_bri2] [ In reply to ]
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Ahh, good one. Canoe U, yeah, I went, and I have to say I loved every minute of it. Graduated 2000. So by calling it that, did you go?

On the glucose monitors, does anyone have any experience, or know anyone that has tried the Glucowatch? I looked at it for a while, but it just seems too troublesome. The calibration time seems too long and there are a few other factors that don't really seem to suit a normal lifestyle. I love the idea, especially for endurance sports, but I'm not too keen on their current packaging. Are there any other continuous meters available/upcoming? That would really the ideal thing (aside from an artificial pancreas). It would be comparable to how HR is monitored now....gotta say, that would be awesome.
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Re: Diabetes and Triathlon [usna00] [ In reply to ]
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No, I didn't go to the academy, but am a former USMC officer (OCS type) and have worked for the Navy for about 23 years, so I know a lot of you "ringknockers" (no insult intended).

I haven't really looked into the non-invasive glucose monitors. Maybe I'll check them out.
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Re: Diabetes and Triathlon [tri_bri2] [ In reply to ]
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Haha, none taken...

So I thought i'd pass on a few links to some of the continuous glucose monitors. Only the Glucowatch is available, but i'm not really a fan of the ergonomics OR the way it works. The other 'wireless' versions are more attractive to me, but thanks to the lightning fast FDA all of those are most likely a few years out still. So, knock yourself out. It never hurts to just be tracking these things so you can jump on the wagon as soon as it starts rolling.

http://www.devicelink.com/...chive/03/05/008.html

http://www.glucowatch.com/us/default.html

http://www.spectrx.com/cgms.asp

http://www.therasense.com/.../futureproducts.html

http://www.sontra.com/...s/glucosemonitoring/

Just picture one of those sitting next to your hrm.....
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