Hi all...I'm a Type 1 and have been for about three years. I run quite a bit; have completed many 5K's, a few 10K's, and 3 half marathons. Since I started running, I've adapted my insulin to help meet my needs but lately, I've had weird issues. I'm currently on a pump and while running all my half marathons I was using the Omnipod. Currently, I'm on the MM Paradigm and absolutely love it!
The last two weekends I've ran races. One was a 20K so 12.4 miles and the other was a 10K so 6.2 miles. Both times, I have eaten the same breakfast as always, given a normal bolus and then I change my basal to about 15% during the duration of the race. During the race, I reply on CGM readings to monitor my blood sugars and I will eat cliff blocks or drink gatorade to get a little bit of sugar. Both races I ended with a BS of 90-110. But then later that day and especially the next day, I ran consistently high. On one occasion I was above 250 and couldn't get it down at all.
So Im wondering if anyone knows about pro-longed exercise causing high blood sugars or if it has happened to anyone else. I ran today for 30 minutes and was fine. So I'm wondering if I just need a separate pattern for the day of or after a long race. HELP!
I started out turning my basal down low like that but lately run more like 50-67%. I will have one GU during a marathon or before a 1/2 but that's about it. Usually, I rely on Gatorade and little bags of jellybeans mixed with Smarties for runs as I find the quick sugar is more useful to stay flat. If you run high after races, maybe try a higher basal? That was sort of my experience and I kind of figured that as I got into shape, I'd need more insulin because I was more in shape so it didn't "burn" as much? I don't know if there's a scientific foundation for it but running about 50% and hitting some "fuel" Gatorade, like 25G of the powdered stuff, works pretty well. Ifmy CGM is running where I want to be, I usually kill the temp basal and go back to 100% for the last couple of miles too.
If you're above 250 the following day, did you possibly get low overnight and have a rebound?
Nope, according to my CGM graph, I consistently was over 200 
My endocrinologist tells me that when my son plays sports or gets involved in highly active play, I should expect highs for a short time frame at the start of exercise (~30 min), due to the increase in stress hormones (cortisol, adrenaline) that comes with the "charge" you get out of participating in a sports activity, but thereafter blood sugar will decrease as the body begins to demand more energy to run at a higher metabolic rate. So it could just be that you're "juiced" (pardon the pun) from the adrenal hormones both before AND after a successful race. Have you found yourself feeling particularly pumped about the race afterward? Because strange as it may seem, that excitement could be producing your high blood sugars.
Either way, if you see a pattern, then adjust your insulin intake accordingly. So first time is happenstance, second time coincidence, third time is a pattern.
Usually, exercise will increase the GLUT-4 receptors and the effect will be an increase in insulin sensitivity for as much as 48 hours. But it doesn't cause you to go high. And while many of us experience raised blood sugars during exercise due to increased stress hormones like cortisol, those effects disappear within an hour of stopped exercise.
Perhaps those extended runs are actually causing you some sort of inflammation or damage. If you actually hurt yourself, you will get raise blood sugars. Any knee, foot or hip pain? Another concern might be that increased stress from long endurance excise has been suspected to take a toll on your body since it can cause a catabolic state. This sort of damage might cause elevated blood sugars. Some people suggest that endurance sports can lead to things like heart damage.
I pretty much blame post run highs on either adrenaline, if it's a short (e.g. 5K) race or underinsulining/ overcarbing during the race. I initially made deep cuts to my basals but have kept increasing them, probably until I run low and then turn it back down a click and figure I'm "there". When I started out trying to run farther, I'd bring a 45G of carb bottle of gatorade and a 0G of carb water. Then I started mixing up the water into 10-12G, which seemed to work better. These days, I think I've gotten close to where I want to be, so the intake of carbs (and fluids, which are useful too...) is pretty balanced to the output and then I bring the jellybean/ Smartie mix for "emergencies". Most of the time they stay in my pocket. I always have something but, for 3 miles, I don't worry about it much more than a glass of skim milk before I start out if I'm a shade low.
I've also noticed that I run high when I have gel/blocks. They always give them out at races but I only eat them for a "snack" (with a "cut" bolus...) at the whatever it was 17 miles or something like that.
It's happened twice now and it's only after a run more than 5 miles so I think there might be a pattern happening. Both runs were completely different too so after the next one, we'll see what happens!
I would check out teamwildathletics.com - their whole focus is specializing in T1 athletes! (fueling, training, insulin, etc)
Also, Mari Ruddy started it (http://www.tudiabetes.org/profile/Mari)
Oh wow! I didn't know that existed! I need to start saving my pennies!
Maybe it was my blocks. I had a few. But I use gatorade as well. I used to use strictly gatorade but sometimes I run low. Maybe I'll turn my basal down before the runs. It's such a hard balance because I want to start out at least over 150 but if I start out too high, I'm so sluggish it's hard to get moving. For all my half marathons, I've used one of the Gatorade G series 1 drinks and that keeps my sugars high enough I think that I don't bottom out. I suppose it's possible that I went so low during the run that my body had to overcompensate but I was surprised it lasted over 24 hours!
I thought about that but it's been three+ years since I started running long distance and this is the first time it's happened. I'm in better shape now than when I started. Plus, I can't give it up, it's too much fun :)
I’ve not found that I go high after running, but I will say that about two months ago, I started some pretty intense cross training, and my blood sugars are ALL out of whack now. My basal rates have had to go up overnight, and I get dawn phenomenon now, which I never used to. If I don’t do the training for about 48 hrs, my sugars come back to an even keel. I have an appointment next week to try to figure out what I can do, 'cause I don’t want to stop the workouts. Anyway, it’s definitely a long term effect (not the 1 hr post workout thing. Someone told me maybe it’s growth hormones from all the strength training? Not sure. Anywho, just saying I know what you’re feeling!
Another thing that I got to think of rather than aiming at "high" or "low" is to aim for "balance" to get the carbs and insulin and exercise to match. This is easier said that done but I think that I had reached the point where I said "if it's high, it's probably high because I 'ate' too many carbs..." and started approaching it that way, taking a bit more (usually basal...) insulin and feeling comfortable that if I had carbs along the way, which lots of people do for long runs anyway, gatorade, gu, etc.
At the Chicago Marathon last year, I turned around and saw that a guy I was running along with had somehow obtained a donut about Mile 14! And they pass out beer at mile 20, lots of folks w/ fruit, pretzels, bananas, etc. I usually use a 1/3 of the bolus amt (calculated by my pump) if I'm running a longer race like that.
If my BG's higher, I'll have a bit more and, if it's low, I correct with quick acting things and maybe follow it up with any stray goodies along the route. Although I was *bumming* I missed the donuts, I had had a spike early in the race as I overdid it on the first couple of gatorade stops as I was paranoid about running low so I had a big spike through the middle of the race and corrected it and drank lots of water.
This is the CGM line from that race, the little black blobs along the bottom are all the boluses. I think I finished at like 68 or something, which was another tactical error as they were passing out some kind of chews and I couldn't read the label (no reading glasses!) so I ran by the last Gatorade stop. The race started just to the left around 8:00ish
I agree that cross training is another matter. Weights/ pushups/ anaerobic exercise pushes my BG up. I usually do that in the AM so it's on top of DP which is not totally unusual so I will usually do a correction and work out and it seems to catch up by the time I'm done so I can eat breakfast.
I never considered doing boluses during races but maybe I should. During my last 20K, I was eating just to keep up with the BG's as my CGM kept predicting lows and I finished at 91 without any boluses so maybe I was too low during the race and caused my ridiculous high the next day. I used to shut off my pump completely during races too but now I leave it at about 15%.
