RAGBRAI LI Route Announced on Jan. 27!

Riding with DIABETES

I am a type 1 diabetic planning on riding Ragbrai for the first time this year *(if I get selected). My MD is working with me to find the best solution to make it through the ride without problems. Anyone have any suggestions? I am on an insulin pump. I currently decrease my basal rate by 50% for an hour before when I bike until an hour after I bike, carry glucose tabs or other snacks. How often do you check? How often do you Stop to eat? How long do you decrease basal rates for? I will take any suggestions you have.

6 Replies

Dave b, February 14, 2016 at 9:13 pm

Hey Denise first I’m going to address the route questions. I am assuming you’re a newbie to RAGBRAI so we need to clear up a few things. You don’t have to be selected to ride. I want to get that clear, you can ride as long as you feel fit enough to ride RAGBRAI. its not a race.. you ride from town to town and can stop as often as you like to eat and recharge in between the towns. Along the way to the next town, houses and farmsteads will often have water and food available for sale in between those stops so the most you will ride during a normal ragbi route in a day is 15 – 30 miles.

Regarding taking care of yourself on the ride it’s important to begin practicing writing now to see how much food and refuel you’ll need so that its not a constant guessing game while you’re riding RAGBRAI. It would be good for you to take a weekend sometime 3 months out so that you can ride 20 miles stop ride 20 miles stop checking your blood sugar along the way if you have an insulin pump you’ll be able to stay safe but you might not feel the best if you’re unsure of how much food you need during that kind of physical activity. If you don’t already make sure that you have the type of insulin that doesn’t need to be refrigerated or have someone that can supply you insulin because it’s very difficult to keep things cool while in route.

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Low Rider, February 14, 2016 at 9:14 pm

Note: all trademarks used herein are owned by their owners and having an implied (R) or (TM) as the case may be with each invocation.

T1D has been asked about in the past. The new forums software on this site makes the “Search for:” function very difficult to use for the prior years unless you know exactly for what you are searching, so I will give you the links from before rather than ask you to search for them.

https://ragbrai.com/forums/topic/a1c-you-later-any-type-1s-out-there/
https://ragbrai.com/forums/topic/riding-with-diabetes/

I am planning on doing my 5th RAGBRAI this summer and I was a Type 1 during the previous RAGBRAI’s and am one now as well. The first 2 RAGBRAI’s I did with test strips and second 2 RAGBRAI’s I did with a CGM (Dexcom). Coincidentally my insulin delivery during the first two RAGBRAI’s was the “poor man’s pump” (lantus and novolog strategically delivered via vials and syringes) and a pump (Omnipod) for the second 2 RAGBRAI’s. It is my hope that I will be able to afford using the Dexcom this summer, but if necessary I can use strips. For the 2016 RAGBRAI I will be using a Tslim pump.

The above links cover some of the territory of your question “Anyone have any suggestions?”

You mentioned you “currently decrease . . . [your] basal rate by 50% for an hour before when . . . [you] bike until an hour after . . . [you] bike” I know it is not polite to answer questions with questions but I feel I must. How long and far are you riding? RAGBRAI days will be longer and harder than what you probably are doing, so keep that in mind as you make your plans. Is the reduction in basal rate working for you now? No hypoglycemia during the rides or at night? No unexplained hyperglycemia? If so, that sounds like you are on a good path. If not, you need to make adjustments.

You mentioned that you “carry glucose tabs or other snacks”. Me too. Training for RAGBRAI is harder than the actual riding RAGBRAI. There are more food buying opportunities on RAGBRAI. Food options tend to be carb-centric so you get the glucose spikes, but there are some protein options for a slower availability of glucose throughout the ride (although a lot of those protein options are fat heavy with the commensurate retardation of metabolic processes). Make sure you have cash for the carb stops, and enough emergency glucose so you aren’t caught low in a bad place. I ride with a glucagen hypo kit in case I am so bad the muscles in the throat don’t work and I can’t swallow. I make sure my team knows about it and when it’s use is indicated.

“How often do you check?” With test strips – every hour of riding. meaning about a month’s worth of test strips during the ride and then more for meals, and other testing. With the CGM – it tests every 5 minutes and I have to manually test periodically (2-3 times a day) for calibration purposes.

“How often do you Stop to eat?” Every hour or so. I try to lay down a base for the day with a good balanced meal (carbs and proteins) for my breakfast, which is harder to do than it should. People don’t realize we are so Alpha our Beta cells have been made non-operational. Those with working Beta’s can do that carb centric RAGBRAI breakfast food. All that being said, nothing like the week of RAGBRAI and you can eat your third piece of pie by 10:00 every morning. The night time carb-fests are also not particularly helpful for us non beta’s.

“How long do you decrease basal rates for?” That is where your records about training, eating, and BG will help you make your plan. We probably have different carb ratios in our pumps and well as different correction factors. You need to find the settings that allow you to keep a tight control of your BG and yet keep you from dragging because you are hypo or borderline hypo. I would error on the side of being hyper rather than potentially going hypo during RAGBRAI.

