Disclaimer: The information contained within this blog post are my thoughts and do not constitute medical advice. Please consult your medical team before making any changes to your diet or blood sugar management program.
I decided to get an analogue bicycle and I have loved the challenge of riding it. I had a terrible GC half marathon (GCHM), complete with muscle spasms, but I finished so that was nice. The training for the GCHM was amazing and I got to run in some pretty interesting places, like the NSW rail trail in Casino.
I have developed a host of new features for my Diabetes Analysis Tool, including an integration into Strava, where I update my exercise description with my exercise stats.
Physiological Metrics
I am currently on an average of 42.9 units per day and an average of 150g of carbs per day. These carbs include carbs from fat and protein (gluconeogenesis).
You can see from the graph below that my weight has fluctuated quite a bit this year, with poor eating habits (snacking at night) the biggest contributor to a lower time in range. My lowest bodyfat was 15% (confirmed by 3rd party testing). This dramatic weight shift was due to training for the GCHM.
Extract from the Renpho smart scale imported for Analysis.
Weight and Bodyfat graph exported from Diabetic Analysis Tool.
Exercise metrics
Every year I try to increase my distances and time in range (TIR). This year I increased my TIR by 2%, which is incredible. Although my CV and SD are lower, average glucose is down 0.06 mmol/l. I attribute this to lower insulin closer to exercise time, and refuelling at appropriate time intervals.
Annual view of exercise stats2024 exercise stats (grouped by distance)2023 exercise stats (grouped by distance)
Energy Burn Rates
A table of the estimated energy replacement carbs consumed.
Time-in-range (TIR)
A graph of Time in Range (3.8-7.8) per exercise.
Blood glucose control metrics
Extracted from Nightscout Reporter
Insulin sensitivity
In the below graph we can see that walking and weight training result in the lowest changes in sensitivity.
Graph derived from AVG_EXERCISE_STATS_2024_GROUPED_INSULIN_SENSITIVITY table.
The half marathon has passed. The training this year went well, with no running related injuries to speak of at the point of writing, although I did get food poisoning a week before the race and I missed my last long run. I have learned a lot over the course of the year, which has helped get me to this point. The actual race was a totally different experience, it rained for the first few kilometres, I had stomach cramps and I suffered intense muscles spasms, none of which happened in over a thousand kilometres of my training over the course of the last two (2) years.
Race Day
Race day 2024 was very different than I expected. I felt confident due to all my training. The rain was an annoyance, but one easily overcome by a running jacket (if I race again I’ll get a opaque poncho).
I woke up at 03:50am with little sleep and a blood glucose of 5.8 mmol/l. This crept up steadily, likely due to cortisol and adrenaline. By race start time I was 9.0 mmol/l with 0.9 units of insulin on board (IOB). Due to the IOB I ate about one third of a Cliff Bar (18g of carbohydrates) which in hind-sight was a mistake.
Nightscout graph for the entire day.
Due to the inclement weather my Garmin didn’t pick up my heart rate on my watch consistency, or perhaps even accurately. I found my Garmin advising I was running at approximately 130 BPM even though I felt I was pushing quite hard. I got a personal best (61 minutes) for the first 10 kilometres.
AAPS graph for race day.
Label
Race Day
Average during Training
Start Time
06:23 am
Distance
21.2km
Average HR
133 BPM
Standard Deviation
2.3 mmol/l
0.8
Coefficient of the variation
31.9%
11.3%
Blood Glucose – start
9 mmol/l
6.5
Blood Glucose – min
4.4 mmol/l
Blood Glucose – max
11.1 mmol
Blood Glucose – average
7.4 mmol/l
6.7
Time in Range (3.9-7.8)
51%
71.9%
Insulin on board
0.99
0.1
Race day compared to training was wildly different, I will need to analyse the data and come up with a better race day strategy.
Time vs. Pace with a Stamina and Blood sugar overlay. Time vs. Heart Rate with a Pace and Blood sugar overlay. All Garmin Race Stats
Training
I’ll add the link once all data is processed.
Equipment
I try to come prepared for all possibilities.
This year I spend a lot of time finding the perfect shoe for my unique requirements, namely that I supinate on my right foot due to an atrophied right calf muscle. In my testing, the Brooks Ghost performed the best, allowing me to run any distance with no pain or discomfort.
