Hey all,

I'm a type 1 (insulin dependent) diabetic, and I've been cycling for many years... but I'm looking to try out something new and different... some long distance cycling.

I currently commute daily (20 miles round trip) and ride longer on the weekends. My weekend rides are normally between 35 and 55 miles... saddle time is normally 2 to 4 hours. I want to do some centuries, and I'd like to work up to do some brevets. The idea of a brevet really captures my imagination... and as a diabetic, it will be a real challenge.

That's where I need your help.

I'm looking for someone who has first hand experience as both a type 1 diabetic and as an endurance athlete. My doctor is great... he's an endurance athlete himself (he placed 3rd in the 60-64 age group at 2007 Hawaii Ironman Triathlon) but he's at a loss as to what tips to give me for managing the effects of a 200k or 400k brevet on my diabetes. He's helped several of his patients train for marathons... but never an ultra-endurance type event like this.

I've searched the forums, but most of the threads are about type 2 diabetics (type 2's have a whole different set of problems than us type 1's). Other threads consist of non-diabetics talking a lot about something that they don't really know about.

I plan to email some of the folks at Team Type 1 (http://www.teamtype1.org/)... they won the team category at RAAM two years running. And most of them are type 1 diabetics. Hopefully they will have some info to help guide me.... but I really could use your input.

Is anybody here in LD a diabetic? Or know of some resources for us "metabolically challenged" athletes?

Thanks guys... and I look forward to seeing ya'll out on the roads! :thumb:

I have T1 diabetes but I'm not pedaling far enough yet to call it long distance. You might check out www.type1rider.org

I'm a Type 1 diabetic, but mostly riding the same distances as you. What type of therapy are you using? Shots? Insulin pump?

If you're not using an insulin pump, you might want to look into it. The pump, combined with a fast-acting insulin analog like Humalog, gives you quite a bit of flexibility in terms of matching insulin levels to exertion. If you're already using a pump, the book "Pumping Insulin" by John Walsh and Ruth Roberts has some pretty good info on how to deal with exercise. It doesn't give any advice on ultra-endurance events, but does explain the potential problems of exercise as well as strategies for solving those problems. FWIW, I've been using insulin pumps for about 20 years and can't say enough good things about them. My current pump is made by Medtronic MiniMed.

You might also want to look into continuous blood glucose monitoring systems. I think there are several vendors that offer these products, but MiniMed is the only one I'm familiar with. The MiniMed systems are very, very expensive. And, most likely, not covered by your health insurance. I think my doc has said that the Dexcom system is more affordable. MiniMed has a system that is integrated with their newest insulin pump as well as a product called Guardian that doesn't require a pump. These systems monitor your blood sugar continuously and provide alarms if your blood sugar moves outside a range you specify. I think this would be great for endurance events, where you don't necessarily want to be carrying testing supplies or jumping on and off the bike to do glucose tests.

FYI, it looks like Team Type 1 used the FreeStyle Navigator continuous glucose monitoring system during training and race events....

Thanks for the input Dan and Sstorkel...

I've been wearing a pump since 1991, so I have that covered. I don't think that I could do the riding that I do if I didn't use a pump.

Yeah Sstorkel... I know what you're saying about using a constant glucose monitoring system. I am currently battling my insurance company to get a CGMS approved (and I bought the Minimed 722 pump because of the integrated CGMS), but they seem to want to pay for one only if you need it in order to solve some life threatening problem. They don't want to understand that I intend to use it to improve my health and quality of life. *sigh*

I like the type1rider site's information... Thanks for the pointer, Dan! It has more usable data than I've found anywhere else. I'm an engineer, so my instinct is to break the system down into its component parts and manipulate those parts in order to control my diabetes. I may end up doing my own experiments with basal vs bolus insulin, high GI foods vs low GI foods, etc. in order to get the results that I'm looking for.

What do you guys know about the new insulin analogs... mainly Apidra? I'm looking at trying that out in place of my current Novolog. The faster onset and shorter duration curve may be more easily managed and predicted during exercise. Do you know anyone who's using it?

Bobby

Yeah Sstorkel... I know what you're saying about using a constant glucose monitoring system. I am currently battling my insurance company to get a CGMS approved (and I bought the Minimed 722 pump because of the integrated CGMS), but they seem to want to pay for one only if you need it in order to solve some life threatening problem. They don't want to understand that I intend to use it to improve my health and quality of life. *sigh*

Have you received help from your Doc in terms of getting this approved? My Doc seems to have a knack for getting stuff approved, though I'll admit I haven't started the CGMS battle yet. Insurance companies understand money. So, rather than convince them that your health will improve, which is a somewhat nebulous goal, I would focus on the economics. Specifically: you're planning to participate in long-distance endurance cycling events. You will be far from human contact for long periods of time. Without a CGMS, you will likely experience hypoglycemia, which may cause you to crash or otherwise be injured. The expense of transporting you from the crash site to a treatment facility combined with the cost of treatment would clearly be more than the cost of a CGMS. ;)

If worse comes to worst, pay for a CGMS out of your own pocket. The MiniMed system is obviously the most convenient for you, but I think it's also one of the most expensive. The start-up kit for for the MiniMed CGMS is $1000, which seems outrageous for what you get. Sensors are $350 for ten and they last 3 days each. My doc was encouraging me to go with the MiniMed CGMS when I upgrade my pump this year. When I protested about the cost, she said that the Dexcom system works pretty well and was around $400 to purchase. Don't know about supplies. The one problem I see with the Dexcom is that the alarms aren't as sophisticated. The big one that's missing is an alarm based on the rate of change in your blood sugar.

Finally, as my doc is fond of reminding me, you don't have to use the CGMS full-time. Once you get things dialed-in, you only have to use it as necessary. In your case, you might use one sensor/week to fine-tune your training and then another during the event.


