Samantha is going through pre-season conditioning for field hockey. These workouts are more intense than her usual softball workouts. This is the start of our first field hockey & hot summer softball season with T1 diabetes! Here’s what happened last Thursday: early morning workout in the park for field hockey. Lunch break, then softball practice in the 95+ heat. Sam was supposed to go to an evening field hockey workout, but her BG was hovering around 60 and wouldn’t come back up. She ate several things, including a bowl of ice cream, then later a big bowl of mac & cheese. Nothing would bring it up. I finally figured out that she didn’t eat before the field hockey workout in the morning. I think that’s what threw her off for the day?? But she says if she eats before that exercise program, she’ll throw up. That did happen last year, so she has a point. My idea is to wake her up at 4am and get her to eat a Power Bar, go back to sleep, then she’d be ready at 8 am. Does that make sense? I don’t think the dinner meal will carry over. She takes about 14 units of Lantus at bedtime. She is on Novolog shots. Before a day of hot softball games, I fed her a bacon, egg & cheese sandwich + tater tots. That worked.
Today, the girls on the softball team wanted to have their BG checked when Samantha checked hers. That’s fine, I told her she’s working on diabetes awareness She checked Annebelle’s blood sugar (my 13-year-old without diabetes) & her BG tested 75 – after a breakfast of pancakes & a Coke at Dairy Queen. Isn’t that weird? Doctors have told us to check Annebelle occassionally just to see how she’s doing with BG, since Sam’s diagnosis was a shock. I plan to get Annebelle tested for antibodies – haven’t done it yet.
Is the girl on insulin? Perhaps she needs to reduce it radically before training - especially in hot weather and during heavy exercise. Eating a hefty breakfast several hours and preferably starting the training higher than normal will help. The levels will come down with exercise or soon after. She needs to keep checking very frequently and drinking plenty.
Random thoughts. Cheese and ice cream both contain a lot of fat and fat will delay the raising of blood sugars after a low or lowish. This is possibly why she could not get her sugar levels up quicker. I do not know what mac is, but the cheese would certainly delay things. This is one of the reasons why it is said that we should not have chocolate for a hypo - and because it is so slow to raise blood sugars we tend to over compensate, and that can lead to weight problems.
As for Annabelle, I cannot comment, since I do not know what is high and what is low in the American way of dealing with blood sugars. Test her by all means. It is nice that the rest of the team are interested enough to want to take their own blood glucose levels. However, diagnoses cannot be made on one result.
When I’m running, I have an 8 oz bottle w/ 45G of powdered Gatorade dumped into it and another bottle w/ 10G of the powder, reasoning that the electrolytes are useful separately from the BG. That seems to work pretty well to get my BG up if it gets down and as fuel. I agree w/ LatvianChick that ice cream and mac & cheese don’t work as quickly, I’d stick w/ the fast stuff. I generally skip dinner the night before races but I dunno if I’d do that every day like w/ a camp situation? I still eat breakfast though, usually a piece of toast, light but filling, gets the job done for me? That’s what the running books I’ve read suggest too.
A better strategy for morning training is to have a fast digesting. I particularly like having a whey protein shake with milk. Being a liquid and using whey, it is more rapidly digested (typically passing through your stomach within 1/2 hr) and the extra protein will provide energy to fuel the workout.
Many of us suffer from post exercise hypos. Sheri Colberg had an article recently that talked about this and ways to manage it. This condition, sometimes called Postexercise Late-Onset Hypoglycemia (PEL or LOH) occurs a lot in kids. In a study of 300 kids, PEL occured in 48 of the kids and it was noted that it typically had an onset of 6-15 hrs after exercise.
In my case, it typically occurs 2 hrs after workout. I find that eating after workout and signifcantly reducing bolus levels help. If I have PEL, I can go through 100 g of carbs and still not get my blood sugar over 100 mg/dl.
LOL, I always eat protein after I work out so I will get ripped! Admittedly, I have a long “whey” to go but that’s a good suggestion!!
First, mac & cheese and icecream are not good low treating foods. They are too high in fat and will take too long to digest to see results. You need faster-digesting carbs (gluco tabs, sports drinks, fruit, etc). Basically, anything sweet without fat.
I’ve played a lot of sports over the years with D, and it definitely takes a bit more planning. Before going on the pump, if I had an intense practice in the morning, I would reduce my nighttime basal insulin. In the AM, especially if it was hot, I would have a powergel or Gu, as these would not make me puke (your daughter is right, working out with any food in your stomach is often a puke recipe. I could NEVER eat an egg&cheese sandwhich before working out in the heat. Just thinking about it makes me way to puke).
