- Thirst – 4-6 litres of water a day, going in and almost straight back out
- Hunger – if it was edible, it was fair game
- Weight loss – lost 10% of my body weight and still going
- Night sweats – I was sleeping on a towel
- Cramps – jumping out of bed at night, calves in knots, 20km of the fell race above was completed with cramping calves
- Massive fatigue
2) transport function – moving blood glucose into the muscles for use when needed, but also knowing that as you exercise you become significantly more insulin sensitive
3) glucagon suppression – normally, when you exercise, as you blood sugar drops in response to the transport into the muscles, glucagon releases stored sugars from the liver. Insulin supresses this, so a double whammy. For short sharp exercise, adrenaline may kick in and do the same, but in an endurance athlete that’s not happening.
- Short sharp exercise, sprints, intervals – no change to doses, but watch the BG level as it can rise or fall
- Steady stuff, in the aerobic zone – at least 3 hours from my last bolus dose, monitor glucose every 5km, eat additional carbs to compensate for the drop
- Long sessions – reduced basal dose, on experimentation I need to reduce by about 60%, massively reduced bolus at the previous meal, typically breakfast. Down to 0.5 unit from typically 2-3 for a bowl of porridge. This one is a balance between the risk of high blood sugars before I set out and the massive drop I get in the first 5km. Prepare to eat, test every 5km and carry 40-60g carbs per hour, plus a reserve just in case.
Breakfast of porridge, nuts, berries 45-50g carbs in all, 0.5U insulin. BG before 5.8, +30min 12.9, +60 min 15.2 – a bit high, +1hr 45 13.2 – just about right.