After the weeks and months of training hard for an event and then battling through a week or two of taper the final piece to the preparation puzzle is figuring out my diabetes plan for the race. Since late 2014 I have used a similar formula for all of the races which is based on a basal program to deliver sufficient insulin throughout the event to allow me to maintain stable BGLs within a good range whilst consuming necessary carbohydrates and thus performing at my best. If you have been following my blog over this time you will have seen that this does not always work out, usually running high with a bolus correction dose required. With the various physiological and mental influences on you BGLs it is certainly a challenge to get things exactly right.
To prepare my plan I start with the race times (travel, prep, start, swim, bike, run and finish) and then work our what my BGL will be to start, what carbohydrates I’ll consume and when, what the exercise BGL pull-down will be and finally what basal rate I need over the race hours to keep my BGLs within a good range.
Excel is an excellent tool to develop an insulin plan; setup, make changes and review.
Critically important elements to the plan are if/when a pre-race meal will be consumed and allow enough time/amount of insulin so that you are OK to start the race and not hypo (during the swim). As I predominately train in the morning without eating before starting I don’t eat prior to a race and will only consume some protein in the hours before and then a small amount of liquid carbohydrates within 30 minutes of the start. This allows my BGLs to rise prior to the start and then stabilise once the race has started.
For me, I prefer to be cautious with regards to a hypo as having a bad hypo will almost certainly be the end of your race. It’s obviously a balancing act though as you don’t want to run too high either. My best advice is to trial an insulin plan during you longer training sessions and this will give you the best understanding of what is required. For Ironman events this will involve a swim followed by a ride or a ride followed by a swim. Be sure that the duration of these is long enough to reflect the event which you are competing in. Luckily most events start first thing in the morning so it’s easy to train for this.
When a diabetes plan does work perfectly it is an amazing feeling of relief which usually also results in amazing performance. My Ironman Melbourne in March 2015 was such an event and one of my proudest achievements.