Monday, August 16, 2010

The Nutrition Protocol Drawing Board

My attempts at exercise starting at a lower initial blood sugar has been going on for about a month now.  At times the process has been tremendously frustrating, like getting to the pool parking lot with a blood sugar of 75, sitting there for 15 minutes and then realizing a swim just isn't going to happen.  Or going out for what you hope will be an 8 mile run and having your blood sugar drop into the 40s during the first 20 minutes of the attempt.  However, I totally expected this to run into some really frustrating moments as I attempted to tweak my nutrition.  After a month I've noticed some trends and am getting more comfortable taking insulin before I workout.  Also, thanks for some of the great suggestions with my last post on this topic, please keep the ideas coming!

Thus far swimming has been the easiest thing to change my nutrition protocol for.  For swimming I can take in more insulin than for biking or running pre-workout and my blood sugars seem to be more stable for the duration of the effort.  It also seems I need a lower level of initial carbohydrates for swimming than I do for the other two disciplines.  Not sure how that will play out in a race but as a stand alone the new protocol is helping alot.  In the past I would start a swim with a blood sugar upwards of 220 and that number would continue to rise throughout my warm up.  During the early part of my main set I'd often be dizzy or just not feel that great.  Now starting at a blood sugar of 140 - 160 allows me to feel much more fluid in the water, concentrate to a higher degree and feel much stronger at the end of my set.  I've been taking in about 35 grams of carbohydrates pre-swim with 1 unit of insulin compared to 60 grams of carbohydrates pre-swim with no insulin; the protocol still needs some tweaking as my blood sugar is dropping into the 70s or 80s if I swim for more than 1,500 yards but at least I am avoiding the massive blood sugar spike post swim that I had encountered in the past.

I have only been on my bike 4 times since IMCDA but 3 of those times came in the past week.  My physical therapist wanted me to hold off on biking as we've been working on my back but having made some progress I was comfortable enough to get back in the saddle.  Last week had mixed results for blood sugar management on El Bastardo.  Monday I threw my bike onto my trainer and was set for an hour long effort.  I took in 1.5 units of insulin for a clif bar about 40 minutes prior to my workout.  20 minutes into the ride my blood sugar dipped to the 60s which required a 20 minute break before my blood sugar came back up.  Thursday I attempted the ride again this time taking in 1.1 units of insulin for my clif bar and was able to hit the ride out of the park.  Confusing the issue has been a major basal/ bolus rate problem I've had since diagnosis. Almost everyday sometime between 4pm and 5:30pm I know I'm going to go low.  No matter what I do, what I change, what I eat, I go low.  A future post will feature that issue since I have no clue what the heck is going on in the afternoon.

The run has been by far the most frustrating part of the nutrition tweaking idea.  I know for certain taking in insulin greater than 1 unit in the 40 minute window prior to running will make my blood sugar go way low in over the first 2 miles of a run.  I have also realized that when I run with a blood sugar between 130 and 150 I feel freaking awesome, especially when compared to running with a blood sugar near 200.  The stomach issues and cramps that I normally associate with a run are absent when exercising at a lower bs.  There is a really delicate balance between insulin intake, carbs or board and running duration to my blood sugars though and I just don't have it dialed in yet.  I'm getting closer - on Saturday I headed out for what I hoped to be an 11 mile run (bonked at mile 9.85, fitness has left the building!) by mile 4.5 my blood sugar was in the 90s and I felt a little low - in the previous attempts I'd get that feeling around mile 3.  I was able to recover my blood sugars quickly and continue the run with a stable blood sugar in the 120s.  There however is a huge mental hurdle to get over to have the confidence to run at a stable 120 when you have spent 3 years freaking out if your blood sugar was below 160 for a run.

The quest continues; a few more weeks of this and I'll hopefully have everything locked in.

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