My 2yrs on CGM and Insulin Pump

In October 2014 I was formally introduced to the insulin pump and CGM. Up until that point my 18 years with type 1 diabetes was based around 1,000’s of finger pricks and injections. There was no real reason why I hadn’t investigated these amazing technologies earlier but I guess up until that point I was managing OK and just thought that managing diabetes was meant to be challenging. In saying that, my insulin pump and CGM technology has had an amazing positive impact on my life and I now find it hard to believe that I ever lived without them.

My journey onto an insulin pump and CGM started with my utter frustration that I was unable to target my insulin levels and BGLs around my increasing triathlon training loads and this difficulty and subsequent variability in  my BGLs meant that I was unable to get the most out of my training sessions. Trying to get BGLs right over night for morning sessions, for recovery after sessions and then for evening session was really difficult when I was using injections at meals and before bed only. The daily variations in training, recovery and food needed a much more flexible approach. I was very lucky to be put in touch with another diabetic triathlete who also worked for a diabetes tech company. She put me in touch with a fantastic diabetes educator whose passion and knowledge for sport and exercise gave me great confidence in her advice. Having managed my diabetes on my own for so many years, thinking that I knew everything that I needed to, it was humbling and fantastic to get advice which nearly instantly changed my diabetes life.

IM Melb Finish

Finishing 2015 Ironman Melbourne, one of my proudest achievements and one which may not have been achieved without my pump and CGM

Over the past two year I have achieved many things that I am really proud of as an athlete but especially as a type 1 diabetic. Some of my proudest achievements on my insulin pump and CGM have been:

  • First Ironman Triathlon in 2015 at Ironman Melbourne (Asian Pacific Championships) in a time of 9hrs 28mins
  • 600km unsupported ride through the Victorian high-country (one week after starting on the pump)
  • Multiple Ironman 70.3 triathlons and personal best times
  • Several open water swims
  • Cycling Gran Fondo’s including L’Étape du Tour (Stage 16 of the 2015 Tour de France)
  • First road marathon at the 2016 Melbourne Marathon in a time of 3hrs 1min.

Although I may have still achieved all of this if I was not on a pump or using CGM, using these devices has allowed me to train and races more closely like a non-diabetic athlete and have a far greater understanding of my physiology and why things happen (hypos, fatigue, poor performance, etc.).

For all of these great achievements there have been plenty of difficult and challenging times which have taught me a lot about managing my type 1 diabetes. Starting on the pump has also been the catalyst for me starting Type1Athletic and blogging about my experiences. Some of the great things which I have learnt from since starting on my insulin pump have been:

  • Able to maintain very stable BGLs overnight including accounting for a BGL rise when I fall asleep and the dawn effect
  • Achieve stable BGLs before, during and after training sessions including morning, afternoon and longer weekend sessions; all require different basal insulin rates and carbohydrate consumption
  • Allowed for finer insulin adjustments at any time to account for meals and activities; the change from single unit pens to 0.05 unit adjustments on the pump has been significant
  • No longer needing to carry around injections or pens
  • With the need to understand carbohydrates (carb counting) I have learnt more about what I eat and what is actually in my food; I believe that my diet is now healthier
  • With the need to adjust basal and bolus setups in my pump I have learnt a lot about how insulin works with my body and with the food that I eat
BGBC Image

So much information from my pump and CGM; this day in particular was great but having this information has allowed me to learn from every experience.

In terms of managing my day to day diabetes I believe that the development of CGM technology has had the greatest impact on my diabetes control. Prior to CGM I was testing my BGLs up to 30 times per day to provide me with the understanding that I needed to keep my BGLs stable throughout the day, especially when training. I started on the Dexcom CGM and have since started using the Freestyle Libre Flash Sensor, both sensors have provided me fantastic insight into my BGLs and made my day to day diabetes management a lot easier. Some of the benefits which I have found from using a CGM are:

  • No need to finger prick test!
  • Easier to check levels with the bonus of history and trends
  • Provide far greater understanding of BGL variations including from physiological processes, psychological states, high and low GI carbohydrates and exercise
  • No need to carry around a bulky blood testing kit any more
  • Improved athletic performance by making testing and tracking BGLs far easier (finger prick testing on the bike is certainly a challenge)
  • Some CGMs provide real time feedback which allow for trends and warnings to be setup; I see this especially being beneficial for young children who rely on their parents to check their levels, and people whose BGL awareness is not effective

Apart from a couple of years at University I believe that I have always had pretty good control of my diabetes. Before my insulin pump and CGM I thought that I had everything under control and I was satisfied with how I managed my diabetes day to day. Since starting on my pump and using CGM devices I now have better control and BGL stability, my understanding of how insulin, food and exercise effects my BGLs and physiological processes is far great, and I am far more educated about type 1 diabetes and exercise in general.

