Diabetes type 1 and running.

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spence

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Type 1
Hi guys. Want to get back to running soon. Have had type 1 since October and tried to run once but ended getting near a hypo. I have 15 units of long lasting insulin in the morning and 2 units of fast acting with my evening meal. Is there anyway I can go out and not need to worry about dropping down to low. We only aim to do a 3 or 4 miler.? Any help be fab, thank you
 
Hi @spence What time do you go running? When I exercise I use a combination of reducing my bolus and eating extra carbs (before and during). What insulins (names) do you take and do you count carbs for your evening meal?

If you’re not having bolus/fast insulin for your other meals, perhaps your basal insulin is doing some of the work of a bolus insulin and you could manage with less?
 
I take abasaglar (slow release) in the morning and flasp (rapid insulin) at evening meal time m what is bolus? Not counting carbs yet. Should I be? Thanks for your reply.

Inka said:
Hi @spence What time do you go running? When I exercise I use a combination of reducing my bolus and eating extra carbs (before and during). What insulins (names) do you take and do you count carbs for your evening meal?

If you’re not having bolus/fast insulin for your other meals, perhaps your basal insulin is doing some of the work of a bolus insulin and you could manage with less?
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spence said:
I take abasaglar (slow release) in the morning and flasp (rapid insulin) at evening meal time m what is bolus? Not counting carbs yet. Should I be? Thanks for your reply.
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Yes, you should be counting carbs. It’s crucial and will help your control and also your running because you’ll be able to calculate the carb amount that works for your running. Carb counting is simple. It always used to be taught at diagnosis, then a few hospitals seemed to decide it was ‘easier’ for Type 1s not to be taught it. It’s not easier at all. It makes life harder and means you’re driving without a map or satnav.

So, I really recommend you get a couple of good books about Type 1 and also look at carb counting. You can’t control Type 1 without it.

Here are two great books about Type 1:

Think Like a Pancreas’ by Gary Scheiner.

And Type 1 Diabetes in Children Adolescents and Young People by Ragnar Hanas (ignore the title - it’s great for adults too)

For carb counting there’s BERTIE:

https://www.bertieonline.org.uk/

If you say when you go running, then we can make suggestions to help. You’d probably find a twice daily basal like Levemir more flexible too.
 
Inka said:
It always used to be taught at diagnosis, then a few hospitals seemed to decide it was ‘easier’ for Type 1s not to be taught it.
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NICE recommends it be taught, but they suggest around 6 months after diagnosis. (The structured education they recommend includes other stuff, too, but a lot of it is about varying insulin dosing. Also includes some strategies for exercise (depending on the specific course).)

There are some videos (including participation by sports people) that Abbott and (I think) ABCDiab produced which include some more sophisticated strategies. Those are a bit Libre specific (would apply to other CGMs, obviously). (The basic idea is to reduce insulin before aerobic exercise (and perhaps afterwards, too), and/or eat. More subtle ideas include eating lower-carb (so you need less insulin for the food so there's less insulin in your system when you exercise), and mixing aerobic and anaerobic exercise (the latter can raise blood glucose, apparently).)
 
When I did the local equivalent of DAFNE, it included a section on exercise.
I wonder if the Bertie online course covers it to
 
6 months after diagnosis is stupid. Basic carb counting should be taught at diagnosis. It’s not hard and it makes life easier.
 
Oooh yes - on diagnosis I was handed a Roneo'd leaflet telling me eg approx 7 chips = 10g, one egg sized potato = 10g .... but hang on said I - what size egg is this? Ostrich, goose or pullet? Packets of things told us nothing and they hadn't yet invented the internet, though some rich people did have mobile phones. Chip shops didn't sell chips by number. Were they thin french fries or fat ones?

Spence clearly has not yet (in terms of his diabetes) been taught how to walk, let alone run - and although it's been long enough, he doesn't even bolus for other meals except his evening meal, so that is going to complicate dose adjustment, cos it'll be basal not bolus he has to fiddle with.

@spence - have you used The Learning Zone? - cos I think you should so you can understand properly what people on here are trying to convey to you.

Once you've done that, the next thing I'd suggest you do, is a Basal Test.
 
Nothing like a Roneo'd leaflet to raise your suspicions TW..... If you had been given a modern day app you would have accepted it without question!
 