Final Thoughts
The food poisoning caused an electrolyte balance, which resulted in muscle cramps on race day. This was something I had not experienced during my training, an I was ill prepared for it.
My sugars were higher than during training again, and if I do this again I will refrain from coffee or any carbs prior to the event.
It’s been just over a year since I permanently switched to the Omnipod, and my experience has been a blend of highs and lows. Despite a slight increase in my A1C from 5.7% to 6%, in part due to increased carbohydrate consumption, I appreciate the benefits of the Omnipod’s tubeless design. Not having to deal with tubes and the convenience of the Omnipod’s form factor have made managing my diabetes a bit less intrusive.
However, the transition hasn’t been without challenges. The Omnipod system requires immediate activation upon insertion, which can cause insulin resistance due to the initial trauma of insertion. Its design also means that you experience any issues with insulin resistance or site trauma and need to change a pump early, it can be a costly endeavour. This resistance is difficult to manage, especially around meal times when precise insulin delivery is crucial.
Another problem I encountered was tunnelling, where insulin leaks out from the cannula site. This not only affects insulin delivery but can also cause irritation. The excipient nicotinamide in the insulin formulation has also caused some site reactions for me so I mix insulin with a 50-50 ratio with Humalog. Please note this is off label.
Tips and Tricks I’ve Learned
Despite these challenges, I’ve discovered several strategies to improve my experience with the Omnipod:
Adjusting Insulin Profiles:
When installing a new pump, I set my profile to 120% to counteract any initial insulin resistance.
I try to install the pump a few hours before or after a meal to avoid the insulin resistance coinciding with a meal.
If I miscalculate the timing and need to change a pump around meal times, a short 5-10 minute walk on the treadmill helps improve insulin absorption.
Securing the Cannula:
Using Opsite Flexifix under the pump has been a game-changer. It keeps the cannula in place and reduces the need to replace the pump after activities like running.
For additional security, I use Smith+Nephew Primaflex Plus or Fixomull stretch over the pump. I use an old pump or the over-tape provided by Dexcom as a template to cut pieces as needed.
These tips have significantly improved my experience with the Omnipod, making blood sugar management more consistent and reducing the frequency of pump replacements due to physical activity.
Interesting Facts and Supporting Information
A1C and Diabetes Management: An A1C level of 6% is considered good diabetes control. According to the American Diabetes Association, an A1C below 7% is recommended for most adults with diabetes .
Insulin Absorption: The angle and method of insulin delivery can impact absorption. Studies have shown that the angle of insertion can affect how well insulin is absorbed, with certain angles potentially causing more issues like tunneling .
Use of Adhesives: Using adhesives like Opsite Flexifix can help secure insulin pumps, reducing the risk of dislodgement and improving insulin delivery reliability .
In conclusion, while my journey with the Omnipod has had its ups and downs, the freedom from tubes and the ability to manage my diabetes with less visible technology are significant benefits. With the right strategies, I’ve been able to mitigate some of the challenges and maintain effective blood sugar control.
For individuals living with diabetes, maintaining stable blood glucose levels is a critical aspect of managing their condition effectively. Traditionally, glycated hemoglobin (HbA1c) has been the primary metric for evaluating long-term glucose control. However, it provides only a snapshot of average glucose levels over several months. To gain deeper insights into daily glycemic patterns and fluctuations, healthcare professionals and patients are turning to a more comprehensive and dynamic metric called “Time in Tighter Range” (TITR).
What is Time in Tighter Range (TITR)?
Time in Tighter Range (TITR) is a metric that quantifies the percentage of time blood glucose levels remain within a specific target range. The target range is often defined as the optimal window where glucose levels are considered both safe and effective in reducing the risk of diabetes-related complications. Commonly, the TITR target range is set between 70-140 mg/dL (3.9-7.8 mmol/L), but it can be tailored to an individual’s needs based on age, health status, and treatment goals.
Why TIR Matters in Diabetes Management
Real-Time Assessment: Unlike HbA1c, which provides a retrospective average, TIR offers real-time data, empowering patients and healthcare professionals to make immediate adjustments to diabetes management strategies.
Insights into Glucose Patterns: TITR helps reveal patterns and trends in glucose control, identifying potential trouble spots and offering opportunities for targeted interventions.
