April Training Review

After completing the Canberra Marathon at the start of April this month has been slow. Apart from two slow recovery runs on the Tuesday and Wednesday after the Marathon I have not been able to do any running.  It is funny how my frustration levels grow when I am not able to train.  I have really noticed this during the down time.  I should be back on the road this Monday and I am looking forward to it.  I love this part of the training cycle because I am full of enthusiasm and desire to train, my motivation is very high.


I feel I have used the down time well.  Kerryn and the brilliant guys from Norwest Sportsphysio got my body back to normal and had me walking without any pain 3 days after the Marathon.  I felt so good I did a 10k when I was told not too, I pulled up ok but then thought better of it.  I have not risked it since because I know I will pay for it further down the track.


Apart from getting my body right with physio and swimming I have made a big effort to get my diabetes under better control.  My A1c was 6.7 which is not too bad but I probably need to get it closer to the magic number 5 if I am going to be serious about the Marathons.  I also need to reduce the gap between my highest readings and lowest readings thus making my sugars more consistant.  It is funny how you can read and read and read about other people's experiences and tips but until you make the mistakes yourself you will not fully understand.  The last couple of marathons have been a learning curve I have learnt the basics but I think it is time to get some professional help.


I have my holidays getting referrals for a diabetes care team. My GP suggested this would be very beneficial so she set me up to have a Team Care Assessment done.  The idea is because I have a chronic condition which lasts more than 6months I am entitled to 5 specialist visits per year.  This is great as it will save me a couple of thousand dollars a year.  So thank you to my new GP as none of my previous local doctors have told me this was even available.  I have now made an appointment to see my Endo who I have not seen since my honeymoon.  I have also made an appointment with a sports physician to discuss my diabetes, diet and marathon running.  I then made an appointment with a good sports podiatrist to keep my feet in shape as foot care is important for diabetics and even more so for diabetic runners.  I will also keep my standard appointments with the wonderful Norwest Physio team.  


To further improve my diabetes I downloaded a app for my iphone Glucose Buddy which is a cool app.  It allows me to enter and keep track of my medication, diet and activity.  It turns all this data into a graph so I can keep track of how far outside the 5.5 mmol/L daily average I am. It also has links to diabetes forums and online magazines which I have found very helpful.  I was testing 12 times a day for the first week of my holidays to get a true indication of my daily patterns before exercise the next step is to do some heavy testing while exercise and compare the differences.  I am looking forward to finding all this out.  In terms of my diabetes April has been a big month, it has been a big step in the right direction . . . I even joined a Diabetic running club for the Melbourne Marathon I filled out all the online enrolment forms but have not heard back yet I am really pumped about this.  I hope it all works out. 

So now my focus will move to the Cities M7 Marathon which will take place at the end of the next school holidays.  I am thinking I may approach the school and see if we can organise members of our school community to be involved in the kids marathon on the day and raise some money for Diabetes Australia or the Juvenile Diabetes Foundation.  

2011 Canberra Marathon

"Wow" what an experience.  It seems each run I do the atmosphere and excitement of the festival grows.  As the festivals continue to get better the size of the running group increases by one.  For this one we had a crew of 4.  Me, Anita, Shereen (Anita's Sister) and her boyfriend Chris took a trip down to Canberra to take part in the Australian Running Festival.  The highlight of the festival for us was Anita's 10km time of 1hr.  This was her goal time which she had been working towards for over 2 months.  After missing the start she was able to get around the track in 60 mins.  Well done Anita, I'm sure this is the start of many successful runs in the future.  There are also rumours she will be aiming to complete a half marathon this year.  

After 2 months of preparation for this marathon I felt a lot more prepared.  If anything over prepared.  I had been running some big distances in my lead up.  I now know a 50km week with a 28km long run the week before a marathon is not good.  All this information is on the internet, but I never seemed to bother to check it out. Being a PE teacher I also know the basic training principles, and I broke these.  I felt the more k's I do the better prepared I will be.  In hindsight I was ready but it was far from the perfect preparation.

I knew I could make the distance, I now had a goal time of 4hrs to break, I felt this would be an easy achievement with the work I had been doing.  I had been working hard to keep my diabetes under control.  I was testing and monitoring my food intake, I was getting the rest I needed and I had created a race eating plan which allowed me to eat 15g - 30g of simple sugars every 30 - 45 mins and 30g - 45g of complex carbohydrates every 90mins.  In theory this seemed like the perfect plan.  In my race pack I carried 2 bottles of premixed Powerade with Glucodin powder added in, Powergels which are full of fast acting carbs, jellybeans and space food sticks all of these are great as they have high carb rating and are small enough to fit into my Hypo pack.  I had banana's at certain drink stations along the way to give me the long lasting carbs for the end of the race.

Now, I ruined the 2 months of solid preparation the night before the marathon when we went out for dinner.  I missed my insulin injection and ate a huge pasta meal with out even thinking about it.  The idea was to load up on carbohydrates for the next day.  After having a good night out with everyone talking about their races and how well everyone did I started to feel tired, dry in the mouth and I felt like I had run with them.  It was like lactic acid was building up in my muscles.  I knew straight away I was high.  I then realised I had not had my insulin when I should have.  


When we got back to our accommodation I was 26.8 mmol/L.  This is very high, luckily I had no Ketones.  I gave myself a big shot of insulin 20 units of Novorapid and My normal 27 of Lantus hoping this would settle things down.  I drank quite a bit of water and then fell asleep.  When I woke at 3am I tested again and I was 20.1 mmol/L .  Now this is where I began to get worried as I knew there was no way I would get through a marathon if I was high like that.  Again I gave myself a big shot of insulin this time I gave myself 16 units of Novorapid.  I had some more water and went back to sleep a little bit nervous.  When I woke I was down to 5.8 mmol/L.  This was better but I knew this was too low for a marathon so It was time for some food.  I hoped 1 Powerade, 3 space food sticks and 1 museli bar would be enough to get me to the start line.   And it did. 

