Health care is a basic human right, not a privilege. For some reason, we’ve allowed ourselves as Americans to be fooled into accepting that one must be blessed with “means” to actuate appropriate health care. As a nation we have failed to realize that our health care system is a barometer of our society’s value for human life.


Thursday, September 21, 2006

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!


Scott K. Johnson said...

Super duper right on track post for me today!

I have so many questions that I would love your thoughts on. I started writing a comment about them, but realized that it was MEGA long.

So, I think I'll do a post on it sometime, and we can go that route. I also wouldn't mind feedback from others that stumble by the blog.

Your timing is just uncanny - I have been thinking about this a lot today, and was just thrilled to see you post about it!!

I'll tell you again - I'm SO glad you started a blog!!! Yay! :-)

LaLa said...

This is such excellent info for diabetics who exercise! I constantly seem to struggle with getting my blood sugar "just right" to start my workout so that I don't plummet midway through or right near the end of my workout. It's so frustrating when I have to stop and treat a low blood sugar. I'll have to try the GU stuff - I've heard of it, but never tried it. I usually work out around 4:00 - which is about 4 hours since my last meal. Most days I'm okay if I start a temp basal around 2:00, but other days it doesn't seem to matter at all - I go low anyway! I can usually figure out how much to eat to balance my cardio workout, but I just can't seem to get my basal low enough to prepare my blood sugar for a hard workout. I don't like running above 250 all afternoon just so I can workout without going low!!

Thanks again for the post - I love your blog!

Sarah said...

I scoured the internet for clues to deal with blood sugars during my run, and I scoured the internet to look for clues to deal with blood sugars AFTER my runs. It took me forever to find even small hints other than what my diabetes educator told me. None of the things Ive done with exercise worked ALL the time PERFECTLY. I continued to have my highs and lows. The differences I had were the difference between not being able to reach my own endurance/running goals and finally reaching those goals. I also managed over time to reduce my post run spike so it didn't cruise over 200 about 75% of the time, and I was pretty happy with those results. Ive read about runners who were type 1 diabetics who don't have the spikes. Im envious! I do have a really good journal article ( I think it is a journal article) that I will share some links to in my future posts that really go over what is metabolically happening in your body when you exercise and why the type 1 diabetic is having a rise in blood sugar while exercising, or a fall. There is also some great resources Ive found, with actual tables to reference, about how many replacement carbs are "typically" needed for certain amounts of different cardio activities. I take that with a grain of salt though. They acted like carb replacement to exercise for type 1 diabetics was some newly discovered thing. HA!