Reduction of Hypoglycemia and Hyperglycemia: Maintaining TIR within the target range can reduce both hypoglycemic episodes (dangerously low blood glucose levels) and hyperglycemia (elevated blood glucose levels), enhancing overall quality of life and mitigating diabetes-related complications.
Tracking and Monitoring with TITR
Using TIR involves continuous glucose monitoring (CGM) or frequent blood glucose measurements. The data is then analyzed to determine the percentage of time spent within the target range. Several approaches can be used to track TIR:
CGM Devices: Advanced CGM devices automatically calculate and display TIR data, offering users real-time feedback on their glucose control.
Data Logs: Patients and healthcare professionals can manually record blood glucose readings and calculate TIR using spreadsheets or dedicated apps.
TITR in Real-Life Scenarios
Personalized Diabetes Management: TITR allows for a tailored approach to diabetes management. It helps healthcare professionals customize treatment plans and make timely adjustments to insulin dosing, diet, and exercise regimens.
Pregnancy and Diabetes: During pregnancy, TITR is critical for expectant mothers with diabetes, as tight glucose control is vital for the health of both the mother and the baby.
Sports and Physical Activity: For athletes with diabetes, TITR provides insights into glucose fluctuations during physical activity, helping them optimize performance and avoid glucose-related issues during exercise.
Conclusion
Time in Tighter Range (TITR) is a valuable and dynamic metric that goes beyond traditional HbA1c measurements, providing real-time insights into daily glycemic patterns. With its ability to track fluctuations and trends within the target range, TITR empowers individuals and healthcare professionals to take proactive steps towards better diabetes management. By striving for optimal TITR, patients can enhance their quality of life, reduce the risk of complications, and achieve greater control over their diabetes. As TITR continues to gain prominence in diabetes care, it offers new possibilities for personalized and effective diabetes management strategies.
Recently my diabetic inspiration David Burren wrote an article about his results using an Artificial Pancreas System (APS). In this article he compared his results to those of 2019 CGM study of people without diabetes. His results are far better than my own, but I was interested to see how I stack up.
*The last two (2) weeks of data with me being back in the gym.
GMI – Glucose Management Indicator
TIR – Time in Range (3.9-10 / 70-180)
TITR – Time in Tighter Range (3.9-7.8 mmol/l / 70 -140 mg/dL)
CV – Coefficient of variation
Analysis of current results
When analyzing my results on a glucose percentile diagram we can quickly see that the area I need the most work on is in the evenings. Making healthier choices here should have the most profound effect going forward.
Goals
I want to aim for an SD of less than 1.2 and an average BG of less than 6 to have a CV of 20% or less. This is considered to be an optimal range for non-diabetics. This equates to a TITR of around 90%.
The Dawn Effect and Blood Glucose: When we wake up in the morning, our body experiences a surge of hormones, commonly referred to as the “dawn effect” or “dawn phenomenon.” This natural hormonal response can lead to an increase in blood glucose levels even before we consume any food or engage in physical activity. Cortisol, growth hormone, and other hormones play a role in this phenomenon. For individuals with diabetes, the dawn effect can pose challenges in maintaining stable blood glucose levels, especially during a race. The hormonal surge may contribute to higher blood sugar levels, making it crucial to adjust your diabetes management routine accordingly.
This graph shows the average blood sugar during training vs. my blood sugar from the Gold Coast Half Marathon.
Training vs. Race
Average distance (km)
Average time (min)
Average HR (bpm)
TIR (3.9 – 7.8)
Average Blood Glucose (mmol/l)
Coefficient of variation (%)
Pace
Training
14
92
156
92%
5.8
14
6:40
Race
21.4
140
151
21.4%
9.9
22.54
6:39
This table shows the average metrics during training vs. the same metrics during the Gold Coast Half Marathon.
Blood Glucose Management: Pre-Race Strategies: To optimize your blood glucose levels during a race, careful planning and preparation are key.
Here are some strategies to consider:
Race Day Automation: If you use an insulin pump or automated insulin delivery system, consider setting up a race day automation plan. Gradually reducing your insulin on board (IOB) and raising your blood sugar target before the race can help mitigate the impact of the dawn effect.
The automation I use if I plan on exercising at 06:30am. I use 05:00 – 06:00 so that if another automation is active at 05:00am there is opportunity for this automation to run after that one completes.
