Diabetic Climbers and Training

I'm a middle aged type 1 diabetic (35 years now).  I'm looking for other type 1 diabetics to discuss how diabetes is impacting your training.  

As most type 1 diabetics know there are various aspects of being a diabetic that can make climbing a bit more difficult.  Reduced healing rate, perpensity for connective tissue damage, body fat retention due to sysnthetic insulin, and not to mention regulating blood sugars.  How are other type 1 diabeteics here dealing with this challenges?  

Biggest challenge I have is managing my blood sugar on long climbs. I bring a backpack loaded with soda with me on all multi pitches I do, which can be a real pain when there are offwidth pitches. Carrying a tag line to pull the bag up after I climb or simply clipping it to a sling sling around my shoulder work well enough. I’m gonna try a small Fanny pack next time and see if that’s nicer. I keep my blood sugar higher while climbing. Probably too high honestly… but I’m working at bringing it down a little.

I don’t think it’s impacted my training but maybe I’ll start using that as an excuse as to why I’m not climbing V10

I can't help you as I'm supposedly T2 but my blood sugar sky rockets when I climb.  And falls off a cliff when I'm done.

I typically climb multi pitch with a second chalk bag that I’ve modified with a zippered closure. In this bag I keep energy gels, my meter, insulin and a few syringes.

I find that my blood sugar can temporarily spike when climbing. It lasts for only 15 minutes and is due to adrenaline. I don’t correct for these highs unless they persist for 30 minutes. Other than that I will reduce my basil rate by 40% for multi pitch.

I can't help with type 1 advise but have advise comments about type 2.  Statins deplete coq10 so take supplements.  Low energy level is a symptom of low coq10.  I went off my statins it was so bad for me.  I read a paper that indicates metformin inhibits formation of mitochondria.  The study had a dose  2000mg in non-diabetic people.  So a couple of confounding factors but inhibited ability to create new mitochondria would make increasing endurance very difficult.  I plan on talking with my doctor about this. 

climber patwrote:

I can't help with type 1 advise but have advise comments about type 2.  Statins deplete coq10 so take supplements.  Low energy level is a symptom of low coq10.  I went off my statins it was so bad for me.  I read a paper that indicates metformin inhibits formation of mitochondria.  The study had a dose  2000mg in non-diabetic people.  So a couple of confounding factors but inhibited ability to create new mitochondria would make increasing endurance very difficult.  I plan on talking with my doctor about this. 

Do you have problems with increasing endurance?  I haven't had that experience myself.

skik2000wrote:

Do you have problems with increasing endurance?  I haven't had that experience myself.

Yes but I don't know if my problem is really lack of trying.    My endurance decreased dramatically when I when on metformin etcetera.  Most of my loss was at the high end of output, probably down 30% in 4 months.  I went from being 1st on hour long approach to being last.  

On the road bike I had highly variable output over short time periods.  Something like 5 minutes of good and then 5 minutes of bad   But the major component to that problem was the statin.

I think I am still down 10% but I can put put it out continuously for quite a while but still less total time than before going on the meds.  I am now near the beginning of the group on approaches but not at the front. I am also worn out for the day sooner than before. 

My blood sugar is high when I feel bonked.  I think that might be the mitochondria issue.  But I need to talk to my doctor about it.  

Dating a type 1 diabetic, not an expert but I did find some interesting papers on exercise physiology to apply to climbing. I can share my simplified understanding of a couple topics.

Our bodies use ATP to contract muscles. To get this ATP, fuel is broken down either aerobically or anaerobically. During low intensity long duration exercise, oxidative phosphorylation and fatty acid oxidation are dominant, and use muscle glycogen (fuel stored in the muscles), blood glucose from liver and gut, and fat ( nature.com/articles/s42255-…). A good book to reference to improve this capability is ‘Training for the uphill athlete’.

During high intensity exercise, anaerobic metabolism dominates. It’s a fast way to get a lot of ATP in the muscles, but it isn’t as efficient, generating only 2 ATP for every molecule of glucose. Aerobic metabolism can generate 35+. Glycogen fuels this process, which is a limited resource.

Stress causes the adrenal glands to release catecholamines (adrenaline is one of them) which trigger the release of glucagon which stimulates the breakdown of glycogen into glucose and released into the blood.

