Avoiding Post-Race Hypoglycemia

| May 8, 2010

I woke up on the floor of my living room, soaked in sweat.  I could not stand, or even sit up.  I could not raise my arms or control my hands enough to grasp anything. Forget reaching for the telephone, even if my brain could have formulated the thought to try.  I could not speak, but I lived alone, so there was no one to hear anyway.  I did not know what day it was, but the hot July 4th late afternoon sun was shining brightly through the windows.  After an unknown period of time, my brain must have had a flash of coherence that I was having severe hypoglycemia

Eventually I started dragging myself across the floor, on my elbows and arms with my face down, into my kitchen, and then into the pantry.  It may have taken 30 minutes or an hour, I do not know.  I ended up below an open 12-pack  box of Sprite sodas that was on the shelf above me, about two feet off the floor.  I lashed at the box with my hand and eventually pulled the box off the shelf, cans of soda falling on top of me and rolling.  I must have managed to trap one and pry the tab open while my fingers and hands twitched and jumped.  I lay on the floor and somehow poured the can of Sprite on my mouth, or in the general area of my mouth, much of it running off my face and onto the floor around me.  Then I lay there and waited, barely able to understand what was happening.  Waiting for my blood sugar to come up.

That was me very early in my racing career, years ago when I was just learning how to race bicycles and manage my blood sugar.  Early that July 4th morning, I had cycled in a tough 60-mile bike race in the mountains of North Carolina, about three hours of very hard, hot exercise.  I had no problems in the race, and I even drove approximately 40 miles home after the race with no problem.  But late that afternoon I ended up on the floor, desperate and helpless, with severe hypoglycemia.  I learned a scary lesson that day about post-event fueling.  For any elite athlete competing in ultra-endurance sports like long-distance triathlons and cycling, post-event fueling is critical for recovery to prevent muscle soreness and to train or race the next day.  But with type 1 diabetes, post-event fueling is even more important, even for the recreational athlete.

My pre- and post-workout and race fueling strategy is as much a part of my performance as my fitness.   It does not matter if I am the fittest, fastest guy in the race if I do not fuel right.  The night before a workout or race of over two hours, I eat a high-carbohydrate meal such as pasta and carefully dose my insulin to make sure that it covers the meal so that I do not awake with high blood sugar on race morning.  It is very risky and dangerous to do a correction bolus (i.e., take extra insulin) on race morning.  I eat a good carbohydrate breakfast such as a bagel or oatmeal, and then fuel during the race as I have practiced many times in training.  You must practice fueling in training just like you practice your sport.

Immediately after a race or long workout, I begin my post-race fueling, both for muscle recovery and to stabilize my blood sugar.   You may notice professional athletes drinking sport drinks immediately after competition.  For a non-diabetic athlete, carbohydrate recovery drinks are great for replenishing and rehydrating muscles during that critical 30-minute window after a workout.  For those of us with diabetes, it also starts stabilizing blood sugar for the rest of the day and night.  At the finish line of an Ironman triathlon, there is a virtual buffet of carbohydrate foods, sport drinks, and water.  Like the other athletes, I sidle up to that feed line and eat and drink everything, both to recover and because I am worn out. I also carefully bolus insulin to get the glucose into my weary muscles.

I check my blood sugar multiple times throughout the rest of the day and until bedtime, and I continue to "graze"  on calories and carbohydrates in small portions, reducing my insulin dosing as my blood sugar tests indicate.  Before bed I eat another high carbohydrate meal, and I usually reduce my meal bolus of insulin by up to 20 to even 40 percent from what I would take for that meal on a non-race or training day.

The key to avoiding post-event hypoglycemia is refueling with carbohydrates, testing your blood sugar frequently, and being careful with insulin dosage.  Finish, feed, test, and think.  You did the race, now you are ready for the next one!