Before starting I was 9.3 mmol/L which I thought would be ok.  The race started and I felt strong I was trying to hang back and stick to the race pace I had worked out but I felt good and ran a lot quicker than I should have . . . again.  While I was doing this I knew it was a mistake I was running 4.30 km's well ahead of my 5. 40 needed to break the 4hrs.  The kms were passing with ease 2, 4, 6, 8 then at the 9k mark I started to feel tight and heavy.  My sugars were down but I still felt ok. 
I made it to the 10k mark in about 45 mins. I stopped and tested and my sugar was 1.3.  This was not good.  I drank a full Powerade mix and had 2 Powergels.  Straight away I felt crushed, I knew i had stuffed up the night before and now I was going to pay for it.  I tested again and was up to 4.1 I had 32km's still to go and my sugars were below 2mmol/L I was not in a good place.  I ran the next km and stopped when I got to Anita.  We tested again and I was 1.7 I went through the testing, glucose loading and this time Anita made me wait until I was upto 7.4 mmol/L this took 15 mins.  This was the longest 15 mins I have felt for a long time.  
At one point I felt I would have to pull out of the race, the smartest thing to do is to stop, any doctor would advise me to stop and have another go another time. I did not want to be a non finisher . . . that is what I pride my self on being the diabetic who finished the race.  So I went on.  I made it to the 22km mark in under 2hrs which I was very happy with but the rest of the race after that became an even bigger battle.  My body was chewing up glucose like I can not describe. My blood sugars were rarely above 3.0mmol/L at the testing points.  
I made it to the end in 4h 26min 47sec which was a PB by around 10mins.  I was very disappointed but satisfied at the same time . . . I don't know if that is possible however that it what I felt.  I had made a small improvement not as big as I had hoped but I was still moving forwards not backwards.  

The Australian Running Festival was an amazing event, great atmosphere, great organisation and a modern course to run.  Seeing some of the elite athletes run on the Saturday was awesome.  The festival defenatly caters for the novice to elite runner.  Again this is another event I highly recommend to anyone interested in a good festival feel.  For me now its back to the drawing board to work on a proper training program and get my diabetes sorted.

2010 City to Surf

This is funny I'm doing this post from the apple store in castle hill testing out the new IPad2. Looking back at the 2010 City to Surf it was probably one of my best runs of the year. I think in am more suited to the 10km - 20km events but I still love the challenge of finishing the Marathon. The day was amazing. We were blessed with beautiful weather, great event staff and awesome people to run with. I was running the City to Surf with my wife and a friend from work. My wife decided she wanted to challenge herself as she had recently begun running for fitness and Ernesto is a seasoned veteran of the event. Every year he tells me how good the event is and I should go in it. I was proud to be running with Anita and Ernie and it was a great lead up . . . no pressure just a fun run.


It had been a long time since I had been in a big event like the City to Surf the energy off the participants is amazing. I realized the start was divided into 3 starting groups and we were in the last start group. As the start countdown began and we ran off with excitement in our faces I realized it was going to be hard to just jog the whole way. I did the first km with Anita and Ernie and Anita could see I was getting frustrated being in the large section of the crowd. She smiled and told me to go. . . That's why we are married.


So I took off and ran through the crowd I was feeling very comfortable and keeping a decent pace about 4.40 for each km. The run was beautiful some highlights were running along New South Head Road seeing a different side of Kings Cross and Double Bay. The performers along the way were very cool but the best view is the finish running down to the finish line and seeing the beach full of hundreds of thousands of people the finish of any race is a good moment but the races where there are spectacular sights are even better and this is one of those races.


All in all this was a great event for me my sugars were good, I felt comfortable and best of all no hypos. Job well done. While I was waiting for Anita and Ernesto to finish I got talking with a guy who finished near me. He was wearing a New York City marathon finishers singlet. I asked him all about the experience and training leading up to the event and my mind was flooded with ideas. The biggest idea was I have to experience the New York City Marathon. That event was the first to go onto my lifetime ultimate run list.

2010 Hunter Marathon

In my previous posts I have tried to provide a bit of background information about diabetes and how to take the first steps to getting fit with diabetes. Now we can get to the good stuff. My posts from now will look at my running and physical activity. (I’m not sure this will interest anyone however it will be a good way for me to reflect on what I have done)

There is so much I could say about my very first marathon, which I ran in the Hunter Valley. First and foremost it was fantastic to finish (4h 36min 48sec). I cannot describe the pride I felt when finishing such a challenging event. So many people helped me get all the way to the end, they would chat and encourage me as we were running. I forgot how supportive the running community is. I want to thank everyone who took the time to have a chat, you have really motivated me to make marathon running something I do more often.

Secondly while my finishing time was a long way off my goal time of 4hrs, I was very pleased with my run considering the many mistakes I made along the way. My first marathon was always going to be a steep learning curve. Seeing as I had a short preparation for the run I felt satisfied with my efforts to finish. I was very happy with my half way time of approximately 1h 45mins but this may have been my downfall. Going too quick in the first half did not leave me a lot for the challenging second half and this is where my mistakes became evident.

I started the race at 7am with a blood sugar of 9.3 mmo/l and felt good after a decent breakfast. Standing at the start line with my homemade Hypo pack around my waist and emergency contact details pinned to my shirt I felt ready and like nothing could stop me. I was feeling nervous when they asked all the first timers to raise their hand. We all looked at each other and raised our hands, then the rest of the runners gave us a round of applause and the gun went. This is where I made my first mistake - I felt strong and took off overtaking the people around me working my way to people who were running at a good pace.

