Adjusting Type 1 Diabetes to a Racing Tour of America’s Dairyland (Wednesday, June 22)

Anne Findlay has been racing road bikes for three years and just joined Team Type 1 this year. She was diagnosed with type 1 diabetes in 1988, at age 14. For more information about Anne and Team Type 1, go to www.teamtype1.org.

Often when I travel, it seems like I need to increase my insulin basal rates, but racing this week in Wisconsin required a surprisingly large adjustment.  Leading up to the start of the series for me, I had my basal rates on increased “taper” mode, which is what I try to remember to use when I have a rest week in my training or am tapering my training before a race.  (With a decreased training load, I need more insulin.)  

After arriving in Wisconsin for my first race (Friday),  I turned on my “race day” basal rate profile.  This profile has an approximate 30 percent increase an hour before my planned breakfast and throughout my races, which are all 30 to 40 minutes in length, beginning sometime between 11:20 and 11:50 AM.  At other times, the basal rate profile uses my normal rates.  At my race Sunday in Waukesha, my BG started around 190 and ended up around 300 forty minutes later.  I don’t necessarily expect to have a flat line BG-wise) during a race, so my goal is to start lower so that I don’t finish the race quite so high.

Aside from the race-related BG spikes, I have had overall higher BGs, frustratingly resistant to multiple corrections.  Leaving my race day basal rate profile on constantly was still not bringing my BGs down, so yesterday afternoon I just decided to increase my basal rates by another 30 percent or so.  Overnight, things were a bit better, and this morning, I programmed a new basal rate profile that is 30 percent higher than my already high “taper” profile.  I looked back and saw that instead of my typical total daily insulin dose of 20 to 32 units, I was needing more than 40 units for consecutive days, which is very much outside the norm for me.  Since I had been staying high after meals and my corrections were not working well, I also reprogrammed my carb ratios from 15 g/U to 11 g/U and lowered all of my correction factors by 10 mg/dL/U.

It has seemed a bit paradoxical that during an 10-day race series (with eight races), I would need so much more insulin.  But perhaps it makes sense.  Although I am racing almost daily, the races are short and intense.  My blood sugar always goes up during 30-to-40 minute crits, which are high-adrenalin events.  The common thought is that with high intensity activities, adrenalin is released, causing the liver to release glucose from glycogen stores. For someone with diabetes, the lack of a normal insulin response can easily leave the blood sugar high.  Furthermore, the short duration of these crits means that my overall exercise volume is much lower.  To compound that, we spend most of the rest of race days resting or doing light activity, in contrast to a more typical day of traveling (by foot or bike) to and from work, working a full day, and so on.

So far, during our rest day today, I have only had a couple brief excursions over 200, which is a huge improvement over the past few days.  It is always nerve-wracking to take so much more insulin, but it seems to be working well so far.  But really–since when did I have to take 1.4 units for an apple?  We will resume racing tomorrow and continue through Sunday if all goes well, and I fully expect that I will have to make more adjustments.  Diabetes is always a work-in-progress!
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Sheboygan BGs–Update on My Insulin Tweaks (Thursday, June 23)

Anne Findlay

Anne Findlay has been racing road bikes for three years and just joined Team Type 1 this year. She was diagnosed with type 1 diabetes in 1988, at age 14. For more information about Anne and Team Type 1, go to www.teamtype1.org.

After a bit of a low BG before going to bed last night, I shut off my pump for an hour, which allowed my BGs to creep up to around 200.  The increased basal rates were a bit too much from about midnight until I woke up, as evidenced by a steady but slow drop between those times. Fortunately, I landed in a nice spot this morning, right around 100.  I lowered the early morning basal by 0.1 U/hr, so hopefully tonight will be better.

For the rest of the day, things have worked out pretty well.  The first bump on the Dexcom shown here is my breakfast spike, which came down after about a 20-minute warmup.  I saw “86” with a slight downward trend about an hour before the race start. I still had my basals cranked up, so I ate a granola bar.  I warmed up a little longer and then headed for the car once it started raining, about 40 minutes before the start.  My last BG check before the race showed about 135, and the Dexcom showed a flat trend at 120.  Finally things seemed to be where I wanted them!  I was a little anxious, actually, about having a normal BG, so I popped a couple of Dex 4 glucose tabs just in case.

The rain began in a complete downpour, and I was soaked just waiting on the line. The field quickly became strung out, and I was somewhere in the middle (I think), tucking in behind people when I could.  One of the biggest puddles on the course was right in the corner, but I actually enjoyed plowing through the water–at least it wasn’t cold!  After the race, I was elated to learn that my teammate, Becca Schepps, had won the race!  I knew she was strong enough and had the tactical skills to do it, so I was glad that it worked out! Very exciting.

Once I had changed out of my sopping clothes, I checked my BG and it came in at 115, although I felt more like 60.  If the race had been much longer, I think I might have gone low. I might either bring my race basal down a little or eat a little more before if I find myself in the same position tomorrow.  I’d rather be up a little at the finish just to be on the safe side. I bolused a huge amount (compared to normal) for lunch and then corrected for the high (seen as the excursion above the line) and have been satisfied with how things are continuing to work out.

Although this game never ends, I am glad to have tamped down some of the constant highs and BG spikes.  Tomorrow we race in Fond du Lac, and I am hoping for similarly good BGs, but a race without rain!

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