Training with Type 1 Diabetes

Hi all, I thought I’d ask the hive mind for my brother, who at 30 has just been diagnosed with Type 1, about training and glucose control with training. I get that his insulin sensitivity will increase and he’ll need a constant stream of glucose, but he’s going to get an insulin pump and it’d be great to see how people manage it on the road.
Any other hacks would be appreciated as well.
Thanks everyone
Jamie

I don’t have T1D but my wife does and caveat, she isn’t an endurance athlete.

But what I can say is that getting a Dexcom continuous glucose monitor would be huge here. Can be expensive or incredibly affordable depending on insurance, but by automatically tracking her blood sugar every 5 minutes and sending that reading to her phone or another handheld device (doubt it would go to a Garmin or something), she can get alerted to trends & current readings to stay on track. You can get that blood sugar reading to display on the default screen of an Apple Watch too for a quick glance during a ride.

As for pump, the tubeless Omnipod would probably be a good option because the pump itself isn’t connected to you via tube. My wife’s had tubed pumps before and will never switch back from the Omnipod. Not that the tubes are bad, just the convenience of tubeless is great.

Everyone’s blood sugar response to exercise and foods are going to be different, so that Dexcom CGM will give you the data needed to figure out eating frequencies & how much to bring on a ride, what types of food to eat before a ride, etc.

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My Bro-in-law got a Dexcom also and he said it was a game changer. Prior he was very proactive about testing his sugars so he had it “managed,” but now he says he can basically keep it almost perfect.

I was diagnosed T2 right around the time I started riding. I would say the suggestion above to get a CGM is excellent and to track and take note of how his body responds not only to fuelling but too hard/recovery intervals as well as hydration.
Another pointer is to keep track of pre-ride glucose numbers and post right glucose numbers and how long it takes to come down into a normal range.
I know for myself I need to eat something as soon as I start paddling or else I have a huge glucose down from my liver which will spike up to the sky. After that it all depends on how hard I’m working-if I continue to have long hard efforts i need to take on food every 20 to thirty minutes in small quantities but I’ve also learned that I need to allow for recovery during my outdoor rides or else the numbers keep going upwards.
I’ve ridden with a CGM and have seen my glucose line mirror that of the TDF climbing stage -Going up when I’m working hard and then coming down during recovery so basically it’s following the same line as me going up and then back down the mountain.
Happy to share any of my experiences-you can even check out my blog at:


I hope posting a link isn’t a problem for the form if it is I’m sure it will be removed.
Nothing to sell on my site-it’s just a site about my passion for cycling and living with diabetes

Im T1D and have been for 29 years.

Im lucky in the fact i can tell a long way off when my blood sugar is dropping and can then take something to raise the level. Alls i can say is tell him to take plenty of fast acting foods with him, haribo etc work well.

Im still on injections due to the lack of available funding in my are (UK) but would love to get on a pump

i would also suggest getting a Dexcom along with the insulin pump, but i would also suggest setting it up with “nightscout”, that way the Dexcom (or other CGM’s for that matter) can be monitored directly on a garmin bike computer/smartwatch/etc with a Connect IQ app… the following has been a real gamechanger for me since i can monitor everthing just by looking at my gps, i got a custom datafield with power, cadence, heart rate and bloodsugar - i can recommend going that route if its an option ofcourse

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Hey!
I’ll start with the age old caveat, what works for me might not be applicable but my experience as a T1 cyclist (used to race) would be;

For Aerobic workouts; Have any fast acting insulin out of your system before you train. By this I mean I do all my TR workouts in the evening. I have my lunch (usually high carb) no later than 1pm. This leaves 5 hours for the insulin to be absorbed. Depending on brand fast acting can have residual effects for 6 hours after injection (even fast acting).

I’ll then snack on something low GI an hour before I train to bump up the BG’s accepting this might take me a little higher than recommended.

The work out usually then brings me back to normal. And I have 30g of dextrose ready in a bottle just in case.

If I’m going out in the morning I don’t have any insulin with food but am out the door within 30 mins of eating.

Anerobic; glycogen dump from the liver will make BG’s skyrocket.
I don’t personally correct for the high with insulin as it’s a hormone response rather than food response. Usually sorts itself out. But I do an extended (15 min) cool down as if you stop straight after efforts you’re still releasing the sugar from the liver.

Recommendations for kit are helpful but your biggest bang for buck is understanding the science behind your condition. Tech is great but only if you understand how to get the best out of it. Think from a cycling perspective best kit might give you watts but training the right way will give you more.