I did not even think that I have to keep this pace for another 41km. I call this schoolboy error 1. I kept the strong pace up for a good 6km then begun to feel fatigued and tired. Throughout the next 4km other runners slowly began to pass me this was where I knew I had made a mistake. I not only tired out my legs because I had pushed myself more than I needed to, I could not use them to gauge if I was low or not. Normally when I run I get heavy legs quite suddenly now I was not going to be sure what my levels were without testing and guess what I had plenty of sugar supplies but no glucose tester. This was schoolboy error 2. I decided I had only one option and that was to treat myself as if I were low. In my hypo kit I had a packet of glucodin tablets some jellybeans; space foods sticks and roll ups. I decided I would try some glucodin tablets and see how they worked.

I was at the first of many hills so I thought it was a good time to have a little walk and ate my glucose tablets while going up the hill. I had read a tip that if you are fatigued it is best to work your way slowly up a hill or incline to conserve energy so I felt this was worth a try. After having the glucodin tablets my legs felt better and I was off again. In hindsight I should have ate a space food stick at this point to get some long acting carbohydrates into the body.

Running through the wineries is amazing and I highly recommend the Hunter Valley course to runners who want a scenic and challenging course there are a lot of different landscapes you run through. The best is running through the gardens at the half way mark. At this point I felt confident but I did tell myself once you go through the gate for the second lap there is no stopping . . . for a few moments I did think I'm not sure if I will make it but I decided the second lap looked good and went on.

Not long after this I ran past my wife who was waiting at a viewing point for me, I felt good. She was asking me "do you want me to test you?" I said I felt fine she then said are you sure? I said “no I’m all good!” This was schoolboy error 3. If someone asks if you are all right you most probably aren't, even if you feel good. I kept running down the track. And again ended up hypo. I had not been sticking to my eating plan through the race.

I had been eating more than I had planned at each of the drink and fuel stations leaving myself a bit short on supplies. Now I was at the 28k mark with a few jellybeans and glucodin tablets again I felt I needed to eat something as I had an unusual hunger pain. I thought this is probably a hypo symptom so I had my remaining bits of sugar. At the next drink station I had a premixed PowerAde with extra glucodin added to it waiting. I just needed to get there before I dropped anymore. I made it to the drink station and downed the PowerAde, and a few extra cups.

Event staff was handing out bags of jellybeans and bananas I was feeling pretty good but knew I was out of sugar supplies so I took a bag of jellybeans. This was the smartest thing I did all day. I thought as a diabetic it is probably not a smart thing to turn down any sort of sugar when taking part in an endurance event. It was not like I was aiming to win. It was all about finishing and the bag of jelly beans would help me finish.

Turning at the drink station meant I was on the long home straight. I was about to learn all about the pain of the home straight and poor preparation. Because I had been low for quite a while my glycogen supplies would have been used up very early and now is the time my body would normally be using it if I were not diabetic. Approaching the 30km mark my quads and calves cramped with every step I took. My legs became like concrete, I thought I could feel the muscles moving over each other, they were so tense. I was still trying to move forward but in a world of pain.

I immediately jammed a handful of jellybeans into my mouth and the cramps settled down. I walked for a bit and loosened up as much as I could then I started to jog again. I got a few kilometers further then I was cramping worse than before. I felt shattered because I thought my run was over. I had completed 34kms and I did not know how I was going to finish. I kind lady saw me in pain and told me that no matter how much it hurts I need to jog gently . . . I had no idea how that was possible but I gave it a go and It worked little tiny baby steps and I was on my way again and the pain was easing off. I made it to the 38km mark where my wife was waiting and this time I took her up on her offer to test me. My blood sugar was 1.6 mmo/l. I waited and ate more jellybeans until my sugars got up to 8.0 mmo/l then I took off to complete the course.

Finishing was a magic moment, I had made it hard for myself but I had done something I consider remarkable. This may be egotistical but I think I was able to complete something only a small part of the population will do in their lifetime and something even fewer diabetics will do. I was so proud to finish regardless of the time.

I will definitely do another marathon because of the experience I had in the Hunter Valley. I will need to research more about marathon running with diabetes as I made many mistakes along the way. I am looking forward to my next big run. I have written this blog as a narrative hoping people may read it and be able to provide me with some tips to improve for next time.

After my Hunter Valley effort I spent sometime looking online for tip about training for marathons. I found the information below very useful you can check the website out at -http://www.sport-fitness-advisor.com/marathon-training-program.html

Foundations of a Marathon Training Program

There are many principles of training - some unique to marathon training. You're probably already aware of at least some. Here are few key considerations we need to take into account to build an effective marathon training program

Over-Training
The fitter and more capable an athlete becomes, the more likely he or she is to over-train. The false logic goes that because they are fitter, their bodies can cope with greater and greater demands, more and more miles. But in actual fact, as mileage increases, the longer the body needs to recover - even for experienced athletes. And because the speed and intensity of each run increases this doubles the importance of adequate rest. Avoid performing long runs at race pace. Leave this for shorter, more intense sessions.

Periodization
Periodization is the preferred method for designing any kind of intense training schedule. Quite simply it means to break the overall plan into smaller cycles or chunks, each with their own specific outcome. The opposite - a progressive marathon training program would simply have you run more and more miles at a faster and faster pace indefinitely. Instead by breaking the plan up into smaller periods or cycles, training intensity and volume looks like a series of peaks and troughs...

