High blood glucose caused by endurance sports

Hello FastTalk guys and gals. Love your podcast and look forward to it weekly.

My concern is a recent finding, May 2021 during my yearly physical exam. My yearly blood work showed an increase in blood glucose. 103mg/dl, 3mg/dl over the high end of the safe range. At 65 years old this is alarming, my grandfather was type 2 diabetic. Looking back through my past yearly physicals showed consistently good numbers. I’m a life time cyclist who rides in season approximately 4-5 days per week. (6-10 hrs).
I hadn’t fasted the night before the blood work and had my usual breakfast of oats/PB, banana and maple syrup before the blood work.
My doctor suggested the cause of the slightly elevated number was due to the non fast. I suggested a retest in 3 months, we agreed.
Three months later I retested with fasting and got the same elevated number within one mg/dl.
working in the engineering field all my life has lead me to a very questioning mind.
During the first two months after my first test I had a really consistent block of training and was concerned with fueling during my ride. To keep energy up usually on rides longer than 1 1/2 hrs I took in approximately 60 grams of carbs/hr, usually energy bars. I’m 5’11", 145lbs.
The third month before my second test I only road two days due to work and weather. (Argh!)

So… over years of endurance training can our body become adapted to allowing exercise to control blood glucose levels and thereby decreasing the need for insulin regulation?
In the absence of consistent training might our blood glucose level increase while the insulin production (pancreas) becomes lethargic due to neglect?
This is very concerning to me. I’m almost afraid to consume carbs.
Step 1… for fuel and have decided to try and get my carbs mainly from veggies.
Maybe use a Constant Glucose Monitor?
I went online to research this and went to a dark place, lots of conflicting articles concerning endurance sports causing high glucose blood levels and diabetes! Yikes!
I’m pursuing more testing, ie HbA1c.

What do you think?

David Howes

A quick answer as a question: Have you ruled out LADA? Patients may have a slowly progressive insulin deficiency and varying degrees of insulin resistance, and often do not require insulin treatment for a long period after diagnosis - so-called “latent autoimmune diabetes in adults” (LADA). Furthermore, despite some blood glucose values, I definitely recommend further examinations - the HbA1c value is a good long-term marker. Nevertheless, endurance exercise is the most underestimated basic therapy for type 2 diabetes, and if most patients were just athletes, they would not have type 2 diabetes. I am only a simple senior anesthesiologist. Therefore, I cannot give you expert advice here. However, reading your values, I think everything is fine. In the ICU, we are alerted when blood glucose rises above 180mg/dl…but that is a different ball game.

Hint: If you ask your general physician to rule out LADA he simply have to dive deeper into the problem…and so he have to check also antibodys :wink:

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Thank you, I will research LADA and discuss with my doctor.

you measured just twice and you are concerned?
Try to measure every day and before breakfast for 1-2 weeks and maybe even more and then we see how if there is a pattern because otherwise its just bad luck

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Yes @ogni. Or ask your personal physician to check Hemoglobin A1C. A single fasted blood sugar is not typically diagnostic but a screening tool.

Ahh. I just saw you were going to do that at the end of your most. Even athletes are mortal. And so we can get diabetes. Sure. If your fasting blood sugar were 500 (for some it is), you have diabetes. But 105 is not crazy. Retesting and checking Hg A1C are appropriate next, stress free steps.

I am very much a proponent of a high carb diet, or at least a diet sufficient in carbs, but the role of lots of processed carbs during exercise, over the long term, for aging athletes, seems like it could be looked at. I think we understand insulin response to carbohydrate ingestion is attenuated during exercise but I’m not sure I’m totally secure in the long term results of that 60- 90 g carb/hr…(should be separate thread…)

Thanks for all your input! I had my HgA1c test done and the result was 5.3, so that looked good. Regardless of the favorable HgA1c number I’ll continue to work towards more fiber in my diet as well as consuming carbs earlier in the day. I did a few rides 1.5-2.5 hrs without carb intake and felt lacking in energy at the end of the ride. Did a ride two days ago, 2.5 hrs with some carb intake and felt better.

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also… most of my carb intake off the bike is plant based, cutting out the mostly pasta fuel mindset.

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Good news on A1c being normal! I always go back to some of those excellent, nuanced nutrition podcasts in the FTL archives. Especially the ones with Noakes. Remember, even super lean athletes can become insulin resistant and move towards prediabtes/diabetes if consuming the wrong fuels at the wrong times.

One thing that stood out to me in your original post was “and had my usual breakfast of oats/PB, banana and maple syrup before the blood work.” Is this a normal breakfast on any given day, or is this a normal breakfast right before or right after exercising? There is a lot of refined grain and sugar in this meal, especially if not consumed for the specific purposes of fueling a workout.

oats: 1/2 cup = 27g CHO (1 cup = 54 g CHO)
peanut butter (if no sugar added): 2 tbsp = 6 g CHO
1 banana: ~30 g CHO (+/- depending on size)
maple syrup: 2 tbsp = 27 g CHO
TOTAL = 90-117 g CHO (depending on oatmeal serving), possibly more depending on serving size of all components

I am a big advocate of monitoring with a CGM as you cannot “escape” the live feedback you get from diet, exercise, stress, sleep, dawn phenomenon, etc. Really good data you can dive into (since we are all nerds here). It can really allow people to tailor a lifestyle that works for them. CGMs typically require a prescription and insurance may or may not cover it. GoodRX usually has coupons to make them more affordable. But at the very least spending the $$$ for 1 sensor to get 2 weeks of really good data could make all the difference.

A good marker of insulin resistance (if you are concerned about this) is looking at your Triglyceride:HDL ratio (if you have lipid panel results from your doctor). Ideally you are looking for a TG:HDL <2 (</= 1 even better). Anything >3 you are likely insulin resistant to some degree.

And if you have a “cool doctor” :stuck_out_tongue_winking_eye: you may ask to perform the Kraft Assay as this is arguably the best biomarker for diagnosing insulin resistance. (Read this if interested. And this!)

Just as an aside a couple of years ago I had my first routine blood tests due to my age (I’m in the UK) and was called in to see the practice nurse as the doctor wanted to see me as my lipids were abnormal. I asked if he wanted to put me on on statins which it turned out he did. It took me to point out my triglyceride levels were on the low side and it was pointless me seeing him because I wasn’t going on statins. Hope I was correct! Also they wouldn’t let me have a copy of the complete test because it belonged to the NHS!!! But they did graciously allow me to photograph the computer screen.

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