The following story tells the individual experience of someone using insulin pump therapy and frequent blood sugar monitoring to manage his/her diabetes. As you read, please remember that the experience is specific to the individual. While clinical studies support pump therapy and frequent testing as effective tools for controlling blood sugars, results may vary, and not every response will be the same.
A Runner's Training Diary
From: Jessica Ching
Subject: Half Marathon
Pumper, rower and marathon runner Jessica Ching
Dear Medtronic Diabetes,
I ran another half marathon a couple of weeks ago. Nothing special about that, except that my blood sugar before, during and after the race was normal, and I ate nothing during the 13.1-mile race. I managed it via basal rate adjustments. I have told people about this before, and they are amazed that "pumps can do that." I think it is hard to conceptualize a person with diabetes exercising over two hours without almost any food and not going low. What follows are my chronological accounts of two recent races and my conversation with you detailing how I train.
Half Marathon #1
Orange County Half Marathon, Oct. 2002
Race Day Log
Target: Time under 2 hours 30 minutes; no injuries; no major lows
Course: 13.1 miles through central Orange County, along the creek and bike trails. Course starts and ends at sea level. Mostly flat with 6-7 freeway under pass "hills."
Weather: Cool and sunny; temp in the upper 60s to low 70s. No wind or rain.
Race routine: Race the exact patterns and routine as when training. Eat the same food (don't get tempted by free pre-race treats), use same timing, same clothing and shoes etc. Bring extra sugar for "insurance." Don't get too wound up and waste energy before the race.
5:30 am Wake up to set temp basal rate (2 hours before start). Test 94.
6:30 am Get up to get ready for race. Test 102.
7:15 am Ate 1/4 bagel and an orange wedge--about 20g carbs.
7:30 am Starting gun goes off. Blood sugar is 120. Would like to be a little higher, but have carbohydrate gel if needed.
7:50 am Pass mile 2; still getting warmed up. Give it time.
8:00 am Normal basal rate kicks in. It's a little hairy to think about with two hours to go, but I have practiced this basal pattern without problem. Have the carbohydrate gel if needed.
8:45 am Pass mile 7. Sun just came out. Running strong.
9:00 am Stomach acid slows me down. Blood sugar still good: 135.
9:30 am A little tired at mile 11-I need new running shoes! Blood sugar is 120 and holding.
9:40 am Where is the finish line?????
9:45 am Realize my finish time is going to be a personal best.
9:48 am Sprint to finish line. Finishing blood sugar is 115. Race time is 2:18:45.
11:00 am Getting worked on at massage tables. Ahhhh. Blood sugar is stable at 110.
11:45 am Lunch--first meal today. I'm HUNGRY! Still no spikes; blood sugar is stable but down to 80. Note: in ideal case, I would eat a snack within 1 hour of finishing a race.
2:00 pm Naptime! Blood sugar is 125.
Half Marathon #2
Pacific Shoreline in Huntington Beach, Superbowl Sunday, January 2003
Race Day Log
Target: Personal Best 2:15 (about 4 minutes faster than last race)
Course: Flat, along coastline. One group of hills around mile 9-10.
Weather: Dry, sunny, cool.
Race routine: Same as training
4:30 am Wake up to basal down: Cut basal rate in half, 2.5 hours prior to staring race. Blood sugar is 170; take .3 units. Go back to sleep.
5:45 am Get up to get ready for race.
6:30 am Pre-race check blood sugar: 135. Perfect. Eat 1/2 Balance bar and 8 pretzels (about 20g carbs)
7:07 am Starting gun goes off at start: blood sugar is 130 (this test shows me not increasing nor decreasing trend in blood sugar). Normal basal rate kicks in.
Mile 1-2: Running very strong
Miles 3-6: Still running very strong. Time of 58:00 is better than my target of 10 minutes/mile.
Mile 6: Feel a little tired. Going low or energy low? Test 160-- too many carbs pre-race. Not a major problem but slow down due to low blood sugar ruled out. (Note: conservative blood sugar strategy during race dictates that no insulin be given for a blood sugar of 160).