Adjusting Training Load
To expand on our explanation of periodization - week 1 of the program might start relatively easily, gradually increasing at week 2 and week 3, then week 4 sees a decrease in training volume before stepping it up again in week 5 and week 6. These 6 weeks could be classed as one cycle. To take it step further, each week (a mini cycle) would also vary intensity and volume. This approach is one of the best methods for avoiding over-training.

Tapering
Closely related to the above two points is tapering. This is simply a planned reduction in training volume and intensity as the weeks and days draw closer to the actual marathon. Even for many experienced runners, tapering equates to a day's rest before the 26 mile run. That's not enough - not if you're run a 20-miler within the last week. In fact, as you'll see below running distances close to marathon length less than 3 weeks before the race can be disastrous. It can take that amount of time to fully recover. Aim to peak (in terms of training miles) 4 weeks before the race. Avoid runs of more than 10 miles during this time.

Hitting the wall
You've heard the phrase, you may have even experienced those energy-sapping effects 18 miles in affectionately known as "hitting the wall". The weak legs, light-headedness and strong urge to stop are caused by a depletion of glycogen (carbohydrate stores) and an almost complete reliance on fat for fuel. While fat can power a runner for days in theory, it can't maintain the same speed and intensity as carbohydrate. Couple that with dehydration and it can bring you to a sudden and grinding halt. Fortunately, there is an effective weapon against the wall...

Nutrition
Understanding how nutritional status affects the body during exercise is something you would also benefit greatly from. And it's not just about race day. Eating the right foods at the right time, before during and after long training sessions will compound to make your overall marathon training program that much more effective

DIABETES AUSTRALIA - http://www.diabetesaustralia.com.au/

How the idea began

I am lucky to share my life with someone special.  In October 2009 she became my wife.  Anita is someone who spurs me on and keeps me focused.  She knows my strengths and my weaknesses, she also knows diabetes is part of my life and it will never go away.  While we were on our honeymoon travelling through Europe I was reading a book by Dean Karnazes called 50 Marathons in 50 Days.  I was so inspired by Dean and his super endurance.  


I did not know it yet but the marathon bug had been unleashed in me.  I had been running before my wedding and dropped a lot of weight.  I was enjoying running again.  While on our honeymoon I made sure I did at least one long run (usually 2 hrs) in each country we stopped in.  I saw some amazing sights, I run up to the top of a volcano in Santorini, I ran along the Tevere in Rome seeing St. Peters Basilica lit up at night, I ran around the Louvre and Eiffel Tower in Paris, I ran through the town centre in Dublin, London,  Germany, Austria, Switzerland and Spain.  

 I had begun slow and built up the distance gradually.  I was feeling good and physically fit again.  On the plane home I begun working out a weekly training program.  I read something about a 10% rule you should not increase your distance or intensity by more than 10% a week.  This is a great rule to follow if you are diabetic and starting any sort of new exercise program.  Following this rule I continued to develop my fitness and as my fitness improved so did my diabetes management.

Training became tough as I had no goal.  I had lost weight, my fitness was pretty good and I was making my distances with out any trouble.  I decided it was time to try a marathon. I looked online and found the Hunter Valley marathon was a couple of weeks away so I registered and took the plunge. I was going to attempt to become a marathon runner. I had no idea what I was getting into. I had follows the recommendations for starting an exercise program pretty closely however I was about to make many mistakes in doing my first marathon.   



Below is some further information taken from the Diabetes Australia website looking at the process for starting a new exercise program. Click on the link above to visit their website and find out more information about Type 1 Diabetes and exercise.



Starting an Exercise Program

Before commencing a regular exercise program see your doctor for a full medical examination. There are also two things you have to be careful of:

Take it slow: You don’t want to start off too hard because if you are not used to the exercise you will be sore the next day and this will not make the exercise experience an enjoyable one! Always increase the intensity of the exercise very slowly.

Get checked out. If you have any health problems such as diabetes complications like retinopathy, nephropathy, you should talk to your doctor or an accredited exercise physiologist before you start increasing the intensity of your exercise.


Suitable Types of Exercise

Suitable types of exercise depend on the individual. Here are some suggestions for you to discuss with your doctor:

• Walking 
• Swimming 
• Dancing 
• Water aerobics 
• Gardening 
• Golfing 
• Cycling 
• Exercise bike 
• Walking machine. 

Increasing your general physical activity is also helpful, e.g. taking the stairs instead of the lift, getting up to change the TV station instead of using the remote control, housework, and gardening.


Amount of Exercise

Ideally, you should be doing about 30 minutes of exercise every day. If this is not possible, then this time can be divided in 3 x 10 minutes sessions. 



Intensity of Exercise

You do not need to puff to gain the benefits of exercise. Aim for moderate intensity. This means you should still be able to talk as you exercise without becoming breathless. 



Exercise Tips 

• Drink extra fluid before, during (only if prolonged exercise) and after exercise to avoid dehydration. The fluid may be water or a sweetened drink if extra carbohydrate is required. 250 ml every 15 minutes or one litre of fluid per hour is recommended. 
• Take care of your feet when exercising. 
• Wear comfortable and well-fitting shoes. 
• Always inspect your feet before and after exercise. 
• Ulcers or other lesions on the feet are a serious danger for people with diabetes. It is important to avoid foot damage especially for middle-aged and elderly people 
• It is wise to avoid exercise that causes stress to the feet (e.g. running). Exercise which poses minimal weight or stress on the feet is ideal such as riding an exercise bike or brisk walking in good footwear. 
• Take extra carbohydrate before and during exercise to prevent hypoglycaemia. Extra carbohydrate is often needed after exercise. Discuss adjusting carbohydrate intake with your doctor or dietitian. 
• Monitor your blood glucose levels before, if possible during (at least initially), and after exercise to assess your requirements for extra food. 
• It may be necessary to reduce your insulin dose prior to exercise. Insulin adjustment varies with each individual. Discuss appropriate adjustments to suit your exercise schedule with your doctor or Credentialled Diabetes Educator. 
• Wear sun block when exercising outdoors. 

