Friday, May 1, 2009

highs and lows

Reader Bob, commenting on the previous post, asks about how the bicycle training has affected my diabetes--"highs lows and such."

This really gets to the heart of the challenge. Most doctors I talk to pooh pooh the idea that type 2s have to worry about low blood sugar (hypoglycemia), unless they are taking one particular type of drug (sulfonyureas), which I'm not. I have tried to explain that I am prone to going low, especially in the afternoons, but I can tell that they are unconvinced. They suspect I am just giving excuses for not exercising or not keeping my numbers lower. (For type 1s, the issues are very different, because they are completely controlling the insulin intake.)

These docs--some of whom I consider to be friends, all of whom I respect as experts--have never had a low themselves. They have no idea how dreadful it feels, and how terrifying it can be. They do know, because of some new research that we wrote about here in Diabetes Forecast, that people with type 1 are often inactive because they are afraid of lows. I think that's true of some folks with type 2, too.

That said, if you can figure out a pattern to your lows and exercise, you can really make it work well. When I used to go a gym on a regular basis, I always had to have my (full sugar) yogurt afterward, and that staved off the low I could feel coming on after a good 45-minute workout. Now that I am getting on the bike, I like to eat something about an hour before I exercise, test my blood sugar before I start riding, and then test again after (usually sitting in my car, before I get on the road). So far it's worked well--love seeing that 128 on the meter!--but I will keep an eye on how things change as my rides get longer. I'm not up to the 6 miles that Bob does, but I am not surprised that he feels he needs to eat something at that point. I've been carrying the same old pack of just-in-case Skittles with me on my rides (I choose a candy I don't like on purpose), but will soon switch to a glucose gel. And I have a smaller meter that's easier to bring on the bike, since when you're feeling low the best thing to do is test right away.

I'm also looking forward to our July issue of Forecast, which has a big package on fitness. One of the people we quote is Sheri Colberg, who wrote a book called Diabetic Athlete's Handbook, an exhaustive "guide to peak performance" that I am planning to start reading this weekend. You know, in all my free time!


Anonymous said...

If you are like me, your body's insulin resistance drops significantly the first hour of exercise. For me it is ~50 points.

Do you and Bob ride with your meter? I test at one hour intervals when I'm on training rides to see where my numbers are. Make adjustments. Ride on.

It isn't always that simple, but with frequent testing and tracking, you can get a good idea of what your body's bg is or is not doing.

Mike said...

Trust your medical team, trust experts like Sheri C, but more than anything trust yourself! In the eight years I've been living with type 1, I have yet to meet two athletic people living with diabetes where the same formula works. Like Zin says, "test!" Oh and since I won't be there in VA for your Tour, "GO RED RIDER!"

Sara said...

Thanks, guys! I am flattered that Zin suggests I might be riding more than an hour at a time (ahem! not quite there yet!). Will be heading out for a ride on Sunday, meter, glucose, and your good wishes in tow.

Mike said...

Yeah, well, keep in mind who or should I say what Zin is! He is an ANIMAL. Come on, Race Across AMerica, even in my cyclist centric brain, that is nuts! But, oh by the way, GO ZIN and GO TEAM TYPE 2!

Slide said...

Hi Sara,

I read about your blog in the May issue of Forecast. Read all your posts back to the very beginning.

I'm proud of you for starting this. I'm in somewhat the same situation. Got my first 2-wheeler at 16, and wasn't very good at it even then. But I remember that riding felt like flying.

Decided I'd like to ride in one of the rides for breast cancer, because several people in my husband's family have died of cancer in one form or another, plus some friends.

I'm a Type 2, diagnosed in 1999.
When I read the article in the magazine, I said to myself, if she can, I can. Only I'm a few years older than you. I'll be 64 this year.

My husband has a fit with the idea of me riding on the street. I've ridden an exercise bike for many years, but not faithfully. Perhaps thinking about you learning to ride will keep me accountable. :)

When I ride, my numbers are much better than when I don't, but that hasn't been enough to keep me at it consistently. Thanks for providing the inspiration I need!

Sara said...

Great to hear from you, Slide. If there's a Tour de Cure near you, maybe that would be another impetus to get going! (And my husband doesn't want me riding in the street either--but then again, I'm still too scared to even try...)
Keep in touch!

Anonymous said...

You'll get there Sara!

I started with a ride around the block with my kids. Thought I was going to die! UGH!

That ride around the block has led me to where I am today. Little by little. Small steps. Enjoy this adventure! Cycling has proven to be one of the best things to ever happen to me! Both in controlling my diabetes and enriching my life!

Controlling your bg can be tricky on the ride. If you are on oral meds, you can't bring a high bg down. All you can do is work harder and wait for it to burn out of your system. This is how I've done it for years. Now, I'm lucky in that I now use Apidra rapid acting insulin to keep my bg in check when fueling on the bike. It has made a huge impact on my performance! Amazing how well your body can perform when you are able to fuel it properly!

When you make the move to riding on the streets, just keep in mind that the same laws apply to you as they do to any vehicle on the street. Ride with traffic, and signal your intentions. Start off riding side streets with little traffic.

I'm excited for you Sara. I'm trying to get out there to VA to ride with you on your tour! May and June are CRAZY months for me leading up to RAAM, but I would really love to come ride your first tour with you!

Mike. You crack me up dude! I think it is ironic that you and I have never ridden together! What's up with that?

Above all else, Remember to "Live Adventurously!" while controlling your diabetes!

Sara said...

Thanks, Zin! It would be amazing if you could make it to the Reston ride, but it sounds like you have a lot going on, so no pressure.
More rain here today!

Mike said...


Shoes - biking shoes make a huge difference whether you are riding a little or a whole lot. Trust the old guy here, I bought my first pair of cycling shoes well before clip-less pedals were even invented!


Here's the deal on riding with you, a) you scare me and b) you scare me! My hope is to intersect the RAAM as you come across NM and perhaps, for a mile or two, find a place I can pace with you!

- Mike