Tag Archives: Chris Scully

Logging for Rebels (Guest post)

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Please go to Chris Scully’s wonderful diabetes blog here and check out my guest post for her.  It’s about my lazy way of tracking my glucose trends in order to make the right adjustments.  Let me know what you think!  Suggestions are welcome!

Happy Wednesday to you.

An Intro to Running with Diabetes

Chris

This is a guest post from my dear friend and adventure seeker, Chris Scully who blogs at CanadianD-Gal.  I read an old post of hers recently where I realized that she didn’t always run half and full marathons and it hit me that everyone has to start somewhere.  Many of her posts detail her diabetes management prior, during, and post run (or bike) and she is a world of knowledge when it comes to handling intense and long duration exercise and diabetes.  For all of you wondering if you too, could become a runner, check this out for some seriously valuable advice.  Take it away Scully!

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I am not a professional.  Not even close.  I have learned everything through experience and trial and error.  Please consult your physician/CDE/Endo on how to start running while managing diabetes.

30 seconds into it and I feel like I’m going to cough up a lung.  I’ve never breathed so hard in my life.  I feel dizzy and nauseated.  I have no idea how some people do it for 26.2 miles at a time.

I’ve taken my first steps into running.

I think it happens to everybody who decides to pick up running.  That is the best thing one can try to remember.  Pretty much EVERYBODY goes through that.  The trick is not letting that feeling make you want to throw out your running shoes.  The trick is getting PAST that feeling.  It’s going to hurt no matter what you do.  The other trick is learning to harness that discomfort and find a way to level it out.

The best piece of advice I can give from someone who tried many times to become a runner is “SLOW DOWN”.  I think most of the time new runners bound out the door sprinting rather than running.  It’s hard to tell that you’re probably going too fast when you’ve never run before.  Take it slow and steady.  Walking does not make you a failed runner.  Some people learn very well with the walk/run approach.  At the beginning, walk more than you run while eventually increasing the run time and decreasing the walk time.  Slow down and ease into it.  It’s going to hurt at first and it’s going to hurt a lot.  Let your body recover between runs.  With time and patience the pain will subside.

Learning to run takes a long time.  Especially if you have very little athletic foundation to begin with.

One of the things that helped me more than anything else is an article I read on breathing while running.  This was over 10 years ago so I can’t quote it and have no clue where I read it but it goes like this:  2:3 ratio.  2 in, 3 out.  Breathing, it’s that simple.  2 steps of inhaling, 3 steps of exhaling.  The day I put that to practice is the day I learned to love running.  I remember reading that your exhale should be longer because you want to really empty your lungs. Focus on long deep breaths from the belly, not the diaphragm because then you end up shallow breathing.

To this day I let my breath guide my body and it has become second nature that I am always counting the breaths in my head.

Running with breath allows control I find.  There’s two ways to look at it, let the body guide the breathing or the breathing guide the body.  If you force one, the other will follow.  This breathing technique is similar to the “conversation” marker.  Can you feel like you can carry on a conversation with a running partner? If the answer is no, then you’re running too fast.

That’s how I learned to run.  That’s what worked for me.  Paying close attention to my breath made it so it stopped feeling like my lungs were going to explode out of my chest.  It taught me a comfortable pace that I could eventually maintain for longer periods of time.

As for the diabetes aspect? I haven’t always had an insulin pump and I wasn’t always the most responsible diabetic.

When I began running (post diagnosis) I didn’t have an insulin pump.  I was on shots of Novorapid and Lantus.  The timing of the runs were what was most important.  I was an evening runner so hopefully there wouldn’t be any weirdness from leftover insulin and food by the time I got home from work.  I probably took a bad approach to it because I wouldn’t leave the house if my BG was under 10.0mmol/l (180mg/dl).  I would normally eat a granola bar or something that my stomach wouldn’t try and regurgitate half-way into the run.  There was a lot of waiting.  I would still carry my glucose meter and some sort of fast acting sugar just in case and would really only use it if I was low.

I don’t remember very much from the running and pre-pumping days.

Blood sugar management while running really depends on a lot of factors.  Doesn’t it always though? But seriously, I’m going to stick strictly to running for now.    The key to my success (when I have it) is the temp basal option on my pump.

What effects the BG while running?

