Diabetes and cycling.....

[RubyTuesday]

I have just started cycling in the past few weeks and have run into an issue with my Diabetes.

I have type one Diabetes and am on an insulin pump. To keep the insulin use down (weight gain if you use too much), I generally eat pretty low carb. The problem I am having is after about an hour on my bike, my blood sugar takes a major nose dive. That really isn't a problem with all of the gels and bloc's available. But, I have also found that several hours after my ride, I am low again. Really low.

Diabetes brings all kinds of issues with cycling. I am also having a pretty hard time with skin integrity in the "seat" area. I bought some Hoo Ha Ride Glide and so far that seems to be helping. Can I say "minty fresh?" ;):D

Is anyone else on this forums riding with Diabetes? How do you manage the lows and how much of an insulin decrease is needed for say a 20 mile ride?

[RubyTuesday]

Sorry, this should of gone under health issues.

Newbie here.... mods please feel free to move this.

[zoom-zoom]

I'm not diabetic, but I am on a JDRF fundraising team. I haven't really noticed my type 1 friends eating differently during rides than those of who are not type 1, but they DO check their blood sugar pretty frequently and make adjustments to their insulin as needed. My guess is that your experience is fairly common, since it seems like most of them are checking with increasing frequency later in our long training rides (which are now up in the 70 mile range).

Does this resource (http://www.diabetes-exercise.org/) help, any?

[TsPoet]

I have just started cycling in the past few weeks and have run into an issue with my Diabetes.

Is anyone else on this forums riding with Diabetes? How do you manage the lows and how much of an insulin decrease is needed for say a 20 mile ride?

Type1 since I was 11, I'm now 44. Been on a pump for 20 years.
#1) Remember that anything you see with your blood sugar is due to something (esp insulin) 1-3 hr before. So back way up in time to make changes.
I set my basal to 25% before commuting for work - for the first 30 min (it's a 1 hr commute). For an all-day ride, I'll turn it off for the first hour, then to 25% for the next couple of hours. This might work for you, or even turn it off for the first 30 min of your ride.
The after-ride effects is due to the exercise. Do you have alternate basals? I have one that is 50% of my usual - I use that for long rides or all day rides, just leave it at 50% during and after rides.
You will have to do trial and error and figure out what works for you.
Also remember that the gels and blocks are generally fairly quick sugar, so you might try eating a boiled egg or slice of cheese or something at the same time - for its effects later. You can also eat a small snack after the ride - something small and with protein.
There is a pretty good diabetes forum, with and "athletes" subforum.
http://www.tudiabetes.org/
I no longer frequent the forum, I got tired of all the self-pitty. But, you might find some help there as well.

[DarcyInOregon]

The only thing I can add to the advice is to register every year with the Tour de Cure in your region and ride on weekends with your local Tour de Cure training group; the Tour de Cure is the annual bike event that raises money for the American Diabetes Association. Many of the registered cyclists are diabetics, and many with type 1 diabetes, and I know the type 1 diabetics have it figured out because they ride long and hard. If you join the weekend training group, you will meet other type 1 cyclists and can ask them questions and learn from them how they solved their blood sugar problems. You also get a free Red Jersey that tells everyone you ride with diabetes for the American Diabetes Associatioin.

[Becky]

Me.

IMO, reduced basal rates and extra carbs are the way to go. For short rides, I'll just eat some extra carbs. For longer rides, I have to go to a 50% basal rate, starting 1 hour before the ride, and eat as needed. It's very much a trial and error process, but a worthwhile one.

I recommend two books: The Diabetic Athlete by Sheri Colberg and Pumping Isulin by John Walsh.

Feel free to PM me if you'd like.

ETA: Active bolus plays a huge role in how many carbs I need during a workout. The less insulin remaining from a bolus, the less I need to eat, and the less likely I am to go low. I try to time meals carefully with respect to my workouts, and it's made a big difference in how I feel and perform.

[7rider]

Team Type 1 (http://www.teamtype1.org/)
Pro, Development, and elite cycling, running and triathlon.
Many/most/all with Type 1 diabetes (depending on the squad).
Information and inspiration....

[RubyTuesday]

Thanks for the replies. I will check out both sites carefully. I really think I just need to find a good temp basal rate for riding. I tend to avoid carbs, but find I have to have them before a ride.

Thank you zoom-zoom for riding in the JDFR fundraiser!!!! :)

[zoom-zoom]

Thank you zoom-zoom for riding in the JDFR fundraiser!!!! :)

It's my pleasure! My hubby is a coach and has been a part of this team for about 6.5 years. He initially got involved so that he could do something helpful for someone and have incentive to ride. Now we ride because it's personal--these people with insulin pumps are dear friends and we would do anything to help see the end of their suffering.

[bhashiguchi]

Type 1 for 13 years, pump for 10, been riding since last fall. I've found for 20 mile rides, a 30% decrease and a bottle of gatorade while I ride seem to work for me. I also tend to get low at the end of rides, and then sometimes at 3am after a ride. So extending the basal decrease so that it stays low for an extra hour after you get done riding might work. If I go to bed on the low end after a ride, I'll set a 10% decrease for 4 hours overnight, that seems to help avoid the low.

