Olympic Triathlon - High Blood Sugar and Leg Cramps

Healthy Living Physical Activity
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I completed my first Olympic distance triathlon this past weekend, yay! My blood sugar management was not good, boo! Pre-race nerves got to me and I didn’t manage to get that in order before the race started. Normal breakfast, same insulin doses used in training, etc., but still started the race with a whopping 398. Took a unit (not enuf) right before the swim, and was still high in first transition. Let it ride, but kept basal rate at 100% instead of my usual 50-65%, had 2 shot blocks (16 g total) and plenty of water on the bike. Still high after T2, so another 1.5 units on the run, wound up at 122 after the race. Nice landing, but too late! Mid-mile 3 in the run, I started having leg cramps. First on top inside of knee, then outside of calves, then a small muscle on left shin that caused my foot to want to go a weird way. Could not get them to go away w/ several walk breaks, so they stayed with me until the end.

I’ve had occasional cramps in the water, but never on the run, and not in those particular muscles. Didn’t feel like I pushed it that much on the bike (heart rate supports that), though the course was a little more up and down than I train on. Don’t think it was a hydration issue. While I definitely could have done more bike/run bricks in training, I think my overall volume was sufficient. Gradual build and a couple of sprint tris since April/May timeframe, and month leading up: 324 miles biked, 101 miles run, 23,000 yds swam.

So two questions I wanted to ask the group for help on:

  1. Could the high blood sugar have caused the cramping in and of itself or was it more likely a training deficiency of some kind (like not enuf bricks)?

  2. How aggressively do you bolus to combat the pre-race nerves? When you saw that 398 prior to the swim, would you have bolused 50% of your norm to bring it down, or some other %? What is your pre-race routine that has served you well?

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First, Congratulations on your first Olympic!

Wow, I don’t know how you had the energy for the swim. I usually feel like crap if I ever get that high.

I’m a type 2 so not sure how much my advice is going to help. I usually drink just a little Gatorade pre-race and shoot for around 150 mg/dl. By T2 it is burned off and back to around 100 or a little lower and I take a few more sips before the run.

I guess it is possible that the cramps are from the high blood sugar. You might have been a little dehydrated from running high earlier. But if you cramp on the run it is usually from not doing enough bricks in training. My last race I cramped bad in the first half of the run and had to actually stop and stretch out for a bit against a tree. The last half was smooth sailing after that.

Good luck in training and your next race!

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Thanks Chris! Your input is appreciated, and I think you are right on the bricks. I got into a “just get the volume in mode” and need to be more focused on the bricks going forward. I was really nervous this time due to a deep water start on the swim. I knew I could swim the distance fine, but treading water had me wigged out. My adrenaline must have thought I was about to die instead of just start a race :).

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Hi, I’ve done 2 Olympic Tri’s and my first went just as you described except I cramped through the swim also. My nutritionist, who also specializes in Endurance diabetics, said it was the high #'s and with the high #'s there is then some hydration issues, even if you may have felt you drank enough leading up to the race, the high #'s dehydrates you. At least in my experience.

As for bolusing I tend to stay at my regular bolus, I stick to simple things oatmeal in the morning, PB & honey on the bike. I do start the swim high…upper 200’s and they fall all through the race, mind you I’m not fast it takes me 4 hours. I fuel on the bike and hydrate with G2, I just take water on the run.

I did the DC international in June started at 297 was 127 in T1, swimming just drops my sugars, 108 in T2 and crossed the finish line at 94. yahoo!

It’s like you are running 2 races one with your BS’s and then the tri. it’s going to be a lot of trial and error. I do my third this Sat. and I’m hoping to break 3:45 and come in with my sugars around 90-100.

Good luck with figuring it all out, it’s a big puzzle sometimes. :slight_smile:

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Congrats on the Olympic distance! Very cool!

