being flexible and not afraid of changes is key to manage type 1 diabetes well
The one thing I have learnt about my Diabetes over the past 26 years of living with it is that being flexible and not afraid of making gradual changes is key to manage it well. A great example and reminder of that was my week of cycling in the stunning Pyrenees as part of a training camp.
With no experience of cycling in the real mountains, I had no idea what to expect both from my legs and also from my blood sugar (how would it behave?).
Over the past two years I have gained considerable experience in managing blood sugar levels on the bike up to 6 or 7 hours but yet the training camp in the Pyrenees was a very different challenge: Whilst I pursued the same strategy of reducing my insulin basal rate to 50% from up to one hour before heading out on the bike and applying a similar nutrition strategy that I knew would work for long endurance sessions on the bike, I had to make considerable adjustments from the minute I reached the top of the mountain and taking a break or when going on the long downhill descents.
Plan B needed
So, by adjusting to my race breakfast mainly in form of protein, I was able to stop hypos from the breakfast bolus.
The long climbs
My helper: The CGM (Continuous Glucose Monitor)
Yet I still experienced problems after that: When I descended the Tourmalet, again, my blood sugar had risen from below 100 (5.5) to 186mg/dl (10.3mmol/l) without me taking on any food!
To tackle the problem of rising levels after reaching the top, I decided the next day to have the pump back running on 100% basal rate the minute I reached the summit (since we usually would have a 20-30 min break) and depending on the length of the stop I would sometimes even inject a little booster of 0.5 units.
Most diabetics can probably sympathise with me when I say that it scared me to inject insulin boosters.
It is pretty counterintuitive to inject and increase basal rate when you are actually still exercising.
1 single strategy turns into 3-stage strategy
That day we cycled a total of about 140km with over 2000 metres of climbing. The first climb of the day was the Port the Bales, a stunning 19km climb with the first half at a nice 4-6% gradient and the latter half a little more to 7-9%. I started the climb with 89mg/dl (4.9mmol/l) and reached the top with 101 (5.6). Spending only a short while on top we descend for about 10km to the bottom of the second climb: The Col de Peyresourde, a 15km climb with an average of 6-7% and the steepest section around 9.5%. I managed to keep levels stable at that level and reached the top of the Peyresourde with 96mg/dl (5.3mmol/l).
Glucose profile of the day taken from my CGM:
It was another reminder that in order to have stable glucose levels, I need to remain flexible and adapt insulin and nutrition to the demands that the environment I am in throws at me.