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Pump it up - Adventures of a type 1 triathlete with insulin pump
Pump it up - Adventures of a type 1 triathlete with insulin pump
Please visit my new blog here: Pump it up - Adventures of a type 1 triathlete with insulin pump

Diagnosed at the age of 5, I have been a type 1 Diabetic for over 29 years; being on an insulin pump for 11 years now. I took up triathlon in 2011 and am hooked ever since! Being diabetic doesn't stop me from doing what I love - swimming, cycling and running!

Five myths about exercise and Type 1 Diabetics

Eva29by Eva29Mar 23rd 2015
Five myths about exercise and Type 1 Diabetics
When it comes to Type 1 Diabetics and exercising there is a lot of useful information out there but equally a number of misconceptions about what we can or can’t do. I’d like to clear up on five myths about Type 1s and exercise:

1. Type 1s are not allowed to eat sugar (because our sugar levels are high)

The blood sugar values of a type 1 diabetic are not constantly high; blood sugar varies just like anyone else so we are absolutely allowed to eat sugar. Indeed, sugar (in the form of bananas, energy gel, juice, coke, white bread) is highly useful when blood sugar levels are dropping low (going hypo). The main difference with a type 1 diabetic is that we are required to regulate our own blood sugar because out bodies are not able to do so.

Blood sugar can go low when too much insulin is injected for what we eat or exercise. Therefore it is not about eating sugar or not, but rather the quantity of sugar (and carbohydrates in general). From personal experience my normal diet does not include a lot of sugar (and generally carbohydrates) because it raises my glucose levels so that often the insulin I have to inject for it doesn't work quickly enough to keep levels relatively stable.

When it comes to training and racing, the amount of sugar/carbohydrates matters most! If I feel my levels are dropping I often use wine gums or similar as well as fruit bars or gels to get my sugar level up but here is the key: I won’t have an entire gel but say half or I eat three sweets rather than 10. This allows me to have just enough sugar on board that my body needs, without going so high that I need to inject insulin to bring levels down again afterwards.

The closest for a healthy athlete to get to experience low blood sugar is when he or she is “bonking’:

This term describes a situation whereby the athlete experiences extreme fatigue and loss of energy which can occur after very long training hours and is caused by the depletion of glycogen stores in the liver and muscles. Usually there are some signs accompanied with this like change of mood or feeling a little dizzy. These are very similar to a Type 1 having a hypo.

2. Type 1s cannot do long endurance exercise (because we will drop into a hypo

Because it is endurance-based exercise (i.e. long aerobic effort) it doesn't mean a Type 1 cannot maintain balanced blood sugar levels for a prolonged period. Long usually implies sustained effort at a pace and intensity that is very controlled. As a Type 1 it needs a bit of extra planning and thinking when going on a 4-hour bike ride or running a marathon to know by how much to decrease insulin rates, when and how much to eat and possibly testing sugar levels throughout but it is absolutely possible to maintain stable sugar levels for a prolonged period. Personally I have completed several half Ironman and one Ironman distance triathlon, training camps etc with safe and stable sugar levels.

3. Diabetics have to exercise because they are usually overweight

There are two different types of Diabetes which differ significantly from each other in cause and treatment:

Type 2 Diabetes is usually caused by an unhealthy diet and lack of exercise, often occurring in people who are overweight. It used to be occurring more in older people but there are more and more children developing Type 2. The pancreas of a type 2 diabetic is not producing enough insulin to match the increased demand for insulin due to regularly high blood sugar levels. They are regularly high because of a diet high in refined carbohydrates and a lack of exercise.
Treatment for a Type 2 is often tablets to lower sugar levels (sometimes injections) accompanied with maintaining a healthy diet and exercise. I have heard from a lot of cases where Type 2 diabetes was reverted with improved diet, weight loss and a more active lifestyle.

Type 1 Diabetes occurs at any age and is not hereditary. The cells responsible in the pancreas have for some reason stopped producing insulin. In my case I was diagnosed with Type 1 at the age of five and I don’t know what caused it; some suggested a virus but nobody knows for sure. I was a very healthy, active girl and never overweight. Type 1s will need to start injecting insulin immediately when diagnosed and will rely on insulin for the rest of their lives as Type 1 cannot be reversed. Once the cells in the pancreas have been destroyed they cannot recuperate.

For sure with technology advancing as much as it does it is getting easier to manage Type 1 Diabetes with new insulin pumps and blood glucose devices that talk to each other: who knows with research into artificial pancreas they may be away to stop needing to injecting insulin one day.

4. Type 1s need to eat a lot during exercise (because otherwise they will hypo)

As previously mentioned Type 1s have to regulate their blood sugar themselves which means there is a danger that during exercise glucose levels can drop too low. However, there are also a number of other factors that will have an impact on how much exercise lowers glucose levels and therefore alters the demand for sugar intake during exercise:
  • Time of day:
    The body is naturally more insulin resistant in the morning which means generally glucose levels do not drop so much or so quickly. Late morning or late afternoon is usually a time where insulin sensitivity is greater. For me if I train at that time of the day I will need to take on extra carbs and/or reduce the insulin rate during this time temporarily because I am more likely to go into a hypo.
  • Type and duration of training:
    In my personal experience, there is a considerable difference to how my sugar levels behave depending on what type of training I do: If it is short, sharp, high intensity, I barely require any additional food as my levels are likely to remain where they are or even go up. For longer more sustained efforts, I have to take on some food and/or reduce my insulin rate depending on duration.
  • Race situation:
    At the start of a race when your body is full of adrenalin and other “stress” hormones (e.g. Cortisol), some Type 1s like myself are much more insulin resistant which results in higher sugar levels and therefore no need for additional food intake. This is because these hormones are counteracting insulin. When the race is underway then I usually find levels will decrease at a much slower rate than during training which is due to the time the body needs to break down these “stress hormones”.
  • For female Type 1s:
    The monthly cycle with various hormonal changes happening has a huge impact on insulin sensitivity or resistance. It is very personal but I actually try and plan my races accordingly to avoid racing on days when I am very insulin sensitive and much more likely to hypo.
5. Exercise causes sugar level rollercoaster (“too much is not good for you”)

As with everything too much or too little is probably not good. As a Type 1 we have to take extra care when exercising and it is more work to ensure that levels remain stable. In my experience glucose levels overall are much better when I am active rather than sitting down all day. What I have been able to observe is the reduced need for insulin overall when I train consistently, without overtraining. Sitting around, doing nothing for a week or two on the other hand makes my blood sugar levels much harder to manage.
 
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