How to Do the Outdoors?

Sports & Exercise
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tl;dr newly diagnosed and looking to keep doing my sports and hobbies!!!

long version: before my husband died in 2021 (the air force widowed me young), my husband and i were a 2-person high altitude technical climbing and ski mountaineering team. after he died, i sort of switched sports and became a middle distance runner (10k and half marathon), recreational trail runner hiker and backpacker, and in the winter i still ski (in the resort as well as backcountry touring: i try to summit and ski at least one volcano a year, this is always health- and snow conditions-dependent though!). in summer time i cross train by swimming at the community pool or in local lakes, and keep a standard rotation of basic lifts/core work in there 3 days a week year-round.

most of these sports require an hour (or many hours) of sustained activity, sometimes far from civilization or medical support. i find it pretty easy to manage training sessions in the gym, but i frequently find that i struggle to hit that “sweet spot” so that i don’t run myself right out of range. i do wear a cgm, and when running outside (mostly local trails, i live in the cascade foothills) i go alone with my alert-dog-in-training (no human training partner right now).

any pro tips on:

  1. pre-activity snacks and timing? what do you eat and how far in advance?
  2. during activity fuel: what do you use? do you fuel at set intervals or in response to cgm alerts?
  3. post: how quickly and what do you do after?
  4. what do you carry for emergencies on long runs?
  5. do you do anything special on race day to ensure your blood sugar doesn’t tank your time?

obviously i understand all of these shift with duration and intensity of activity so i guess i’m asking generally not super specific.

another one: do you have a target starting range for your sugar before you toe the line? where do you like to be at the beginning?

backpacking: oh lordy how do you manage backpacking food?!!! it’s usually all carbs!! help :sweat_smile::woman_shrugging:t2:

thanks all in advance, as you all know this is a LOT to (ha!) get up to speed on. i’m just eager to get a better handle on managing my diabetes for my lifestyle!!!

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Hi @panda!

I have a lot of recommendations for the activities. Each activity you mentioned has a little bit of a different setup.

But really, before I can suggest anything, I need to know what you use as far as your insulin management!

Are you on a pump, or do you use injections?

And if you do injections, tell me what types of insulin’s you use!

Let’s get that info first and then we can start getting into some of your questions.

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oh! well in hindsight yes that is relevant and crucial information isn’t it :sweat_smile: oops!

i use lantus/novolog injections on the low dose scale right now (a recent change, my first provider kind of made a mess of things, still working with new provider to titrate exact doses) and i am hoping to get set up with a pump soon, but there’s a waiting list to get seen here so it might be a bit.

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I have run races using Lantus as my basal and syringes to dose during the race. Then I went to a pump.

The huge advantage of a pump - any pump - is the ability to turn off the basal.

If you can’t do that, you have to feed the basal a little bit. It’s manageable, but just a little bit more challenging.

When I used Lantus, I went to roughly half my dose in the morning on race days.

What time do you take your Lantus, and how many times per day do you take it?

I suggest trying to get a pump a high priority. I think for activities like you have mentioned, it will be so much easier to use.

Tandem is fine. The OmniPod Dash is fine. (I like the tubeless aspect of the OmniPod Dash, that’s what I use.)

Steer clear of the Omnipod 5 or any Medtronic product. Those won’t be easy for you if you do a lot of activities.

We can go through all of the different scenarios for different activities. But once you get a handle on one, the others will pretty much start to make sense.

Skiing is not too much of a problem. Unless you are racing, you can just stop and take some sugar if you need it. Same with backpacking. Just stop, open up your pack and test and eat and then return to your hike.

Racing though is where you gotta work on everything and practice it to keep going. I don’t use a CGM, it’s not current enough. I want to know my BG at that moment, not get a general idea of what it was 20 years ago. I test while running. And I inject while running too.

For running, I like 3 different types of fueling gel, because they all have different speeds and I can pick the one that will work for that moment. Have you heard the 30-60 gram per hour rule? I always try to hit the top end of that. It’s super important for the longer races.

I can point you to a ridiculous thread if you want to read through it as an example of some of the stuff that can be done. :joy:

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diligently taking notes this is more helpful than you know!!

and yes please, i’m always up for a little light reading (and there’s no reason to make people retype things that are easily linked to!)…thank you!!!

as far as the pump: definitely a high priority but i’m at the mercy of the medical system getting my foot in the door :sweat_smile::woman_shrugging:t2: you know how it goes.

looks like my insurance covers omnipod models though so that’s a lucky break! looking into that now. and yes please do send any additional reading my way!

