Wednesday, October 8, 2014

Training - and the consequences...

Max had a relatively intensive one hour training today.

Training from Pierre Vandevenne on Vimeo.

 According to the otherwise excellent "Think Like a Pancreas" book by Gary Scheiner, a carbohydrate replacement of 50-55 grs should have been enough for a boy of Max's weight (50 kgs) playing an hour of tennis . We barely made it through (low alert after 45 minutes) with a 100-120 grs load, about twice the recommended load. This has been a frustrating constant recently: we go as low as we can with insulin (4 units for a total, including the previous meal, of 200 grams of carbs) and he keeps crashing during training anyway...Carbohydrate loading with gels began at 15:12 precisely, then 15:45, then 16:10, in the hope of synchronizing glucose absorption and exercise. BG started to fall in the middle of the session and Max became mildly symptomatic at 16:45.

To be honest, I am starting to think that the available published data about carbohydrates replacement for young T1D diabetics is only valid for casual sport... not for the real stuff. It's a touchy topic: one can't obviously tell people "your sport session was a joke". But all the advice found in books or on the net seems to be intended for what's actually low intensity exercise. Studies at 60% VO2Max fall in the same category...

And, to add insult to injury, despite a very quick reaction and carbohydrate reload post exercise (see how the IG curve recovers relatively quickly), we are still getting an awful, fairly typical, "delayed lows" night. No quick fix here as I have no idea what his net glucose debt is.

So, that's another night of watch duty for dad. But, thanks to the CGM and the Nightscout Project (by a bunch of truly remarkable volunteers), I am fortunately able to monitor the situation as I write this post.

With the CGM + Nightscout combination, Max
  • can play tennis as he likes to play it.
  • will go through the night relatively undisturbed (correction + a finger prick or two)
  • will not overshoot to 350 mg/dl just because we would have to be on the safe side.
Without the CGM, we would have had
  • to skip tennis altogether "Max, we are sorry, but diabetic kids can't do that".
  • or to overload carbohydrates blindly to be on the safe side.
  • to finger prick multiple times during the night, and possibly miss lows anyway.
Without Nightscout, I would be camping in his room doing nothing but worrying.

Can't help wondering how this would have unfolded if we didn't have those tools...

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