-Types of runs, ie: Speed work, LSD (long slow distance), Hill repeats, short runs, etc… etc… etc.
-Time of day
-personal insulin requirements
-duration, intensity

LSD runs are usually anything over an hour.  They are meant to be run at a slower than usual pace and therefore won’t rid me of glucose as fast. However, because they are long (for me 2 or 3+hours) eventually I will run out of stores.  When preparing for my LSD runs I find it optimal to manage my blood sugars so that taking in a gel or the equivalent of 25-30g carbs per hour won’t ruin my BGs.  If I set my temp too low, I might have to take insulin with my gels.  I need the fuel during the long runs just like a non PWD and having to take any amount of insulin is sketchy.  I try not to have any IOB since I find even just a little bit of insulin can have a huge effect.  Though if I do need some insulin just to take the edge off or if I’m high when I really need a gel, I will take a bit.  maybe just a unit.

Early mornings for me are different.  I usually run about an hour but I am super insulin resistant at that time and don’t need to do anything for my BG.  I don’t need a temp basal even though at that time my basal rate is at the highest for the whole day.  I run on an empty stomach and my blood sugar still rises by the end of the run.  Unless I am low before the run, I don’t need any carbs.

My evenings are when my basal rates are the lowest and subsequently when I am the most insulin sensitive.  I need a very low temp basal and usually still need to eat something before I run.

I find when I run under 1/2hour it’s easier to do nothing than to suffer the consequences of post run high BGs.  It’s too short to effect my BGs.

Post run is touch and go.  I often need to set a high temp basal before the exercise finishes.  That would be to counter the effects of the extra glycogen that is released from the liver and is now running rampant through my body when I stop.  I will set a +50% temp basal about 20 minutes before I’m done running and leave it on for 2-3 hours depending on the time of day and how it relates to my insulin sensitivity factor.

About 4 hours after the run is when my BGs will start to go down and I might set a -15% basal.  More often than not this is when I’m ready to eat and I will just make adjustments with my bolus.

So the main factors to remember are:

-Your personal insulin sensitivity at that time of the day
-The intensity of the run – high intensity often means higher glycogen being released (depending on the duration of course)
-The duration of the run – the longer the run, the more glucose stores you use up

ON THE RUN!

I carry at LEAST 1 gel at all times.  The longer runs I will have 2 on my person as well as the bananas and dates that I stash ahead of time with water.  I never run without my glucose meter.  EVER.  I used to carry it in my hand the entire time.  That was before I discovered Tallygear.  I used to test nearly every 15 minutes for learning purposes.  Now I test about once an hour unless I feel weird.  I always carry my phone on longer runs in case of emergencies, diabetes related or otherwise.  I don’t have a medical ID because I rely on my medic alert tattoo but that’s important too.

TIPS FOR STRIPS!

They don’t work in the cold or when they are wet.  My meter acts up at about 5C (41F).  The strips will sustain a bit colder but not the meter.  I put hand warmers in my meter case all winter long.  If they are wet, they won’t work.  Even just a little bit of sweat.  Mini Zip lock bags work but I find they still get wet inside after awhile.  I have been using the strip container but the rattling of the strips drives me bonkers.

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The best thing I can say is, start slow and always carry a glucose meter and sugar no matter what.

If there is something about running and diabetes that I might have some experience on, feel free to contact me.  I’m always willing to share, even the embarrassing problems.   I know what I know because I put myself through the “learn through experience” program.  Available everywhere.

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Thank you, Chris!  I am so eager to put this advice to work and I’m sure many others have appreciated an insider scoop.  I urge everyone to check out this post on Chris’ blog where she talks about her love of running and how far she has come (and potentially, where you and I could one day be because frankly I’m still in the huff and puff stages).  Just knowing it takes time and practice and knowing what to look out for blood sugar wise makes me very hopeful.

Interview with Chris Scully, Adventure Seeker

Chris at the Himalayas right before snowboarding down
Chris at the Himalayas right before snowboarding down

 

Chris Scully writes at her own blog Canadian D-Gal.  I have been following her posts for some time.  After reading I frequently come away with a feeling of “whoa this is girl power and diabetes power’”. You see, Chris, despite being a type 1 diabetic, is very in active outdoor sports.  She caught my attention big time when I learned she had backpacked for 4 months in South East Asia and lived abroad in Taiwan for two years while teaching English. It’s not an impossible feat.  Yet, I feel extremely intimidated just thinking about going off into the wilderness as a type 1 diabetic. Or living in another country, for that matter.  Even for a day.  So her experience means a lot to me.  It says, “you can do it”.  We diabetics can use that reminder every day.  We can’t let it hold us back from what we really want to do.

