Nutrition And Diabetes: What Is An Athlete To Do?

I am an endurance athlete. I have lived with type 1 diabetes for 30 years. I have survived two bouts of breast cancer. I founded the Red Rider Recognition Program that celebrates cyclists with diabetes who ride in the American Diabetes Association Tour de Cure. I am the founder and president of Team WILD: Women Inspiring Life with Diabetes, an organization that coaches and educates women with diabetes in fitness and endurance sports. As a result of who I am, I regularly get asked this compelling question:

“What should I eat when I”m exercising?”

Usually the person asking me this question is someone living with diabetes. They are genuinely perplexed about their nutrition while exercising and managing diabetes. When they ask this question, I can feel their nearly desperate hope that I have a quick simple do-able answer for their inquiry. How I wish the answer was quick and easy. There is an answer, and I have spent considerable time thinking about the answer, experimenting with the answer and putting together resources to help others answer this essential question.

In my extensive experience, here”s what the journey toward the answer looks like. I began, and I think people with diabetes who are seeking the answer to, “what should I eat when I am exercising” should begin by answering some additional questions and doing some introspection. Here”s what I suggest seekers consider: What medications are you taking? How do these medications impact your blood sugar levels? How often do you test your glucose levels? Are you willing to test your glucose levels more often if needed?

And continuing with a few more questions, Are you keeping a log of food, exercise, medications, blood glucose levels? Are you willing to keep logs of these things for at least a few days in a row each month? Do you understand the scientific method? Are you willing to learn and study your own body as if you are your own science experiment? What do you already know about sports nutrition? Are you willing to learn more about sports nutrition for athletes who do not have diabetes as well as for athletes who do have diabetes? What do you already know about exercise and the impact on diabetes management? Are you willing to learn about exercise and diabetes management? Are you willing to believe and understand that while there are general guidelines in sports nutrition and in diabetes management, each individual person is an individual body and the what and the how of peak performance will be highly individual?

And there are more things to consider: Are you clear about what level of fitness you are at now? Do you have fitness and exercise goals? Do you know that the nutrition requirements shift depending on your fitness level, your fitness goals and your performance goals? Do you have friends and family who support you in your goals? Do you have athletic coaches and medical support to help you learn and reach your goals?

That”s a lot of introspection and quite a few questions. In my work world I am a professional asker of questions! I like questions. And I especially like helping people delve into their personal answers to these questions. For the sake of this article, I will attempt to give you some insight into how I answer these questions on myself.

This year, my goals are to lose about 10 more pounds during the off season, which goes from now until April 1st. Then starting in April, my season will begin and I will no longer focus on weight loss but will shift into training and performance mode.

First, right now during weight loss season, I exercise between 4 to 6 hours per week. I plan my exercise in one hour bouts, thus I can time my meals and my exercise so I can keep my need to consume extra calories to a minimum. I also time my insulin with my exercise so that I don”t have low blood sugar incidents that require extra calories. In other words, exercise bouts of less than 60 or 90 minutes in duration generally do not require extra calories, especially if timed near meal times and snacks. I know quite a bit about exercising and weight loss and I have consulted extensively with a diabetes educator who is also a sports dietitian about how to best approach weight loss and nutrition in the off season. The key thing I learned early on is that it is virtually impossible to lose weight during the training season! If one seeks performance, then one can”t be depriving the body of the fuel it needs to perform!! Thus, lose the weight in the off season and start the season at race weight. During the season, you still pay close attention to calories in, and the quality of the food, it”s just that you use the calories for performance, not for weight loss. This important insight has guided me to successful weight loss and weight maintenance for several years now.

Once the season begins for me on April 1st, I will slowly begin to increase the hours I spend each week doing aerobic exercise. I will move to at minimum 7 hours of exercise per week up to 15 hours a week at my peak of training. I am training for a 70.3 triathlon with Team WILD. The race is October 2 and for it I will swim 1.2 miles, bike 56 miles and run 13. 1 miles all in the same day. The one and only other 70.3 that I did it took me 7 hours and 35 minutes to finish. My goal is to reduce that time by 30 minutes. I believe with the fitness I now have and the weight loss I have done, I should be able to meet this new time goal.

As I increase my exercise bouts from one hour at a time to up to 4 and 5 and eventually 7 and 8 hours at a time, my nutrition focus will shift. The general guideline that I follow is 30 to 60 grams of carbs per hour of exercise. I start eating before I start swimming, biking or running. I aim for about 40 grams of carbs per hour, that seems to be my “sweet spot” for peak performance. I weigh 138 lbs at the moment, which is about 10 lbs less than last season, so we”ll see this year if 40 grams is still my ideal amount. I will do extensive record keeping to figure out if 40 is still my ideal amount per hour.

I consume these calories mostly in the form of cytomax and gu. These are the brands that work for me. I”ve done some heavy experimentation and these are the products that work in my gut and in my body. Remember, what products you choose are the ones that work for you. There are no products that are better or worse, even though the brands tell you theirs is the best. The key is experimentation. I would ask that when you find the ones that work for you, go ahead and tell others, but keep in mind, just because they work for you does not mean they will work for anyone else!!!

You might wonder, what does she do about insulin? Well, that is an excellent question. I think about what my insulin and what it is doing all the time. In fact, I think about my insulin much more than I think about my blood sugar. My goal is to make sure I have just the right amount of insulin on board to cover the calories I am consuming to achieve maximum performance and to keep my blood sugars in the ideal performance range. Rather than focus on blood sugar level, which is an end result, I think about calories, exercise and insulin first. Once I made this paradigm shift in my thinking, I have achieved much higher performance, and ironically, much better blood sugar control.

My insulin strategy for an exercise bout depends on what I”m going to do. I start my strategy hours and hours before I begin the exercise. If I”m going to do an extended session, of more than 3 hours or so, then I get up and eat breakfast and do a full bolus for the meal 3 hours before the session will begin. In this way, I will not have active bolus insulin on board for the exercise session. This helps prevent hypoglycemia. I use my basal insulin to cover my calories/carbs during the exercise. Therefore, I rarely lower my basal rates more than 10 to 20 % during exercise. I set the basal rate down at least 90 minutes before starting the exercise so as the new basal rate is in full effect when I begin the exercise.

As I get more fit and am more effectively burning my carbs during exercise, I don”t lower my basal rates at all in order to cover the calories I will eat during the exercise. I should mention that as I get more fit and am exercising several hours every day six days a week, my overall basal insulin drops by 20 to 25% compared to my off season basal rates. I do basal testing several times per year and at key moments in the season to make sure I”m on point with this important background insulin.

I hope that getting a little glimpse into how I think about nutrition, diabetes and exercise gives you some insight as you grapple with this important question for yourself. I know it is actually rather complicated, however once you delve into it and start to learn and explore, it”s my hope that you discover that you are amazing. Your body is unique and incredible and extremely interesting! As humans, feeding ourselves for nourishment, performance and comfort has occupied us since we came into being. Diabetes just makes things more interesting. A little more spicy in fact!

For the women out there who want some support, education and guidance from expert coaches and sports dietitians and incredible diabetes educators, I founded Team WILD: Women Inspiring Life with Diabetes just for this reason. This was the resource I wanted when I started exploring how to be an endurance athlete with diabetes. There is something for every woman with diabetes at every fitness level at Team WILD. Please check us out at http://teamwild.org. And to all people with diabetes, you are worth it! Learn about your body, learn about fitness and then get out and move!!