Training and competing with Diabetes

Training – I work out 5-6 times per week, sometimes twice a day. Hence, my "normal" state is typically either during training or post-training. As mentioned earlier, having excessively high blood glucose levels affects my training (and competing) performance negatively. Having low glucose levels, on the other hand, introduces the risk of severe hypoglycemia. Consequently, I strive to maintain an optimal state for mental and physical performance, which, in my case, is around 180mg/dL.

Unfortunately, the body's energy production changes during physical activity. For diabetics, the primary difference is that it requires less insulin for blood glucose to reach the cells. Non-diabetics merely cease producing insulin, but diabetics continue to release what has been injected – refer to the section on insulin types. Any excess or unnecessary insulin causes the blood glucose to be absorbed by the cells at an increased rate, potentially leading to a hypoglycemic state.

It's even more complicated as the body reacts differently to various types of physical activities. For instance, as a climber, my body response varies whether I'm bouldering (an intense, short-term activity where glucose levels initially even rise) or doing lead climbing (more of a power endurance activity where the insulin demand decreases almost instantly).

One of the most challenging and potentially dangerous aspects, regardless of the kind of training, is the 'muscle cell glucose fill-up effect' post physical activity. After a long and demanding training day(s), my muscle cell glucose storage depletes, and my body spends several hours refilling and repairing the cells – a process that requires significantly less insulin compared to normal times. This is why I've switched my long-term insulin to Levemir, as opposed to the 24-hour insulin, Lantus, I previously used.

With Levemir, I can substantially reduce or even skip the insulin injection in the evening. Nevertheless, I've endured countless nights where my smartphone alarm goes off due to my blood glucose level dropping below the alarming threshold. I've had to wake up, drink some juice, or have a quick glucose drop. If I underestimate the demands of the training and the necessary replenishment effect, and administer insulin, I've had nights where I got up at midnight for the first glass of juice, again at 3am to consume some bread with honey, before officially foregoing sleep at 6am for a breakfast of porridge with fruits. As a climber striving for peak performance and concurrently mindful of maintaining my weight, consuming these excess calories due to a miscalculation can be frustrating.

Especially during my early years, being younger, I relied on a feature of the smartphone app that allows my parents to monitor my glucose levels, proving a welcome support on multiple occasions. They helped me oversee it, and sometimes I could even disable my alarms, relying solely on my parents' alarms instead. They could then decide whether to act on a threshold by waking me up or deem that it was still safe and balanced out. This was a massive relief, but it becomes challenging when thousands of kilometers away in a hotel room. Thankfully, even in such situations, I have coaches and teammates well-versed with me and my Diabetes around me, ready for backup if necessary.

I always carry an emergency drug for hypoglycemic states during travels and shorter trips, although I've never used it thus far and don't plan to delve into that subject here.

Competitions certainly rattle my blood glucose and insulin balance. It's rather unfortunate, happening precisely at a time when I want to feel at my best and stay focused. If I manage to maintain my blood glucose level within the appropriate range, I enjoy an incredible mental boost; my body signals that it's in balance and primed for action. However, if I don’t manage it, maintaining calm and executing the right steps can be a real struggle - that’s when having a coach or friend on hand for support can be a lifesaver.

Why does my body react so wildly during competitions? It primarily boils down to the adrenaline my body releases to switch into 'fight' (or 'flight') mode. This adrenaline prompts the liver to release its glucose store for additional energy - problematic for a diabetic like me, as this glucose originates internally, making it difficult to gauge how much has been released.

How do I manage? Well, it's hit and miss. Each competition presents a unique set of challenges - sometimes, my nerves kick in days ahead, leading to premature adrenaline release. Other times, I can effectively prep myself, consuming the right foods and gradually upping my insulin intake without risking a low sugar incident (which would force off-plan eating). Consistently eating familiar and regulated meals prior to a competition is a definite advantage. By doing so, I can eliminate one of the unforeseen variables - although this is not always feasible, especially when travelling.