People with diabetes are generally discouraged from strenuous physical activity if they feel unwell or have ketones present in their blood or urine.
DIABETES AUSTRALIA - http://www.diabetesaustralia.com.au/

Diabetes and Exercise

Exercise is an important part of my life.  As a young person it defined who I was, it provided me with a chance to excel and be fit.  I joined Blacktown Little Athletics club when I was 8, I'm sure it was not my choice.  I'm sure mum was getting me involved in sport to help manage my diabetes, but I loved it.  I liked making friends and competing with kids my age.  I represented Blacktown at the state championships and won a bronze medal in my first year of athletics.  I then went on to represent NSW as a 13 year old.  Keeping fit helped me to become confident and allowed me to see I was no different to other athletes my age.  I did understand I had to be more organised but diabetes did not limit my ability. 


I have been involved in a number of sports through out my life soccer, athletics, cycling, rugby league, touch football, swimming and now marathon running.  When I finished high school and began university I stopped my involvement in sport.  This had a negative effect on my diabetes.  My management became very poor, I did not test as regularly and I slowly gained a lot of weight.  It was not until my 3rd year teaching when a friend asked me to play in a touch tournament that I realised I was missing being involved in sport.  Playing touch lit the competitive fire again and I wanted to get fit. I started training and my diabetes management improved.  I tested more and ate better because I was training.  12 months later I was playing in my first Touch Football State Cup team.  


During the competition I could not get my blood sugars right and things did not go so well. My average blood sugar was 16.7 mmo/l which is not good.  Blurred vision is not good for playing touch neither are tired legs.  But it was a massive learning curve.  As diabetics we all need to realise we will never really know how our body will react to exercise so during new competitions or routines we need to test a lot more and be prepared.  It is better to run a little high than be too low. And most important let someone know you are diabetic.  A lot of young athletes are afraid to let people know they are diabetic, In my 25 years competing in athletic events I don't think I have ever had a negative reaction when telling someone I am diabetic. Most people want to do as much as they can to help you out.  


Below is some further information taken from the Diabetes Australia website looking at the importance of physical activity and keeping active. Click on the link above to visit their website and find out more information about Type 1 Diabetes and exercise.


Diabetes and Exercise - Keeping AcT1ve

Everybody benefits from regular exercise. If you have diabetes it plays an important role in keeping you healthy. Regular exercise is an important part of your diabetes management. If you are on insulin, it will help your insulin to work more efficiently and assist with your blood glucose control. However, if your diabetes is poorly controlled (i.e. fasting blood glucose levels greater than 14 mmol/L and urinary ketones) then it is best to avoid exercise until your blood glucose has settled. Exercise in these circumstances can actually elevate blood glucose and increase ketone production. You are discouraged from strenuous physical activity if you are feeling unwell or have ketones present in your blood or urine.

For a person with diabetes exercise helps:
1. Insulin to work better, which will improve your diabetes management
2. You control your weight
3. Lower your blood pressure
4. Reduce your risk of heart disease
5. Reduce stress

We all know that exercise is good for us but diabetes presents some challenges - blood sugar levels can drop low or rise unexpectedly during exercise, but don't be deterred! People
with diabetes can achieve amazing things 

Zippora Karz was a member of the NYC ballet at age 18.  She was diagnosed with Type 1 Diabetes at age 21 and then went on to become a soloist at age 27.
Sir Steve Redgrave is one of only four Olympians to have won a gold medal at five consecutive Olympic Games. This achievement led to him being hailed as Britain's greatest Olympian.  He has also won three Commonwealth Games gold medals and nine World Rowing Championships.

Gary Hall Jnr was diagnosed with Type 1 diabetes in 1999.  Upon his diagnosis, Hall struggled with the possibilities and the effects he knew the medical condition would have on his life. He overcame these worries to go on to win 10 Olympic swimming medals and a number of other international titles.

Will Cross has ascended the highest peaks on all seven continents including Everest and walked to both the North and South Poles. He has also led expeditions to 15 unmapped, unexplored mountains in Greenland and also in Patagonia, Mountains of the Moon, the Sahara Desert, and the Thar Desert of India.

Missy Foy is an extremely well-known long distance runner who was diagnosed with type 1 diabetes at the age of 33. In 2000 she became the first athlete with diabetes to qualify for the Olympic Marathon trials. In 2005 she was ranked #1 in the world for the 50-mile trail race
Closer to home Brett Stewart is an NRLfootballer who plays for the Manly-Warringah Sea Eagles in the National Rugby League. He is an Australian international and New South Wales State of Origin representativefullback known for his prolific try-scoring. He has played his entire NRL career for the Sea Eagles, with whom he won the 2008 Premiership


Dr. Sheri Colberg-Ochs talks about Exercise and Diabetes


Dr. Sheri Colberg-Ochs, an Associate Professor of Exercise Science at Old Dominion University, author of the book The Diabetic Athlete, and a diabetic athlete herself, provides some useful information for managing diabetes around whichever exercise you may wish to do or continue doing. Regular exercise is the most important activity that you can do to slow the ageing process, manage your blood sugars, and reduce your risk of diabetic complications.  The best way to deal with the multitude of variables is to learn your own responses to all of them by checking blood sugar levels before, during, and after exercise. Intense exercise can cause a large increase in blood sugars due to the surge in glucose-raising hormones. You may find that after training for several weeks, your blood glucose does not drop as significantly as it did when you first started training. Regular physical activity improves blood glucose control by increasing the body's sensitivity to insulin. It is crucial to know when your insulins peak in order to determine your blood sugar response to exercise and your need for supplement carbohydrates

Dr Colberg-Ochs recently answered some people with diabetes' questions in an interview conducted by About.com.