The issue I ran into (and I’m assuming this is what’s happening with your daughter) is that she injects her lantus at night and that lantus pools under her skin. Then, she goes out in the heat, runs, and this causes the lantus to absorb REALLY fast, thus causing a low. If there’s not some carbs in her system immediately ready to use up that lantus, she goes low. This is actually REALLY dangerous. I had a bad hypo seizure because of this during a sports practice.
The problem with sports and long-acting insulins is that you can never really anticipate the exact nature of your workout and perfectly adjust your long-acting insulin. You may think the day is going to be hot and the practice intense, but things change. Also, I’m the kind of person that goes high if I’m doing something that causes a sudden adreneline rush. Everyone is different.
Have you considered getting her on the pump? With the pump, you can make adjustments just an hour or two before working out, and correct much more accurately when things change. I am still very active and the pump for me has been a lifesaver. I have so much more flexibility with my workouts and I don’t get as stressed with trying to plan for all the workout variables. It’s great that your daughter is so involved in sports, and she should really work to find a regimen that can accomodate her level of activity. Feel free to PM me if you have any questions!
Thanks! We’re going to try some of these suggestions this Thursday. I really need all the help I can get. Last week, she felt awful. Forgot about ice cream. We were just trying whatever we could! I have to go buy some more Gatorade.
She wants the pump, but we’re not there yet with our endo. Maybe in the next few months.
MyBustedPancreas went over the issues pretty well.
As a diabetic athlete in college, balancing my insulin and nutrition needs was always tough. The bottom line though, she has to eat regularly. There’s not way around that. The caloric requirements for athletes are unbelieveable and they are no different for diabetic athletes. I HAD to eat between 3000 and 4000 calories daily just to get through a long season of nearly daily practice and competitions. I’m not saying her requirements are that high but they are substantially higher than even your typical growing teen’s and trying to substitute complete meals is a tricky proposition. Proteins shakes and the like are designed to be supplements, not stand alone meals, which she needs.
When I first got back into athletics, I did indeed throw up many a good breakfast and lunch. I think a lot of it was just the associated effects of getting back into shape after months of inactivity. Regardless, the consequences of not eating regularely as a result were just as you described, constant lows and weeks of poor workouts and the general consequences of poor nutrition.
Through a lot of trial and error, I just had to find the right things to eat to go along with the correct insulin dosing strategy. I found out that I couldn’t eat anything too “heavy” or with any kind of seasoning before practice. I ate a lot of turkey and cheese sandwiches for breakfast (plain ol eggs and cheese, along with lightly buttered toast worked well too) and a ton of peanut butter and jelly sandwiches for lunch. I still had to supplement with protein shakes and post-exercise snacks for exercise induced hypos. I generally poured on the calories for dinner after a day of practice or competition.
I’d generally start practice on the high side (120-150) but I still went through entire packages of glucose tabs to make it through something like a two a day practice schedule. Juice worked well to deal with the hypos too, but i had to be careful, even, about what I drank during an intense practice.
Stick with it though. In the long run, with a focused strategy, her BG numbers are going to be fantastic.
You will need to apply a bit of math to the issue of T1 sports, each sport or activity burns glucose at a different rate. For me jogging and downhill skiing burn around 30g/hour, while volleyball, soccer tend to burn around 5 g/hour and weight lifting or sprinting causes my BG values to go very high without any added sugar. The idea is that as the intensity of the workout goes up the body burns more sugar, however this is offset by the amount of sugar that your liver is pushing out. When the body is pumping out large amounts of adrenaline the liver is also pushing increased amounts of sugar into the body, this is why things like weight lifting and sprinting tend to raise BG values while activities like jogging do not draw an adrenaline response and therefore BG values drop. Each sport and person is a bit different, so you need to analyse this each time she plays to truely understand it. As a few others mentioned, the best way to do this is with measured amounts of quick acting sugars (glucose, fruit juice, gatorade, etc) which usually take around 45 minutes to fully digest and start working in about 10 minutes, pasta and ice cream will take around 3 hours to fully digest, and she will likely have gone low before that. Also if at all possible do not play with any mealtime insulin in her system as this is a recipe for disaster, because your sensitivity to insulin is very high during and immedietely after sports. If you don’t understand the math let me know and I can walk you through it, once you have done it once it is actually very simple. I keep a spreadsheet which I update every time I play, that way you can see the trends. I found that doing it this way works very well and my BG values are predictable, before I did this it seemed kind of random and hard to understand.