Since its about a month to my last race and writing about interval training isn't all that interesting or entertaining I thought I'd take the opportunity to write an FAQ about how I handle diabetic related equipment issues when working out. Several people have left comments over the past couple months asking how I handle testing while swimming, what I do to keep my pump in place and how I keep my infusion sites attached while sweating heavily. So here's my best attempt at answering those questions; if you have any more just leave them in the comments and I'll update the post accordingly!
1. How do I wear my pump during running and biking?
This took some time to figure out; I've dealt with cuts from the little plastic piece that attaches the pump to the tube; skin burns from the pump clip rubbing against my skin and tremendous fright as my pump has flown off my bike shorts to slap against the side of my bike frame. But through it all I figured out two ways that let my pump sit really comfortably on my body during exercise.
When biking I take my pump and put it inside my bike shorts with the clip outside my shorts on my left hip. For some reason my pump seems to fit perfectly against my left hip and doesn't interfere with my pedal stroke at all. Also, in the event of a crash, having the interface side of my pump against my hip makes me feel somehow safer.
Running has two options of pump wear, but in each case I use as much cloth/ material as possible to hold the pump in place. When running putting my pump against my left hip doesn't work as well as it seems to put pressure on my hip during my stride. So if I'm not wearing my fuel belt I clip my pump to both my shorts and spandex (although I just got a nifty pair of running shorts with a liner so we'll see what I do now!). If I'm wearing my fuel belt, I clip my pump to both my fuel belt and shorts/ tri shorts - this normally keeps my pump firmly in place. During intense efforts I'll normally clip my pump right above my butt as it seems to jostle around less during tempo runs.
2. How do I prep my Minimed Infusion Site area to ensure the site doesn't become disconnected?
Really I just dry the site well, use IV Prep and the Minimed gun. For whatever reason the Minimed infusion sites seem to really work on me, possibly because they go in at an angle rather than straight, and have a crap load of tape for the weight of the infusion site - way better design than the Navigator sites if you ask me. If I'm doing a long race or a long swim I will occasionally add IV 3000 for extra security. During the Ironman I kept a spare infusion site in my bottom just to be safe.
3. How do I adjust my basal rates prior to exercise?
My basal rate reduction is variable and can have alot to do with the time of day, heat and the active insulin in my system. If there is too much active insulin in my system then no amount of basal rate reduction will allow me to workout. My baseline for running is to reduce my pump to 40% an hour before exercise, for swimming the baseline is 60% and for biking 50%. Biking on the trainer requires a lower basal because of the extra intensity (environmental and pedal stroke) the trainer provides. For lifting I reduce my pump to 75% about a 1/2 hour prior to exercise and remove the pump for an hour lift.
4. What steps have I taken to try and keep my Abbott Freestyle Navigator attached?
I have tried everything from IV Prep, IV 3000, Athletic Tape; I've thought about trying crazy glue or stapling the damn thing to my skin but I thought that would be a stretch. My 2 biggest complaints are the cannula isn't long enough and the tape isn't wide enough to support the weight of the sensor. I've tried to speak to Abbott health about this but the people on the phone don't seem to understand my dismay. I'm going to try Matisol next!
5. How do I test when I'm swimming?
Last year my testing equipment would side nicely in a plastic bag with a "swimmers towel" at the end of my lane. This year I've been a bit less neurotic and usually just keep my testing equipment in my locker. I've taken to swimming early in the morning so that my IOB doesn't affect me as much as it did last year in the water. I still freak out when I swim; and yesterday I ran out of the water to test, and was surprised to see 200 on the meter. I still have problems knowing the difference between fatigue in the water and low blood sugar and am extra cautious because I don't really trust the life guards at the pools I've swam at.
6. Where do I keep my testing supplies during exercise?
During runs of less than an hour I rarely bring my testing supplies with me. I now have enough experience to know that with the right starting blood sugar point and the right nutrition protocol a run of an hour has a minimal chance of bringing me critically low. On runs of more than an hour I have either my 2 or 4 bottle fuel belt with me where I keep my testing supplies in a pouch I bought for the fuel belt. The sound of the test strips bouncing around drove me crazy so I normally stick some tissue in the canister to "lock" the strips next to the wall.
On the bike I keep my testing supplies in my back jersey pocket and pull over to test. I'm way more comfortable when that pocket has a zipper, but that seems to be rare on bike jerseys so I usually keep the meter in a separate pocket from the strips and lancet for security. I still don't trust myself enough to test while riding but that is something I need to work on!
7. Some of the dumbest mistakes I've made with diabetes stuff while exercising (but learned from!)
I learned the hard way that a drop of water on one's nose is a test strips biggest enemy. I ruined at least 150 test strips during the early days of triathlon training because I would forget to dry my nose or the end of my hair before testing. I now also hold the canister sideways when removing a test strip so that sweat doesn't ruin all the test strips.
I've learned that having dried nutrition on your hands can totally screw up the reading on your meter and that testing in the rain is next to impossible. I've learned that a small adjustment in your basal rate can go a long way in correcting a blood sugar during exercises. And I've learned that I can eat an amazingly large quantity of food in an attempt to raise my blood sugars for exercise; without throwing up. All that came with practice and was alot of fun!