Jennifer asks: "Why does my blood sugar actually rise after my regular morning exercise session?"

Dr. Colberg-Ochs answers: Many things can affect your blood sugar response to exercise, and it is normal for intense exercise to actually cause a rise in blood sugars." "In all likelihood, both the time of day that you are exercising and what you are eating for breakfast are probably having a large effect on your sugars. Morning exercise is notorious for causing less of a drop in blood sugars, even when compared with the exact same type of exercise done later in the day. The reason for this is that after you fast overnight (not eating between dinner and breakfast), your body releases extra hormones to keep your blood sugars normal, particularly high levels of cortisol and growth hormone, and the livers in diabetic people often overproduce glucose overnight as well. These hormones, while working well to keep your blood sugars normal overnight, also make your insulin less effective, thereby creating an "insulin resistant" state in your body in the early AM. By eating breakfast, you 'break' your 'fast' and provide alternate fuels that allow the levels of these hormones to then drop. So, breakfast is important, but it is also the meal at which our bodies have the hardest time with carbohydrates causing a bigger increase in our blood sugars. You may want to stick with a lower carb breakfast, saving them for after your workout when your insulin action has improved. Also, you may want to experiment with exercising at different times of day to see the effect. If you do continue with your morning exercise, though, the temporary elevations in your blood sugar will be just that: temporary. If they begin persisting past an hour or two, though, then you will need to rethink your strategy."

Carl asks: "I want to exercise to decrease weight and become more healthy. However, I have found that my sugar level drops quickly when I exercise. This of course leads me to feel as if I need to eat, and in return for eating I feel I defeated the purpose of the exercise which was to burn calories and lose weight. Is this cycle avoidable? Or is the eating actually ok?"

Dr. Colberg-Ochs answers: "If you're using exercise to try to lose weight, then it would definitely be better to minimize the additional eating. However, a few simple changes in your diet and/or medications could easily help you to break this cycle. If you are able to make changes to your regimen, though, then you should be able to correct this problem. If exercise is causing your blood sugar to drop, then you can either lower your insulin dosages (consult with your physician if you don't know how to do this on your own), or adjust your diet for exercise. When you know that you are going to exercise following a meal or snack, eat foods with more carbohydrates in them (but that have approximately the same calorie content as what you would have eaten otherwise). These carbs will then be available to your body during exercise and should help prevent any drops in blood sugar. If you still have to eat something afterwards to compensate, consume only quick-acting carbs that will quickly correct your 'low' feeling, like a glass of soft drink, or 5-6 dry biscuits, but that will add relatively few calories. Do not eat foods high in fat or protein as they will not quickly correct a low blood sugar!"

Ian asks: "I'm a rock climber operating in the upper grades of the sport ... I rarely see any info regarding diabetics in 'power' sports like climbing/bouldering as opposed to more endurance based sports such as rowing/long distance running. Any thoughts on better diets/regimes for power athletes?"



Dr. Colberg-Ochs answers: "Power athletes with diabetes need about the same carbohydrate intake as anyone else participating in such a sport, but having diabetes, it is vitally important for you to balance your food intake with your insulin to maintain your blood sugars in the most normal range possible." "Muscle glycogen (the storage form of carbohydrate in muscle) is only effectively replaced when your blood sugars are under control. Furthermore, being in poor control can cause you to dehydrate, which can also have a negative effect on your performance." For a more detailed discussion of this topic and helpful suggestions, please consult my book, The Diabetic Athlete (Human Kinetics, 2001), which details regimen changes for over 86 sports and recreational activities as well as giving nutritional advice. The two main things for any diabetic athlete to think about are 

Metabolic control before exercise: 

• Ingest carbohydrates if glucose levels are below 5.5 mMol/L. 
• Avoid exercising if fasting glucose levels are more than 14mMol/L and ketosis is present, and use caution if glucose levels are greater than 17mMol/L and no ketosis is present. 
• Blood glucose monitoring before and after exercise 
• Identify when changes in insulin or food intake are necessary. 
• Learn the glycaemic response to different exercise conditions. 

Food intake for exercise:

• Consume carbohydrate as needed to avoid hypoglycaemia. 
• Keep carbohydrate-based foods readily available during and after exercise. 
• Conduct further reading about Diabetes and Exercise

DIABETES AUSTRALIA - http://www.diabetesaustralia.com.au/

Hypo vs Hyper

Because a diabetic's body can no longer regulate insulin production we must now do that for ourselves by injecting insulin. The body is an amazing machine designed to automatically react to slight changes in carbohydrate levels, emotional stress, physical activity, temperature and a load of other factors that can impact on our blood sugar levels. We are not as accurate as the human body normally is at detecting these changes so sometimes we get the dosage a little bit wrong. The result is either a blood sugar that is too low or sometimes too high. 

Low blood sugars or Hypos are correctly known as Hypoglycemia. This is where there is too much insulin in the body and the blood sugar drops below 4.0 mmol/l. The body's best operating level is around 6.0 mmol/l but for good control you are meant to try to stay between 4.0 mmol/l and 7.0 mmol/l as much as possible, as this mimics the body of a person who has a pancreas that works. This is very hard to achieve. I have found specialist will allow a little leeway especially for young diabetics. I think this is where I first learnt the importance of setting my goals high. It is better to have a high goal and fall a little short than set an easy goal and achieve it. I use this philosophy in my diabetes and everyday life.