Timing of Pre-Exercise Snacks: To align the digestion of carbohydrates with the energy demands of the race, it is important to time your pre-race snack appropriately. If your blood glucose is around 5 mmol/l before starting, consuming a carbohydrate-rich snack approximately 15 minutes before the race can help maintain stable blood glucose levels, in my experience cliff bars have the perfect amount of nutrients for a long run.
Managing Blood Glucose During the Race: Once the race begins, various factors can influence your blood glucose levels.
Here are some considerations to keep in mind:
Listen to Your Body: Pay attention to any signs or symptoms that may indicate fluctuations in your blood glucose levels during the race. Feeling lightheaded, fatigued, or experiencing unusual thirst may indicate the need for carbohydrates. Regular Blood Glucose Monitoring: Carry a portable blood glucose meter to monitor your levels throughout the race. This will enable you to make timely adjustments and take appropriate remedial actions when necessary. Carbohydrate Consumption: Plan to consume carbohydrates during the race to maintain your blood glucose within a desirable range. Experiment with different forms of carbohydrates, such as gels, sports drinks, or energy bars, to find what works best for you. Remember to consider the impact of any exercise-induced insulin sensitivity and adjust your carbohydrate intake accordingly.
Data Extract from AAPS.
Post-Race Recovery: Upon crossing the finish line, it’s essential to prioritize your recovery and address any pain or discomfort that may have emerged during the race. Be mindful of the following:
Musculoskeletal Discomfort: Races can place significant stress on your body. Pay attention to any pain or discomfort in your muscles, joints, or tendons. Consult with a healthcare professional if necessary to address any post-race injuries. Blood Glucose Check: After the race, continue monitoring your blood glucose levels as they may fluctuate due to post-exercise hormonal responses. Adjust your post-race nutrition and insulin dosages accordingly.
Conclusion: Participating in a race as a person with diabetes requires careful consideration of blood glucose management strategies. Understanding the impact of waking up on hormonal levels, adjusting your approach accordingly, and incorporating remedial actions during the race are crucial steps towards maintaining stable blood glucose levels. By staying vigilant, prepared, and responsive to your body’s needs, you can conquer the challenges of a race while managing your diabetes effectively.
References:
American Diabetes Association. (2021). Diabetes and Exercise. Retrieved from https://www.diabetes.org/healthy-living/fitness/exercise-and-type-1-diabetesGupta, L., Khandelwal, D., Singla, R., Gupta, P., Kalra, S., & Dutta, D. (2017). Dawn Phenomenon and Its Impact on Blood Glucose Control. Indian Journal of Endocrinology and Metabolism, 21(6), 901–909. doi: 10.4103/ijem.IJEM_284_17
Exercise stats from Garmin
Equipment
Equipment Name
Note
Osprey duro 6 – Hydration pack
This hydration pack is a great option for long runs or cycles. It holds 1.5 liters of water, which is more than enough for most people to drink on a 2+ hour activity. It also has multiple pockets at the front of the vest, which allow you to store food, your phone, and your blood glucose meter. This makes it easy to access your essential items while you’re running or cycling.
Glucose gels
My general rule of thumb is bring at least twice the amount you expect you will need.
Cliff bar
The cliff bar was a new addition to my nutrition. These bars seemed to work well to stabilise blood glucose and I required no additional carbs for most runs between 14-18km.
Blood glucose meter + extra strips
If my sensor were to fail or I was to become dehydrated enough that my CGM reading was inaccurate I wanted to be able to assess my blood glucose.
Dexcom
Continuous glucose monitor. I ensured this had at least 24 hours to settle before the race. This way readings would more accurate.
Android APS phone
The phone that contain my artificial pancreas system.
Onmipod Dash
Bluetooth enabled insulin pump, allowing me to use Android APS. I ensured that I inserted the pod at least a day before the race so I had enough time to identify issues.
Brooks Ghost shoes
A comfortable pair of shoes you have tested and run in prior to the race. I still developed blisters so its imperative you get the correct size.
Asics running socks
A comfortable pair of socks.
Hat
A hat to ensure I don’t burn.
earbuds
To enjoy some music while I run.
