Half Marathon 8. Stress

 

Every December sky must lose it’s faith in leaves and dream of the spring inside the trees. So sang Beth Neilsen-Chapman. She wasn’t singing  about diabetes of course  but the same lyrics applied to this run. Just 3 days after my ‘Easy Street’ marathon I went down with a cold. A pretty straightforward viral- type cold only lasting a week and not enough to need to go to bed, just to take things quietly and not exercise for a while until the slight muscle aches went away. It just doesn’t seem right to run with muscles that themselves are struggling. But I do often run through early sore throats though, it is my treatment for sore throat based on the assumption that exercise improves immunity. It seems to work okay if you can get out within a day of getting that sore throat sensation. But once an infection gets hold I tend to back off the exercise. Running is also a good treatment for muscular back ache. After about a mile of pain, the muscles fall into line and as if by magic, back-ache gone! You might think I run in a hair shirt running vest, but I don’t. If the back pain is just muscle pain it works. Anyway, that is to digress. This cold took hold.I missed the window of opportunity to get out for a run. But, while it only lasted a week, it had a bad effect on glucose levels for 6 weeks overall. It was quite shocking. I had to double my rapid acting insulin for at least 4 weeks in order to get even modest control. I even had to give lots of added injections between meals as a sort of damage limitation exercise. Only a couple of units here and there in an attempt to keep the glucose reasonable. But despite this, glucose levels would frequently get into double figures and stubbornly stay there, even with additional doses of rapid acting. I’m sure many people have been there. It is not good. With the addition to mental stress on top, and disturbed sleep, things were pretty dire indeed. Of course it is all relative. Back in the day when I was carbohydrate counting I would have been pleased to have achieved such profiles even on a good day. But I had got used to doing better than that. Complacent almost. I was doing fine with a simple diet adjustment. And having had a long period free of illness I wasn’t paying much attention to other aspects of diabetes. But I knew just by observing glucose levels that there was more going on than just reaction to diet, and that insulin resistance was still there. I was also aware of the effect of general stresses of day to day life were having on glucose control. I suppose the relief of just being in control for the first time in over 20 years on dietary change alone and the improvement in everything diabetes related does allow one to just carry on doing the same thing. There is far more to life than a ketogenic diet. That is just a tool to enable life to be fun again. Lemming Test-Pilot reckons they are pretty slick at ketogenic dieting. It helps enormously and is life-transforming. A ketogenic diet is  fundamental in managing Type 1 diabetes.

But this stress reaction of course was way beyond the insulin-diet model. If only diabetes were that easy! The problem of gaining control here was related to infection and mental over- stimulation in a negative way. We are talking stress reactions. Acute stress on top of chronic stress; infection and mental stress for a short time on top of a background of the long-term low level stress of diabetes.

Stress! A great word that means many things. It can have both positive as well as negative meanings. What we are talking about here is the negative one. Infection and mental stress can affect the immune system. As can the sleep deprivation that often goes with it. The internet is awash with advice and information on stress. And perhaps it is no surprise that there is often a supplement being sold to treat it. There are endless antioxidants and super-foods, pills and potions, that are claimed to reduce inflammation caused by stress. Not to mention all of the medicines for mental health that identify a single molecule that is causing the damage and invent a pill for it. Lemming has been interrogating the internet and decided that one needs a brain the size of a planet to understand the biochemistry of stress. The end result of all of that research, has led Lemming to the conclusion that stress reactions are nothing more than a consequence of the condition the body finds itself in.

Anyone who has read the blog this far (and you might benefit from this explanation of stress as a result, well done and thank you!) will have a reasonable grasp of how carbohydrate, real food and lifestyle can transform Type 1 diabetes). That in itself is a great start. Type 1 in a low-stress environment responds to a ketogenic diet and relatively low levels of stress are manageable. But ramp up the stress and it is another challenge entirely. Lemming has discovered so many stress-related biochemical pathways and biological compounds that it is difficult to work out what is significant, and what has less importance in the grand scheme of things. There is the acute stress reaction to infections, and reactions to lower level persistent stresses in such things as chronic disease including the metabolic upset of Type 1 diabetes, through to inflammatory effects of external agents such as food and the air we breathe. And don’t forget emotions and the brain. Stress reactions can raise levels of stress hormones such as cortisol and adrenaline, which are best known, but there are also others such as growth hormone, prolactin and even insulin. Just about every response to stress operates through the immune system of B-cells, T cells ,which can be subdivided into Regulatory, Helper and Killer cells. Chemicals interacting with the immune system include cytokines, interlukeins ( a whole series), thromboxanes, and prostaglandins. The omega 6 and omega 3 fats work at this level. It is complicated by the fact that there are subfamilies omega fats and that they can have both pro-inflammatory and anti inflammatory effects. There is evidence that the ratio of omega fats 6 and 3 can influence inflammation. Because these fats are only obtained through the diet (the body cannot make them by conversion of other fats), it is thought important that the omega 3 to 6 ration is close to 1:1. In many diets it is multiples of 10’s to 1 which might be driving inflammation in the body. Omega fats are also major components of brain tissue.

