The Importance of Insulin During Training

The first sport I did after I was diagnosed with diabetes was middle school track and field, in seventh grade.  Although I had had diabetes for more than a year, I did not have much experience with managing my blood sugar while being so active.  (I think that anyone will agree with me when I say that exercise adds a completely new element to diabetes management.) 

My team of doctors thoroughly warned me of the danger of hypoglycemia.  They explained it simply: when you work out, your muscles "pull" sugar out of the blood stream for extra energy.   The solution?  Treat an exercise low as you would any low- juice or smarties and a small snack.  When I got my pump, the pump trainer explained how to suspend the pump an hour before exercise, and during exercise, in order to prevent the any lows. 

So, for many years, that was exactly how I handled my blood sugar when I was working out.  I would suspend my pump for an hour before, leave it off for the workout, and treat a low with juice.  I literally ran with juice boxes as a freshman in high school cross-country.  Thirsty teammates used to always ask for a sip, which would launch me into a spiel about the danger of low blood sugar. 

However, juice does not sit well in a running belly.  To avoid the juice box, I compensated with insulin: suspending before and during training.  Lowering my insulin so much was effective- I rarely went low.  But, there was a downside.  Without adequate insulin, my blood sugar would gradually spike, and I always ended up running high, in the 200s and even in the 300s.  As a result, my energy levels would drop.  Often, the spike would last for hours after the workout.  It was a terrible tradeoff: feel better with a greater risk of hypoglycemia, or push through the sluggishness with a peace of mind.

When I joined swim team my sophomore year, I was not ready for the two and half hour practices six days a week.  Although I tried the usual routine, suspending an hour before and during the workout, I discovered quickly that three and a half hours with no insulin is a bad idea.  I felt lethargic and slow, especially as I went longer durations without my pump.  I started using Hammer Nutrition products as a source of fuel- notably the Heed sports drink.  I noticed that my energy levels improved tremendously.  However, the same carbohydrates that gave me energy also spiked my blood sugar!  I determined a new carbohydrate ratio for training, thus coordinating my insulin dosage to my fuel intake.  Exercising with fuel and insulin was a completely different experience than exercising with severely reduced insulin and no fuel.

Training for the Pikes Peak Ascent this summer requires some substantial running mileage each week.  Often, I run for more than two hours.  However, I always wear my pump and I always make sure that I am fueling properly.  (I find that I feel best with about 35% of my regular basal rate and 20-25 grams of Heed carbohydrates an hour.)  Taking any insulin at all used to make me nervous; I preferred the security of running (too) high during training.  Yet, the difference that even a little bit of insulin makes in my energy levels is unbelievable!  I am positive that these are the ideal internal conditions for maximum performance.