Training
To prepare for the Gold Coast Marathon I did the following exercise;
Continuous glucose monitoring (CGM) is a technology that allows people with diabetes to track their blood sugar levels in real time. A CGM sensor is inserted under the skin and measures glucose levels in the interstitial fluid, which is the fluid that surrounds the cells. The sensor sends readings to a receiver or smartphone every few minutes, so you can see how your blood sugar levels are changing throughout the day.
What is traditional blood glucose testing?
Traditional blood glucose testing involves pricking your finger to draw a drop of blood, which is then applied to a test strip. The test strip is inserted into a blood glucose meter, which provides a reading of your blood sugar level. Traditional blood glucose testing is typically done several times a day, but it can be more frequent if you have diabetes that is not well controlled.
Advantages of CGM
CGM has several advantages over traditional blood glucose testing, including:
Real-time monitoring: CGM allows you to see your blood sugar levels changing throughout the day, which can help you make better decisions about insulin dosing and food choices.
More data: CGM provides more data about your blood sugar levels than traditional blood glucose testing. This data can be used to identify trends and patterns in your blood sugar levels, which can help you improve your diabetes management and has allowed for advances like Artificial pancreas systems (APS) to be created.
Less finger pricks: CGM can help you reduce the number of finger pricks you need to do each day. This can be helpful for people who have diabetes and are sensitive to pain.
Disadvantages of CGM
CGM also has some disadvantages, including:
Cost: CGM devices can be expensive, and the sensors need to be replaced every 7-10 days.
Accuracy: CGM sensors are not always accurate, and they can be affected by factors such as exercise, illness, and food.
Inconvenience: CGM sensors can be uncomfortable to wear, and they can be damaged if they are not properly cared for.
When to use CGM
CGM is a good option for people with diabetes who want to improve their diabetes management. It is especially helpful for people who:
Have frequent highs and lows
Have difficulty controlling their blood sugar levels with traditional blood glucose testing
Are at risk for hypoglycemia or hyperglycemia
Are pregnant
What happens when you are dehydrated or playing sports?
When you are dehydrated, your blood sugar levels can rise. This is because your body is not able to get enough water to flush out excess glucose. When you are playing sports, your blood sugar levels can also rise. This is because your body is using more energy, which can lead to a release of stored glucose.
If you are using a CGM, it is important to monitor your blood sugar levels closely when you are dehydrated or playing sports. You may need to adjust your insulin dose or eat more carbohydrates to keep your blood sugar levels in a safe range.
Dexcom sensor settling time
The Dexcom sensor needs about 24 hours to settle after it is inserted. During this time, the sensor may be less accurate. It is important to monitor your blood sugar levels closely during this time and to use a backup method of blood sugar testing, such as a finger prick, if you are concerned about your blood sugar levels.
Sensor placement
The placement of the Dexcom sensor is important. The sensor should be placed on the abdomen or the back of the upper arm. It is important to avoid placing the sensor on areas of the skin that are:
Injured
Irritated
Tattooed
Scarred
Acceptable tolerance of CGMS and blood sugar testers
CGMS devices are not always accurate, and they can be affected by factors such as exercise, illness, and food. Dexcom accepts a tolerance of 20% from blood readings. This means that a CGM reading that is 20% higher or lower than a blood reading is still considered to be accurate.
Most finger prick testers can be different to laboratory results. This is because finger prick testers measure blood sugar levels in the blood, while laboratory results measure blood sugar levels in plasma. Plasma is a thicker fluid that contains more glucose than blood. This is why laboratory results are typically higher than finger prick results.
Conclusion
CGM is a valuable tool for people with diabetes. It can help you improve your diabetes management and reduce the risk of complications. If you are considering using a CGM, talk to your doctor about the best option for you.
Introduction: Monitoring blood glucose levels is a vital aspect of managing diabetes, as it helps individuals make informed decisions about their diet, insulin dosage, and overall health. For many years, traditional blood testers were the primary method of measuring glucose levels. However, with advancements in technology, continuous glucose monitors (CGMs) have emerged as a game-changer in diabetes management. In this blog post, we will explore the key differences between CGMs and traditional blood testers, delve into the effects of dehydration and sports activities on glucose readings, and touch upon the settling time required for CGM sensors like Dexcom.