Inka said:
6 months after diagnosis is stupid. Basic carb counting should be taught at diagnosis. It’s not hard and it makes life easier.
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Yes, I imagine that's what happens in reality. I think the NICE guideline is talking about the DAFNE-style more lengthy education, which I could imagine could be a bit much initially.
 
Bruce Stephens said:
Yes, I imagine that's what happens in reality. I think the NICE guideline is talking about the DAFNE-style more lengthy education, which I could imagine could be a bit much initially.
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Yes - it would - you don't even know what we regard as normal terminology - eg basal and bolus as per the OP.
 
Bruce Stephens said:
Yes, I imagine that's what happens in reality. I think the NICE guideline is talking about the DAFNE-style more lengthy education, which I could imagine could be a bit much initially.
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Regrettably, not in my reality.

I spent 14 days in hospital, after my total panc'y. The first 4 days I was essentially between Theatre, ICU and on a ward sleeping; fair enough. For the next 6 days I was connected to a machine that was managing my insulin, steadily recovering and increasing my daily walking regime as I regained strength: again all pretty sensible and during this period I was given a basic "welcome to DM pack": goodies packaged as a present from 4-SURE. Commercial interests clearly prevailed; they were (are?) the approved supplier throughout that Oxford Trust, but not in Bucks a few miles away. The delightful D Nurse who delivered these was clearly busy, her beeper summoned her away twice and inevitably very little information was conveyed then. I read everything provided; carb counting was not included.
On day 10 or 11, I was taken off the insulin machine and started on MDI. A ward nurse arrived with finger pricker, rook a reading which wasn't shared and returned a couple of hours later with insulun; she had been told what my dose was, had no explanation for why that amount, didn't explain the distinction between basal and bolus but happily said it would all be explained in due course.
This continued for 24 hrs and I eventually reached out to the Consultant who had seen me on a daily basis and asked for more info, which he undertook to get sorted. The delightful D nurse returned, apologised for not returning earlier but alas was covering several wards, got beeped and went away again. Another opportunity missed. On Day 12 the Consultant during his morning rounds said I could go home that day - I pointed out that I'd still not had any instruction about managing my D, had not even been allowed to touch an insulin pen, never mind finger prick and could that all happen before I was discharged. Day 13 arrived, late in that day the truly delightful D nurse returned explained about injection techniques, mentioned carb counting but told me I'd be given more info and instruction, chatted helpfully, got beeped and left.

Day 14, I was discharged. Not really any wiser. I was willing to learn, but the Hospital clearly didn't have the resources (personal or literature) for in-patients, to help with a sensible pre-discarge briefing. I didn't know any different, so didn't politely pester enough. If I had understood then what I now know I feel that, in hindsight, this aspect could have been managed so much better.

Perhaps a distraction from this bit of the "D and running" thread: I'd been visited almost daily by the HPB dietician and asked her about how to find out carb info. During those conversations she 'rummaged' in to some part of the hospital admin and found the carb content for most of the hosp meals; it was a a little out of date, certain meals ere no longer covered. Knowing something about service supply contracts to large organisations, I suggested all of the nutritional and dietary detail would exist somewhere for all aspects of catering srvices; she found a copy, some 40 pages thick and had no idea this had existed. There were 7 or 8 dieticians within the hospital, each working directly in support of their specialisation Consultants, none co-ordinated by an overall Dietectic 'supremo' and these 7 or 8 dieticians knew each other superficially, but had no remit to confer periodically, nor exchange best practice ideas, etc. Disappointing, but not so surprising to me (seen this sort of lost opportunity elsewhere; good people too busy to look around at the wider picture). I asked the Ward Administrator if she ever saw the 40 page nutrition document, which was updated and republished monthly; she went to her desk area, returned with a lever arch file and proudly showed me the ward copy, complete with covering letter, filed under a completely irrelevant title. She filed this every month, no one saw it and over time time no-one knew it existed. It's title included words like "Nutritional Detail .. Service Supply to Oxford NHS Trust..." and not a hint of whatever it was filed under. I got the opportunity to show this to a Matron, who recognised that the Ward, Hospital and Trust could do better; whether they did, I have no idea. I was discharged the next day with a 3 page D supplement from the D nurse including my ratios and fixed doses, but no mention of carb counting nor the need to attend a course such as DAFNE, but a small print suggestion to try BERTIE on line.