To answer your questions:
Yes high BGs can cause cramping. It may have thrown off your electrolyte balance as well so that could have also been a portion of the cause of the cramping. I’m not sure how long you took to complete each leg, but sometimes the amount of bike and run time for an olympic can stack up and if you’re only drinking water rather than some sort of electrolyte replacement (gatorade, nuun, endurolytes, etc) then this can be a big cause for cramping.
I think your volume seemed fine but the more bricks you can do (at race pace, even if only for a short distance), the better off you will be.
Depending on how early you want to get up and get breakfast out of the way may be the best way to decide how to bolus beforehand. I try to get up early enough to bolus normally for breakfast to leave enough time that my insulin duration would be cleared (so no major bolusing any closer than 2.5 to 3 hours prior to race start). This allows the insulin to “do its thing” and I know that when I test before the start, I’m pretty much holding steady at whatever number the meter says (and not on my way down b/c of the remaining tail of active insulin, etc).
If I saw 398 before the swim, for any olympic, I would definitely have bolused at least 75% of what a normal correction would have been. I’d rather deal with a low w/ gels/shotblocks/gatorade along the course rather than being high the whole time and fighting cramping/fatigue/thirst issues. Especially since seeing a number like that would prob increase my cortisol levels as well (stressing about it, along w/ the normal pre-race jitters). But that’s just me. If you are worried about having enough glucose available on the course (either that you brought or that would be provided), then it may be better to be conservative w/ a correction bolus.

Congrats again on your first oly! Keep it up and the BG management will get easier–well, maybe not “easier”, but hopefully slightly more predictable :slight_smile:

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Thanks so much girlygirl and Bradford!

Girlygirl, it’s comforting to know it’s happened to someone else in similar fashion, though I’m sorry for you that it did! Where in the world did you find a nutritionist that specializes in diabetic endurance athletes? That is wonderful! The G2 is a good idea on the bike. I think I will try that in training and next race. Good luck on your third OLY this weekend! Sounds like you have dialed in a really good plan. Hope you will post your experience and results.

Bradford, good thoughts that I will also incorporate. I ate breakfast in plenty of time (4:00 am for an 8:00 am start). But 1st mistake - no interim BG check - so no chance to correct, test again, and see the trend. 2nd mistake, only bolused 30% of normal correction. Highs have never carried any immediate consequences for me other than just the general sloggy feeling, thirst, etc. but lows have stopped me in my tracks and I border on phobic about potentially getting low in the water. Now that I’ve had the cramping issue, I think I will respect the high side of the equation more. Yes, I am slow enough to be out there a while (3:31 for this one), so hopefully replacing water with G2 will help with any electrolyte issues.

Again, thank you all so much for spending time on excellent responses! I really appreciate it. I will get a chance to do this again on Oct. 2 at my next OLY and apply your suggestions to that + training in the interim.

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No problem! Happy that you are excited about experimenting some more and then getting back into action with another one in october :slight_smile:

I think I probably test my BGs like 6 or 8 times between the time I wake up and the firing of the gun on race morning lol. Testing more would at least help you see trends (like you mentioned) so you could be more proactive about what you needed to do (insulin or more carbs) leading up to the start.

It sounds like you’ve got a good plan to work from now and you can use some trial and error w/ your training to see what you think will work best on race day. Looking forward to hearing about the next race!

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Guys - just to add to you Tri-aths - I am a poor cyclist but have under taken several 400 mile races (over 4 days) - London to Paris. The problem I have had is exactly the same with cramps and I am so glad to hear its not just me. Being on the bike for 5 to 6 hours means I can carry both my Nav and Omnipod PDM’s. But my ability to eat early is an issue since sleep is a problem, and I therefore always start high. What is a block ? I use fructose during my climbs (ie when you have just killed yourself up to the max HR) - what is G2 ?

Gos - Uk

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Clif Shot Bloks (they’re like gummy bears (ish?) but have some other electrolytes in them, etc).

And Gatorade G2 (low calorie gatorade)

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I agree with Brad, please post how your Oct. OLY goes… it is so much trial and error that it is helpful to see what works for other people.

I too check my sugars repeatedly before the start, and like you, Progress I can operate with out to much problem ( a little sluggishness at first) with my sugars high. I’m really scared of going low on the swim cause I don’t really feel my lows until they are toooo low, so I’ll start high and then get adjusted between T1 & T2, I pick up my Dexcom in T1 and go from there with the readings. I also check BS’s in each transitions.

