Black and White, Yin and Yang, or Sometimes it all goes to Rat Shit

So far it’s been about 6 months since I started on the Insight pump and I’ve put in quite a bit of hard work in learning how to trim the pump to trim the pump for exercise. Learning the timing of run vs bolus, how much to reduced bolus for imminent exercise, use of temp basal in terms of scale and timing of reduction etc and it’s starting to pay dividends, to the point where I can now consistently manage a 10km run or hour bike session on little to no additional carbs, typically 10-20g and I’ve managed one session of an hour and 15 mins on the bike with no carbs at all.

With an eye on the Autumn ultra marathon in the plan, I’ve started to up the length of longer runs looking at getting back to ten miles/16km for now and then building from there.  I have to say though that it’s not always going according to plan.  Overall the legs, feet, musculature, achilles are all still feeling good and I think I’m being more proactive in massage and mobility exercises which will help.  But sometimes despite all that it just doesn’t quite work, and it’s those failure that are sometimes the most valuable learning points.

Take an example of a recent run after lunch.  The lunch was low carb so no bolus taken and the basal was being managed as expected.  Al that done, I set out on the planned 15-16km run intending to keep an easy, steady pace with a low-ish heart rate, but it never felt right.  Worst of all I felt sick, had to stop two or three times at the side of the road and nearly threw up, I really couldn’t stomach the carbs I needed to take onboard.  I did need to stop for the toilet twice – lucky for public toilets, the HR too high, pace too low, and for the first time in over 6 months developed a stitch.  Overall one of the worst runs of my life, and I contemplated finishing it early more than once, but eventually stuck it out to 14km.  Looking back at it there is nothing specific that I can lay my finger on in terms of activities before it, and the only thing I can come back to is eating too heavy a lunch before the run

Contrast with next few weeks where it all went swimmingly, and last week with 5 days consecutive, totalling 32 km run and >160km on the bike split over 5 sessions.  So what was different?  Not really sure, maybe just taking a bit more time to prepare, I probably had a bigger gap between eating and running by just an hour or so, and maybe that made all the difference. More experimenting needed I think

I’m also starting to plan for my holiday where I’ll be taking one of my upright bikes and trying to get at least two decent rides in, so that’s necessitating training in between.  I’m also putting a slightly lower gearing on it as it’s a bit hillier than the wild Fens, although probably not as windy if last week was anything to go by.

I've bought myself copies of the maps for the Bob Graham Round as well, starting to look at the route, with a view to an atttempt about this time, maybe mid June next year, but first I need to make a plan to train/familiarise.

Otherwise, garden is coming on a treat, veggies romping away both outside and in the greenhouse, and the bonsai are also starting to look very good again.  Here’s an example of a maple that I’ve been growing for the best part of 15 years, from a seedling.  The overall shape is about where I want it now, although the left-right balance needs some adjusting and the trunk needs more time to develop a better taper.  Give it another ten years or so and we’ll be getting there.

This week has been something of an interesting experience, from a running and diabetes control point of view.  I’ve been offshore on a floating platform, so running on a treadmill which is never the best, but made much more interesting when that treadmill is also moving side to side and back and forward as the vessel moves.  Diabetes control has needed a different mindset around the exercise as the evening meal tends to be early offshore, typically 6pm, which is when I’d normally exercise, so it’s swapped the order of things around.  The strategy I’ve adopted, reasonably successfully is to do a normal basal reduction ahead of the run, and minimal bolus at the meal - a typical reduction by 75%, then run about 30-45 mins later before BG has jumped too high.  As usual test during the exercise and take on carbs appropriately depending on where I started and where I ended up.  Starting at 8.x needed carbs mid run, and ended in the low 4.x, starting at 10.x brought me down to about 5.x with no carbs.

The running  this week, more to come at the weekend, was 
8km   / 43:25 / 5:17 per per km, Ave HR 133, Max 144
10km / 51:26 / 5:09 per km, Ave HR 136 , Max 150
10km / 51:19 / 5:08 perkm, Ave HR 138, Max 150

Those of course are all on a treadmill, I'm not going to do laps of the helideck after all.   Today was a mixed on/off road locally and when you take the vagaries of wind and terrain into account, for the same pace the average HR was around 145 over 12km.

In my defence, I've been quite busy

Yes, I know I’m rather sporadic at this, but even I was surprised at almost two months between paltry offerings, but in my defence I’ve had quite a bit happening in that timeframe.

At work, March is normally lunatically busy, but this year it was even more so.  With a Government imposed deadline there is always a bit of a crunch, but this year we just seemed to be less well organised than usual, as a result I ended up putting in about ten days of 12hrs plus to the end of March.  I would be getting up at 5, working for a couple of hours before breakfast, quick stop to eat, work until 5pm, maybe a very short run or something else, eat, and then work again until about 11pm.  And even with that, we still managed to miss the deadline on some of the submissions, and the fall-out is still being felt.