BUT most importantly don’t let it stop you doing what you want to do. My best life experiences have come because I’m a diabetic and it opened up opportunities I would never have persued otherwise.

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I couldn’t agree with any of this more. This should be required reading for any diabetic athlete.

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Sorry for the late reply! But better late than never.

The insulin pump is a great first move. It improves hba1c, and I would like to reiterate what others have said here. Next step, for both better control AND workouts, is the continuous glucose monitor. Dexcom and Medtronic have them. I personally use the Medtronic closed loop insulin pump. The Novo nordisk team, an all type I diabetes pro cycling team has the dexcom with insulin pumps.

There are sports specific diabetes training camps. Short, one week, camps to help diabetic athletes fine tune their performance and MANAGEMENT of glucose during exercise.

I also recommend the Type I diabetes facebook group Race T1. They host online zwift competitions and social rides. The riders are a WEALTH of information and experience.

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I was exactly the same as your brother diagnosed as Lada type 1 at 30 years old. I am an MTB guy and most of my races are sub 1.5 hours although I do occasional marathon styles 3-5hrs. I am using the Medtronic 670g in automode. I start temp target 1-2 hours before a ride and end it 1-2 hours after after completing ride. For the more endurance style rides I take in 40-50 grams of carbs per hour. Also adequate hydration prior to riding is essential. Using the 670g I really haven’t had any issues comparing to my ride days prior to being diagnosed.

I have had type one for over 10 years now and do not have a pump and have no intention of getting one. I just can’t imagine having something attached with a tube 24/7 and would much rather take multiple injections a day. That being said pumps are amazing tech and some people love them (I have considered trying out an omnipod). I currently have a Dexcom G6 CGM and this is a gamechanger. My dexcom is also paired with garmin connect so I can see my BG on my garmin as long as I am in an area with cell signal.

Maybe reach out to team norvo nordisk?

For what it’s worth, I know it’s only one opinion, but my wife used to really dislike the tubing but dealt with it. Then she tried Omnipod on a whim and has loved it ever since for it’s simplicity and lack of tubes. Omni has has a free trial kit that you could always try out too without needing to pay.

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A little inspiration for your brother and those of us with diabetes :blush:

I am new to the forum and realize this thread has been quiet for some time, but here goes anyway:
I am a longtime cyclist with borderline Type 2, have been able to get my A1C down through diet, and am using a Dexcomm to monitor my sugars. This has been a game changer (it’s like a powermeter for food and my body). On more intense rides (I bike in the morning) my blood sugars will go over 200 but then quickly drop once I stop riding or after about 90 minutes (when I’ve exhausted the glucose that my liver has dumped). FWIW: an hour after stopping I’m back to about 90-105 blood sugar level, and stay pretty consistent in that range throughout the day, as long as I manage my diet properly. I’m wondering if others have this same issue, if there is anything to do about this, and how high is too high? My endocrinologist says I’m fine, but he’s not an endurance athlete. I’m not asking for medical advice here, but do want to know how others manage this. I’m sure that this was going on for me for years, before the Dexcomm, but now that I have this information, I want to figure out how to use it.

Hello, I am newish to the forum and Type 1 for about 18 years now. Thanks for bumping the thread, otherwise I may have never seen it!

I use a pump and CGM (Dexcom) with a smartwatch to monitor my glucose levels during rides/races. I often start my rides on the high side (200’s, sometimes 300+ but not on purpose) because I don’t want to be loaded with insulin while I am out on the bike. It’s a little different for T2 diabetics so keep that in mind. The CGM was a game changer as it enables me to monitor my BG during a race without needing to stop and prick my finger. I use a smartwatch to see the readings since my Wahoo does not have the same capabilities as a Garmin (I prefer the watch over a head unit display anyway).

For races over 3 hours, I will usually ditch the pump and just monitor my BG. For 3+ hour events, I have to pack the pump with me. My biggest worry is to have a low BG during exercise, so I am known to carry way too much food with me. I had a seizure one time due to extremely low BG, and it was not fun!

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Hey there, even tho i am a type 1 i can tell that its quite normal to see bloodsugars going to the higher side during more intense work is normal. The reason this happens is basically because the more intense rides causes your body to produce more cortisol and adrenaline which in return will raise your bloodglucose levels, its very normal.