Climbing is a perfect storm. Not only is there hiking at high elevation in cold weather, it’s followed by 20-30 min spurts of scary anaerobic activity with short cruxes at maximum effort. Blood glucose drops as the body is using it up, then spikes from adrenaline, then drops again post-exercise when the body is replenishing glycogen.

Some things that have anecdotally worked, note it isn’t medical advice.

1. Carbs in the morning to start with a slightly high blood sugar, around 150-200 mg/dL (from a normal 100).
2. Heartrate firmly in the aerobic dominant zone during the approach. Under ~130-150 bpm or whatever lactate threshold is for you. This is slower than most people think.
3. Gels are useful but also eat bars with fat during the climb.
4. Extra carbs post-exercise to take advantage of glycogen production while using a normal amount of insulin.

The tslim pump is set to night mode (constant basal), reduced basal would be a good experiment.

I am T1 and usually climb with the chalk bags with some extra pockets, tough to be fast and light but way better to bring this vs a bag or bum pack. My buddy and I were able to do the 67 pitch traverse route in a go and that thing was sweet for it. I find I tend to go low with moderate hiking with a heavy pack more than anything else, it always seems like I tank on the approach if its got any solid vert or length. I try to get my BG trending upward solidly before and it usually will be ok when I get up to the crag if its >1hr

Hello Chad- I have been a type 1 diabetic now for 43 years and I am a full time mountain guide. I love your questions and this is why I am putting together a group of diabetics to get into the wild with one of my clients who is a climber and and Endocrinlogist. The biggest question I get from my clients, mostly doctors, is how do you guide these big objectives everyday and how am I so healthy.
your questions are very scientific and these are something I actually had to good for because I don’t know the answer or I don’t know my body well enough to understand the reduced healing rate, body fat retention ( I am 5’4” 120lbs) , perpendicular for connective tissue damage ( this is actually something I am understanding more of because I am doing lots of dry needling and PT to keep my joints working).
it seems like the biggest issue diabetics on this forum are indicating they have problems with is their blood glucose levels. I agree. This is extremely difficult and my CGM graph looks like a roller coaster on the daily! I absolutely love how diabetics here are realizing the stress of climbing causes sugars to increase. As a guide I deal with this all day long!
I would love to put together an all diabetic climbing group for the weekend to go out with this endocrinologist friend of mine to ask her all the questions and get advice while we do something mega! Would this be an interest to you and some people here on the forum? 

I’d be interested in participating in a trip like that Sarah!

Similar age, T1D for 15+, climbing for only a few years. My experience mimics others: aerobic causes a crash but anaerobic seems to have very little impact other than maybe a spike at the beginning. I used to think I crashed after a session but I haven't noticed that in the last year or two. Perhaps I don't work as hard? Or it's a W since I'm a more efficient climber? I think it was just timing of my session and the need to up my long acting.

I do long acting at 8am and 8pm, which isn't exact when I'm at the crag in the AM or at the gym in PM. It affects me at the time but usually not in a huge way. As you know though, add in a couple variables and an hour delay in insulin and it can cause some crazy numbers. Again, easier to manage with a pack near me at all times. 

I overpack on food and gels but don't do multi pitch much, so it's easier for me to manage. I trail run and hike and that's my concern due to longer aeroic work sessions. My stomach isn't exactly coated in iron so the gels go down easier than food sometimes. Blocks are great but more expensive. Another bonus is that my phone and CGM are always close without multipitch. Would love to do it more, gives me confidence to see yall on it. 

One piece of kit that gives me more confidence is a cooling case for my pens. I've carried them all day in desert heat and didn't see a drop in quality. Highly recommend and I think it was 10 bucks. Also keeping my pens near my body when it's close or below freezing.

The only other thing is talking about it with partners. I mention my phone has my CGM linked, friends usually ask, but I also try to just casually mention if I am high or low just in case it needs to be useful. And then just tell people to call 911 in an emergency. Don't need someone thinking an insulin pen is an epipen. 

Chad Millerwrote:

I’d be interested in participating in a trip like that Sarah!

Would the end of October be a good time for you to get out with a group of climbers? Maybe the weekend of October 28th! I’d love to get the word out and get anywhere from 3-6 people who have type 1 diabetes. Price is not worked out yet cause that will depend on how many folks join but my guess would be around $675??
Be fun to go campout in RMNP at Spearhead and climb the North Ridge 5.6 and talk with Dr Alex to get some in the moment advice! How cool would that be! I will start advertising if this date would be good