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Categories: Blood Sugar, Columns, Diabetes, Diabetes, Exercise, Fitness, Food, Insulin, Jay Hewitt, Low Blood Sugar, Type 1 Issues

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Posted by Anonymous on 8 May 2010

Thanks for a great article. Useful for my running daughter & our dear active friends.

Posted by PinePienaarInfo on 9 May 2010

Hi Jay
Your article has helped me now to understand a lot of things that is happening in my body during extreme training. When I say extreme training I mean for me (recovering coach potato) most properly for you it might just be a warm-up session. Any suggestions what to drink or eat during that 30 minute window?

Posted by Anonymous on 9 May 2010

Absolutely true!!! it is very important to be aware that post exercise DANGEROUSLY LOV B/G may happen hours after the training, even as late as 12 hours later. Never go to bed without you glucose meter and juice or glucose tablets by your side. Never get up in the morning without first checking your B/G because you may not make it our of your room or fall in the shower. Always remember that after training you are at risk for hypoglycemic episode. GOOD LUCK & KEEP ON TRAINING !

Posted by Anonymous on 9 May 2010

Hi! I want to know if we can get MORE articles like this one. I'm trying to get in shape but have a lot of trouble exercising due to these hypos that come *later* in the day. . . not during or immediately after exercise.

are there people who can train type I's to exercise and stay healthy while getting through the problems of hypos? you know, not just become professional athletes, but just be fit. If so, please write about this in your magazine!

Posted by AngelaPast on 9 May 2010

Great article. I would also suggest setting your alarm for 1am and doing another test, both after a race and a hard workout day.

High glycemic foods are great for the window. White bread, sweetened cereals, sports drinks. Check the glycemic tables and choose something you like!

I hope this isn't my second post. I am having trouble logging in!

Posted by Anonymous on 9 May 2010

Have you any advice for a Type 2 on diet and exercise as what to eat before, during and after training?


Posted by Anonymous on 11 May 2010

Great Article!!

I am a marathon cyclist (> 100 mile races)myself and can only say you're rigth about the things you write. Though I have some extra info (which worked for me).

1) Taking ekstra proteine rigth after training decreases peaks in your BS.
2) Because there are so many parameters which make your way to act variates a lot, it's very important to train in extremes. You have to find out how your body is reacting. Training intervals, distances etc., isn't the main thing to train for a diabetic, the far most important training is, training your diabetes. You have now what you need so you're clear how to handle i every situation!
3) Measure your BS while training to find possible patterns!

Hope this can help all of you ((o;

Kind regards,
Guido (www.diabetesogmotion.dk)

Posted by BMAC on 11 May 2010

Hey Jay.

Good article.

I'm not on a pump or OmniPod (I'm a pen guy). I do use a CGM, though it's incredibly unreliable (besides spotting trends), so I still test test upwards to 14 - 18 times a day depending on my training schedule. Having been a TYPE 1 for over thirty years, I've gotten a little obsessive with my BS levels so that's another reason for the high number of test. It's all about the numbers. After reading your story, I hate to say it, but I'm glad I'm not alone. I'm not at your level, but I just completed 9th marathon two weeks ago, have done a few shorter tri's and training for an Olympic in about four weeks, so I have some experience with learning the importance of fueling before, during and most importantly (I think) after training or a race.

A few years back, when I was early in my "learning curve of endurance training with diabetes," I too had a very bad low. Long story short, I ran 20 miles mid-day, ate a normal lunch, had a normal dinner and went to bed. I was testing the entire time and thought my levels were good especially my last test. But I had not properly fueled (re-fueled my body) post run, so I plummeted when I finally went to bed. Totally oblivious to anything I was unresponsive and only responded after feeling a sharp pain in my arm. I awoke (to reality) with two paramedics and my wife standing over me at 2:30am in the morning, with an IV in my arm.

Lesson learned. As you mentioned, one has to be very persistent with fueling and monitoring post training.

Hopefully at least one reader will see your article and learn the lesson the "easy way," not the hard (dangerous) way.

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