On Day 15, I got a face to face with my new DSN in a Bucks Hospital. She was happy to leave me on fixed MDI, stating it was too early for me to bother with carb counting; but to her credit she scrutinised a photo of my 4-SURE logbook sent by email fortnightly and adjusted my doses - all done from a distance (Covid lock down meant we didn't meet FtoF again for over 12 months). After 8 months and by now thoroughly cheesed off with my erratic BG, I found this forum and a suggestion to look at Gary Scheiner's "Think Like Pancreas". Still learning, still trying to secure a DAFNE course.

My conclusion: NICE have tried to provide a framework, including let things settle and leave in depth training for 6 months; not sure if that's correct but it's a start. In practice Trusts are overwhelmed by NICE dictats and don't (can't) keep up with the reading, never mind the implementation; these sorts of things can take years to work there way through the bureaucracy. Not sure how this overarching problem can be changed in the current status quo; Trusts need Chief Executives at the top of their game, able to see beyond the political and financial contradictions, able to recognise the lower level pressures as well as the immediate challenges such as bed shortages, Theatre priorities and media perceptions.
 
@Proud to be erratic it seems everyone’s story is different.
Clearly you didn’t have the best introduction to the World of Diabetes but hidden in your story is that it occurred during lockdown when the NHS was struggling even more than usual.
It is not an excuse but I would hesitate to draw conclusions from a sample of one at the best of times but, not only are we all different, the time of our diagnosis is different and CCGs are different.
It takes us all some time to learn that our diabetes care is provided by ourselves not by GPs, endocrinologists or nurses. They can be enablers but, as you found, so can the internet and forums.
This is why I mentioned Bertie Online earlier. We can complain until we’re black and blue but many of us (like you) can take hold of our diabetes management with both hands and get on with it. We need the NHS to prescribe the insulin and test strips but the rest of the resources are available to us.

I was diagnosed nearly 20 years ago so don’t think my diagnosis story is relevant (what’s the point of the “in my day…” stories?) but I soon knew more about my diabetes than the healthcare professionals I visited and I am still learning about my diabetes as they continue to learn more about Type 1 diabetes in general.
 
helli said:
@Proud to be erratic it seems everyone’s story is different.
Clearly you didn’t have the best introduction to the World of Diabetes but hidden in your story is that it occurred during lockdown when the NHS was struggling even more than usual.
It is not an excuse but I would hesitate to draw conclusions from a sample of one at the best of times but, not only are we all different, the time of our diagnosis is different and CCGs are different.
It takes us all some time to learn that our diabetes care is provided by ourselves not by GPs, endocrinologists or nurses. They can be enablers but, as you found, so can the internet and forums.
This is why I mentioned Bertie Online earlier. We can complain until we’re black and blue but many of us (like you) can take hold of our diabetes management with both hands and get on with it. We need the NHS to prescribe the insulin and test strips but the rest of the resources are available to us.

I was diagnosed nearly 20 years ago so don’t think my diagnosis story is relevant (what’s the point of the “in my day…” stories?) but I soon knew more about my diabetes than the healthcare professionals I visited and I am still learning about my diabetes as they continue to learn more about Type 1 diabetes in general.
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I wholly agree that my 'sample of one' is trivial in the wider scheme of things.

But it does expose that a busy major hospital, which is one of UK's very few Centres for artificial pancreas research, does not have a great process for helping new insulin dependent diabetics. If it did, there would be a booklet from them providing info to those who wanted to know more - the Trust has an excellent booklet on pancreatic cancer and several other booklets for other ailments. If they did have such literature for diabetes (hard copy and/or online), it might well provide a basis for the Trust and its associated CCGs to provide the appropriate meters and test strips, or CGMs - also their less specialised medical personnel would in turn get sublimely educated in theses matters. I.e. become much better enablers.

I don't have a strong grasp on how much Diabetes UK influence how Trusts or NHS at large behave. Perhaps, just a thought, D UK could assemble some of the excellent advice on discrete aspects of D treatment that exists, within this forum and in the parent site, and offer it to Trusts as suggestions for best (or at least better) practice. If nothing is done we unwittingly condone and so become complicit in the bad practice.

I also realise, that even though I still have much to learn (and get right when I regurgitate it!) I already know more about DM management than many GPs and at least 2 DSNs.
 
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