Any tips for dealing with adrenaline during races?

So, I just did my first Short-track MTB race this past Saturday, and ran into a little snag with my BG due to the adrenaline rush. I dropped down to about 75 an hour before the race, and had a packet of Gu to bring me up a bit before I went out to practice. My BG was about 235 15 min. before, so I gave myself a small bolus (0.3 U) to help bring me down. I was wearing a CGM, and my glucose was holding steady in the low 200s at the start of the race.

The track was pretty difficult, and on top of this it was my first race EVER and I was borrowing a teammate’s bike. For the first few laps I felt really jittery and also very parched, but about 3/4 of the way through I started to feel kind of weak and shaky, like I might be low. My CGMS also started alarming at this point, but I wasn’t in a place where I could look at the screen to see if it was a high or low alarm, so I just ignored it and figured I’d keep riding until I had a problem. Then, I wiped out on 2 steep uphills in a row, and after I clawed my way up to the top of the 2nd one I stopped to look at my pump - BG was up to 275. So, I kept riding and finished (I got 3rd place, and some SWEET bruises!).

Obviously, I should have taken a larger bolus, but I’m not sure at this point how to plan and bolus for an adrenaline rush, or i I’ll have the same problem next time I race… Anyone have any experience with this?

No tips, Sara, it is trial and error. I have the same problems before tennis matches. Before practice, I try to be around 180 before I start. Before a match I try to be about 120. That sounds really low, but I find the spike seems to be worse if I start at a higher value.

Can’t say I have experience with this, although i do have a recent blog about my experience with blood sugar in a half marathon. Not the same type of competition, but it might offer some insight.

Since you can’t know how much adrenaline you’re getting or how big the rush, it’s not really possible to fix a bolus amount. Trial and error will get us so far, but practice can’t duplicate the rush and excitement of the actual competition.

Personally, I would try to start off with a lower BG, probably closer to 140 or 150, reduce my basal by 50% and not bolus for anything except any pre-race carbs. Even then I would reduce the bolus by a unit or two to account for the upcoming activity.

Obviously your mileage may vary . . .

Not exactly for MTB races - I only race for fun (no competitions), so here adrenaline is rarely an issue :slight_smile:

However, I have similar issues when I play soccer. Practise is not a problem, but the games will usually send me sky-high if I don’t watch carefully. Only recently have I found a bit of consensus in what seems to work. I have had the best results by starting a little high, like 10-11 (180-200), giving a bolus of 1-1.5 u (in theory 1u should drop me 2.7 mmol/L, i.e. 49 mg/dl, but in and around a game this is not the case, because the adrenaline will cause a simultaneous rise) before starting warm-up, and then just keeping hydrated and trying not to think too much about the BG. I will then test in the break (after 30 min of warm-up and 45 min of the game) and usually be around 8-9 (126-144). I will then send in another 1 u or so, which will usually land me at 4-5 (72-90) after the game, where I am usually hungry and therefore appreciate such a level.

It has taken a lot of effort to find this pattern, and of course it isn’t always “that easy”, because it is not always possible to start at the “preferred” BG-level. When I first got the pump about a year and a half ago, I didn’t like the thought of having to play with it, so I would disconnect, which would cause highs, if not right after the game then an hour or two later, making me quite sick. I was then fortunate enough to be able to borrow a CGMS when I was to try playing with the pump, and the data from the CGMS clearly showed that the highs were most likely caused by adrenaline, because my BG would be solid stable around 110-120 just until I entered the field for the game. At that very moment it would start a step rise, landing me at 216-234 just minutes later, so if I didn’t were the pump I would be sure to be high afterwards.

All in all it is, just as Terry say, difficult to give you any exact advice, but the trial-and-error approach :slight_smile:


On the subject of disconnecting the pump during exercise, which I used to do, I recently learned this:

You are depriving yourself of basal insulin for the period that the pump is off. However, since the insulin you have on board is active for two hours, you are not going to see the results of disconnecting the pump until two hours later. This can explain why your blood sugars would shoot up a couple of hours later - just like mine did - and make you sick - which also happened to me. I used to think that I could disconnect and that the exercise would make up for the lack of insulin - I was wrong. The exercise acts immediately and on top of the insulin on board, but the suspension of basal insulin affects you hours later. The better practice is to reduce the basal, rather than cut it out altogether. I cut back 50% and I haven’t got sick after a workout or a long run since using this approach.

As always, your mileage may vary . . . .

Thanks so much for the input guys! Hopefully in time I’ll either get the bolus right, or else eventually learn to not get so amped up before racing!

I definitely agree with you that disconnecting completely during exercise is not a great option, especially if it’s for more than 15-20 min. I don’t even like to drop my basals unless I’m doing a LOOONG ride and start to have difficulty keeping my BG up - when i have no basal whatsoever I start feeling sick really quickly, even if my BG is still in the normal range. I’ve found that the insulin I have on board seems to course through my system a lot faster when I’m exercising, which shortens the active insulin time by quite a bit.

Terry, I have also learned just that along the way. Although I knew the recommendations regarding suspension of the pump, and actually with this in mind was a bit worried about disconnecting for 90 min of soccer practice, I found that disconnecting wasn’t an issue at practice. I usually had a small snack + bolus about an hour before starting, which could of course be part of the explanation, but even this procedure never worked over the course of games. When my D-nurse suggested that it might be due to an adrenaline surge during the games, I found it hard to believe until I actually saw the sensor data. I guess what I’m trying to say is that while I certainly agree with you that the lack of basal insulin will give you higher levels hours later, I don’t think that this has been the only cause of the issues I’ve had with soccer. Adrenaline definitely seems to play a role, at least for me, in the context of competition.

Actually, what I do on game days now seems rather contradictory to the general recommendations about decreasing basals prior to exercise. I usually increase my basal about an hour prior to the start of the game and let it run this high for the full course of the game. The percentage-wise increase varies, as I have rather different basals during my “normal” days, but always use a rate of 0.70 u/h around games (during day time my basals are otherwise 0.10-0.55 u/h, so the increase can be from a mere 20% up to several hundred %). Once the game is over, I will return to my usual basal setting, have a snack/meal, and only 6-8 or more hours later will I have to consider lowering my basals - due to the delayed effect of the exercise - depending on what I’m doing at that time.

It is indeed tricky… :slight_smile:

Hello Tara:

Can you “piggyback” the adrenaline rush? It is 99.9% consistant that you get one in races correct? If so, perhaps don’t touch the sugar pre-race possibly? The number will kick up once the adrenaline switch comes on…

I know that ~pumpers~ love control but I’m sorry 275… don’t waste my time with a dopey alarm… does not merit my attention… IMO

Congratulations on your race! I am a personal trainer with diabetes (30 years) and run into this as well…it can be very frustrating to say the least. I often times test prior to teaching a class and have great glucose levels and finish up thinking I’m on the low side when I am actually over 250! I wish they had an alarm that would differentiate between low sugars and adrenaline.