Thursday, May 2, 2013

Diabetes and Exercise

On Monday night, Doug and I drove twenty minutes down the highway to listen to a presentation on Diabetes and Exercise put on by Animas. The speaker was Sébastien Sasseville who, I quickly discovered, is a pretty impressive dude.

He is 33 years old and has had type 1 diabetes for 11 years. He pumps. And he takes his pump to places like the top of Mount Everest, the Sahara and five (soon to be seven) Ironman races.

He is my kind of diabetic!

At the beginning of the presentation, I put my hand up and asked him to please share any tips he had for triathlons, particularly things he learned about diabetes management while doing three very different sports.

Sébastien had a lot of really interesting and motivational things to say during his two hour talk. I was impressed with his accomplishments but I am active enough in my own life that I didn't need any more motivation. I have lots of that. I was looking for information. And he gave me plenty of things to think about.

Two things in particular really struck home. It's funny how we sometimes need people to point out the simplest things.

Sébastien talked about his approach to eating during races and long workouts. He used to, like me, focus on keeping his blood sugar in range (as much as possible) and would only eat to avoid lows. Meaning that he, like me, would often struggle with not eating enough during long tough workouts to keep energy levels high. He has since tried a different approach that makes a whole lot of sense. He starts off by deciding how much food he wants to eat during a race or long workout. He then figures out the insulin he needs in order to accommodate the carb intake.

Figure out the food first, then factor in the diabetes.

Makes so much sense.

The second thing he shared that really impressed me was his basal settings for an Ironman. He used to, like me, reduce his basal rate before the race. He would, like me, struggle to remember to change his basal an hour and a half before the start. He would, like me, often forget in the pre-race craziness. He would then, like me, struggle to know how to deal with the fact that he had too much insulin in his body before the race.

So he changed his tactic completely. He now programs a basal profile for race day into his pump. His basal rates change based on his predicted times in the swim, bike and run. I won't give you his numbers because everyone's diabetes is different. It's not the numbers that matter anyway, it's the logic behind it.

This summer I am hoping to compete in an olympic triathlon. Let's assume that it starts at 9am. I would probably swim for about 30 minutes, cycle for 1 hour and 20 minutes and then run for 1 hour and ten minutes. I know my blood sugar climbs when I swim, drops a bit when I cycle and drops a lot when I run. Based on that, here is what my triathlon basal profile might look like

7:30am - reduce basal rate to 60% (don't want a low while swimming)
9:00am - swim starts
9:30am - increase basal rate to 150% (to make up for the fact that my BG climbs when I swim)
10:00am - bike starts
10:00am - reduce basal rate to 50% (to prepare for the run and the fact that I drop quickly on the run)
11:00 am - run starts
11:30am - increase basal to 120% (to prepare for the post-race spike I usually experience)
12:00 pm - race over
12:30pm - reduce basal to 40% (keep it there for 3-4 hours to prevent post race lows)

I don't know if this is exactly what I will do on race day but it's a good first attempt at planning. What I really love about this way of doing it is that eliminates or reduces a lot of the variables on race day. I still can't forget for one second the I have diabetes. But by creating a basal program I wouldn't have to remember to change my basal before the race, bolus after the swim, change basal after the race etc.

Having a waterproof pump will also help a heck of a lot.

Four more days!!


  1. I love that you went to see Seb speak!
    he's pretty rad.
    I asked him what he does when I bumped into him before the Tremblant half ironman. He ups his temp basal for the bike also since that's where he does all his "eating". It's such a brilliant way to think about endurance races.

    i'm excited about your new pump ;)

  2. Awesome post and thanks for all that info! I like the idea of deciding what to eat and then adjusting accordingly instead of the other way around.

    I will be interested to see if swimming still makes you high once you have the pump on you. I would not be surprised if you see this become less of an issue.

    Very excited to hear your reviews on the new pump!

  3. Great info Celine. This way of thinking is how the worksheets are meant to be used in the "Fueling Your Passion for Sport" Workbook. Figure out your food first, how much and when, figure out your fliud next, then plan you insulin adjustments and go out and give it a try. You fill in your blood sugars after and re-evaluate for the next time.