I also bought a new bike in March, but didn’t get to ride it until April.  Here it is, the more perceptive of you will notice that it’s not quite the usual.  I’ve always had a hankering for a recumbent, supposedly much more efficient aerodynamically and more comfortable over longer durations and I’ve been finding that anything over 2 hours on a normal upright bike is leaving me with sore neck, wrists and shoulders these days.  With that in mind I went and tried a few out at a local dealer, and even with a fall from one of them went away with undiminished enthusiasm.  This one then came up for sale on one of the forum boards and even with it being on the other side of the country it was a good deal, done in the car park of a motorway service station half way between me and the seller.  It’s about 5 years old, but has been ridden only a few hundred miles in that time and the previous owner was given a distinct ultimatum to “get that thing out of the spare room if you're not going to us it”. This summer’s project is now learning to ride the bloody thing!

 

So far I’ve had a couple of 1 hour rides and one of 40miles/2hr 30.  I’m not fast on it yet because it’s under geared for my local conditions, has smaller wheels than ideal, and fatter tyres than ideal.  But as I’m not yet instinctive in riding it, those things tend to be taming the overall package appropriately.

It’s also busy season in the garden of course, and I’ve been busier than usual.  The veggie bed has been transformed with three new raised beds, built and filled by me, now seeded and waiting for the fruits of the earth to emerge and multiply. As I write this, the dwarf french beans are going like the clappers, the beetrooot and chard are starting to emerge and the salads and cucumbers are doing nicely.  The broad beans, tomatoes, chillis, peppers and brocollis are still waiting to emerge as are the leeks and roots, but its still early days and most of April was very dry. 

Some of the bonsai have also given me a spectacular early season displays.

In amongst all that I’ve been getting on as usual with a bit of running, cycling, strength training etc.  Since getting the pump I’ve been relearning a bit about how to manage exercise and insulin as it’s not quite the same as on MDI, but as with all these things it’s a case of using the books as a starting point and then experimenting, to get a series of heuristics, or “rules of thumb” that you can apply personally in given circumstances.  So far my experience has been that it is vital to get the basal right and that it can change more than you might expect over a short period of time. 

Whether absorption has become more efficient, or whether it’s due to the change to steel rather than Teflon cannulae I don’t know, but I’m now around 20% lower in basal needs than when I started.  My rules of thumb from that starting point are now;

• Cardio sessions (bike, run, row) of less than 1 hour need a 30% TBR for 3 hours previously, and between 15 and 25g carbs to prevent unaccepatbe pre-exercise highs and mid-exercise lows.  Unfortunately this can lead to a post exercise rebound, which needs to be carefully managed. If <3 hours from the previous bolus either more carbs are needed, or the bolus needs reducing.
• Strength work – HIIT type weights sessions need no TBR and generally end up with a stable or increasing BG.  Treatment of the high post exercise is not a good idea as it’s just due to a liver dump, which then gets reabsorbed.  Treatment of it almost universally results in a hypo
• Yoga – just go with the flow man, and peace out! No, really, it has very little effect at all on BG as it’s a comparatively mild exercise from a cardio point of view and probably has a small release from the liver.
• Long rides/runs – These are normally in the morning at a weekend, so far I’ve been getting away with wake up, turn on the TBR, eat breakfast, reduce bolus dose by 2/3, eat to the meter during the run/ride tesing every 5km running/30-45 mins riding.  Typically 30-40g carbs/hr needed.  I think I need to tweak the TBR a bit here, perhaps going as low as 15% of normal.

And I can hear you asking, what about racing plans for this year? Please tell us.

So far, not much is the answer, I’ve been in something of a doldrum in running terms, stagnating a bit after last year’s output.  I’d thought about a short ultra (35miles) in May, but psychologically that was not going to happen and training did not even start, let alone progress anywhere. As an example my average run has been around 8km so far this year, and only in April have I gone over 10km, and found that hard going in the wind – a clear example of habituation and specificity.  I have however signed up for a race I’ve had in the plan for a while, the River Ayr Way in September, a nice 44 miler following the River Ayr from source to sea.  That gives me long enough to come up with a plan and to work out the logistics, particularly as the race is on a Saturday and I’m, likely to be flying to Algeria on the following Monday. I also have a hint of a Bob Graham Round working away in my brain at the moment, plus another local looney willing to attempt to.  That would be a serious undertaking, 66 miles in the Cumbrian Fells with 27,000ft of climb in under 24 hours. http://www.bobgrahamclub.org.uk/

Most recent data sets?

2hr 30 on the recumbent in windy and cold conditions.  Porridge beforehand about 30g carbs, bolus reduced from 1.2U to 0.4U and TBR of 30% set for 5 hours.

6:30AM – breakfast, 30g, 0.4U, 5.2

8:00 AM – set off BG up to 8.9

Mid ride tests

30min – 3.6, 20g carbs

60min – 4.9, 20g carbs

105min – 3.3, 30g carbs – oops

150min – 4.7, 10g carbs

Lunch – 25g carbs, bolus reduced by 50%, 0.5U, pre 6.1, post 7.0

Learning point – TBR for a long run/ride probably needs to be nearer 20% to avid those big dips in the middle.