Inflammatory reactions can cause cell death which leads to the appearance of altered phospholipids on the cell membranes. These then stimulate the liver to produce a specific binding protein which binds to these. It is called C-reactive protein, (CRP), and is one of the commonest markers of inflammation that is measured in blood samples. Autoimmune diseases such as Type 1 diabetes and Rheumatoid Arthritis can also raise the levels of CRP.

Chemical reactions of inflammation (and just normal metabolism), result in the production of reactive chemicals called free radicals that can damage tissue including DNA. It is not a surprise then that the body has a robust system for mopping these up. They are the naturally occurring antioxidants, such as the perhaps better known Glutathione and Superoxide Dismutase. That is the level at which the antioxidant food and supplement industry operates. Then there is the whole business of the Nitrogen cycle. All Lemming knows about this is that it is important!

The gut also has a way of nurturing the bacteria that exist in it, the microbiome. The microbiome has been shown to influence health and there is a lot to learn. There is a huge nervous and immune system in the gut and special nerve cells called dendritic cells recognise healthy and potentially unhealthy bacteria. These dendritic cells interact with the local immune system and no doubt play a very significant role in health. Vitamin D is thought to operate here, as a modulator of inflammation among it’s many functions, the most well known being maintenance of bone health.

Confused? Lemming Test Pilot is overwhelmed by the complexity of the body in how it copes with stress. And that is only scratching the surface no doubt. We have only recently been able to rapidly identify bacteria but there is no technology yet to identify viruses. When we do, GP’s will no longer be able to use viruses as the fall guy for every unexplained short illness.

It seems likely that some people are more vulnerable to stress reactions as a result of genetics. Unless you are able to choose your parents that is a tricky one, but there are 4 things that can be changed; diet, sleep, happiness and physical activity. So, for practical purposes, that is what Lemming is sticking to. If you stick with the basics the body will regulate itself. A little more tricky when you have a metabolic condition such as diabetes, but a good philosophy nevertheless.

The Run.

This was the worst prepared run so far. By a mile, ‘scuse the pun. No training at all for 2 weeks, then the occasional 3 and 6 mile run. This was going to be another fasted run as there was less preparation to do. Just don’t eat. Then run. Fat oxidation. Simple. And as nature intended. Blood glucose was 9mmol/lit (for mg/dl multiply by 18, or roughly double it and add a zero) in the morning. It was decided to inject 10 units of long acting despite the fact that 8 units had been worked out on the last run. This was because of frequently raised glucoses of 10-15 mmol/lit in the past few weeks. So I decided to inject only one unit of rapid acting insulin. If the rapid acting reduces glucose by 2-3 mmol/lit per unit then the glucose would be about 6mmol/lit after an hour or so. Plus whatever the stress would contribute. It was a cold grey day with fine drizzle so fluid balance was easy. 400ml/hour.

This was 2 laps of open countryside with a gentle few hills. It was a club run and the only one I could find.

Competitors were serious and some had that haunted look of inner torture that one only sees in the eyes of people in competition with themselves. Now that is stressful.

It was a good start to 5 miles. Then came the low glucose at half way. I must have injected too much insulin with little thought of the improved insulin sensitivity that comes with exercise. It was a bad hypo with intermittent vision loss, tiredness and a slight feeling of confusion. The continuous monitor glucose monitor unhelpfully decided to call it a day ( it was in it’s third week), so it was a desperate attempt to get the glucose up and keep running. I needed about 20g of glucose at that time, then ended up low again at 11 miles. This was like the old, pre-keto days. It was so, so lucky that it was a 2 lap event. I was able to stop at the car and get supplies, there was no food provided on the run. So I was saved the embarrassment of needing to get help. The second lap was more of a stagger. The leg muscles were tightening and I was all in. Crossing the line couldn’t have come too soon.

What went wrong?  I reckon that it  was the excess of insulin being injected to counter high blood glucose levels I must have had some increased insulin resistance caused by stress. While blood glucose was not falling in response to more insulin, it was reduced by the effect of exercise. In fact I had noticed the more dramatic sensitivity to exercise when I did get a chance to get out and run in the weeks before the event. It was, if I had paid more attention, a very good example of reduced insulin resistance with exercise. The higher levels of insulin in the blood at the time ( which I had injected in addition to usual diet requirements to try to reduce glucose raised by stress) became available once the resistance reduced, to give a much more dramatic drop in blood glucose. It is obvious on looking back. What else goes past me that I don’t pay attention to?

So the lack of opportunity to keep well trained finally took its toll in this run, with an awful experience, accompanied by fatigue, poor glucose control and muscle pain. This was truly the end of Easy Street. But it was a run put down to experience with plenty of learning in the process. It will get better from here.

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