I have been diabetic for over 20 years and the worst part about diabetes is dealing with the hypos. To explain a hypo I think it is easiest to say the body basically goes into shock. Early symptoms may include hunger, sudden change in mood, feeling a little bit sick in the stomach then the next set of symptoms begin if not treated you get cold and clammy, you sweat, your face and skin may go pale, you get confused and dizzy, sometimes you may get very emotional. If left untreated you may begin to loose muscle control, the body may fit or you may pass out. These are all symptoms I have experienced throughout my lifetime. Lately I have noticed the first symptom I get is it becomes hard to speak or put my words together when I go hypo as I do not get the early symptoms I would previously get. I think this is common when you have had diabetes for a long time like I have. (If anyone has any advice about this please let me know I'm here to learn from others experiences too)

 

To treat hypos we basically need to get sugar into the body. The first and most important thing is to consume something full of sugar like normal soft drink (not diet), jelly babies, jelly beans, sugar packets. After 10mins - 15mins you should test your blood sugars and check your levels have risen above 4 mmo/l. If they are not above 4 mmo/l simply eat some more sugar, if they are above 4 mmo/l eat 15g - 30g of Carbohydrates. This will prevent the fast acting sugar being used up by the body this is the best thing to stop you going hypo again.

 When you treat a hypo you must remember not to over-treat as you may send yourself into a hyper this is the part I find hard when training for marathons. When doing long runs hypos are almost always going to happen so as a diabetic I must make sure I am prepared. Sometimes it is very hard for me to get my sugars up while doing my marathons.

High blood sugars or Hypers are correctly known as Hyperglycemia. This is where there is not enough insulin in the body's and because the 'energy door' is closed the blood sugar rises. Below 14.0 mmo/l physical activity or exercise could be used to lower blood sugars however when your levels get above 14.0 mmo/l exercise seems to send your sugars higher. The reason for this is exercise causes stored sugar called glycogen to be released into the body and it can not be used because the 'energy door' is shut. This is something we will look at in a later post. When your sugars are above 14.0 mmo/l you need to administer extra insulin this is best done in consultation with your doctor as everyones body react differently to the insulin they are on. I am on the short acting insulin Novorapid and I find for every 3.0 mmo/l i can administer 2 units of insulin to reduce my blood sugars. I have a friend who uses the same insulin and she would end up Hypo if she used the same regime.

Highs are not as noticeable as hypos you can be high and not realise it but when you have been high for a while you really notice the symptoms. If you have ever done a hard work out and know the feeling of extreme levels of lactic acid building up in your muscles that is the best way I can describe what a high feels like.  

Your muscles ache and burn, your mouth is dry, you can get confused and your vision goes blurry. It is not pleasant. But highs are a slow reaction therefore your treatment can be slow where as hypos are a fast reaction and require fast treatment. So as you can work out Hypos are the most dangerous and can be a life threatening condition if not treated with importance.

IF YOU DO NOT KNOW WHAT IS WRONG NEVER ADMINISTER INSULIN TO A DIABETIC ALWAYS GIVE THEM SUGAR AND CALL AN AMBULANCE. SUGAR WILL NOT KILL THEM QUICKLY - INSULIN WILL.

I have experienced this as I was hypo and unconscious once and a friend of mine administered a full syringe of short acting insulin, lucky for me this was a few years ago when the short acting insulins took between 30mins to an hour to begin working and the ambulance was able to get me to hospital in time to load me up with Glucagon. So please never inject a diabetic unless they can do it them selves.

Below is some further information about Hypos and Hypers taken from the Diabetes Australia website.  These conditions are explored in more accurate detail. Click on the link to visit their website and find out more information about Type 1 Diabetes.
       


Hypoglycaemia

Hypoglycaemia (also called a ‘hypo’, low blood glucose or insulin reaction), is when your blood glucose level has dropped too low. This occurs when your level falls below 4 mmol/L, although this can vary. Some people may feel symptoms when their level is greater than 4 mmol/L and sometimes it just depends on the situation.

While hypoglycaemia can be experienced by people taking certain tablets for their diabetes, it is more common in people who inject insulin. It is generally not a problem for people with type 2 diabetes who can manage their diabetes through a healthy eating plan and physical activity alone, however, it is possible.

It is important to treat a ‘hypo’ immediately to stop your blood glucose level from dropping lower.

Talk to your Credentialled Diabetes Educator about preventing, managing and treating hypos that is unique to you and your lifestyle. The information covered in this Topic is a general guideline only.

Causes of Hypoglycaemia

Hypoglycaemia can be caused by one or a number of events, such as:

• Delaying or missing a meal 
• Not eating enough carbohydrate 
• Unplanned physical activity 
• More strenuous exercise than usual 
• Drinking alcohol - the risk of hypoglycaemia increases, the more alcohol you drink 
• Too much insulin or diabetes tablets. 
• While these are known causes of hypoglycaemia, in many cases, no specific cause can be identified. Symptoms of Hypoglycaemia

Symptoms of hypoglycaemia vary from person to person, however common feelings are:

• Weakness, trembling or shaking 
• Sweating 
• Light headedness 
• Headache 
• Dizziness 
• Lack of concentration/behaviour change. 
• Tearful/crying 
• Irritability 
• Hunger 
• Numbness around the lips and fingers. 

If you feel any of these symptoms, test your blood glucose level if time and circumstances permit. If you are unable to do so, treat as hypoglycaemia. Treat low or dropping glucose levels even if you feel fine. If you have low blood glucose levels without any symptoms you should discuss this with your doctor or Credentialled Diabetes Educator.

