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Old 11-23-2003, 07:15 PM   #24
pascale
Dojo: Jiki Shin Kan, Utrecht, Netherlands
Join Date: Nov 2003
Posts: 1
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Hi Holmes and others,

I saw your post asking for strategies for aikido training longer than 1-2 hours. I read the replies with interest.

I have diabetes type I since 8 years and I train in aikido since 2 years.

Diabetes is an individual disease. What works for one person may not work for another. Everyone will have to learn by trial and error.

I am a bit different case compared to other people with type I, because I am a LADA type (Latent Auto-immune Diabetes in Adults) and my body still produces some insulin of its own. So what works for me may not work for other people with type I.

I take 4 insulin injections a day. I discussed the insulin pump with my specialist, but he was of the same opinion as your doctor was (If you manage a tight control of your blood sugar level by injections and your HbA1C is small enough then you don't gain much by an insulin pump).

Different individuals have a different sensitivity to insulin (E.g. This sensitivity partially depends on your weight. Overweight people tend to have a lower sensitivity. It also depends on the amount of physical exercise you get during a day). This explains why different individuals require different amounts of insulin for the same amount of carbohydrates. It may vary a factor 10.

I recently learned that your sensitivity to insulin varies within a 24 hour period. Most people are more sensitive during morning and afternoon and less during the evening. But some individuals show a different graph of sensitivity. If your sensitivity to insulin varies, so does your personal ratio of units of insulin per amount of carbohydrates. So what works in the morning may differ from what works for dinner.

I attended aikido summer school (in Netherlands, Europe) twice. The last summer school took 5 days with one training session on the first day and one on the last day and two training sessions per middle three days. Each training session takes 3 hours. I compensated for this larger amount of exercise by decreasing the amount of insulin, both my ultrafast insulin (humalog) and my slow insulin (insulatard). My teacher informed the sensei of the summer school, so I was given permission in advance to leave the tatami any time during the training session (in order to take care of my blood sugar regulation). Normally, an aikidoka has to approach the sensei and ask permission to leave the tatami.

On a regular week night I take 10 units of slow insulin. At the end of the first and last day I took 8 units of slow insulin. At the end of the three middle days I took only 6 units of slow insulin. Each training session was preceeded by a meal (either breakfast or lunch). I decreased the amount of ultrafast insulin for each of these meals, taking 3 units instead of 4 units. I took roughly the normal amount of insulin (both ultrafast insulin (humalog) and fast insulin (actrapid)) for dinner, sometimes rounding down the amount (varying between 7 and 13 units).

I had one hypo half way during a training session (I always hope to avoid that). It was 3.3. mmol/l = 59.4 mg/dl. I treated that one by eating 8 tablets of "dextro energy" (dextrose), slightly more than I would normally for a 3.3 mmol/l, and taking a small break of 5 to 10 minutes. I usually ended with low sugar levels after the second training session on the day, sometimes a minor hypo. I treated those primarily by decreasing the amount of insulin for dinner. I always measured my blood sugar level just before going to sleep. My blood sugar levels just before going to sleep were lower than usual, but not by much. I experienced one blood sugar level below 6.0 mmol/l = 108 mg/dl; it was 4.9 mmol/l = 88.2 mg/dl. I treated that one my eating a mandarin (6 gr carbohydrates). The standard advice is too eat 15 gr carbohydrates when your blood sugar level is below 8.0 mmol/l = 144 mg/dl just before you go sleeping. I adapted the advice for my individual case.

Physical exercise has about 24 (and for some people 48 hour) effect on your blood sugar level. After the physical exercise itself, your body tries to replace the (used up) sugar in your muscle cells. That gave me the idea to try out decreasing the amount of slow insulin after a day with physical exercise (after discussing it with my specialist).

This decreasing the dosis of insulin (instead of one or more timed intakes of carbohydrates) works fine for me.

I apply this strategy to a regular training session (either 1 hours and 30 minutes, or 2 hours) as well. My regular aikido training session is in the evening. So that implies planning my dinner before my training session, taking less insulin for dinner and taking less insulin after training session just before going to sleep. I do not eat any extra food if possible, though I always carry an apple and "dextro energy" with me. Roughly one out of 20 training sessions I experience a hypo during the training session (and eat "dextro energy"), so it works fine. Occasionally, I have a hypo after the training session and eat either the apple or "dextro energy".

With respect to stress. Most people with diabetes experience an increase in their blood sugar level as a result from stress, but some experience a decrease. For some people the increase is temporary and will be followed by a decrease in the blood sugar level. For other people the blood sugar level remains high after increasing. Given these three scenarios, every individual with diabetes should find out for him/herself how he/she responds to stress (and handle it accordingly).

I recently attended an educational weekend on the insulin pump. They advised me to decouple the pump during an aikido training session. They also advised not to decouple the pump for more than 90 minutes. If a pump is decoupled for longer than 90 minutes then one should consider taking an insulin injection. I think one gets better control of one's diabetes when one continues to wear the pump during an aikido training. So, what is the best place to attach the pump during an aikido training? Is there any experienced aikidoka who uses an insulin pump who can tell me?

With kind regards,

Pascale
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