So I will tell you about last year’s RAGBRAI. I carried insulin and pump supplies and only bolused after one really heavy dinner. No basal at all for the week. My CGM alarmed during the nights indicating potential hypoglycemia, the trend lines were such that I could ride out all of the lows. More that once I was asked “to turn off my cell phone so it wouldn’t wake those around me”, and I had to explain it was my monitor to keep me from going to coma land. The CGM showed great glucose control for the week. (My Endo scheduled an appointment the Tuesday after RAGBRAI, (I had to do the A1C before RAGBRAI, it was good but did not cover RAGBRAI) and my daily reports from the CGM were great. He told me I should try to have every week look like that week. Yeah, right.)

Your body may be able to go without insulin for the week or you could be in DKA 5 hours after your first skipped dose. You need to use your logs, and maybe log some additional factors so you can make your plan. I would run very far from anyone other than your doctor or your Diabetes Trainer that would give you pump settings for the week. It is your body and your body will be different from mine and other T1D’s.

Now is the time to experiment so you know your body and how it works. A lot of Endo’s have professional CGM’s that they can put on patients for a week or two. See if yours has access to that and in early June try it out as you do a week of training. You can see how your body recovers each day and night after a ride.

My last suggestion of this diatribe is to pay attention to what your body is saying. One day last year I was feeling bad around lunch. My CGM told me I was in a good range. Turns out my CGM was wrong, the sensor had gone bad. I was very hypo according to a couple confirming manual tests. I had more sensors, in my luggage, but none with me on the road. I sagged out and treated the low then replaced the sensor and had a great ride the rest of the week. That day I wasn’t listening to my body, and believing the lying CGM.

Hope some of this is helpful. Please let me know if you have any other questions.

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KenH, February 14, 2016 at 10:11 pm

Can’t say anything about diabetes since I don’t have it but you do have to be selected to make this ride. There is a lottery for wristbands and while we think the probability of being selected in the lottery is very high, there are a couple of people who have claimed to have missed the cut over the last couple of years. They never answer followup questions so we have no idea if they truly were “losers” or perhaps just failed to fill out the application properly or on time or etc….

You can see from the route basics that have been released so far that the daily mileages will be between 50 and 75 miles so you have to plan for that and better yet have made test rides of that length to verify that your plan works. If you decide to take the gravel loop it is not likely to boost the day’s mileage outside that range. If you decide to take the Karras (century) loop be advised that they can go over 100 miles. The three I have done were 107, 112, and 101 miles. It is easy to pick up 5 to 10 extra miles a day doing incidental riding, like from your campground to the route at one overnight town and then from the route to your campground in the next overnight town.

Food is widely available on the route, mostly in towns but there will be some between towns venues too, locations are hard to predict. I don’t have diabetes but even I find it easier to ride these distances with all the food support during RAGBRAI than I do when I try to do more than 60 miles on a ride that has only the typical snack like food available at the rest stop. I can eat anything of course, so I can’t really evaluate how easy it will be for you to find the food types you need.

There is a meeting town on each day’s route that is roughly half way between overnight towns and I do mean roughly. If your team has a SAG vehicle you probably should press the driver to meet you there every day so that you have a bail out option if you need it. There is also a SAG service all along the route, don’t be afraid to use it if you need it. Normally people who just didn’t bother to train properly are discourage from relying on it to bail them out several times a week or every day. In your case I would say that if you need to use it every day then do so, do not take chances.

If you really need to use refrigerated insulin there are a lot of motorhomes used as team SAG vehicles. It would not be impossible to find someone who would carry your insulin. Obviously you won’t have access to that on the route, but if having it in the morning and evening would help (as I say, I would not know) then it might be possible to get it.

hutchriders caught my attention. Cousins I did not know I had perhaps? But it turns out you are from Hutchinson, MN, so just a coincidence.

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ridingwest, February 15, 2016 at 3:16 pm

I’m diabetic and have been doing Ragbrai for years. The big thing is, make sure you have whatever you need with you. I have glucose tabs and jelly beans etc. with me. I also ride with a diabetic rider sign attached to my seat. Not a big one, index card sized. I would also suggest getting a rider ID, it has your name, contacts, meds, and conditions engraved on it. Think of a med alert bracelet for active people. You can find them at riderid.com.
Remember the ride is a friendly ride and no one is going to let you “dead bug” on the side of the road without helping you. We diabetic riders kind of have our own brotherhood, we recognize each others symptoms and offer help if needed. Ride at your own pace, there are no prizes for coming in first. If you’re not feeling well, catch a sag or stop and see Bob and the Medic crew. They are great guys and gals. Remember there is no disgrace in not riding or having to catch a sag, your health is the most important thing. Enjoy the ride

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Brian Wallenburg, February 15, 2016 at 3:40 pm

Solid advice Low Rider!

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Denise Hanson, February 19, 2016 at 4:23 am

Thanks for the comments and help. To answer low riders questions:

YES I am new to Ragbrai and I am excited to ride.

During the week I bik 15-20 miles 3-4x/week and on weekends I’ve biked up to 50 (that was last summer).

I wear a sensor 24 days a day so I can see my BG at any moment as long as the calibration to done. My MD and nurse can check my BG trend through my device. Reduction works most of the time. I just haven’t done that many miles on a daily basis.

I love the idea of the small sign indicating I am diabetic.

Thanks again and I look forward to riding with you!

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