It’s been a while since V and I went on a run together. Tonight an opportunity spontaneously presented itself. Good thing I have my fuel belt handy, so I quickly pack her diabetes essentials: shot blocks and gel for fast acting sugar, CGM, meter (what if CGM stops working?), and glucagon (just in case, I simply cannot bring myself to leave it behind.) V’s pump remote control is a little bulky, so I decide to leave it in the car and not put it in the fuel belt. After all, chances of V needing insulin on the run are slim to none.
I glance at the CGM before we leave the house. V is around 150. “Not bad but a little low before the run, have a few pretzels” – I instruct her. She happily obliges. I glance at the CGM once more before we get going and she is holding steady at around 140. It is a bit low before running but I decide that we will play it by ear and see what happens. After all, I brought plenty of fast acting sugar.
Jog, jog, jog… We are having a grand time. I keep glancing at CGM. V’s BG is lower but steady. I have her eat one shot block. Jog, jog, jog… V is feeling great but her BG continues to read a little lower still. I have her eat one more shot block. Jog, jog, jog… About 1.5 miles in CGM says that BG is 116 and now trending decidedly down. I ask V to eat one more shot block and she tells me that she really does not like the taste of it anymore. “Are you feeling OK? Are you feeling low?” She insists that she is feeling fine. OK, I pull out the gel and have her eat it. The last thing we need is a crash, and we have to go another 1.5 miles to get back to the car. She will burn it off for sure. We stop and V happily eats her gel. We carry on.
Jog, jog, jog… And then it hits me. OMG WHY DID I NOT REDUCE HER TEMP BASAL BEFORE WE STARTED??? I am feeling so spectacularly stupid. What would I do if V were 150 before gymnastics? Lower temp basal. What would I do if V were 150 before BMX? Lower temp basal, of course. Why it did not enter my mind to do so before our 3-mile run is completely beyond me. And now there is nothing I can do about it, as the remote is in the car and the car is 1.5 miles away.
Jog, jog, jog… V is now below 100 and still trending down. I remind myself that CGM takes a little while to catch up, so she is probably OK. And we have more shot blocks that she will eat if she has to, like it or now.
Jog, jog, jog… V is getting pretty tired but going strong. I glance at CGM again and to my relief see that she’s now stable at 90. We successfully prevented a low! We finish 3 miles strong and happy, and with great BG to boot… Or so I think?
We get home and I have V test and bolus for dinner. I am expecting a great number and CGM reading is in the neighborhood of 120. I’m feeling smug and proud that we nailed her T1D management on a run. She tests: 212. WHAT? How is it possible? She just ran 3 miles for crying out loud! We had a near low! I ask her to re-test and she gets the same result. CGM is now showing 136 with two arrows up, indicating a fast and furious trend upwards. Crap. I am now realizing that I royally over-treated her on the run. Between the shot blocks and the gel she ingested around 40 g. of fast-actng sugar and is now about to sky-rocket.
It’s time for damage control. I increase V’s temp basal rate by 70% (!) and she boluses for her meal. About one hour later she is nearly 300, but at that point I know we need to wait it out as she already has a lot of insulin onboard. She gets back into low 200s by bedtime. I extend her increased basal rate for another couple of hours and add another bolus. She is finally on her way to a good range.
And that, my friends, is how NOT to manage diabetes on a run.