The active bolus is also really important for me- I definitely feel like I can do a better job of controlling things if I ride/workout without much bolus insulin on board, since the exercise makes it work so much better. But, it can't always be avoided so I try to reduce my bolus or further reduce my basal if I have to eat right before I go.

I think that's the most frustrating thing- that it's not always an exact formula since other things affect what to set it at.

I second the recommendations for the Diabetic Athlete Handbook and Pumping Insulin, but trial and error is the best since everyone has different reactions. testing a lot the first few times to see how a change works will help document it and help you fine tune. I always keep my meter (the small ultramini) in my jersey pocket along with glucose tabs in case I need extra while I'm out.

[RubyTuesday]

Thank you bhashiguchi, that is exactly what I needed. I didn't think about the insulin on board. Dumb me. I will get some gatorade and try lowering my basal rate 30%. At least that is a starting point.

Yesterday, I did almost a 30 mile ride and have had lows now since the ride. Stopped half way and blood sugar was 54, ate a scone and some tea with no bolus and at the end of the ride, I was 87. That was good stuff only three hours later I was in the 40's.

Such a balancing act and some days you just don't know how far you might ride. I have read pumping insulin, but will look for the Diabetic Athlete.

Thank you! You gave me a starting point to work from.

[Becky]

Ruby- Use that CGMS! It's such a powerful tool during exercise and for fine-tuning basal rates. Since I figured out the quirks to mine, I almost never have serious lows, even during and after riding. If I recall, there's a pretty good discussion about using CGMS to fine-tune things in the 4th edition of Pumping Insulin.

[RubyTuesday]

Will do Becky. I just got new and NOT expired CGMS sensors. I will hook it up again and give it a shot. I stopped wearing it because of sensor sores. I think I am allergic to the adhesive. However, I could use the info. Back on it goes.

[gbunker]

Funny to find several other folks with type 1 D here! I am 40, was diagnosed at 12, and I use a Minimed Paradigm 522 and a Dexcom 7.

I am terribly allergic to the tape, too, but have been able to tolerate it with a layer of SkinTac underneath. When I used to use the MM CGMS, I would leave a little circle that was SkinTac-free for the sensor insertion site. When I switched to Dexcom, my trainer said I could insert directly through SkinTac and a layer of Tegaderm HP. That has really reduced the skin breakdown problem. Might be worth experimenting with different hypoallergenic barriers.

RubyTuesday, I just saw your post about the Bento Box for D supplies. That looks like it would be perfect for keeping the Dexcom where I can access it. Great idea!

Gillian

[TsPoet]

There are several types of tape! Throw out the MiniMed stuff and try different ones until you find the right one. When I get home tonight I'll have to look at the one I finally found.
But, many like iv 3000. Here's a random website I've never seen before - but they list a whole bunch of different tapes
http://www.insulin-pumpers.org/howto/tapetips.shtml
I think maybe the one that works for me is hypafix, and I don't care that it isn't see-through.
The sensor tape is OK for me, but you can cut it off and use something different if you have to.

[bhashiguchi]

I used to put down a layer of tegaderm under my minimed sof-sets, because I was allergic to the adhesive. since switching to the Animas insets, I haven't had a problem, thankfully. I'm not on a CGMS (yet! really want one though.) but Gillian's suggestion is a good one.

I did 42 miles on Saturday with a 40% reduction and ate breakfast and bolused about 80% of that. I was 87 at the midpoint of the ride. I had a gel pack, and that helped keep me steady in the second half, but I was still 87 after the ride and falling. So, I kept it at -20% for a few hours and had lunch with protein to help keep my blood sugar up.

I'm doing a 60 mile charity ride Saturday, thinking I'm going to try -50% since I know this will be harder since it's long and I'm riding with fast people. I'm also going to keep some energy gel chews on me to eat at the rest stops at 20 and 40 miles. You might try some sort of carb/protein bar (clif bar or clif block are my favorites, but there are others) at mid-ride to help keep your sugar up, plus something short acting like the gel or gatorade to treat the low.

Ruby- do you start your basal decrease an hour before you go out? It needs time to actually reduce the insulin in your system. When I go out in the morning, I'll bolus for my breakfast (usually 80% or so) wait 15 minutes, eat breakfast, and reduce my basal before I go get ready to ride.

Beth

[RubyTuesday]

Great information! I will try some tape under my sensors and see if that helps. I even break out from the tape to hold the sensor down, but can't completely cover the sensor because I am a belly sweater and it gets steamy and itchy if I try to cover the whole sensor.

Thanks Beth. I will try Lowering the basal earlier. I didn't do that. I only lowered my breakfast bolus. You guys are so helpful. Thank you!!!

[Becky]

Hypafix is very sticky, very breathable tape. Since I started using it over my sensor sites and infusion sets, I haven't had problems with sweating them off or itching.

[gbunker]

Also try OpSite FlexFix. I used this successfully with the MM sensors. I think I bought a 2" wide roll on Amazon and cut is to whatever size I needed. Lasted forever.

Gillian