My Diabetes "Challange"

What's the Problem?

One significant issue is that despite the variety of insulin types and the modern CGM sensors, they can’t fully replicate the body’s real-time interaction of blood measurement and insulin production. See, as I mentioned earlier, the CGM measures glucose level in the interstitial fluid, not the blood. It takes approximately 10-20 minutes for glucose to go from blood to the interstitial fluid. Consequently, the CGM displays a value that is about 10-20 minutes behind the actual blood value.

Even the fastest insulin I use, Fiasp, takes roughly 12 minutes post-injection until the first part reaches the blood to interact with the glucose. Let's imagine a situation where I consume a 10-gram glucose drop at 8am. The sugar is quickly digested, and the glucose is released into the bloodstream by around 8:10am. At about 8:25am, the glucose makes its way to the interstitial fluid, and I can observe a rise in my glucose levels via my CGM app. I then administer the Fiasp insulin, which makes its way into my bloodstream around 8:40am. I can then see the effect of the insulin-glucose interaction around 8:55am on my CGM.

So, from consuming the glucose drop to observing if I've injected the correct amount of insulin takes around an hour – and this is about as straightforward as it gets. If you consider eating a meal like pizza, rich in carbohydrates (and therefore glucose) and fats that take several hours to fully digest while constantly releasing fluctuating amounts of glucose into the blood, you begin to understand the general challenge concerning managing blood glucose levels.

Picture 1: A (almost) perfect day. A night of low, but not too low values. My usual no-carb breakfast where only the coffee and adrenalin cause the blood glucose level to rise. A low-carb lunch, perfectly calculated and timely injection. In the afternoon I only had a comparably light training and I kept me fueled with small doses of sirup. Only after the training, in the evening, my blood glucose dropped due to the muscle glucose refill phase stronger than anticipated by me and I had to eat some carbs more than intended. The next night was ok again, due to a low-carb dinner and a reduced basal insulin.

Picture 2: A so lala day. The night was good, however fairly close to being too low. Therefore, I had some carbs (a Brezel) for breakfast additionally which kicked me higher than expected. So I also started higher into lunch and then in the afternoon boulder training session – the yellow values are ok, but I prefer it to be a bit lower. I can then react better, e.g., by having a small snack in between without having to inject Insulin for it. In the evening I misjudged the refill effect after training and injected too little basal Insulin and therefore had a fairly high night.

Additionally, to the pure calculation challenge – how much Carbohydrates does the meal contain to derive the Insulin amount needed – there is also the real life challenge. My body, unfortunately, isn't a machine – it has its ups and downs, and different moods each day. These moods dictate how my body responds to the insulin I inject and how the glucose I consume is processed. On the few 'normal' days I have, I've become proficient at determining the carbohydrate content of my meals. I inject the appropriate amount of insulin, and 1-2 hours post-meal, my blood glucose level returns to the ideal range. There are now countless reasons, particularly as an athlete, why I seldom have these 'normal' days. Let me highlight the most significant ones and describe how I try to manage them.

·        Training – I workout 5-6 times a week, sometimes twice a day. Hence, my 'normal' state is either during training or post-training. I'll discuss this in more detail in a separate blog.

·        Competition – Blood glucose and insulin regulation go haywire before and during competitions. This is particularly unfortunate because this is exactly when you want to feel your best and not be distracted. I will cover this topic in more detail in a separate blog.

·        Diet – Roughly 8 months ago, I transitioned to a low carb diet, which has been hugely beneficial but also poses its challenges as a diabetic. I'll delve deeper into this in a different blog.

·        Traveling – Exploring the globe and meeting amazing people, both in and outside of competitions, is one perk of being an athlete I thoroughly enjoy. Look out for a more in-depth blog on this topic.

·        Infection – Even athletes fall ill, especially during the long winter months when we're pushing our bodies to the limit with intensive training. Most infections result in a much higher insulin demand for me, which can be frustrating. I find myself continually having to inject more and more insulin. Over the years, I have gradually come to terms with this, especially since I've noticed how quickly I recover from an infection when I maintain my blood glucose level as low as possible.

·        Rest periods – Resting isn't my favorite activity, but I make time for it at least once a year for about 4-5 weeks after the competition season ends. During this time, I transition into a "typical" diabetic as my insulin demand significantly increases due to continued high appetite and reduced physical activity. While my average insulin demand during a training week is around 25 Insulin units, and about 35 units during a deload or tapering phase, it skyrockets to 70-100 units after 2 weeks of "couch surfing". It's a struggle to accept this every year, as I start thinking the insulin is ineffective, or something is amiss. But, it helps looking back at what I required the previous year – or having my parents remind me.