I wanted to write a post specifically about my boyfriend EH’s present state as a LADA T1D. Sadly, EH’s current diabetes management is not going well. He’s spiking to 200++ daily, and then crashing after exercise or misgauged boluses. He feels like crap often. He’s not sleeping well, because of bad BG management. So, it’s not working. And the worst of it is, he’s trying to eat right, inject right, and is willing to try new things in his treatment.
Currently, he’s on MDI of Humalog and Toujeo. On @Eric’s suggestion, and our endo nurse who’s also T1, he’s split the Toujeo into two doses, morning and night. He’s using a Dexcom G4 Platinum and we just got Share working.
His current IC ratio is 1:12 and 1u Humalog takes care of about 50 points of correction. He thinks these numbers might be a little off. Last couple A1C’s were around 7 or just below.
He likes to run, but was the type of guy who wouldn’t run for a week or two, and then could go out and do 10 or 12 miles. Which was kinda murder on his BG stats. It’s been revealed to us recently that running every day would be a better bet, so he’s committed to doing this instead (the guy is a champion - fitting in a 6-8 mile run everyday takes some committment).
Historically, we’ve been quite low carb, starting back in January 2012 on the paleo diet, drifting away from that somewhat and now on a paleo-ish diet, we do dairy and corn, very infrequently he does gluten. Total carbs somewhere between 30g and 100g on a day where we cook at home, a little higher if we eat out. High carbs used to equal a BG disaster - big spike, chasing that high all day or night, so we avoided them.
Once we started to better understand the carb requirements for running/exercise, we realized we needed to make some major dietary changes. So, in the last week, we’ve substantially upped the carbohydrates that he’s eaten, and added a serious post-run recovery drink plan. We are shooting for the goals outlined in this post (50% of calculated required carbs w/in 45 minutes of run, bolus for carbs and running, and more carbs for dinner and breakfast):
While this carb increase has made EH feel better during the runs as far as muscle strength and running ability, he’s having a really hard time staying steady during and after the run. So, his muscles appreciate our work, but his diabetes doesn’t.
His observations about exercise and blood sugar: “I feel like I start my exercise around at a BG of 170 or 200 and then within the first hour I consume 60g of carbohydrates and find myself at 100 BG or lower.” The minute he stops running, his BG beings to spike. He does the bolus for the carbs and the run immediately after stopping running, drinks the chocolate milk, and then he crashes or spikes. I want to say it’s unpredictable, but I recognize it is predictable, and I just can’t figure it out.
The Dexcom Share app won’t let me look back further than 24 hours (which I didn’t realize until I sat down to write this) and we haven’t figured out how to get the data off the Dexcom onto a Mac yet. So, I’m missing a critical piece, and I now know I need to figure that part out. And while xDrip seems cool, we have a G4 currently. I’ve been keeping track in a Notes file on my phone, but it’s been suboptimal.
I’ve been helping EH carb count and record a huge pile of data from the last week, but I haven’t been able to make sense of it. Also, it’s put a strain on our relationship (which is fine, we will hold up, but we are both tired of cooking at home and carb counting and eating cold dinners due to my inability to figure out the carbs before I plate the food, and waking up to the call of the CGM, and having to correct all the time).
And, since someone might ask, yes, we change things. All the time. EH travels for work about 60% of the time, so we eat out a ton, we have erratic schedules, he drinks alcohol, and our meals happen at strange times and are often unpredictable.
Yes, I understand, I should tote around 12 PBJ sandos, and a case of OJ, and he can just. eat. that. But he won’t. He lives to eat and drink and run, so we’ve got to sort this out so he can get back to that.
It is sad to see someone so formerly vital be taken down by the depressing aspects of this disease. I need to help him get back to the unlimited part and not feel like crap all the time! For the record, he was running really high and feeling crummy for two weeks prior to our run-everyday-carbo-load-and-carb-count experiment. So, it’s not the change to the exercise+more carbs that’s the major problem. I think generally, his BG management is out of whack and has been for quite some time.
So, I guess I am asking for some help figuring this out. I’ve read the Daisymae’s Swimming BG Thread, and I’ve read all of the Sports Wiki, and found all invaluable. Honestly learned more here than ten years worth of different endos and books that were too dense for post-work reading.
I believe we are going to get the OmniPod and give that a whirl - next endo appointment is September 11.
If you managed to hang in and read this whole thing, thanks! Being concise isn’t a strong point. And I still feel like I haven’t even asked a question, exactly!
Ah, the question has come to me:
I understand how to calculate amount of carbs required for recovery from exercise. The question is how to bolus for those carbs and also how to maintain steady BG before, during, and after the run? And how do you deal with days you don’t run?