Do y’all race with your pumps? I just got the animas, it’s waterproof, I just love not having to mess with putting on my pump in T1

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Just did the a dualtheon. 20k ride -10 run and 10 k ride. The ride i have everything with me, ie Pod and nav in a pouch, but running not good. Closed on 1 hr 15mins. then the hassel started - it took me 80 grams plus to pick up again. ! I went from 10 mmo/L up to 16 when riding - i put in 4 units over my basal and then crashed.

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Jgos, so sorry you had a rough day out there. These multisport events are such a balancing act for us. Were you able to finish?

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So sorry it went down that way for you Jgos! I hope you were able to finish.

It does happen no mater how hard we try to plan and be prepared, I did my International this past Sat. PR"d the swim & bike, was spot on with my sugars in T2, thought I was going to get my goal, yet crashed the run… bottomed out in the low 50’s. I had already taken all of my fuel, thank goodness a volunteer had some Skittles out there on the course. :slight_smile:

It can be very discouraging, we just have to try and learn and move on.

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Girlygirl, congrats on your swim and bike PR’s! Sounds like you are improving with every race, in spite of the blood sugar difficulties on the run. Once you get behind on a blood sugar drop, it can be so tough to recover quickly on the run. I mean it’s not like we can sit down during a race and wait 15 mintues to test again. Like you said though…we have to learn what we can and move on. Just think, maybe if we combined my BG’s and yours from our most recent races we would come up with a good average :)!

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Guys, just got back from a crazy trip from London to Boston and back in 36hrs. I did finish my dualthelon but had the issue again of going very high about an hour afterwards ?? Up to 22 mmol/L where my norm is 6 to 8 but happy to trian at 10 /12. As said by Trumps the recovery is awful either side.

The trip to Boston also underlines the need for CGM, when pitching on empty but using lucozade beans !! Feel very tired now but the Omnipod and Nav allows me to function at the required levels !!

Not sure about the way adrenaline is affecting me in work compared to races ? any thoughts ?

Gos

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Congrats on finishing the Du.
A couple things could be happening after the race which lead you to the spike.

  1. your body does not realize that you have “finished” the competition, and may continue to let the liver dump glycogen b/c it “thinks” that you’ll need it (that you are still racing and exerting energy, depleting the skeletal muscles’ cells stores of glycogen for glucose conversion/consumption). To counteract this, you might try a recovery drink (chocolate milk is one of the most basic, easily accessible items to do this). I’m not saying you have to cross the finish line and down a gallon of milk or anything, but as soon as your stomach would allow you to do so, drinking 8-16 oz would be great (and bolusing appropriately of course). This lets the body know that you’re not racing any more b/c the stomach will draw blood flow away from the muscles and focus on digesting the milk. The drink could also be any other “recovery” drink (some ppl use protein shakes made of soy/whey, some use more carb-based drinks such as Hammer Nutritions Recoverite…it’s mostly a personal preference to see what works best for you).

  2. you could have eaten too many carbs at the end of your race, and they sat in your stomach (b/c all your blood was busy supplying nutrients to your skeletal muscles and carrying away lactic acid and other byproducts, so not enough was available to focus on the digestion process w/ the stomach/GI tract). Once you got done racing, the blood finally realized it was needed for digestion, and so it did its thing (so to speak) and suddenly you get that “dump” from the stomach of all that unutilized glucose that’s now available for consumption. To counter this, you could try not drinking gatorade/sports drink and/or not consuming any glucose products (gels, jelly beans, etc) from about 30 minutes from the finish–only take water and/or electrolyte replacements if needed.

  3. It could have been that your basals were turned down too low at the end of, and following, the race (if you do this). Remember that any basal adjustments you do now won’t actually be utilized in your body (you won’t see any change) for about 60 to 90 minutes. So if I wanted to be back at “normal” basal at the end of my race, I’d want to make my basal profile adjustments so that about 1 hour from the conclusion of my race, it would return to normal (so that once I was done, the normal basal would be hitting my system).

  4. It could have been a combination of all of the above lol. Or it could have been an increase in insulin resistance due to cortisol and other stress hormones from the race, etc. I know that doesn’t help much, but hopefully identifying one of the above possibilities would give you a starting point from which you could practice/adjust to see what might work best for you.

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Congrats on your race and good luck in the 10/2 event!

