Help debug my running

Type 1 & LADA
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41

Thanks for these great thoughts, @Karl.n . In order:

  1. You’re right that I usually eat around noon. This is extremely regular. The calorie deficit explanation makes a good deal of sense. I ate 2-3 scrambled eggs (well, eggbeaters), 1c of oatmeal, and 0.25c of almonds for breakfast, so I’m sure I was hungry.

  2. Yeah, I’ve mentioned my G6 issues on here before. This sensor site (left tricep) hasn’t been bad on the whole–I’m on day 5 of it and I’ve certainly had worse. G7s work a little better but aren’t covered by my insurance at the moment. For what it’s worth it seems to catch drops well, but it lags behind on rises. That’s an ok asymmetry to have.

  3. I recently did some traveling that involved my going over 150 a couple of times after meals out. It’s not comfortable but I don’t think I had “acute” side effects–mostly annoyance. I could try aiming for 150 at the start, though going higher might lose some efficiency.

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42

I’m impressed how methodical you’re being!

Its a personal strategy with you and your medical team but my perspective is I don’t have all day to wait for blood sugar to come up (hate running with that ‘soggy’ leg feeling) and its been explained to me that short periods at <55 is way worse than short periods at >180, within reason.

(Edit for > rather than <)

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its been explained to me that short periods at <55 is way worse than short periods at <180, within reason.

Yeah, I worry about this. In the past 30 days Clarity reports that I’m 97% in range, <1% high, 2% low, <1% very low. This past week has been a lot worse, in part because the change of weather meant that my insulin suddenly got a heck of a lot more potent without warning. I do have more frequent lows than I’d ideally like (many exercise-related), but on the other hand I’ve only been at this for a year and I’m still trying to get a lot of things dialed in. So I hope it’ll smooth out after a bit.

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I was diagnosed in my forties as well. I soon figured out that some of the usual rules that are taught do not always apply to the person who still makes a little of their own insulin. Especially for exercise. The remaining insulin production seems to change week by week and has a mind of its own.

I still find that the tail end of a larger insulin dose(3+ units) to still be working up to 6 hours.

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Agreed, @Josie , I have to make a lot of adjustments away from the standard advice. I was puzzled in this case because usually I seem to get more of an assist from my pancreas later in the day (at least going by my IC ratios). But the change in weather has also thrown me for a loop.

It’s definitely worth noting that this was a larger dose than I typically have at the meal prior to my evening runs, although I’ve done 3.5u at lunch before and not had this much of a problem. It’s frustrating, though, since the alternatives are (1) eat a small meal hours before the run and risk being underfueled for it, or (2) eat a larger meal and use less insulin, meaning that I might stay higher for hours.

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I know that I can do a two hour hike no BG stresses when I first wake up with no breakfast but I’m in a horrible mood without food. I think some people are just not intermittent fasters and that’s ok.

You’re using transcends? While they are the fastest they certainly don’t last very long in me. I cut up Cliff bars into 8 pieces and have a couple twenty minutes before I start hiking. It’s no good for me to eat one when I start because I don’t think I digest food while walking it’s weird.

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I used to just wake up and run without eating or snacking–my dietitian is annoyed by this but it worked for me for years (pre-T1).

I also don’t seem to digest while exercising. I sometimes snack on a mini Clif bar before a long walk or light exercise. But I need more than 20 minutes for them to kick in; sometimes it’s more like 40. Figuring out digestion rates is another annoying variable…

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48

Self-followup: I’ve had more runs that have been too uneventful to log here, but one helpful change I’ve made is using Boost shakes for recovery. Often I don’t want to have a meal right after a run, but these (especially the glucose control variety) are terrific. Fat, protein, and 16g of carbs so 1u will more than cover it post-exercise. Thanks @daisymae for suggesting these in her threads on swimming.

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Ditto from me as well. Those Boost Glucose control drinks are great.

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50

Trial run 7

Lots of uneventful runs have intervened here but I’m logging this because it’s potentially informative.

Today I started prepping around 5:27pm by having 1 glucose tab to get myself from the 80s up around 100. I settled at about 93. I definitely had zero IOB except my tiny basal since I hadn’t bolused since breakfast. So I decided to take a Transcend plus a glucose tab, figuring that 19g of carbs would get me through a ~4mi run.

The run itself was pleasant. Nice weather, did 4.75mi at an 8 minute pace overall. Felt good and ran a few of the splits at 7:40. When I started I was at 96. I peaked around 117 and ended at 104, then rose a little bit to 114 when I injected for dinner.

Why does this matter? Because I’ve been starting my runs around 130 and then adding the Transcend on at the start. But with zero IOB, I can start much lower. This suggests that I only need to start high if I have lingering bolus insulin in my system. Without it, I can probably take the fast carbs and go. This was confirmed because prior to this I did another zero IOB run where I started at 130, took a Transcend, and ended … in the 130s.

Anyway, good to know. Plan to shift to morning runs for a while so I’ll log them when I have more results.

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Trial runs 8 and 9

Two runs, one a catastrophe, the other an attempted replication. Presented as a study in how impossible this can be some days.