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If you are newly diagnosed and are making some basal insulin Omnipod 5s algorithm is sort of amazing at cutting off basal before going low .- as long as there is no bolus insulin still around of course.

Plus I think it’s the easiest one to try out. They also use to pay for 2 appointments with the CDE/pump trainer if you are a new user. Not sure if they still do that?

The activity mode works well but you can always switch into manual and turn of basal completely if needed. I’m not sure why it wouldn’t work for someone doing a lot of activities?

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I know pumps are a personal choice. And ideally, everyone of us could try each one and decide which they like best for themselves.

But realistically since we probably can’t try them all, unless we go through a bunch of hassle with doctors and insurance companies, I wanted to offer my advice simply from the perspective of exercise and activity.

The Tandem algorithm works with a base basal rate that you create, and then makes adjustments to it, up or down, depending on what your BG is. You can change your basal rates on the Tandem if you need to, and it will then adjust those changed rates.

The problem I have with the Omnipod 5 is that is does not use your own basal numbers. It takes your total daily dose amount, and than applies a percentage of that total which it uses toward your basal. When in auto mode, “it” decides what your basal rates should be, it does not let you decide.

And it takes days to “learn” changes (see notes below).

Running 20 miles one day, and then needing the algorithm to wait up to 3 days before it figures out your basal rates have changed is not the best algorithm for endurance sports. I promise, your basal rates are not the same after a run like that.

And after 3 days when it has finally figured out a different need and made the changes, you might be back to your normal basal rates.

Yes, you can use it in manual mode, and use your programmed basal rates. But if you were going to do that, there is no reason to use the OmniPod 5. You might as well use Dash in manual, and at least have the option to Loop if you wanted to.

I also think the O5 could be a problem with changing basal needs for monthly cycles. It is always playing catch-up with your changing rates.

I wished they used a basal rate that you could set yourself.

Just my $0.02. :man_shrugging:

From Diabetes Journals(.)org

Insulin Automation Strategies

The Omnipod 5 algorithm uses total daily insulin (TDI) delivery as the basis for insulin automation, similar to the MiniMed systems, which also use a TDI-based strategy to determine microbolus insulin delivery every 5 minutes. In contrast, the Control-IQ system automatically increases or decreases pre-programmed basal rates in response to CGM data, although it does use TDI to scale these adjustments.
…
The Omnipod 5 System tracks TDI and, with the first Pod change, begins using actual TDI to automate insulin delivery going forward. TDI is updated with each Pod change, permitting the system to adapt to users’ insulin needs across time. With this TDI-based approach, changing a person’s programmed basal rates has no impact on insulin delivery once established in automated mode.

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I have been playing ice hockey with various insulin scenarios for years. Not the same as a distance race or day-long climb but might be relevant. With Lantus basal, best I could do was split my dose into an AM and a PM, and vary the AM on game day to attempt a reduced basal. Then I started Omnipod and would reduce basal well in advance of game times and suspend basal altogether as needed. I have had good luck preventing lows while skating with Omnipod 5. I don’t use Activity mode but I stay in Auto mode which does a good job of suspending insulin when BG is dropping. It’s not 100% reliable at preventing lows though so I use glucose gel to fuel.

I agree with @Eric that the Omnipod 5 has some drawbacks. As for the pro and con of Omnipod 5, the Auto suspend of insulin when BG trending low has been quite reliable. The other major pro is no tubes. I can’t imagine getting my hockey gear on and off, showering, etc. with a tubed pump. But that’s just me, the pros outweigh the cons and I make it work for what I need in a pump.

Since you are new at the whole blood sugar thing… lows can sneak up on you at inopportune times. It can be dangerous if you are engrossed in something hairy and technical like ice climbing and are caught in a low. By the time you feel the BG dropping it is too late to prevent the low, all you can do is treat it and wait.

A book with some good info is by Colberg, “Diabetic Athlete’s Handbook”.

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Hi and welcome @panda ! Learning how to do cardio/endurance exercise with T1 is tricky but very doable. Here’s a thread documenting my experiments with fueling for running. Lots of data on doses and timing here:

On 1 and 2: For short to medium distance runs I was preloading with fast-acting carbs (Transcend, glucose tabs) and supplementing with the same as needed during activity. I learned about how far my BG would drop for various intensities and distances, and fueled on that basis. I wouldn’t wait for alerts to fuel: there’s usually a lag with CGMs, especially when dehydrated or when BG is moving fast. I carried a wrist-mounted glucometer that @Eric constructed for me–invaluable for getting immediate point values. I strongly recommend collecting all these numbers for yourself. You’ll quickly get a sense of how your own body’s dynamics work in different conditions.