CGMs vs. Traditional Blood Testers: An Overview: Traditional blood testers, commonly known as fingerstick glucose meters, require a small blood sample obtained by pricking the finger with a lancet. The sample is then placed on a test strip, which is inserted into the meter for analysis. This process provides a snapshot of the blood glucose level at the specific moment the test is performed. It requires periodic testing throughout the day to get an idea of how glucose levels fluctuate.
On the other hand, CGMs provide continuous and real-time glucose readings throughout the day without the need for fingerstick tests. CGMs consist of a small sensor inserted under the skin, which measures interstitial fluid glucose levels, usually every few minutes. The data collected is transmitted wirelessly to a receiver or a smartphone app, allowing users to monitor their glucose levels continuously and detect trends and patterns.
The Benefits of CGMs:
Continuous Monitoring: CGMs offer a comprehensive view of glucose levels, revealing trends, highs, and lows that might be missed with traditional blood testers.
Alerts and Alarms: CGMs can be set to provide notifications when glucose levels fall outside of a target range, helping individuals take immediate action and avoid severe hypo- or hyperglycemia.
Data Analysis: CGMs generate detailed reports and graphs, enabling healthcare providers to analyze glucose patterns over extended periods, leading to more informed treatment decisions.
Dehydration and Sports: Implications for Glucose Monitoring: Dehydration and engaging in physical activities such as sports can affect glucose readings. When dehydrated, the blood becomes more concentrated, leading to a higher glucose concentration in the blood. Consequently, both CGMs and traditional blood testers may yield elevated glucose readings in dehydrated individuals. Therefore, it is crucial to stay adequately hydrated to ensure accurate glucose measurements.
During sports or rigorous exercise, the body’s demand for energy increases, resulting in the release of stored glucose. This can lead to a temporary decrease in glucose levels. CGMs, with their continuous monitoring capabilities, can help individuals track these fluctuations in real-time and take necessary steps to prevent hypoglycemia.
Sensor Settling Time: Dexcom and the 24-Hour Period: Dexcom, one of the leading manufacturers of CGMs, suggests a 24-hour settling period for their sensors. This recommendation accounts for the initial trauma caused by sensor insertion. During this period, users may experience inaccurate readings or fluctuations. Waiting for the sensor to settle allows for stabilization and more reliable glucose measurements.
Conclusion: The advent of CGMs has revolutionized glucose monitoring, offering substantial benefits over traditional blood testers. With continuous monitoring, alerts, and data analysis capabilities, CGMs empower individuals with diabetes to make more informed decisions about their health. However, it is important to stay hydrated and consider the effects of physical activities on glucose readings. Furthermore, users of CGMs like Dexcom should allow for a 24-hour settling period to ensure accurate and reliable measurements. Embracing this technological advancement can significantly enhance the management of diabetes, promoting better health outcomes for individuals worldwide.
Week 10 is done and dusted. During my long run on Friday I decided to use the New Balance Fresh Foam More V3 running shoes to see if that improved my experience. This is because they are the most padded shoes I own, and the small 3 mm drop is supposed to reduce the risk of injury. Unfortunately this only reduced the pins and needles, but I must have laced them poorly as I got a few blisters. I also started my run way to quickly, and if I cant maintain a few zone 2 runs I am not going to work my slow twitch muscle fibers and improve my fitness fast enough to enjoy this race. These were shoes I had used before so I think it was down to the lacing and running technique. The last run of the week was a 8 km zone 2 run on the treadmill. This was actually the first of run week 9, but I decided to mountain bike ride on the Monday as it was raining on the Sunday so I switched them. For this run I used the New Balance 1080v12 shoes, and this was a great run. Not sure if it was due to treadmill suspension but every second felt good, despise a hypo half way though.
Exercise stats
Blood glucose stats
My experience with AIMI AI has not been a good one, for some reason I keep going on the blood sugar roller coaster and the system either gives too much or too little insulin. I am eating way less at the moment so I would expect more control. I’m back to Boost once this Pod expires to try and improve my glucose values. Probably not a great time to be trying a new system while increasing my training.
Measurements
Weight 75.6 kg
Week 9 (01st – 07th)
In an attempt to reduce the pins and needles I was experiencing I got some 2XU vector compression socks. This seemed like it may have improved the experience somewhat, until I started wearing my Brooks Ghost shoes. During the 8km run with the Ghosts I experienced no issues whatsoever. Blood sugars with AIMI seemed to be much better this week, except for a few isolated incidences where AIMI provided too much insulin. Since AI (or in this instance machine learning) requires data to build its model accurately, its seems likely that I needed more data in order for the system to perform better.