Run 8 started with fueling up around 4:47pm. I took 3 glucose tabs (12g) to get myself up to BG 129 then added a Transcend (15g) and set out. I had only had 1.5u of insulin to cover lunch at 11:47am so I figured after 5 hours it would be gone.

Beautiful day and a good pace–hit some 7:30 splits. Everything was looking steady on the Dexcom, then I saw a sudden drop so I stopped to check with the meter: BG 85 after not quite 3 miles. Given all the carbs that seemed crazy but the arrow was angled down so I added 4 more tabs (15g) since I had hoped to do more miles. Waited 15 minutes and re-tested: now I was at BG 79. I decided to give up and started walking home. Ten minutes later I was at BG 77 so I added 4g more of carbs and arrived home. Showered and then at 6:56pm – a full hour after taking the carbs! – shot up to BG 154 and then up to BG 197 at 7:21pm. I’ll spare you the rest of the rollercoaster night I spent trying to get that down and still eat dinner.

That’s the catastrophe. Run 9 was the retrial.

Started fueling at 12:03pm with 12g of glucose tabs. Had 2u of insulin to cover breakfast at 7:20am so, again, assumed it would all be gone. When I was around BG 121 and rising I added a Transcend (15g) and set out.

Same pattern: a drop at mile 3 on the Dexcom that was confirmed on the meter (BG 86). This time I didn’t add any fuel, but I did stop running. Finished the walk home having stayed steady at that value (BG 89 after a shower and before lunch).

Conclusions:

Man, you’ve got me. Possibly the insulin is still hanging around in my system at 5 hours, although with those low doses it seems incredible. No major changes to diet, sleep, or other routine. I also have no idea why the glucose I took on run 8 didn’t hit until a full hour later. Post-run my IC ratios are also off the charts. Hard to estimate even, but I’d guess 1:25 or higher.

The solution here may be to shift to running first thing in the morning with zero IOB, if that’s the only way to be absolutely sure nothing is lingering after 5 hours. It’s just not practical to arrange my day otherwise.

Thoughts?

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I have been following your thread for information - I signed up for a 10k this year after mostly only doing 5ks for the last 15 years. It is a struggle. I don’t have any advice but I empathize! I’m running too low too fast during my workouts and then rollercoastering all day. It’s exhausting and infuriating.

If you are on facebook, have you seen this group?

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53

YES! zero IOB really helps.

Otherwise, I’d say some of the changes day to day are due to LADA, honeymoon, etc?

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Hi @Karl.n , good thought. That may be right. I’m still at 0.9 C-peptide, so making a decent amount of insulin. I also have major seasonal swings in how insulin hits me. I had 5.5u of bolus insulin yesterday for 182g of carbs, for example – even allowing that some of that is fuel for running, it’s pretty crazy.

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Thanks for the pointer @allison . I’m a social media refusenik unfortunately but these communities do occasionally tempt me to rejoin (suitably anonymized). Sorry that you’re having similar problems. My goal for the year was running a half marathon again by October. It’s a stretch, but we’ll see!

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@needlesandmath
I don’t think the issue is IOB from bolus / mealtime insulin. It’s IOB from basal. But it is essentially the same exact thing. Your body does not know the difference. Insulin is insulin.

I will say this unequivocally - without a better basal system, you will constantly need to feed your basal on your runs. Same note for you on that, @allison.

Tresiba may be great for many things and for many people. But it absolutely sucks for exercise. It is NOT the right basal for endurance running.

@needlesandmath, you are still using Tresiba, right? So you have absolutely no way of adjusting your basal.

@allison, what basal are you using?

If you are dead-set against using a pump, you will have to feed your basal. If you switch to a basal that allows you to have more granularity, like Levemir. You can adjust your dosing times and amounts, and that can help.

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The other thing, on your notes above. If you take sufficient carbs, and you see you are in the 70’s, you gotta get to the point where you trust that the carbs will work. And just keep going.

You are 70-somethning, you take some carbs, keep going, and test again in 1/2 a mile. The carbs will work. You just gotta trust it. As long as you don’t have a big amount of insulin on board, you just have to trust they will work. In your notes above, you ended up at 154. The carbs did their job.

Right now, it may feel unsafe and uncomfortable to run at 70. But at some point, you can get to where it is comfortable.

+++++++++++++++++

@allison, if you want to start a thread, let’s see if we can get you dialed in a little better with everything.

I promise either one of you can run a 5k, 10k, Half, or Marathon. Whatever you want.

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57

Sometimes, longer is even easier to control!

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I totally agree about social media stuff - I only have my Facebook account to join groups like that. I have no friends :wink:

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I have a Tandem pump. I have done lots of 5k races and work out regularly but for some reason running is what gets me! The longest I’ve done is a 5-mile race about a year and a half ago, and I struggled to keep my numbers up with that.

I wouldn’t mind help! I have been documenting everything as I go :slight_smile:

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This makes it a lot easier!

Let’s get going! Do you want to start a thread?

I promise I will be kind. And I won’t tell you to “just eat cinnamon”. :stuck_out_tongue_winking_eye:

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