No Symptoms or Changing Symptoms

Some people have no symptoms of hypoglycaemia. They may lose consciousness without ever knowing their blood glucose levels were dropping. This is called hypoglycaemia unawareness and tends to happen to people who have had diabetes for many years.

Symptoms can also change over time, which may make it harder to recognise.

If you have hypos without symptoms or your symptoms change, you may need to check your blood glucose more often and alert your friends and family to watch out for changes. Treat low or dropping sugar levels even if you feel fine. If you have low blood glucose levels without any symptoms should discuss this with your doctor or Credentialled Diabetes Educator.

Treating Hypoglycaemia

Firstly, make sure you’re safe. For example, if you’re driving a vehicle, pull over to the side of the road.

Then have some quick acting carbohydrate that is easy to consume. For example:

• 1/2 can of regular soft drink (not ‘diet’) OR 
• 1/2 glass of fruit juice OR 
• 3 teaspoons of sugar or honey OR 
• 6-7 jellybeans OR 
• Glucose tablets equivalent to 15 grams carbohydrate. 

Wait 10-15 minutes. If it isn't rising, eat another quick acting carbohydrate from the above list. If your next meal is more than 20 minutes away, eat some longer acting carbohydrate. This could be one of the following:

• A sandwich OR 
• 1 glass of milk or soy milk OR 
• 1 piece of fruit OR 
• 2-3 pieces of dried apricots, figs or other dried fruit OR 
• 1 tub of natural low fat yoghurt OR 
• 6 small dry biscuits and cheese. 

Not Treating Hypoglycaemia

If hypoglycaemia is not treated quickly, the blood glucose level can continue to drop, which may progress to:

• Loss of coordination 
• Slurred speech 
• Confusion 
• Loss of consciousness 
• Fitting. Unconscious, Drowsy or Unable to Swallow

If a person with diabetes is unconscious, drowsy or unable to swallow THIS IS AN EMERGENCY.

Do not give them any food or drink by mouth.

Here’s what needs to be done:

• Place them on their side making sure their airway is clear 
• Give an injection of Glucagon if available and you are trained to give it 
• Phone for an ambulance (dial 000) stating a ‘diabetic emergency’ 
• Wait with them until the ambulance arrives 
• When they regain consciousness, given them carbohydrate to maintain their blood glucose level. 

Glucagon

Glucagon is a hormone which raises the blood glucose level and is injected in a similar way to insulin. Glucagon is recommended to reverse severe hypoglycaemia in people with diabetes. If you are able to treat your own 'hypo', you do not need Glucagon which is always given by another person. Your doctor or Credentialled Diabetes Educator will recommend you have Glucagon on hand in case of a severe ‘hypo’ and will show you, your family and friends how to use it.

Avoiding & Managing Hypoglycaemia

There are a number of things that you can do to manage and avoid hypoglycaemia including:

• Carry a ‘Hypo’-pack. 
• Wear an identification band that says you have diabetes, that way people will know that you need urgent medical help if you have one 
• Make a note in your monitoring book of any ‘hypos’ you have and discuss it with your doctor or Credentialled Diabetes Educator at your next visit 
• Make sure your family, friends, co-workers, school staff and carers know how to recognise and treat hypoglycaemia 
• Look for the cause of your ‘hypo’ so you can try to prevent the situation from occurring again 
• Contact your doctor or Credentialled Diabetes Educator if you are having ‘hypos’ often 
• If you are on insulin or certain types of diabetes medication, always carry quick acting ‘hypo’ treatment with you 
• If you’re taking medication called Acarbose (Glucobay®) carry pure glucose with you such as glucose tablets, glucose gel or Lucozade 
• Eat carbohydrates if you are drinking alcohol 
• Test your blood glucose level and ensure it is above 4 mmol/L before driving a motor vehicle. ‘Hypo’ Pack

A 'Hypo' pack is a pack for treating episodes of hypoglycaemia. Contents of a hypo pack may include:

• Name of the person it belongs to 
• List of contents 
• Written descriptions of hypo symptoms 
• Instructions for how to treat a hypo (in case friends and family need to treat) 
• Fast—acting carbohydrate such as juice boxes or jelly beans 
• Slow—acting carbohydrate such as muesli bars, fruit bars and biscuits 
• Doctors and hospital contact numbers 
• Emergency contact details, such as nearest relative. 

Hyperglycaemia 

Hyperglycaemia means high blood sugar level. This can develop over many hours or days.
It is possible for your blood sugar level to be high and you not even be aware of it. Many people do not experience the symptoms of hyperglycaemia until their blood sugar levels are extremely high. Although their blood contains too much sugar, they cannot tell unless they do a finger prick test.

Symptoms of Hyperglycaemia

• Feeling excessively thirsty 
• Frequently passing large volumes of urine 
• Feeling tired 
• Blurred vision 
• Infections (e.g. thrush, cystitis, wound infections) 
• Weight loss. 

Common Causes of Hyperglycaemia 

• Sickness 
• Infection 
• Stress 
• Too much carbohydrate food at once 
• Not enough insulin 
• Other tablets or medicines. 

Treatment of Hyperglycaemia

For Type 1 diabetes

• Contact your doctor or Credentialled Diabetes Educator for advice about increasing your dose of short acting insulin. You may also need extra doses of this insulin (e.g. 2-4 units every 2 hours). 
• Test your blood glucose levels frequently, as well as your urine for ketones every time you pass urine. 
• Drink extra water or low calorie fluids to keep up with fluid lost by passing more urine.

Contact your doctor or go to hospital if:

• Vomiting stops you from drinking and makes eating difficult 
• Blood glucose levels remain high 
• Moderate to large ketones are present in the urine. 

In type 1 diabetes, high blood glucose levels can progress to a serious condition called Ketoacidosis.