Exercise stats
Blood glucose stats
AIMI – ModelAI
Measurements
Week 8 (08th – 14th)
This week was was a big training week with the start of the extended distance (15-20 km) runs in the training plan. I have bee using the Ghosts more and although I no pain during my runs, I had quite a few blisters afterward the 15 km run. No vector socks this week. The long run was a little difficult to manage with my sugars requiring (22g+25g+28g) 75 g of carbs to stabilize for the run. I wasn’t expecting that. Quite a few more hypers that lasted longer than I had hoped. I think this is my last week of testing AIMI-AI before heading back to good old Boost. I like the fact I can very accurate with IOB with Boost, although my difficulty is due to AIMI adapting so well with all the changes. I also found myself on my Strava groups leader board twice 🙂
Its been interesting to see the difference between how Garmin and Strava track fitness, with Garmin using Vo2 max as its measurement and providing a stamina metric.
Exercise stats
Fitness
Below is a post highlighting the difference between the two systems in relation to fitness metrics.
The Strava fitness metric seems to build with every run, providing some motivation to keep hitting those zone 2 runs. I am still 10 fitness points lower than I was in December. I am currently averaging 6 points every two weeks. If keep at this pace I should reclaim my fitness in about 23 days, or by the 6th of June. So that leaves almost the whole of June to work on improving fitness.
Garmin fitness metrics
The Garmin fitness metric is Vo2 max, or maximal oxygen consumption. This refers to the maximum amount of oxygen that an individual can utilize during intense or maximal exercise. This measurement is generally considered the best indicator of cardiovascular fitness and aerobic endurance.
Blood glucose stats
AIMI – ModelAI
Measurements
Week 7
This week I decided to shake things up, do a little mountain biking in New South Wales and also travel to new beach locations for my runs. It was amazing and I had an incredible time. I have also been asked to be a front runner for the Gold Coast Marathon team training sessions at HOTA.
Exercise stats
Blood glucose stats
AIMI – ModelAI
Measurements
Week 6
This weeks long run was a little harder than usual, but it did have a beautiful view. I wanted to do a 15km but unfortunately was cut short to 14km. My feet felt good and good issues with blistering with the Ghosts. I also did a park run which almost ruined everything as my tendon issue faired up with the lack of a proper warm up. I was a little slower than I thought as I only managed 5min/km for 2,5km before burning out.
Exercise stats
Blood glucose stats
AIMI – ModelAI
Measurements
74kgs
Week 5
This week’s long run was fantastic! I completed the full 16 km without experiencing any pain or discomfort. As an experiment, I decided to try a Cliff Bar for the first time during my run, and I think I may have found my new go-to snack for long-distance running. I started my run with a blood glucose level of 4.1 mmol/l and waited approximately 20 minutes after consuming the bar before getting started. This slight delay caused a small spike in my glucose levels at the beginning of the run. To mitigate this, I plan to wait only 15 minutes before starting my next run.
Analyzing the graph below, we can observe when the Automated Insulin Delivery Systems (AAPS) kicked in to provide a temporary basal rate adjustment to lower my blood sugar levels. Since I set a slightly higher temporary target of 8.3 mmol/l, AAPS registered my insulin sensitivity to be around 55% less than my standard needs. AAPS responded perfectly, gradually bringing my glucose levels down to a comfortable 5.2 mmol/l by the end of the run.
Overall, this run was a success, and the combination of the Cliff Bar and the effective response of AAPS made it even better. I’m excited to continue fine-tuning my routine and exploring the benefits of different strategies to optimize my long-distance running experiences.
Exercise stats
Blood glucose stats
AAPS – Boost 3.9
Measurements
74 kgs
Week 4
This week was a bit of a mixed bag for me as far as my diabetes management goes. On the one hand, I had a great park run, where I managed to run a respectable 5:10 min/km for the 5km duration. This landed me in second position overall for this particular park run.
My long run started off very strong, but towards the end I developed some pain in the glute which resulted in me needing to stop the run at 17km, rather than the planned 18km. I managed to stay in range 100% (3.9-7.8 mmol/l) for the duration of the run with an average of 5.8 mmol/l, and my standard deviation was 1.024. I attribute to this to the cliff bar I ate 15min prior to starting the run.
