Diabetes and Training

I am a Type 1 diabetic and so any training or race that I do needs careful consideration and more importantly proper preparation.

I was diagnosed as Type 1 diabetic in September 2001 and was using insulin injections from December 2001. It was quite something to deal with but at 31years old was an easier adjustment than had I been in my teens or twenties. How I developed it is still a bit of a mystery but on looking at my medical records I had viral pleurisy in the February of 2001 and the doctors felt that it may have been that that was the catalyst for developing diabetes. There was also a hereditary aspect with my maternal grandfather being a Type 1 diabetic.

I self diagnosed my diabetes based on a number of symptoms that I validated using netdoctor. I lost a lot of weight very quickly, this was masked as at the time I was cycling to work (return from Bristol to Bath daily), running with colleagues and playing football. The clincher though was the rampaging thirst that I had – I was drinking litres and litres of water and fizzy drinks to try and cut through the thirst. You Google that symptom and it's diabetes!! The doctor did a simple blood test and confirmed it – actually it was a locum doctor who bottled it and got my wife to tell me!

So September 2001 was when it happened. I was very active at this time with running, cycling etc and did not want anything to change that. The doctors explained that being fit would help with my diabetic control and so I did some research on how to manage my diabetes and learn what I could. There is surprisingly little written and I put this down to the fact that due to the seriousness of Diabetes and what getting it wrong could mean the risk of documenting something was too great. I did manage to find some information based around the exploits of Gary Mabutt and Jay Hewitt. The message was clear, it's not a barrier it just requires more planning and for the type of events that I do awareness.

As a diabetic I manage my blood sugar to ensure that within a couple of hours of eating (and the accompanying injection) my blood sugar is within a range 4-7mmol. For this I have a blood glucose monitor that works from blood I take from my finger using a pricker. I am therefore responsible for injecting the correct dose of insulin for the meal I eat. Sometimes I get this right and sometimes wrong. The wrong can either be too much insulin meaning my blood sugar drops below the healthy point or not enough meaning I am too high. Too low and there is a risk of diabetic coma and too high there is a risk of damage being done to the body by the high blood sugar count. It's a constant balancing act, everything I eat is considered against the backdrop of when did I last eat? What did I last eat? What is my blood sugar? What am I doing next? It sounds difficult but actually it's pretty intuitive and as anyone that knows me will testify it doesn't prevent me eating anything that I want to J

In the context of training my preparation is vital. Before any session I need to know what my blood sugar is currently and when the last injection was. In practice this means I cannot train within at least 2hrs of eating, it also means that when I do I need to make sure my blood sugar is high enough so that I do not crash too low during the session. As a rule of thumb I try to start any session with a blood sugar of between 8-11mmol and then depending on the session will carry gels/energy bars/glucose or sometimes just the glucose. For a run a blood sugar of that level in context of when I last ate/injected is good for up to 10km without additional nutrition. Basically anything up to 40-50mins. For cycle sessions or brick sessions of around 2hrs plus I will eat a gel after 45mins then eat an energy bar about 1.5hrs in. That's enough to get me through and finish with a good blood sugar level. Essentially I have to make sure that I have enough nutrition with me for the training session and cannot afford to bonk under any circumstances.

Managing blood sugar while I am training is relatively straight forward as the nutritional supplements that are available make this straight forward. I use a variety of products, PowerBar gels, SIS gels etc then Nak'd bars, TREK Bars etc. All washed down with Nuun.

Where it gets a little more tricky is post training. After a session my blood sugar is more responsive to insulin meaning that I need to adjust my insulin doseage down to take into account the impact of training. This sees me more often than not doing what I call chasing blood sugar. It goes like this, have a meal with insulin, the insulin acts quicker/more efficient meaning that I then need to eat again much sooner than normal. I find this very difficult as too low and insulin and the blood sugar will be high but slightly wrong in the post exercise zone and it plummets. I then end up eating additional food that I don't really want. Cereal bars, or cereal and bananas are favourites. Along with muffins J it's manageable but means I generally eat more than I need to or want to.

When training with a group or buddy make sure they know you are diabetic and what they should do if something happens. On race day it's important to make sure you write your medical situation on the back of your race number. Something may happen that is unrelated to your diabetes but whoever finds and attends to you will need to know. You have to take responsibility for yourself.

Through all of this the overriding message that I have learned is that by being fit and working out I am better able to manage my diabetes. I have had illustrations of this as when injured and not training the amount of insulin I need to dose myself with increases and the responsiveness decreases. My control also varies wildly and I tend to have more highs and lows as opposed to the consistent levels that I generally experience. This adds to the depression of not being able to train knowing that as well as my fitness deteriorating I am also losing good diabetic control.

The fact is that if you are diabetic the impact of training on your blood sugar and control is, if you are like me, massive. When training I am a 'good' diabetic with great control. My 6 monthly levels rarely above 7 etc. When not training the range of blood sugar readings is more broad and I will peek over the 7 mark for the 6monthly levels. Also with all the complications associated with diabetes taking care of yourself and training can only help to delay these complications and potentially help to prevent them. Things like heart disease and obesity for example.

Obviously I am not a doctor and this is based on my experience and something that I have been doing from day 1 as a diabetic. It definitely works for me but the message has to be that you need to consider what you are doing, how you are doing it and what your nutritional needs will be. Once you have that assessed make sure you carry more food than you need as you never know what will happen out there!

Diabetes doesn't need to prevent you from tackling anything you just need to make sure you plan it correctly and if you are starting out consult your doctor or clinic. I am not a doctor just someone who has learned through trial and error what works for me.