Avoiding Post-Race Hypoglycemia

I woke up on the floor of my living room, soaked in sweat.  I could not stand, or even sit up.  I could not raise my arms or control my hands enough to grasp anything. Forget reaching for the telephone, even if my brain could have formulated the thought to try.  I could not speak, but I lived alone, so there was no one to hear anyway.  I did not know what day it was, but the hot July 4th late afternoon sun was shining brightly through the windows.  After an unknown period of time, my brain must have had a flash of coherence that I was having severe hypoglycemia. 

Eventually I started dragging myself across the floor, on my elbows and arms with my face down, into my kitchen, and then into the pantry.  It may have taken 30 minutes or an hour, I do not know.  I ended up below an open 12-pack  box of Sprite sodas that was on the shelf above me, about two feet off the floor.  I lashed at the box with my hand and eventually pulled the box off the shelf, cans of soda falling on top of me and rolling.  I must have managed to trap one and pry the tab open while my fingers and hands twitched and jumped.  I lay on the floor and somehow poured the can of Sprite on my mouth, or in the general area of my mouth, much of it running off my face and onto the floor around me.  Then I lay there and waited, barely able to understand what was happening.  Waiting for my blood sugar to come up.

That was me very early in my racing career, years ago when I was just learning how to race bicycles and manage my blood sugar.  Early that July 4th morning, I had cycled in a tough 60-mile bike race in the mountains of North Carolina, about three hours of very hard, hot exercise.  I had no problems in the race, and I even drove approximately 40 miles home after the race with no problem.  But late that afternoon I ended up on the floor, desperate and helpless, with severe hypoglycemia.  I learned a scary lesson that day about post-event fueling.  For any elite athlete competing in ultra-endurance sports like long-distance triathlons and cycling, post-event fueling is critical for recovery to prevent muscle soreness and to train or race the next day.  But with type 1 diabetes, post-event fueling is even more important, even for the recreational athlete.

My pre- and post-workout and race fueling strategy is as much a part of my performance as my fitness.   It does not matter if I am the fittest, fastest guy in the race if I do not fuel right.  The night before a workout or race of over two hours, I eat a high-carbohydrate meal such as pasta and carefully dose my insulin to make sure that it covers the meal so that I do not awake with high blood sugar on race morning.  It is very risky and dangerous to do a correction bolus (i.e., take extra insulin) on race morning.  I eat a good carbohydrate breakfast such as a bagel or oatmeal, and then fuel during the race as I have practiced many times in training.  You must practice fueling in training just like you practice your sport.

Immediately after a race or long workout, I begin my post-race fueling, both for muscle recovery and to stabilize my blood sugar.   You may notice professional athletes drinking sport drinks immediately after competition.  For a non-diabetic athlete, carbohydrate recovery drinks are great for replenishing and rehydrating muscles during that critical 30-minute window after a workout.  For those of us with diabetes, it also starts stabilizing blood sugar for the rest of the day and night.  At the finish line of an Ironman triathlon, there is a virtual buffet of carbohydrate foods, sport drinks, and water.  Like the other athletes, I sidle up to that feed line and eat and drink everything, both to recover and because I am worn out. I also carefully bolus insulin to get the glucose into my weary muscles.

I check my blood sugar multiple times throughout the rest of the day and until bedtime, and I continue to “graze”  on calories and carbohydrates in small portions, reducing my insulin dosing as my blood sugar tests indicate.  Before bed I eat another high carbohydrate meal, and I usually reduce my meal bolus of insulin by up to 20 to even 40 percent from what I would take for that meal on a non-race or training day.

The key to avoiding post-event hypoglycemia is refueling with carbohydrates, testing your blood sugar frequently, and being careful with insulin dosage.  Finish, feed, test, and think.  You did the race, now you are ready for the next one!