I’ve asked her a few questions about her experience and here are her answers:

GG: Chris, I’m curious, what are all the outdoor activities you do? How do you manage your diabetes on those activities?

Long distance running and cycling, spin class, stair climbing, mountain biking, rock climbing, rollerblading, snowboarding, snow shoeing, hiking, back-country camping including backpacking and canoe tripping.  I’m sure I’m missing a few things. I manage it all quite differently since the activities differ greatly.   A lot of these things I do alone and that makes some activities harder than others. Since the pump, the Temp Basal Rate option has become my best friend.  I owe all my successes to having that feature.  It requires careful pre/post-planning and constant monitoring throughout.  Protecting my meter also being my number one priority.  Keeping it dry or cool/warm.  Keeping it close and protected while always having spare batteries, lancets and strips just in case.  Without being able to check my blood well then I’d be going at it blind.  Which I’ve done on many occasions and where I learned most of my lessons from.  Always having different kinds of fast-acting sugars depending on the situation.  Most importantly being able to address the situation no matter what might arise.  Contingency plans whether it’s carrying too much glucose or notifying family of a possible phone call is key.  Knowing that things can and probably will go wrong is not something to ignore but something to keep in mind at ALL times.  If I didn’t go out there with the utmost confidence that I will do my best to handle whatever situation arises I would never go out.

GG:  How long have you engaged in outdoor sports?

Since I was a young teenager.  I started rock climbing and back-country camping at 14.

GG: Ok, so you spent two years in Taiwan teaching English.  How did your life take you there?  And how did you do with your diabetes management while there?

My boyfriend at the time and I thought it would be a neat experience to teach English in Taiwan.  As far as diabetes management it was hell at first.  I went with all the supplies I had which was only a few months worth.  Once I got settled I had to find out how the “system” worked. My mum was back home frantically trying to find a way to ship it to me but it was too much trouble requiring import/export licenses.  I qualified for a Taiwanese health card.  I had to go to the hospital (only on Tuesday nights) and wait in up to a 3 hour cue to get my prescription.  They would fill it right there in the hospital and it cost me almost nothing.  There was a language barrier, so once they got used to me coming once a month there weren’t many questions.  They would only ever give me 1 month at a time. I had to buy my test strips at the store for full price.  I never got blood work done the entire time I was there because of the language barrier and I was a pretty irresponsible diabetic back then.

 

One of Chris's Kindergarten classes in Taiwan
One of Chris’s Kindergarten classes in Taiwan

 

GG:  Did you discuss this trip with your health care provider before taking it?  If so, did you receive any help or guidance?

I came home for a visit from Taiwan after the 2 years teaching before I went back to travel.  I met with my CDE at the time.  I had no travel plans set in stone but I told her all the countries we may or may not visit. She then contacted Lily and got a list of which countries had what type of insulin.

Some countries had only the old school “N” stuff where you must wait 30 minutes before eating.  Some countries didn’t have pens or some had only Novo insulins.

Taipei, Taiwan
Taipei, Taiwan

 

GG:  When you backpacked through South East Asia, what places did you travel through?  What was the most “diabetic friendly” place?

Thailand, Laos, Cambodia and India.  None of them were diabetic friendly as far as food options but Thailand was the most diabetic friendly for medical care.  I quickly learned how to read “carbs” in different languages.

Southern Thailand
Southern Thailand

GG: I understand you were on MDI (Multiple Daily Injections) while in Taiwan and during your 6 months backpacking.  How did you keep your insulin?  Where did you buy it?  Did you need a prescription for anything while abroad?

