Diabetes Self-Management Blog

I hope you enjoyed reading the first report on my blog. This edition is coming to you from a hotel room in sunny South Africa. The past seven days have been spent on airplanes and in motorized vehicles, with not enough time on the bike. During this last week, I’ve been through three time zone changes and have raced in two very competitive races.

The first leg of my journey took me from my home in Atlanta, Georgia, to Mumbai, India, for the Tour of Mumbai. The team sent a group of six riders to the Tour, a UCI (International Cycling Union) 1.1 level race. (A 1.1 level race is the highest level race outside of a Pro Tour race.) The difficulty participating in a race like this for a person with diabetes is figuring out when to adjust his long-acting insulin or when to change the basal rates on his pump to be current with the new time zone. I make every effort to adjust as quickly as I can and to get on schedule with where I am racing. In this case, Mumbai is 11 hours ahead of Atlanta.

My procedure on this trip was to take a long-acting insulin two times each day. I took 65% of the total amount in the morning and adjusted the evening dose based on my training that day and the training I had planned for the next day. My flight to India was at 6 PM; I usually take my second injection around 8 PM. Because I was going to be sitting on a plane for the next 16 hours, I decided I would take my second injection one hour later at 9 PM and do my usual morning dose (even though it would actually be my evening dose). I also had my CGM (continuous glucose monitor) on to help me out.

So how did it work out? Well, by delaying my second dose by one hour, my blood glucose had risen slightly, to around 180 mg/dl, by the time I took my injection. I decided not to do any rapid-acting insulin to bring my blood glucose back to my normal range due to the fact that I had extra basal insulin in my system. With my CGM alarms set, I decided I would try to sleep. I woke up after four hours of sleep to a blood glucose level of around 110. I decided to eat an apple and to again not do a bolus. The next few days did require some tweaks to the bolus amounts due to the fact my biological clock had not fully accepted the time zone changes. But all in all, I was able to get off the first flight in the 130 range and head to the next flight with my diabetes management adjusted to India time in just one injection.

About 28 hours after I landed, I was set to start my first race of the 2011 season. The race was 175 kilometers (about 109 miles) long, with a big mountain at the halfway point. It was very hot and the race started off very fast. During a bike race, groups of guys will “attack” and try to form a “breakaway” to gain an advantage over the main group of racers (which is known as the “peloton”). The goal is to “stay away” and not get caught by the peloton.

I am usually one to stay in the main group and wait for the final sprint to the finish line, since sprinting is more my forte. However, in this particular race I followed another racer as he attacked the group. Four other racers came with us and we rode fast enough to gain an advantage on the main group. I found myself in the main breakaway of the day. This was very good for the team as well as for my teammates: The team got some good press for having a rider in the breakaway, and my teammates didn’t have to chase the breakaway down.

That said, the breakaway is not an easy place to race from. You are always working and don’t get much shelter from the wind like you do in the big group. Nonetheless, we gained an advantage of 3 minutes, 45 seconds over the peloton. We were about halfway up a 6-kilometer climb when a very strong rider from Uzbekistan decided he would ride up the mountain at a pace that I could not maintain. I was in front with 80 kilometers left in the race when I was caught by the peloton.

During the race, my blood glucose levels were great, ranging from 134 to 181 the entire time.

The Tour of Mumbai was great for the team. Not only was I in the breakaway group the first day, but my teammate Martijn Verschoor was in the breakaway on the second day. And we had a guy finish in the top 10 each day!

After leaving India we flew to South Africa, which involved a 3-hour time change. To accommodate this change, I took my basal dose early, timing it with my dinner, and did a small bolus to cover the carbohydrate in the meal.

Now we are getting ready to start the Tour of South Africa: An eight-day stage race!

Joe

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