It is an unfortunate necessity of being a cyclist with Type 1 diabetes that a fair amount of thought goes into blood sugar levels on the days before, during and after major rides. Despite all the warm fuzzy “Diabetes doesn’t stop me from doing anything” sentiments – which I in fact do agree with – there is still an inescapable fact of life: Diabetes is a big pain in the ass. I’ve talked before about some of the challenges that cycling, or any athletic endeavor, can present to a diabetic. To that end, I’ve decided to share some of my methods of managing my diabetes while I’m riding, and ask for your stories to help me address some of the areas I’m struggling with.
First off, the all important disclaimer: I am not a doctor. I don’t even play one on TV. Instead, I’m just a guy with diabetes trying to find out what works for me. That means that anything I say about what I do is just an opinion and not a suggestion to do anything in particular. Your diabetes management strategy is a choice that you must make for yourself, in conjunction with a qualified health care provider.
I’ve been thinking about writing this for some time, but decided that today was the day. I’m recovering from my Tahoe ride yesterday and for the most part I actually feel pretty good. I’ve surprisingly got absolutely no leg pain or stiffness, due in large part to the great massage I got post-ride yesterday. However, I am currently struggling with an issue that I, for lack of a better term, will title the “Post ride diabetic hangover.”
The post ride diabetic hangover is the situation that happens the day after a significant ride. You’re body seems to think you are still climbing the hills or sprinting to the line. Normal basal rates and carb/insulin rations keep your blood sugars at dangerously low levels. You find yourself constantly treating hypoglycemia.
This can be a tricky and annoying situation to deal with. For me today, the problem actually started in the middle of the night. I’ve been running at a 50% reduction in my normal basal rate ever since then, and I seem to be holding steady.
I tend to deal with these days by the “constant correction” method. I intentionally reduce my basal and bolus doses. Hopefully I get the adjustment numbers right. If I don’t and my blood sugars start to climb I correct. I always favor slightly higher blood sugars to hypoglycemia. This, of course, requires constant blood sugar checking.
All of this would be a lot harder to deal with if it were not for my Continuous Glucose Monitor (CGM). I personally use the Dexcom Seven Plus – and it is worth its weight in gold to me, not only for recoveries like I mention above, but while I’m actually riding. Trying to stick your fingers while juggling a meter and a test strip is downright dangerous in the saddle. And if you’ve reached any level of seriousness about your riding, you’re probably not going to be coming to a complete stop each and every time you need to test. This is why, in my opinion, a CGM is one of the most important purchases that a diabetic cyclist can make.
A little tip about the sensor (which almost universally seem to attach to the belly) and cycling bibs, however. Bibs can be the enemy of your sensor. I suspect those of you running MiniMeds or other pumps with a separate infusion set might be in the same situation. There are a couple of times I’ve stopped to use the restroom and ended up with part of my bib shorts caught on the sensor without me being aware – eventually resulting in the sensor being pulled off enough to stop functioning. Either get in the habit of placing your sensor much higher or lower than the band of your bibs, or just be conscious of this whenever you adjust your bibs. I tend to keep my sensor lower on my abdomen and just try to be conscious of snags. It has been working out so far.
Insulin injections are challenging on the bike too – especially basal shots. Just like with the GSM, switching to an insulin pump made things vastly easier. The fact that basal is delivered slowly over time (like your body is supposed to do) also means that you can adjust dosages down on the fly and have an almost immediate effect. I’m an OmniPod user myself. I just find it much more convenient to have the controlling unit completely separate and wireless – makes it easier to move the display to a position that is reasonable for me to read and operate while still pedaling. I’ve also heard a couple of times that the Dexcom sensor and OmniPod pump are soon to be merged into a single controlling device – reducing two devices down to a single one. Now if only I could get that data to my cycling computer!
Above all, though, just be aware of how your body reacts on the bike. Even if you don’t have the luxury of a CGM, pick days where you do a normal training ride, or simulate a scheduled ride, and stop frequently to check your blood sugars. I know that I personally often have a really hard time telling the difference between the feeling of low blood sugar, and simple fatigue from pushing really hard through a difficult effort. It would be awesome if more of us could get access to the amazing information available to the diabetics riding with Team Type 1. Just imagine having someone there to help you manage your blood sugars. Someone that knows both cycling and diabetes. Well, you’re going to have to become that person for yourself – at least until the team decides to pick you up!
So here’s some advice I will give my fellow diabetic cyclists. This advice is disclaimer-free and I actively encourage you to do this. Educate yourself, know your limits and don’t assume that diabetes will prevent you from riding your bike.
And spread your experiences! I know there are numerous hints and ideas about dealing with diabetes while riding – post them in comments here. Tell others what works for you, or perhaps more importantly what doesn’t. The cycling community is a close family – the diabetics in that family an even tighter group. Share and share alike!
There are lots of us out there riding. I ran into many on my Tahoe ride, as it was also a benefit for Juvenile Diabetes Research Foundation. And I know from direct conversations I had with many (Hi Dave! Hi Randy!) they were out there riding with Type 1 diabetes just like I was (and a couple kicked my ass on the climb to Spooner Lake too.) The stories say that the whole Team Type 1 pro group started when one amateur rider happened to see another checking their blood sugar before a race, realized they were both diabetes and struck up a conversation. Let’s repeat that. Share what you know with others.
Ross Del Duca – JustAnotherCyclist