Wow.  This might take awhile to answer, I apologize in advance! Well Bangkok is basically the hub of south-east Asia for backpackers. We used to go to Bangkok for the weekend since it was a cheap 3 hour flight from Taiwan.  Needless to say I knew it VERY well and treated it like my second home.  The first thing I did once arriving was to go to the recommended hospital for foreigners and start poking and prodding around to get some information.  Armed with my “list” from my CDE I knew that Bangkok would be my best bet.  The doctors I saw here were extremely friendly, knowledgeable and helpful.  This is where I was first introduced to Lantus! I received a months worth of supplies.  Pen cartridges, pen needles, bottle of Lantus and syringes.  It wasn’t cheap, I had to pay full price for it. From here I decided it would be easiest to just return to Bangkok once a month for refills. The other countries were much lower class and it was unlikely I would be able to find what I needed. Also, traveling 16 hours on overnight buses/trains/boats and staying in cheap guesthouses with zero luxuries meant that carrying more than a months supply was impossible. We had, however, planned on spending 2 months in India in which getting insulin there was going to be a necessity since Bangkok was now an expensive flight away.  I spent the first two days in New Delhi traumatized by the insanity of the city all the while getting sent on wild goose chases just trying to find where I could buy it.  I couldn’t get it through hospitals like Bangkok (I was led to believe) and although Indians speak a lot of English they were the least bit helpful.  I eventually found some random little apothecary/booth thing that looked eerily untrustworthy and they sold me a disposable Novorapid pen at an outrageous price.  Luckily I never had to use it because I cut the India trip short.  I don’t remember him pulling it out of a fridge either.

GG:  Now that you use a pump, do you think you would have been able to do all this on the insulin pump?  How do you think having a pump would help or hurt experiences like the ones you’ve had?

I don’t think a pump would make it any more difficult except the fear of what happens if the pump malfunctions.  This was also a number of years ago and who knows what’s changed as far as insulin availability in other countries.  I would still need to get vials of insulin somehow.  Pump supplies I would certainly carry them all with me.  It would probably be easier with a pump.  It might even be easier to research it nowadays. It would require a bit more careful attention.  Like when swimming around in waterfalls/oceans or scuba diving.

GG:  What was the hardest thing, diabetes-wise, about your experiences abroad?

Knowing I couldn’t travel on a whim.  Everybody else was just going with the flow and I envied that.  I never got to visit Vietnam like we had planned because of time constraints on my insulin.  I spent an extra two weeks in Cambodia before going back to Thailand because we were having such a good time and we were days away via bus/train/etc.  I had been running my insulin for over 6 weeks in insane heat.  I know I wasn’t feeling so hot. Keep in mind I didn’t know nearly as much as I do now. Oh the other hard parts were having hypos in strange places like the killing fields in Cambodia, or the middle of the night in a sweaty strange grungy guest house.  Oh and its hard to drive a scooter hypo.

GG:  What advice would you give to a diabetic interested in doing something similar?

  1. Have a plan.For example, I used the “shoestring lonely planet guide to South-East Asia”.  So I was following dirty hippy cheap backpacker routes (YAY!) So I knew I couldn’t rely on refrigeration.  I went armed with some decent health insurance also.  Traveling in 3rd world countries as an insulin-dependent diabetic just meant I had to be extra careful which I was.
  2. Have a friend.My boyfriend at the time was always looking out for me.  He understood the dangers of traveling with a type1 diabetic.  Trust me, I needed him on more than a few occasions.  He was often running around in search of sugary drinks when I ran out of whatever I had with me.

GG:  What is your greatest memory from your trips?

Climbing up the Himalayas with snowshoes above the treeline in Northern India and experiencing a touch of altitude.  Then snowboarding back down.

Was diabetes there?  I can’t even remember!  I can’t forget all the adventures of teaching English in Taiwan.  That was an experience I’ll never get again and I loved it all.

GG:  Would you do it all over again, diabetes and all?

Mekong River, Laos
Mekong River, Laos

 

 

MOST DEFINITELY!  These are some of the best memories I’ve ever had. I’ve daydreamed about doing something like this again ever since.  I laugh now at the gallivanting around Delhi in a rickshaw trying to find an insulin pen. Most importantly, I barely remember diabetes distracting me.  It certainly wouldn’t have been the best for my Diabetes management to do this for say a year.  We gotta give in somewhere.  I wouldn’t trade that experience for anything.  Even if I did end up in a strange room half passed out in some mountain village in India with a doctor spending an hour trying to find a vein to insert an IV into me.  I’m happy to forget that experience though.

 

Thanks so much for answering all these questions, Chris!  I never realized how hardcore you are until now.  I’m sitting here quite amazed.