I’ve had cramps due to the high BGs (and associated dehydration). Probably too late in the game now - but I know you mention training “volume” vs. “intensity” - you might see some differences with a switch in focus (mental and physical - as well as blood sugar-wise). I’ve had the pre-swim highs (but not above 300) in the past - mental focus on something that is calming (or that removes me from whatever the fear factor is - example, having breathing problems on the swim in the past and having to grab onto a kayak) has helped some with that.

Looking at the additional info below - I think the increased checks between eating and starting are a necessity, especially if you’re eating 4 hours before race start. What are you eating - are there fats/proteins that aren’t getting rapidly absorbed? I eat 2 hrs. prior - pretty much carbs only and cover with a bolus. With this I’ve dropped low (60s) twice this summer, had a gel about a half hour before to cover that, then started the race in the 120s with a gel right before getting in the water.

As far as covering highs - I’ve been very aggressive (full bolus) - based on what I knew I had in terms of time on the bike, and very passive - based on not wanting to fight the hi/low battle. The aggressive approach served me better on the half IM a couple weeks ago - BG was 90-120 prior to the run after being 341 (for a number of reasons) on the bike at the halfway point. The passive approach enabled me to be miserable (cramping) for several hours during an IM - both on the bike and the run (finally bolused at the halfway point of the marathon - knowing what was left - and felt better about 6 miles later).

Hope some of this helps :slight_smile:

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Jgos, congrats on your duathlon. Sorry the aftermath was like a whole 'nother event. That kind of travel schedule can throw “normal” out the window all by itself.

IMVic, thanks so much for your comments and suggestions. They do help, and even though time is short before the next race, this will not be my last one :).

I was relatively calm before my previous sprint OW swims. But like you said, I had something else to focus on. Pre swim on both of those I was trying to talk my nervous friend down from the ledge. I guess I convinced myself at the same time. This time it was just me and the “voices in my head” + it was a different kind of start, first time at this distance, etc. Hopfully this next one won’t wig me out so much, and I’ll try to just focus on the idea of swimming to the first buoy my way.

Breakfast is 1/2 c oatmeal w/ 10 dried cherries + 1 slice bacon + 1 egg. So a mix of carbs, protein and fat. This is my normal pre-workout fare (sometimes sub veggie sausage for the bacon/egg or kashi waffles for the oatmeal). I like it because the mix of carbs/fat/protein tends to help me not feel hungry for a while. Will probably stick with that for now, but definitely need to have a test fest before the race. I was staying with a new friend and rushing around a bit more pre-race, and let my normal pre-race testing routine slip.

Your comments about focusing more on intensity were not lost, and I’ve been thinking about that lately. I have thus far taken a very simplistic approach since this is my first season. But now that I have a bit of a base, probably time ,as you said, to shift my focus.

Thanks for sharing your experience re: being more aggressive with the boluses. I’ll remember that when/if I’m making that decision at this next race and hopefully it will give me more courage on that. I’ve also done more bike/run bricks this time (at my current “race level” intensity), and BG management has gone really well. I’m hoping to fit in a couple of full swim/short bike bricks before the race…find those more logistically hard to fit in, but I think they are critical for figuring out the BG issues after being disconnected during the swim.

Again, thanks so much for sharing your experience and input. The specifics you offered are valuable, as is the support and knowing I’m not alone in continuing to sort through and keep tri-ing!

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congratulations triathlete! what was your time?

  1. cramps could be a lot of things - dehydration, lacking salt/electrolytes. don’t think it’s lack of bricks - you’d feel that the first steps thru the first mile not so much on mile 3.

  2. not a pumper so have no advice here

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Thanks Joe! It was 3:31…plenty of room for improvement :).

I’ve been having great BG’s during workouts the last couple weeks, and PRed a 10K last weekend. With that + determination to work the blood sugar game more aggressively (thanks to the input I’ve received here), I’m really hoping for a better showing at the next OLY on 10/2. I’m going to drink diluted G2 on the bike in addition to a couple of shot blocks if my BG allows…should have plenty of electrolytes coming in. I shouldn’t be losing as much to sweat either…next race will be cooler. I’ve done a few more bike/run bricks at closer to race intensity, and plan to do a race distance swim/bike tomorrow to dial in the post swim bolus to the extent possible.

Now I just have to convince myself that the mass swim start will not kill me. Seems like every tri I do has a different type of swim start, geesh!