The reality is, there is no fix. We can only fine tune the corrections.
It can be a real frustration at times when we think we have found the answer to correcting lows that show up in times and places only to have the blood sugar issue we’ve been chasing make us think we were wrong all along. What I mean is, during training regimens, we can run a course, the same course over and over again and find patterns. Which is great. Because patterns help our strategy to correct things, like lows that show up at the same place during a run, same time, like clockwork.
I have been training for this 10k trail run for the past few months and have been plagued by lows at a fairly consistent point on the course. Now this course is a mountain road course in Glendale, Caifornia and has over 1,700′ (520M) of gain in under 5k. About 12% incline on a gravel fire road. It’s an out and back (or should I say ‘up’ and back)… 5k up , turn around, 5k down. It’s a pretty intense leg buster. Your calfs get it on the way up, and your quads get it on the way down, and all the while your ankles are given the pounding of a lifetime.
Pre-Fuel
Normally, I would fuel-up before my training runs with energy gels and various other high-calorie sources of energy at least 30-40 minutes before getting to the trailhead and stretching out the old calves and quads.
This pre-fuel up is in an effort to get my glucose up around 200mg/dl – 250mg/dl before starting this trail. Yes! I need my glucose at least this high for this particular trail to prevent crashing at the first km.
My slow-Burn fuel for the trail is my trusty, go-to chocolate milk. It’s a slow-burning base that will keep the energy sustained longer than most carbs found in sugary foods.
My quick acting fuel, for when I need an immediate bump up in the blood sugar. Each pack of energy gel has about 20gm of quick acting carbs, and during a grueling run like this one, I might go through 4 of these.
So, here's the issue...
In this graphic below, I have composited the place on the course, the distance on the trail, the elevation gained since the trailhead, and CGM markers indication the sort of BG readings I’m getting at this point on the course.
Satellite rendering by Suunto Movescount
The Plan...
It’s a simple plan really:
1. Up the glucose load pre-run.
2. Lower the temp basal to -90% for 1 hr
Here’s what that upped glucose looked like…
Chomp down 3-4 of these Scotch Finger shortbread cookies, and add one more chocolate milk to the equation, pre-run. Really push the pre run sugars up with no bolus insulin dose to help it out, just residual, on board baseline insulin, and whatever the temp basal gives.
The result?
BG way above 350 to start the run.
In the graphic composite, you can see how the BG progressed and burned out of the system as I made my way up this mountain.
Even on the 5k descent, BG continues to fall from it’s stratospheric heights in the beginning of the run. And it was also nice to see the leveling off at 198 at the finish line.
Also to note: I had to give myself a bolus (about 4 units) at the end to take care of the post- exercise rise which naturally occurs after an intense workout, and also for any lingering glucose that may have been left in the system and not metabolized. And of course, all that lactic acid (read: glucose)
More fine tuning is needed, but I’m getting more and more confident about pre-fueling correctly, and tackling those course lows with a plan.
Race day is in less than a month. Let’s see what else I can try before then…
Do you have a similar story about pesky lows that show up during training?
Did you find a solution to keeping blood sugar where it needs to be?
Let me know in the comment box below.