I run a dexcom g6 myself and here is an example on how different ride intensities affect my bloodglucose:


The picture on top is some endurance riding followed by Pettit +1 and Obelisk, bloodsugars remain normal all the way through the ride, and on the picture below that is a warmup followed by the Ramp Test followed by endurance riding with a mate on Zwift… as you can see, after the ramp test were the body is quite stressed the bloodsugars just goes up up up despite not eating anything (and actually having abit more insulin than i normally would when riding) and after some time as the stress levels comes down again so does the bloodsugars (i am not bolus’ing aka taking any insulin to get it down, it just starts to decrease again on its own as i ride). Thats just the daily struggle of trying to predict the unpredictable with diabetes :smiley:

As your endo says, its all good and i dont think you should be concerned at all, especially if it “only” goes to about 200 it should not affect performance either, in my experience after 20 years as type 1 i feel performance first start to decrease as i get over 230’s.

So just keep riding it should all be good :smile:

And for reference… my bloodglucose on the picture above dont use the same units as you do, here in Denmark we use mmol/L in stead of mg/dL as you do, how so you can relate, 80 mg/dL = 4.4mmol/L and 200 mg/dL = 11.1 mmol/L.

I hope this can be of any help to help to you.

And also @RyanO i can see from your post that you and i are on the same setup with Dexcom, pump and bloodglucose on watch - i am fairly experienced with riding and avoiding having lows, in fact on usual outdoor rides i rarely carry more than 1-2 gels… so if you feel you got any questions on how you can use your pump more effectively to avoid lows while riding/wants to avoid having to carry food in excess then feel free to ask, im always happy to help if i can be of any use :smile:

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Thank you, @SirNorden. If any questions do come up, I will let you know. I feel like I have a pretty good grasp on things right now. We’re lucky to have this new technology. Things are much easier now than in the recent past!

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What program are you using to overlay your glucose with your workout?

How do you guys like your set up? I personally have the Medtronic closed loop, but thinking about switching over. Thoughts? Recommendations?

@RyanO yes we are idd fortunate to have these options nowadays, and there at coming more and more technology to the market these days… which is just gonna make it even easier for us. I cant imagine going back to the old-fashioned methods, taking a short look at the watch to see the glucose levels are just so much easier than having to stop and do the measurements with a glucometer… has def been a gamechanger for me and my racing performance, riding with normal glucose levels is just so much better!

@ktmccusk i did it using the analyzing tool in garmin connect, i have my bloodglucose written into the .fit files that my Fenix 6 records by the xDrip/Nightscout ConnectIQ app (Spike/Nightscout if you are on Apple devices). From there you can select it in the analyzer and overlay it to your power/heart rate data.
My current setup is a Dexcom G6 and a Medtronic 640G pump, back in the days i used to run both Medtronic pump and Medtronic CGM but i had huge problem with it while riding, basically everytime i started a ride (both inside and outside) the CGM dropped its signal to the pump after 5-10min of riding, and first regained connection half an hour after the workout was done, and it was each and every single day. It had me quite frustrated since the reason i got the CGM was because i am no longer able to feel when i am going hypo, it has to be really really low before i feel it. I have once managed to drop all the way down to 1.4mmol/L (25 mg/dL) during a ride on my local trails…only reason i figured out i was hypo was because i all of a sudden struggled to remember the route, and its a trail i have ridden hundreds of times, thats what caught my attention, otherwise i could not feel anything at all, and the CGM did not alarm me because that one had dropped connection… so after that incident i got a Dexcom CGM in stead and that one is just awesome, very accurate and does not require calibration, cant be more happy with that. Only downside ofc is that it cant communitcate with pump, however i dont see that as a negative since i just use my phone as reciever in stead and run it over xDrip+ and Nightscout, which is what enables me to have all the glucose data on my watch, while at the same time also having the numbers in the cloud so everytime i am out riding, the people around me can follow it aswell, it gives a good sense of security, i can highly recommend that setup (most cgm’s can connect to xDrip/Nightscout btw, not only Dexcom). I hope in very near future that i can get setup with the new Omnipod Dash (or similar type of pump that can be controlled trhough bluetooth), its not yet available here however i hope to get my hands on it soon, since that will enable me to fully close the loop through either OpenAPS or AndroidAPS, which is gonna take even more of the work away from me :smile:

But yea thats my setup currently, can highly recommend it (also with other types of CGM’s and pumps, xDrip/Nightscout as a datafield on the gps or as a watchface for daily activities is just awesome) :+1: :+1: :+1: