How to Manage Diabetes while Riding

You can still ride (and even race!) after a type 1 or type 2 diabetes diagnosis, with a little knowledge and planning. – By Selene Yeager

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In a nutshell, diabetes is a human energy crisis condition. Type 1 develops when the body cannot make any insulin, the hormone that controls blood sugar. Type 2 develops when the body cannot produce enough insulin, or the insulin being produced does not work properly. Insulin manages your blood glucose levels by moving sugars from food you eat into your cells; without it, that fuel remains in the bloodstream, where it damages organs and tissues. It’s fatal without treatment.

As one might imagine, that can make daily living—let alone bike riding—a challenge. With the right steps, however, it’s a challenge you can meet. We solicited advice and wisdom from successful cyclists living and competing with diabetes, including pros racing for Team Novo Nordisk, a global all-diabetic sports team of cyclists, triathletes, and runners; Team Skyline Pro Cycling; and Colavita/Bianchi p/b Fine Cooking. Here’s what they told us about riding while diabetic.

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Form Your Team and Plan of Attack
The first step in managing diabetes is to work closely with your healthcare professional to figure out a plan that matches your riding and exercise goals. This is a non-negotiable step: Everyone with diabetes is different, and your approach must be personalised to your specific needs. Find a doctor who understands how much you ride and your riding goals.

“In many ways, someone with diabetes is very similar to other athletes in that you need to manage your exercise and nutrition,” says Wil Gibson, 50, of Bartlesville, Oklahoma, a cyclist with Team Novo Nordisk’s Type 2 team. “But we need to be consistent about checking our blood glucose levels and always be prepared with food and medication in order to manage our diabetes.”

Your doctor can help you establish a plan, including best times of day to train and how to go about monitoring, adjusting, and ultimately managing your fluctuating glucose levels. “I’ve gone to the same physician for many years and he is well informed of my intense training routine,” says Gibson. “We’ve worked together to develop diabetes management guidelines specific to me. Whether I am on the bike for one hour or five hours, I am able to make adjustments as needed to maintain peak performance,” he says.

“Once you have your plan, start the program slowly,” says Matt Vogel, vice president of marketing and medical affairs for Team Novo Nordisk. It’s going to take some trial and error to figure out how your body best responds.

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Equip Yourself
Remember that this is a condition requiring careful calibration. That means a lot of self-monitoring. Riders with diabetes track their blood sugar before, during, and after exercise using a finger-stick style blood glucose meter or a continuous glucose monitor (CGM). For optimal performance, they need to keep their blood sugar levels within a target range.

You need a prescription for a CGM, but if you’re cycling regularly—especially over long distances or in races—it’s extremely useful, says Morgan Patton Brown, who races with Team Colavita/Bianchi p/b Fine Cooking. “The CGM works by measuring the amount of glucose in my interstitial fluid every five minutes, then sending the information to a receiver—which a lot of people mistake as my pager, because that’s what it looks like,” she says. “This way I have a constant blood glucose reading and see how my blood sugar is trending, which is key when being a competitive athlete.”

The CGM will also sound an alarm if your readings are dangerously high or low. If you use an insulin pump, there are systems that allow you to link it to your CGM, so you don’t need to manually program the pump, but rather get continuous adjustment. The data from the CGM can also be downloaded onto your computer or smartphone and shared with your doctor or coach.

“The reality for cyclists is that no system is 100-per cent perfect; you just have to learn to deal with it,” says Ryan DeWald, owner of Skyline Bike and Skateboards and president of Team Skyline (for which he also races). “I have a Dexcom monitor that is stuck in my arm and an Omnipod pump on my abdomen,” he says. “But these devices can be tricky for fit cyclists who have less subcutaneous fat where you’re inserting the needles. It takes practice and it’s not perfect. You learn to rely on your senses as well.”

You’ll also need to fill your pockets with other essentials, says Vogel. “I always carry my continuous glucose monitor, blood glucose meter for backup, medication, food, water, medic-alert ID bracelet, cell phone, and wallet.”

Even with all the monitors and readouts, it’s important to remember that managing diabetes isn’t an exact science, says Vogel. “One day can differ from the next and each day’s management can vary,” he says. To spot trends and hone it in the best you can, Vogel recommends old fashioned tracking by journal. “I keep a logbook, including my blood glucose values, medication, food intake, and exercise.”

Be Consistent and Diligent
Having a regular routine is good for everyone, but especially for people managing diabetes. “I am committed to exercising at least one hour per day, seven days a week,” says Gibson, who includes total-body conditioning as part of his diabetes management plan, choosing exercises he can do without a gym or special equipment so travel doesn’t throw off his routine. “I do things like body squats, lunges, burpees, pull ups, push ups and planks. Most of them can be done almost anywhere with little to no equipment needed.”

Obviously you have to be most consistent and diligent when training and competing, says Ben Dilley, a pro rider for Team Novo Nordisk . “I always start my training day with a solid breakfast because my diet is an important part of my diabetes management plan. I closely monitor my blood glucose levels so that I’m able to start my training ride with my glucose levels at their optimal level, so I can be focused on the day’s specific workout,” he says. “Throughout the training, I make sure to stay properly hydrated and fueled with food. I also constantly check in on my glucose levels with my continuous glucose monitor. If I need to, I’ll make adjustments using insulin and food to maintain my optimal glucose level. After training, I make sure to eat a good recovery meal to replenish my fuel stores so that I’m ready to go again the next day.”

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All the riders agree that the three phases of a ride require their own special diligence. Specifically:

Before you roll out: “For me, the preparation before a ride is crucial,” says Brown. “I make sure not to have a meal too close to when I start to ride so that any active insulin on board in my system does not create hypoglycemia, while at the same time dosing enough for my meal without being hyperglycemic.”

If you’re taking insulin, the Mayo Clinic recommends testing your blood sugar 30 minutes before exercising and offers the following guidelines relative to your blood sugar levels —measured in milligrams per decilitre (mg/dL) or millimoles per litre (mmol/L)—to know if you’re ready to roll:

Lower than 100 mg/dL (5.6 mmol/L): Your blood sugar may be too low to exercise safely. Eat a small carbohydrate-rich snack before you begin riding.
100 to 250 mg/dL (5.6 to 13.9 mmol/L): For most riders, this is a green-light range indicating you’re good to go.
250 mg/dL (13.9 mmol/L) or higher: Use caution. Before saddling up, test your urine for ketones, which your body makes when it breaks down fat for fuel. Excess ketones mean you don’t have enough insulin to control your blood sugar, and could make riding dangerous. Postpone your ride until your levels are low or clear.
300 mg/dL (16.7 mmol/L) or higher: Your blood sugar may be too high for you to ride safely. Put off your ride until your blood sugar drops to a safe pre-exercise range.

The foods that work best pre-ride vary by rider, but most eat a pre-ride meal pretty similar to what the rest of us would reach for. “I don’t follow a strict diet or meal plan per se, but I do have personal go-to foods,” says Dilley. “My typical pre-race breakfast is a bowl of oatmeal with dried fruit and nuts, sometimes a spoonful of peanut butter or maple syrup.”

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During your ride: This is where the CGM comes in handy. You can watch your levels as you ride, hydrate, and fuel yourself. If your blood sugar gets out of hand, you may need to make adjustments by administering insulin if it’s too high, and by eating or drinking something with carbohydrates or taking a glucose tablet if it’s too low.

“During training and racing, I make sure to always have my diabetes supplies and a snack with me. I’m routine about what I do in training, and I try to always carry that over to race day,” says Mandy Marquardt, who races with Team Novo Nordisk Women’s Team. “I always have a bottle of water and a bottle of Nuun, which I’ll sometimes add a scoop of carbohydrate to. For a snack, I prefer something like Nature Valley Protein Chewy Bars, preferably peanut butter dark chocolate. I can’t always control race day nerves, which can cause changes to my blood glucose levels. So I need to be ready to take the correct measures I need to manage my diabetes.”

“I’ve learned that I need about 20 grams of carb for every unit of insulin to keep rolling strong,” says DeWald. “But that changes if I’m racing stage races or crits every night. Then it may be 30 grams for every one unit.” He also manipulates his pump to back down the flux of insulin 30 minutes before riding, so he doesn’t have a blood sugar crash shortly into the ride or race, but the system isn’t perfect. “I carry one bottle of Accelerade and natural food bars like Ally’s Bars as well as quick sugar hits like blocks to try to adjust if it gets too low, and a bottle of plain water to chug if it starts getting too high.”

Post-ride recovery: All cyclists, diabetic or not, need to restock their muscle glycogen stores to recover from a hard ride. For riders without diabetes, that just means getting in carbs and protein and hydrating while your metabolism does the rest. Riders with diabetes need to help the process along. “I usually take a unit or two of insulin right away when I get off the bike,” says DeWald. “Then I eat a post-ride meal that is a ratio of four-to-one carbohydrates to protein.”

“Avoiding hypoglycemia can be tricky even hours after training and racing has ended—even in the middle of the night,” says Brown. “All of this is easier for me to handle when I am wearing a CGM, because it alerts me when I go too high or too low.”

In the end it’s all a balancing act, says Brown. “It’s taken me years to get somewhat good at managing it all and I am sure will be something I am constantly having the think about for the rest of my life… or until there’s a cure.”

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