I had a high percentage of low blood glucose readings on my CGM this week, which was mainly due to CGM sensor issues. This, in conjunction with poor rest has resulted in my HRV being quite for low for the week.
I went one full work week without sugar free soda. This change was due to recent research released indicating the significant detriment to health sugar free soda can have.
Exercise stats
Blood glucose stats
AAPS – Boost 3.9
Measurements
Week 3 (12-18th)
Exercise stats
Blood glucose stats
Measurements
Week 2
During my last long run, I had to make the difficult decision to bail out early. Unfortunately, I was dealing with an ankle and tendon injury, which limited my capacity to cover the desired distance. Additionally, my blood sugar levels dropped significantly, adding another layer of challenge. Upon reflection, I realized that this low blood sugar episode was a consequence of inadequate planning. I had not set a high enough temporary target of 8.3 for a sufficient duration, leading to the drop in blood sugar levels.
To alleviate some stiffness in my legs, I sought a massage on Sunday. However, this revealed another issue – lower back pain on the left side. It became evident that this discomfort was likely a consequence of my existing tendon problem on the left side, as my body attempted to compensate for the imbalance. While I have been diligent in incorporating stretching exercises into my routine, it is unfortunate that I began doing so too late to make a significant impact on my current situation.
Despite the challenges I have faced, I consider these setbacks as valuable learning opportunities. Moving forward, I intend to implement the following lessons to prevent similar situations:
Prioritize Injury Prevention: Understanding the importance of injury prevention, I will be more cautious with my training and listen to my body’s signals. This means recognizing the need for adequate rest, seeking professional advice when necessary, and gradually increasing intensity and distance.
Establish Effective Blood Sugar Management: To avoid experiencing low blood sugar levels during physical activities, I will proactively set higher temporary targets and ensure their duration aligns with the demands of my workouts. This way, I can maintain stable energy levels and perform optimally.
Address Imbalances and Compensatory Patterns: By acknowledging the connection between my tendon issue and the resulting lower back pain, I will incorporate exercises and therapies that specifically target these areas. By addressing imbalances early on, I can prevent further complications and improve overall performance.
While my fitness has undeniably declined due to the limitations imposed by my injuries, I have gained valuable insights from these experiences. By emphasizing injury prevention, refining blood sugar management, and addressing compensatory patterns, I am confident in my ability to overcome these setbacks and continue progressing on my fitness journey. Remember, setbacks are not roadblocks but opportunities for growth and resilience.
Exercise stats
Blood glucose stats
Measurements
Week 1
The lead up to race week has been less than ideal. Unfortunately my injury is preventing me from training and is causing pain and discomfort when I run, especially at incline. This was a reminder that injury prevention is key, and if I ever attempt this again I will ensure I follow a program that prioritises injury prevention through intelligent training, gradually increasing mileage and strength training. Please read my retailed post about the race below.
It’s been three weeks since my last post on the half marathon goal for 2023. I had set myself a target of being able to run 10 km by the 28th of April in order to commit to the 21 km run. So far its undecided as I seem to keep getting a numb right foot during runs, although my fitness seems like its returning slowly.
Blood glucose Analysis for the last three weeks:
During this time I was using a dev branch of AAPS with automations to scale the insulin requirements.
Exercise analysis for the three weeks:
The last week was the start of my running ramp-up increasing distance more substantially from 3-4 km to 6-7 km.
Unfortunately I have been plagued by a numb right foot as I exceed the four (4) km distance. This prompted me to do a little research and the most common problem found seemed to be shoes that did not fit well, or that were laced too tightly.
This could of course be glucose related (neuropathy), as when my A1C was in the sevens (7) I experienced something similar, but It seemed to start as I laced up.
Today’s run I changed shoes to see if that helped, unfortunately I still experience the numbness quite early on in the run, but I kept going. At around the seven (7) km mark I decided to increase pace and this seemed to remedy the issue strangely. Below is a graph of the 9 km run from AAPS / Nightscout data using my custom Python scripts.
The next steps are to purchase some Omega 3 and Alpha lipoic acid and ascertain if that can assist with the foot pain.
Dick The Diabetic's APS Adventures 