Virtual Races and Diabetes: Have I Mentioned that T1D is a Pain?

Way back in April, in a moment of... something... I succumbed to peer pressure (shocking, I know, and very out of character) and signed up for a virtual race with a couple friends. The Social Distance Run promised to be goofy enough to appeal to my tongue-in-cheek sensibilities and historic loathing of organised events. With the lure of dad jokes, a cool shirt, a medal, and the slightly terrifying prospect of an actual training plan, I agreed to run a half marathon.

At first glance of the training plan, I went "oh god, training plans. Barf." But since I'm not a quitter (most of the time), I sucked it up and mostly followed it. Two shorter runs, an intervals day (hills or track, but I hate tracks so only did hills), and a long run on the weekend. There was a strength and stability day in there, too, but after doing it twice and limping around like a cripple for a few days after, I decided to stick to the running and leave the "getting stronger" thing for other people.

Gotta say, I've fallen back in love with running. Daniel (of aforementioned peer pressure) did most of the long runs with me (at a socially appropriate distance, of course), which made for an awesome weekend tradition that I'm hoping to keep up after race day.

 

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I've been running for 10 years ish and was so goddamn sure that I had a handle on the diabetes and endurance running. I've talked in the past about my learning curve when I started running and how I'd managed to get things figured out. Welp, it turns out that when you haven't been doing long runs or high milage for a few years and are also, ya know, ageing, your body behaves differently. My diabetes didn't get the memo about behaving the way it did 6 years ago.

This virtual race thing coincided with my relatively new use of Tandem's Control IQ system. Initially, I was super pleased with Activity Mode. It impressed on shorter runs (2-3 miles) and hikes, and as long as I had minimal insulin on board and ate 15g of carbs before starting, it seemed promising and sustainable. When I wrote my review of Control IQ, I raved about it, noting that it was great for physical labor, hiking, and the runs I was doing at the time. 

Welp, fast forward two months and 150 miles and I need to amend my original review. It turns out, my 30-year-old body doesn't like to process sugars or carbs while exercising. Also, I get ultra-sensitive to insulin while running / doing aerobic exercise. Looking back, I always addressed this by carbo-loading and setting temporary basel rates, going into long runs with a high blood sugar, and no insulin corrections. Unfortunately, the Control IQ algorithm doesn't allow you to do this effectively, what with the auto-corrections to keep you in the target range and the inability to set temporary basal rates. 

As I followed my training plan (complete with the promised dad jokes) and upped my milage to 20-ish miles a week, I found myself constantly fighting hypos. I started messing around with my diet in an attempt to stave off the inevitable crash during long runs, joined a couple Facebook and reddit type 1 diabetic running groups, and trying different supplements and gels on the recommendations of other T1D runners. I even tried making my own gummies using UCAN powder (surprisingly easy), which seem to be pretty effective at postponing the BGL crash if I take them 45 minutes before a long run. Supplement with regular gummies and Huma gels, and I think I have the diet thing mostly sorted out. After much struggling and many hypos, I also stopped trying to make Control IQ work for runs farther than 3 miles and started turning it off so I could set a temporary basal rate. I'm definitely on a stats kick right now, tracking my BGL and carb intake throughout my runs.

A major problem for me is that, for some unknown reason (probably because it likes being contrary), my body does not seem to absorb sugars when I'm exercising. What this means in practice is that I start a run, begin trending low, treat with some fast-acting sugar, and nothing happens. I can take on 60g of sugar during a run and still maintain a gradual (or fast) downward trend until an hour or so after the run is over, at which point it all seems to absorb at once and I skyrocket back into normal range (sometimes I get high, but as long as I don't keep treating the low, I don't seem to rebound in an extreme fashion). Basically, my best outcome for a long run is to slow the decline enough that I'm finished before it gets dangerously low.

Have I mentioned how annoyed I am that my old method of "carb up, wait 30 min, then run" no longer works?

Further complicating matters is the fact that I've been having some pretty gnarly reactions to the Dexcom adhesive, making my CGM use a bit sporadic. I've been on the phone with Dexcom about this repeatedly, and they insist that nothing has changed in their adhesive or manufacturing. I call BS. The T1D running forums are full of people complaining about abruptly developing allergic reactions to the Dex adhesive and seeking ways to mitigate it. So far, I've tried Flonase and IV Prep to create a barrier (to no avail). This week I tried some Skin Tac barrier, but it's definitely not going to last the full 10 days; at this point, I'm hoping it stays on through my half marathon before the reaction bubbling under the adhesive rejects the CGM completely. The next attempt will be an actual adhesive barrier like Tegaderm, which I've been trying not to do because I have a history of reacting to similar products. I have photos of the reaction progression. They're not pretty. If you want to see them, I can show you, but let's spare unsuspecting eyes the trauma.

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Tomorrow is race day. I have a plan. The plan involves lots of complex carbs in the morning, a bunch of slow-release carbs during the run, and a beer at the end. Ev and I are aiming to meet Daniel around his halfway point (crazy guy's doing a marathon) and finish the run together at a brewery.

Let's be honest.... I'm really just in it for the beer.

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Update:

Half marathon on the books. And apparently, I finally got the diabetes part right (shocking, I know). Also, selfies while running (and dying) are super flattering.