How can somebody with Type I diabetes keep blood sugar levels acceptable during and after a multi-hour ride?

Question

I recently upgraded my bike to a Merckx EMX1 and started doing some serious riding. I am riding 50–70km(30–45 miles once a week usually including a second cat climb and sometimes one or two 3rd and 4th cat climbs. I have read through some of the nutrition questions and although the answers and suggestion apply in a general sense. I have more often than not had problems of super high blood glucose after a ride, not problems with hypoglycemia. This is because I am very worried about have a hypo while on a long ride. I would be stuck far away from my car or possibly anywhere where I could get the instant help I need. I am also usually alone (though I am looking to get involved with a group ride).

I am looking for some help and advice on how to effectively eat before during and after a ride. I usually stop half way through and test my sugars to make sure I am ok and see if I need to add more food. I don't usually drink electrolytes but I make sure to stay well hydrated. I carry nutrition bars and energy gels on my rides, usually way more than I need.

I do this excercise to stay fit and to lose weight. I am 185cm (6ft 1") tall and 87.5KG (193 lbs), I would like to get down to around 80kg (176 lbs).

My question is really how can I eat and take insulin effectively avoiding high and low blood sugar whilst making sure I am not eating too much that I have no net weight loss.

Answer 1

I too am a type one diabetic and I understand your concerns, how ever I might have some suggestions to help with your problem. I always make sure to carry a Camelbak pack with me to enure I have my Glucometer and other supplies along. I check my sugars before I start the ride, if possible I might have a little extra food at the time, just to get me started.

I also make sure to carry along some chocolate bars if my sugars get low. I find Oh Henry or Mars Bars to be good, since they have various types of sugar in them and they also have peanuts to help sustain the glucose intake. In addition to the sugar I bring along, I also bring protein bars since those have carbs in them, but also a lot of protein to help release the glucose in to your system slowly.

The name brand or protein bars I use is called "Clif Builders" and you can get them at Costco in Canada, hopefully you could get them in your area as well or a similar product, the important thing is that the protein bars release the carbs slowly.

I also drop each of my insulin dosages by 2 units on my morning dose and sometimes my evening dose also gets adjusted because after a long ride your body continues to burn sugar at an accelerated rate.

This helps me not need to overeat, the high problem of high sugars after a ride is due to over compensating for the amount you fuel being burnt on the ride and most important of all at least until you get to know you routes really well and what you truly need for food intake, make sure to check your blood sugars on the ride before you eat and on a regular basis and bring along extra protein and chocolate bars, they don't take up much space and the Camelbak will have lots of room for them. Remember the Chocolate bars are only for when your sugars get low, otherwise stick to the protein bars.

You will also find your rides will be better and more energetic if your sugars are in the nominal range. The other advantage to lowering your dosage on riding days, is that it will help you lean down. It doesn't help you at all if you have to overeat to keep your sugars at a normal level, but if you lower your dosage and understand that the bike riding it self will lower your sugars to a degree it will make it easier, it really is about knowing your body how it burns sugar and how to balance it all on days you ride.

P.S. My longest ride so far was 55Kms and I found by dropping my morning dosage, it helped me out in not battling the insulin to keep my sugars up at a normal level. Perhaps if you are going on a longer ride you might need to lower your dosage another unit or two, don't make huge changes in dosages until you know your insulin needs. 2 units less is quite safe and make sure even if you lower your dosage to bring plenty of food along.

I hope you find this information helpful, enjoy the rides.

Answer 2

I've been on week-long rides with Type 1 diabetics, though I've never had a chance to query them on their practices. But my (non-cycling) wife is Type 1 (50 years) so I'm familiar with the issues.

First off, you should have a Medic Alert bracelet or neck chain, of course. After that, you should probably carry a glucagon injector for serious hypoglycemic episodes. And look into continuous blood glucose monitors -- they're still imperfect but are getting better. (My wife credits hers with allowing her to lose about 10 pounds.)

Beyond that, probably it's "know your body" more than anything else. You should keep a journal of ride info -- what you ate before & during the ride, glucose at start/middle/end, how much insulin you took, etc. Also record, of course, time, distance, wind/hills, etc. Try to learn whatever signals you're body is giving you when glucose is dropping on a ride -- there likely are clues if you look for them.

PS: If my conversions are right you're about 6'1" and weigh about 193. This is maybe just a hair on the high side of the "recommended" range. It's probably more important for you to develop a healthy(er) lifestyle than to focus on any particular target weight.

Answer 3

I am 50 - 70km once a week usually including a second cat climb and sometimes one or two 3rd and 4th cat climbs.

Something you might find easier, better for you, and good training, is to cycle shorter distances more frequently: like an hour or two for four days a week, instead of several hours on one day a week.

Answer 4

I think it could be useful if I answer my own question. I asked because I was looking for advice as to how to manage my sugars on long rides. It is clear that there is not straight forward answer, but there are many different things to try that might help. I will share some of my experience in the hope that other Diabetics might be able to benefit.

My usual diabetic regimen is 4 units of NovoRapid (short term insulin) for each 15g of carbohydrate plus 1 unit for every 25mg/dl I am above 100mg/dl during the day. In the evening I take 3 units per 15g and add 1 for every 30mg/dl above 150 (I aim to go to bed with blood sugar between 170 and 200 - this may seem high, but if I go to bed lower I will wake up in the middle of the night with a hypo). I also take 30 units of Levemir (long term insulin) at the same time as I take my short term for my evening meal.

My last Hba1c was 7.0, I do not smoke (I did but haven't smoked heavily for years and at all in 2012), I am 185cm (6ft 1") tall and 87.5KG (193 lbs) - so I could lose a little but I am certainly not unhealthy. I drink more than I should but as I ride on saturdays my big drinking night was Friday so that has stopped. My regimen above has been worked out with my Doctor (specialist in diabetic medicine) and my dietician, who I see every 3 to 6 months where we tweak anything that needs tweaking. I haven't seen them or done and Hba1c since I started seriously training.

I usually go on a big bike ride early on a Saturday morning. I get up around 6/630 and by the time I have got my stuff together and driven out of the city I am on my bike by about 745 - 8am. Currently the morning temperatures are in the early to mid 20s rising towards 30 by 11am - 12pm. The night before my ride I will make sure that I eat a decent and balanced meal with protein and carbohydrate, I will only take 20 units of my long term insulin and I knock of 2-3 units of my short term insulin. I will wake up with blood sugar around 200 -230. I on my drive to where I cycle I will drink a cup of coffee with milk a bread roll with cheese or Peanut Butter and drink around half a liter (1 pint) of water, I also take 4 units of short term insulin. I check my blood sugar again before my ride. If for whatever reason it is lower than 200 I will have a granola bar.

I take with me in my jersey pockets about 4 granola bars, 4 or 5 energy gels (this is way more than I need but better to be safe), my Freestyle lite glucose monitor, money, ID and a phone (good for emergencies and using Strava to track my rides). I have two bottles which total about 1.7l when full.

My rides are between 50 and 70KM which is anywhere between 2 hours (for a flat 60km) or 2.5 to 3.5 (for a hilly 50 or 70KM). I have routes that I repeat and but I change things around to keep it interesting. I usually make sure I have something to eat along the way especially before I hit one of my 2nd cat climbs. On my flat circuit I will stop after the first loop after about and hour and check my sugar, have a drink catch my breath for about 5 mins before continuing. On my hilly ride I will stop at the top of the 2nd cat climb and check my sugar. If it is lower than 180 I will have a granola bar and a coffee as well as refill my water bottles. If I am just descending and going back to the car then I won't eat anything unless I am lower than 150.

When I get back to the car I rest and drink plenty of water. I will check myself every half an hour afterwards to get an idea of which way my sugars are going. Often my sugars go up drastically after a big ride I have often seen 300 and even once 400. It is not easy for me to just take insulin at that point because it will drop very suddenly. I will go home and test again before having an early lunch. I find my body will come back in to line in the afternoon if I wait to take insulin with a meal.

Over all as a result of doing this training my sugars are better during the week and I have lost about 5kg so far. My goals are better management of sugars before during and after my rides, I will be having a long chat with my Doctor and Dietician about this when I see them next to help with this and I am looking into getting a continuous blood glucose monitor; I wish to lose more weight and to improve my endurance for longer rides and longer and harder climbs. I would like to take part in some of the sportifs that are done in France that include some of the Tour de France cols.

Thanks everyone who has commented or answered so far. I appreciate all the advice, if you have constructive comments on what I have written here or you are diabetic too and need more advice please feel free to comment on this answer.