Mile 7: Starting to "feel the ground" as I run-this means I'm losing some spring in my knees and will be getting tired earlier. Time of 67:30 is still good (better than my target time).
Mile 8: Need to keep going. Need to have a good time at the mile 10 checkpoint in order to hit my target race time. Have ruled out low blood sugar as a reason for being tired, so just have to keep going.
Mile 9: Need to keep up pace. Time 89:30.
Mile 10: Tired but going to make it. Time 100:30. Mile 9 turns out to be my slowest mile (11 minute pace). The hill is killing me!
Mile 11: Need to pick up pace slightly in case mile 12 is tough. I tell myself I can keep going for another 15 min.
Mile 12: Tough mile. But looks like I'll make it. Where is finish line marker?
Mile 13: Cross finish line with time of 2:14:12-beating my target by 45 seconds. Post race test: 135. Immediately take .2 units.
Have a snack within 1 hour after finish (1/2 banana and 3/4 of Taco Bell taco). Processed food goes down very easily.
2 hours post-race: Eat a small bowl of rice and stew. Bolus 2 units to cover my snack.
5 hours post-race: Low. Drink OJ. Will I ever learn to basal down 4 hours post race? Have never remembered to do this yet. . . .
6 hours post-race: First full meal. Pasta and a little chicken. Test normal.
7 hours post-race: Walk 1 hour. Helps my stiff legs a lot.
Training Q&A
With Jessica Ching
- What are your basal rates on "normal" days (during the work week)?
- My normal daytime basals run from .4 to .5, depending on daylight savings (believe it or not) and how much I'm training. Early morning basals run .8 to 1.0 although I have gone as high as 1.2.
- Do you do anything different when you are practicing "intervals" during training?
- DO NOTHING DIFFERENT. That's a rule for training. How you practice is how you will run the real race. Food, time, duration, testing, clothing, equipment, how you wear your pump etc. I've even changed my training time to include more mornings, because that's when real races start and I need to practice my food/insulin routine at that time of day.
- Do you do weight training, and if so, how do you adjust for that?
- I don't do a lot of weight training. But, when I do, I find that anaerobic exercise does not have nearly the impact on blood sugar as aerobic.
- What temporary basal do you set for training runs?
- Lowered basal rates are the absolute key to running for without going low and without having to eat much (if at all). I've tried the "basal down an hour before exercise" and found that whoever made that rule does not wear a pump! I do not basal down for shorter runs (under 30-40 minutes). For longer runs, I turn down to half my basal rate 2 to 2.5 hours before running (with Humalog) and 1.5 to 2 hours before running (with Novolog). This means I often start my run on FULL BASAL.
The basal down lead-time prevents the spike up in blood sugar that many diabetic runners seem to have 1-2 hours after the race. If my blood sugar goes up within 2-3 hours after a run, I know I did not basal down early enough. If I go low during a run, I know I set my basal down too early.
One thing to add to this is that I need to basal DOWN 1-2 hours after the race -- to avoid the crash that diabetic runners seem to have later on race day. You always think you won't need to do this, since you expect to be eating a lot of goodies afterward. But people tend to be low in the afternoon following a race or hard training run. - What is your temp basal for the race?
- During the race itself, I am on normal basal rates. Assuming races start between 7-7:30am, this means my basal throughout the race is .5.
- Did you drink any beverages with carbs, such as sport drinks?
- I rarely need to use any food during the race. Just in case I always have a couple of packets of carbohydrate gel. I won't take oranges, bananas, Gatorade, etc. that they give you during the race UNLESS that's what I trained with. Unless I'm low, I try to stick with the type and quantity of food that I've trained with, and eaten only at the time and interval I've trained with.
Information on this site should not be used as a subsitute for talking to your doctor.
To find out if intensive diabetes management using insulin pump therapy and frequent blood sugar monitoring is right for you, call 800-MINIMED (800-646-4633) or 818-362-5958 for a referral to a diabetes specialist.