On 3: Post run it just depended on where I landed. Be sure to eat something, though, to replace the muscle glucose you used up.

On 4: For emergencies a Transcend or two will help you out of many holes, but if you’re especially low and far from possible assistance I’d add some other more substantial fuels that work over longer durations. For longer workouts I’d also consider a mix of fast and slower acting carbs.

Anyway, that’s off the top of my head. Lots of folks in the forum will chime in with other helpful information, I’m sure.

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Just to clarify my opinions on a pump, I prefer the OmniPod pumps for the same reason mentioned here - they are tubeless. So I use Dash pods and have Loop setup on my phone.

If I could not use Loop on my phone with the Dash pods, I would have a tough choice. I might have to wait until the Tandem tubeless (Mobi) pumps are available.

I am just not sure I would ever turn my basal over to the OmniPod 5 algorithm. And I am not sure I would ever go with a tubed pump! So I am a bit picky on the pump choices.

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@panda,
Can you tell me, what time you take your Lantus, and how many times per day do you take it?

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Welcome to this forum - there is a ton of great info here given by lots of people who are active and working hard for their numbers!

I wear a vest or fanny pack when running - I like fruit pouches (like Buddy Fruits). I haven’t gone more than 8 miles though, so we’ll see how I do when I get to longer distances.

My biggest tip personally is to limit insulin on board before starting exercise - no boluses or doses within several hours before working out. I turn my pump off for an hour, but obviously you can’t do that on MDI. So I don’t have any suggestions there!

These facebook groups are great too:
Type 1 Diabetic Athletes Group
Type One Run Community

And this book is just good for all kinds of sports:
The Athlete’s Guide to Diabetes: Sheri R. Colberg

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Can you expand detail on the gels?

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hey everyone, thank you all for the wisdom and tips, please keep it coming! i am just lurking back here trying to soak up as much information as i can, so that i can ask smart questions and be an effective self-advocate for necessary Rx and treatment decisions at my next appointment. (honestly i also feel a little shy and embarrassed because you all know so much more about this than i do and i feel like a bit of an idiot :sweat_smile::woman_shrugging:t2: i’ll catch up don’t worry, quick learner.)

on pumps: my primary care doc wants me to see an endocrinologist to get set up with a pump, which could be a really long wait. is that actually necessary or should i seek a provider who will prescribe one directly? i am obviously continuing to train meantime, so just considering the wait time for an appointment and wondering if there’s a faster way.

someone asked about my lantus: currently 1x daily in the morning. but everything is in flux because i finally got a doctor who isn’t trying to keep me away from insulin, so this is absolutely subject to change.

my first provider really didn’t want me on insulin at all and kept telling me that my goal should be to get off it; she also prescribed me only lantus and metformin, and refused to offer me any kind of shorter acting insulin. so trying to get this stuff ironed out for exercise has been… something of a nightmare so far. it’s been really really tough. my new provider though has been really helpful, making the obvious call to get me tested for t1.5, giving me the right Rx, and encouraging me to seek communities like this one for my lifestyle quirks! thanks to all of you for being here and being so welcoming, please keep all this great knowledge and links and so on coming!

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There’s another thread here somewhere about the fact that pretty much everyone had a poor experience with the initial provider of diabetes care – many people were initially misdiagnosed. Rn I’m fortunate to live in the Boston area, home to the Joslin clinic, and they are excellent.

But I started with the Cambridge City hospital. They weren’t too bad but they did misdiagnose as well.

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Ya, I asked about Lantus. :slightly_smiling_face:

Some important things to discuss with it. Lantus can be tricky.

In a perfect world - at least on our planet with our 24 hour clocks - Lantus would last exactly 24 hours. And you could take it the same time every day and everything would always line up.

You would take it right when the previous dose was ending.

But…sadly, Lantus may not last 24 hours. :frowning_face: For me, I get about 18 hours out of it.

It may last 24 hours for you, it just depends on the person. I have heard ranges of 18-24 hours with Lantus.

But I want to bring this up because… just because they say “Lantus lasts 24 hours…” does not mean it actually lasts 24 hours. It may last that long, it may last less. It’s different for each of us.

These are things you have to find out after using it and testing and seeing what your BG does, etc.

So that means you may have a gap in your basal coverage if you are only doing 1 injection per day. But…that’s okay! If you do have a gap in basal, let’s make it work for us instead of against us.

When do you take your Lantus? And what time do you usually like to do your exercise?

This is just an example, not necessarily one that applies to you exactly. But just an idea of how this might be worked a little bit.

  • Suppose Lantus lasts 21 hours for you.
  • Suppose you exercise every morning from 8am-10am.
  • And suppose you take your Lantus every morning at 10am.