What do you guys know about the new insulin analogs... mainly Apidra? I'm looking at trying that out in place of my current Novolog. The faster onset and shorter duration curve may be more easily managed and predicted during exercise. Do you know anyone who's using it?

Haven't heard anything, other than it's available. My insurance company isn't great about covering new (read: expensive) drugs, so I'm not sure I'll have a chance to try it anytime soon. Sounds interesting, though. If you end up trying it, I'd be interested to hear what you think....

I've tried both Apidra and Novolog, can't tell the difference. In lean T1DM the difference may be only a few minutes. In obese T2DM the difference can be up to 30 min. Ask your doc to give you a couple sample bottles to see if you can tell the difference.

I'm a type 1 (minimed pumping novolog) and do a lot of fairly long distance riding (100+ miles tomorrow and 160+ next Saturday on the Ride Across INdiana www.rainride.org). I've been doing distance cycling for about 3 years now and the formula's pretty consistent:
- Check your sugar, make sure you have glucose available in a couple of forms, ride, check your sugar, repeat!
Just this summer I've added the continuous glucose monitoring system to my regime and that helps a TON! Last week I was on a week-long cycling tour and set the alarm so that if my sugar exceeded 150 MG/DL or went under 70 MG/DL it alarms to let me know. For excessive highs, I just pump a little extra insulin. For the lows I take a few extra gulps of gatorade and/or use glucose tablets.

The best part of the new continuous glucose monitoring system is that I can very easily look down at the pump and get a graph that tells me which direction (if any) my sugar is going. That lets me make adjustments (insulin or sugar) before they get too far out of reach.

Also, I've learned that short jaunts, although fun and good for you, don't wreak havoc on my blood sugar for more than a few hours. Distance cycling, however; often causes my sugar levels to stay low for up to 36-48 hours after a very long ride. I've learned to set a temp basal dose on my pump to 50% (sometimes lower) on long rides and leave it that way for 24-36 hours following the ride. That helps avoid the lows at night. However, with the monitoring system, I get an alarm that wakes me up if my sugar dips at night, so that's better too.

Lastly, I'll say that cycling has had a PROFOUND effect on my diabetes. I've lost 100 pounds, my cholesterol and blood pressure are in great shape and I use MUCH less insulin that I used to.

I'd be happy to share other experiences if you have more specific questions.

I'm a type 1 (minimed pumping novolog) and do a lot of fairly long distance riding (100+ miles tomorrow and 160+ next Saturday on the Ride Across INdiana www.rainride.org). I've been doing distance cycling for about 3 years now and the formula's pretty consistent:
- Check your sugar, make sure you have glucose available in a couple of forms, ride, check your sugar, repeat!
Just this summer I've added the continuous glucose monitoring system to my regime and that helps a TON! Last week I was on a week-long cycling tour and set the alarm so that if my sugar exceeded 150 MG/DL or went under 70 MG/DL it alarms to let me know. For excessive highs, I just pump a little extra insulin. For the lows I take a few extra gulps of gatorade and/or use glucose tablets.

The best part of the new continuous glucose monitoring system is that I can very easily look down at the pump and get a graph that tells me which direction (if any) my sugar is going. That lets me make adjustments (insulin or sugar) before they get too far out of reach.

Also, I've learned that short jaunts, although fun and good for you, don't wreak havoc on my blood sugar for more than a few hours. Distance cycling, however; often causes my sugar levels to stay low for up to 36-48 hours after a very long ride. I've learned to set a temp basal dose on my pump to 50% (sometimes lower) on long rides and leave it that way for 24-36 hours following the ride. That helps avoid the lows at night. However, with the monitoring system, I get an alarm that wakes me up if my sugar dips at night, so that's better too.

Lastly, I'll say that cycling has had a PROFOUND effect on my diabetes. I've lost 100 pounds, my cholesterol and blood pressure are in great shape and I use MUCH less insulin that I used to.

I'd be happy to share other experiences if you have more specific questions.

Thanks for the info, Dewbert... you're just the type of rider that I've been looking to talk to...

It looks like I've cleared all of the insurance hoops to get the CGMS to go with my MiniMed 722 pump, so it's good to hear your comments about the benefits of using it. Right now I'm trying to learn how to handle the impact of really long rides on my glucose levels, so the CGMS should help with that.

I'll have to try lowering my basals after long rides too. I've been setting them back to normal after rides, but I'm finding that that runs my sugar down into the weeds. When running normal basals post ride, I often find myself cutting my boluses by 70%! I'll try switching that up some... I never realized that the metabolic "afterburn" could last that long. What ride time do you find requires you to start lowering basals? Does a short 1 hour ride call for lowering yours? I know that I'll have to experiment to find where my limits are... but I'm trying to pick your brain so that I can figure out where to start! :D

Glad we connected! It takes about 40-50 miles before I have to make adjustments. I recently completed the Ride Across INdiana (160 miles) and I left my basal at 25% for almost 48 hours!

I've been living with IDDM for awhile. However, I just started cycling this summer and haven't worked up to your league just yet. I am in the second week of training for a century ride. My longest trip so far is 30 miles.
I am training on a long-wheelbase recumbent. You can read more about my bike in the Recumbent folder.

What's a 200k or 400k brevet? Is it biking for 200km or 400km? In how many days ?

What's a 200k or 400k brevet? Is it biking for 200km or 400km? In how many days ?

A brevet is indeed a ride of a given distance... 200K... 300K... 400K... or 600K are the most common. There are also the big daddy 1200K rides if you're up to it.

These rides are done in one chunk, basically. There is no race... just a time clock that doesn't stop, even if you do. You get a set amount of time to complete the ride... your stopping, eating, napping time all counts in your time total.