HIM training with diabetes

As you know, it's better to be high than it is being low.  The lows will kill you, the highs may just make you pee and get you dehydrated.

Are you requiring insulin or pills only?

I am a T2. It's important to realize that the underlying cause of our T2 and how our bodies react to carbs is very different so the only way for you to figure it out is test, test, test.

I assume that 80 mile bike was more than 3hrs. You could have bonked just like many people would after such a long ride and it may have nothing to do with your diabetes.

The only time I take nutrition when training is when I do a race rehearsal and those are typically the longer rides

To figure out my nutrition I started by testing. I would take my BG at the beginning, take 8g of carbs every 15min and measure my BG every hour. When I found a number of carbs that kept my BG at a constant level and not too high, that was my target. For me it happens to be 32g of carbs per hour or a cliff block every 15mins. 4oz of the sports drink they give at the IM events is also 8g of carbs. It's best to spread the carbs out as much as possible. Low glycemic foods are also good. This is going to sound gross, but peanut butter wrapped in lettuce, held together with a toothpick, in my bento box provides a good source of fuel.

A recent race report and follow up comments  talks about some of the challenges

http://www.beginnertriathlete.com/discussion/forums/thread-view.asp?tid=252426

I run (in races) with my meter. I test coming off the bike and adjust my run carbs accordingly. In Orlando I was high (180) so decided not to take on any more. I never test before a race, stress probably has my levels quite high and knowing they were high would just add more stress. I know the swim brings them down as does the first 15min on the bike.

As you will see, I don't take a lot of carbs when racing. I think my ability to go on so few is because I have trained my body to do so by taking so little during training.

I do not agree with the comment that too much will just cause you to pee. Bonking is never fun, but taking on too much easily results in a HYPOglycemic incident. As a T2, there is possibly some insulin resistance occurring. Take on too many carbs, get your BG to skyrocket, insulin resistance causes insulin buildup and sometimes the effect of excercise can cause the excess insulin to make you go hypo.

Also keep in consideration time of day. Most T2s are more insulin resistant in the morning and even more under stress. Early morning, waiting for you swim wave is prime time for insulin resistance. When you test, do so in the morning, that's when you will be racing.

If you decide to go on mostly water be careful to take on the right amount of electrolytes. I made that mistake last year and ended up in the med tent with hyponetremia.

Hope that helps a bit.

Thanks a bunch for all your posts.   Yes, I am only on pills right now but my endo told me that eventually my body will not be able to produce insulin at all and i'll have to be on a pump, its just a matter of time.  The amount of time is up to how well i take care of my body.

I'm usually very good about what I eat when it comes to carbs and sugars but when training heavily, like on a 4 hour 80 mile ride in 95 degree 60-70% humidity weather, I haven't quite learned what my body does.  I definitely need to test more often, I am bad about that.

I'm pretty sure what I experienced was more than a bonk, I've had those many times.  This was different.  My extremities went numb and then I could feel tingling in my fingers and toes.  I couldn't move my arms, like I was paralyzed and I was hyperventilating like crazy.  It took everything I had not to pass out until I got some food (apples and oranges), and then I was fine almost instantly.  

First time anything like that happened to me, and scared me (and the wife) pretty good.  So I'll be carrying my meter with me more often as well as enough carbs and electrolytes.  The weird thing is I was sucking down Gu and sports drink, as well as oranges and bananas all throughout the ride.  Still wasn't enough in the end.  Live and learn I guess!

OK, I thought he had done the ride without nutrition.

You may have experienced what I was describing previously. If you have insulin resistance (which many T2s have) you may have experienced a high BG, insulin buildup, then that insulin kind of 'kicks in' at once and cause a massive crash in BG levels.

I have had this happen before. Not fun. Once my BG levels went to 270 so I went running to try and get them down and they just came crashing down and I went hypo.

As well, when you BG goes above 200, the body can go into a mode when it is even more insulin resistant. pumping the GUs and drinks during the ride may have done that.

These are just theories about what could have happened. The trick is to keep your BG in check and stable.

First thing talk to your Doctor, thell him/ her what happened. give them all the details you can.

Second you said you are on pills, What pills are you on?

I was on Glyburide for a while but It made my nu8mbers crash about once a week or so. Switched over to Metformin and now my Dr. added Glipiside (Ad Hoc).

Have you been to a nutritonist? I worked with opne for about a month to balance out my intake needs and when I should take things on the long rides etc.

I am also type 2 and working toward an HIM this fall. good luck and stay healhty

I am T1, not a doctor or trying to be one but do have some experience with the 'Betes and endurance training.  Nutrition is so key to 'Betes management especially with endurance sports.  Test often and then even more often.  I typically test every hour on the bike, sometimes more if I don't like what I'm seeing.  Lots of different things out there that will fuel you and not send you BG into a tizzy.

Definately keep in mind that if you start high you will come down, faster and lower than if you were to start in a normal range.  Numerous studies out there to support that.  So not a fun roller coaster.

Like anyone on a long ride you need to fuel your body, you can go about 90 minutes on your reserves before you have depleted them and then you will bonk.  General rule of thumb for anyone is 30-60 g carb/hour.  I use about 51g/hr. 

Also, keep in mind that a high BG can be made worse by dehydration and that dehydration will cause a high BG.  Viscious cycle. 

Keep a meter and some glucose tablets with you on your rides- it will help your mental health if nothing else.  And make sure your training buddies know the symptoms for highs and lows just in case. 

Also check out www.triabetes.org for some great folks to connect with.

I am unfortunately too well educated on Type 1 as my daughter has it.  It is dreadful and I give a ton of credit to anyone with any type of diabetes who is an avid athlete.  In her case, she is in the water about 12-14 hours a week, competing at a very high level.  A few tips:

1 - never be more than a few feet away from your meter, never, ever.

2 - never be more than a few inches away from a source of quick sugar. NEVER EVER.  When you train, carry a glucagon and have your training partners carry sugar for you as well.  Take 2 minutes and show them how to use the glucagon.

3 - effective management starts a least a day before your event, often much longer.  This includes hydration, getting your BS to where you need it to be prior to your race and having contingency plans for every single potentiality.  

4 - log, log, log your experiences to draw on them for future events, training sessions.  Experience, we find, is the most important part of management.  

5 - triple the number of times you check your blood sugar on race day and make immediate decisions.  Waiting around and hoping never works, for us anyway.

6 - know how every type of food you consume impacts your training and racing.  Don't eat white rice one day and then peanuts the next race and expect the same results.  All carbs are not equal.

7 - find an endo or a CDE who is sports knowledgeable

8 - pat yourself on the back and give yourself a break.  You are doing something hard with an added burden.  I think that's awesome.  Just remember that even when you do everything perfectly you will still have bad days and that's not your fault, it just happens.  

Just finished reading 'Not Dead Yet' and found it to be an amazing book and very inspiring.  I thought 'Its Not about the Bike' was inspiring when i read it over 10 years ago, but this one hits home with me so much more.  I recommend it to anyone who is a cycling fan, has diabetes, or needs some inspiration.

I'm also going to look into the FreeStyle Navigator continuous glucose monitoring system that Phil Southerland mentioned using during the RAAM in the book.  I'd like to have that for my HIM and long training sessions, if my insurance will help pay for it.