Hmmm… :thinking:

You would have basal in your body from 10am-7am the next morning (21 hours). You would have zero basal while exercising. (That’s a good thing! You don’t need to worry about feeding it.) And when you are finished exercising, you take your basal and you are covered until you start exercising the next morning. :partying_face:

I know, this is overly simplified, but I am just writing this out to show you a little bit of how we can think through this and work it a little bit.

If you exercise at night, same kind of possible idea. Just need to figure out the timing and all of that. The most important thing is to get an idea of how long Lantus lasts for you.

@JessicaD is a Lantus expert. She is so savvy, she takes it twice a day to get a full day of coverage.

It’s been a few years since I was using Lantus, so let’s get her in here to talk about Lantus a little bit.

@JessicaD, how long does it work for you?

I got a million more things, but let’s start with the Lantus stuff.:grin

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it does seem to be a sadly common experience: of course the next doctor i tried was a sort of old school older dude and he told me we would test my blood to find out if i “did this to myself or not”.
…
so basically after that appointment i just cried and immediately started looking for yet another doctor because that just seemed like such an unbelievably inappropriate and awful thing to say, regardless of what type the diagnosis actually came out to…! i am on doctor #3 now and hoping she will work out… i live in rural eastern WA state, so finding diabetes providers with a clue isn’t easy here! slightly jealous of your location, won’t lie :sweat_smile:

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i am 100% a morning exercise person: it’s usually the first thing i do every day.

doc #1 had me start taking lantus at night but i was struggling with bad lows overnight so moved it to the morning: i did that based on BG patterns, and getting super sick of getting up every night to deal with lows, and it sounds like i accidentally did exactly what you described!!! i dose lantus right when i wake up, then hit my daily workout which lasts 1-2 hours, so the insulin is kicking in right as i head for food. i haven’t had the confidence to go beyond that duration because of how my sugar has been so far.

i hadn’t really considered that “squishiness” in med duration but it makes a lot of sense. see? learning new stuff already!!!

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@panda it sounds like you have been through a lot already. I am so sorry it’s been a tough road so far. I will say: welcome to FUD – this is THE BEST diabetes community in the world (and seriously one of the best online communities for anything, hands down). So much warm, unlimited support. It’s rotten that you had to find us, but you are welcome here.

Before I get to talking about Lantus, I will jump in with a couple more things. First, endocrinology support. If you don’t mesh with your new provider, covid has opened the door for virtual medicine like we’ve never seen. Would it be possible to see a provider in person in Seattle or a larger city in WA once/year and do virtual visits for the rest of the time (you are likely constrained to the state of WA)? That might open the door to finding some great providers, especially sports-focused, type 1-focused endos.

Second, if you are open to starting your journey on a pump, push for it. I wish I used a pump. I have had diabetes for over 30 years now and I think my life would be so much easier if I could accept a pump into it. I also work out a ton and a pump would make that part of my life (ALL parts of my life, especially hiking-- hiking can be so tricky to deal with for some reason!) so much easier. If you can advocate for getting one now and figure out how to make it serve you, your life with type 1 will be smoother.

Ok, now for Lantus! With the caveat that a few months ago, after using Lantus for 20 years I made the switch to Tresiba! (Tresiba is truly a 24+ hour insulin, which is working quite well for me… maybe something you would consider instead of Lantus?) So, I also only got 18-20 hours out of Lantus, so took a mid-day + bedtime dose and achieved 24 hour coverage and once I started with the 2x/day dosage didn’t notice any peaks.

Welcome to this community – please continue posting and asking and do feel free to reach out to any of us with the “messaging” function as well. I’m always happy to chat! Jessica (50+ years old, diagnosed type 1 age 20, lives in Boston, avid tennis player, hiker, cold plunger; mom to 2 kids)

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an aside on cgms:
as you say, i noticed early on that my cgm sometimes struggled to keep up during long or speedy sessions: that is one of the main reasons m got her job assignment! after i got diagnosed and started managing with meds, she started new behaviors, whining and pawing at me at what seemed like random intervals…and then the cgm alarm would go off a few minutes later, like clockwork. that’s what gave me the idea to train her for alert with the intention of her main function being for sports and outdoors: she now identifies both lows and highs, and can retrieve sugar sources (she knows where the juice is in our home) when needed. her breed is incidentally well suited to endurance sports too, so we got started with a training program and she is well on her way to being a living glucose monitor! if anyone is curious i do have some short videos of her training (and even in action!) she’s in my profile picture but here’s a better look at her:

IMG_4705
IMG_4705463Ă—886 137 KB

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