Managing Diabetes the Morning of a Race

Even though I train and compete regularly, my body is unpredictable.  Although I have probably run the same 7 mile loop around my house over fifty times (in the last year!), I have never had the same experience with my blood sugar on that loop.  I notice trends; I try to analyze them, understand them and prevent them, but even the most absolute of "rules" have exceptions. 

It doesn't seem fair that even the best training and perfect taper can be negated on race day by out of control blood sugars.  When I first started racing, I believed that this situation was unique to the diabetic athlete; however, I have learned that all athletes, even those without diabetes, need to be aware of their meal timing and content in order to maximize performance.  I have to remind myself that, even though I do have to pay extra attention, I am working with the same "tools" as any other athlete- carbohydrates, protein, and insulin. 

When I first wake up on the morning of a race, about two hours before the start, I have my usual breakfast: a ½ cup of oatmeal, about 27 carbs, and a source of protein, such as an egg or a 3 oz. serving of salmon.  I have found that although it does not take much, a little protein goes a long way in slowing down the absorption of the oatmeal, minimizing that spike.  Even though I am anticipating the race, I take full insulin for that meal, often as soon as I wake up.  If I take it early enough, I can be sure that the insulin will peak before the start of the race.  Most importantly, I know that I will receive all the energy from breakfast.

On the morning of a race, my first priority is to make sure my blood sugar is between 140 and 160.  (This is a comfortable range for me- low enough that my energy levels are high, yet high enough that I don't have to worry about going low in the first ten minutes.)  But, because the races that I do are usually an hour to three hours in duration, I am also concerned with the "stability" of my blood sugar, so I try to evaluate a trend.  (I look to see if my numbers are rising or falling, and how fast.)

I run a normal basal throughout the morning.  However, I test frequently to chart what my blood sugar is doing.  If I see it dropping, I usually cut the basal in half, to about 50% of my usual hourly rate. If I see it climbing, I take small bolus, using my sensitivity ratio to correct down to about 180.  I am careful not to correct too aggressively to avoid a last minute crash. 

I never fully "suspend" my pump.  Instead, I prefer to keep a 35% basal running throughout the entire race, and then consume a small to moderate amount of carbs as needed.  I am a huge fan of Hammer Nutrition products, especially the Heed sports drink.  One serving, about twenty-five carbs, has yet to fail me- it always seems to "lock" my blood sugar in place between 90 and 140.   For races where I can carry my fuel source, I carry one serving of heed mixed in water.  On looped courses, I leave a bottle of heed at the water station.  Not only are these carbs important in stabilizing my blood sugar, they also improve my overall energy levels.