Tackling the Exercise Lows and Carb Replacement

In the past year, I have tackled some pretty daunting distance running feats. Now, I am no marathon runner (although I hope to be in 2008…maybe 2009, no firm deadline set yet) but I have managed to put some mileage under my belt. While running, as my mileage increased, I ran into three major problems. I imagine that most diabetics who attempt rigorous exercise beyond the norm have run into similar problems as what I will outline. The first major problem was lows during exercise. I actually would have lows that forced me to stop running as they would not come back up, despite carb replacement, unless I stopped the exercise altogether. This then leads to my next major problem concerning exercising and blood sugar control, and that is post-exercise spikes. Yuck! Nothing really sucks quite like hugging the line of bottoming out for two hours then skyrocketing up to 400 immediately after you finish. The third problem I ran into was a dip in blood sugars around 4-6 hours after completing the exercise. This was not consistent and seemed to vary based on the length of time I ran. I am going to focus on lows during exercise and carb replacement in this post, because I doubt you want to read a book today! Over the next few weeks I’ll follow up to detail how I tackled post-exercise highs and then beyond that, the post-exercise lows.

The lows during exercise were the first problem I encountered, before I even got to any real distance in running. I started with the initial mind-set that most of us would begin with, lower your basals and then have carb replacements available because no matter what you do, baby you are gonna DROP! I soon learned that running and vigorous exercise, however, can make some of the tricks you might take up for carb replacement on an exercise bike or a walk around the block, seem less appealing. First off, before when I exercised, I would just have an extra snack before I headed out, something along the lines of granola bars, saltine crackers, or fig newtons. I would then take along a bottle of sugar soda or Hawaiian punch in my hand or in a backpack, depending on the activity, for a quick sugar boost if I needed in the midst of the activity. As my distance increased however, running on a full tummy of Hawaiian punch and granola bars led to fruity burps, stomach rumbling, and yes, even diarrhea. Having all that extra crap in your tummy just does not lend to a good running experience. Another problem I had, was other than the discomfort, granola bars and sugary drinks just didn’t MAINTAIN my blood sugars beyond 50 minutes. I could eat this stuff at the outset, spike my blood sugar up to kingdom come, and then 50 minutes later be in a downward slide that no amount of sugary drink would bring back up. I would end up having to stop running and try again the next day.

I was blessed with a back injury while struggling with this 50 minute limitation in running that resulted in my introduction to a sports therapist/chiropractor who not only assisted in the mending of my broken (okay, not really broken, but a sprained iliac joint can FEEL like a broken back) back but opened my eyes to the wonders of GU. With the help of this fabulous stuff, I was able to take my running beyond the 50 minute/5-6 mile barrier I had always run into before. This stuff is great (tastes NASTY!!)!! GU is a short acting glucose along with a long polymer glucose gel that instantly will give you a boost in sugars as you head out but then is slowly absorbed over the course of around 45 minutes to keep kicking in sugars to help maintain blood sugars. I would start a run with one or two GU, then I would have another every 20-30 minutes or so (excluding the morning runs, when two GU to start was plenty for the longest runs). Try and drink water with this stuff to help avoid cramping (pile of carb gel gu sitting in bottom of tummy is NOT a good feeling) and assist in absorption. I tried to do at LEAST four ounces for each GU, but I have heard that eight ounces is the recommended amount. The great thing about this stuff is it is carb power packed into a little bit of gel. No Hawaiian punch/cookies sloshing around in your belly as you try and master yet another endurance threshold, only the carbs in your tummy that you need to maintain your sugars until it is time to stop. With the help of this GU, I took my running from 5 to 6 mile max to my longest run of 16 miles. Before GU, I physically could NOT run beyond five or six miles because my blood sugar drop was too severe and I could not replace the carb fast enough.

Try and remember that during vigorous exercise your tummy is not going to absorb food as quickly as it normally does. If you are having problems with low blood sugars when you go out, and you feel like you have eaten enough of the GU or other similar carb gel or replacement, try drinking more cold water the next time you go out. Cold liquids speed up your tummy’s absorption, while warm liquids and sugary drinks can slow absorption. Try not to mix a carb gel like GU with a sugary sports drink because that can REALLY slow down absorption because all of that sugar curled up at the bottom of your stomach. I used to put ice cubes in my water bottles when I went out to make sure the water I drank was super cold on my runs. I also scheduled when I drank my water to coincide with when I would take a GU so that I got the best absorption effect possible. I would map my runs and schedule in water/bathroom stops to refill my water bottles for later in the run. I would get some pretty rough cramping if I had GU and not enough water. This would only be on longer runs where I had had perhaps 4-6 GU and I really hadn’t hit the water like I should have been.

Along with the carb replacement aspect of exercise/running and diabetes, there is also the aspect of lowering insulin before you go out to help avoid a low. I found that for myself, the recommended lowering basals by 30% before going out just wasn’t low enough. My body is really sensitive to activity, needing twice as much insulin per hour while sleeping than I do during the day, and I found that I had to lower my insulin substantially (to .05u/h for 3 hours pre-exercise, down from .6u/hr) and then completely shut my pump off while exercising.

I think exercise initially can cause so much variability in most type 1 diabetics, especially when we test our own limitations and set new endurance goals for ourselves that are outside of most normal expectations. I have related what I learned for myself concerning tackling low blood sugars and carb replacement for endurance activities, but in reality, what works for you may be completely different! I am constantly amazed by what I read on the OC because everyone seems to have their own formulas for how to tackle different things! I would perhaps be less amazed if everything was neat and everyone had the same formulas, but we don’t! What works for me, in all likelihood, won’t work as well for you as it does for me! You can gather ideas from what I’ve offered, though, and through testing testing testing and more testing, figure out something that works well for you. Your own personal formula!