An insulin pump may not be for everyone but the development of CGM’s has been game changing for diabetics. Easier testing, BGL history and trends, along with warnings provide the best possible information for a diabetic to manage their BGLs. They can be expensive and this can certainly be a turn-off, but even using a CGM sporadically will provide you with a greater understanding of your diabetes. It is fantastic that technology is advancing so quickly now and I am excited to see what the future holds including advanced trails of a CGM closed loop system which is due to occur in 2017!

#All the information provided in this post is from the authors experience only and the opinions expressed are the authors only. See Disclaimer.

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Ironman 70.3 Cairns Race Report

Cairns was a fantastic race to end this block of training and racing for me. I’ve have many challenges over the last 12 months and to finish with a tough and successful race is really positive and has made me more enthusiastic to continue racing and improving. 12 months ago my mindset was all about the end result but I have learnt that there are many smaller victories along the way and enjoying the journey and the racing is the most important thing. I am now a better athlete for all that I have experienced.

Ironman 70.3 Cairns is a little more complicated than other races with the travel from Melbourne, organising my bike and kit, planning nutrition, different start, transition and finish locations, and of course keeping my diabetes under the best control possible. Cairns is a huge event that felt like it took over the whole region with the Ironman atmosphere. Getting that buzz when you arrive is great and gave me that little kick to get through to race morning.

Coming to Cairns with a season worth of training and racing under my belt I was focusing on the other important things including; nutrition, hydration, rest and of course my diabetes. Leading into the race I was in such a positive mindset that everything felt like it was running to plan and even my BGLs were stable and predictable. I had everything planned out and I just wanted to get to the start line and race. I have not felt like this for over 12 months and it was really energising to go into a race knowing that everything was under control. I was really enjoying this and being positive was also making me feel physically buzzing also.

Race day I was up at 3:30am to get to the bus terminal for transport up to the start at Palm Coves (45mins trip from Cairns). My BGLs were running perfectly at 6.0mmol/L from 3:30am to when I arrive at Palm Cove at 5:00am. My plan was to setup my transition, do a short warm-up, get into my wetsuit and then have something to eat about 30 minutes before the start. For the hour before the race start it was raining heavily and the winds were picking up making things a little awkward getting ready squeezed under the limited available shelter. With my BGLs still tracking at 6.5mmol/L I got down my carb/protein/coffee shake at 6am and was ready get on the beach for the start.

As a sub-30 minute swimmer I started in the first couple of groups off the rolling start. I was relaxed and enter the water calmly duck diving a couple of times and then swimming to some clear water around the first buoy. It was a little funny when I realised that I hadn’t done a swim in the “ocean” for a long time with all of my recent races in protected water. The ocean swells and choppy conditions were certainly a little challenging but the swim course was straightforward and passed pretty quickly. I was able to swim in clear water and sighted the buoys clearly. 29 minutes out of the water, feeling great and even giving my support team (Inge, Mum and Ken) a quick smile as I started the long long long run to my bike in T1 (I’m guessing this was about 500m and a pretty unique transition).

I am always happy to get onto the bike as I feel relaxed riding and it gives me plenty of time to check my BGLs and adjust if need be. Starting on the bike leg my BGL was at 10.0mmol/L that was a little higher than I thought it would be after the swim but still in a good range. Using the new Freestyle Libre Flash glucose monitor for the first time in a race it really made checking my BGLs easy and I trusted that the reading would be accurate. I wasn’t wrong and I honestly thing that this little device relieve the one of the stresses from previous races when my CGM wasn’t accurate I was finger prick testing during the race.

BikeRun

Not needing to eat straight away I got in plenty of fluids (no carbs Endura) and settled into a steady rhythm (aiming for 85 cadence at 250 watts). There had been plenty of chatter about the drafting enforcement and there were a lot of TA official’s on the bike course. I had ended up in a group of 4 riders with each trying to push away but all seeming to remain together generally at a legal distance. The Captain Cook Hwy is a beautiful stretch of road and with the rolling hills and the ocean almost within reach the kilometres passed really quickly. The rain was pretty constant and at times so heavy that I couldn’t hear myself think as the massive tropical raindrops hammered into my helmet. After the turn-around point at the 30km mark I was feeling great and still in the group of four. There was now a slight head wind and the heavy rain continued. At around the 50km mark just as I had pushed to the front of the group I noticed my front end go wobbly and looking down I could immediately see that I had a flat tyre. Having had not handling issues on the wet and slippery roads to this point I nearly came off when trying to come to a stop now. Heart racing and legs pounding I was immediately annoyed but quickly got off, flicked off my front wheel and changed the tube. It may have taken 5 minutes all up but I didn’t worry and I was quick to get back into my rhythm heading to Cairns back past Palm Cove.

With 15 kilometres to go I was feeling the power draining from my legs and after checking my BGL realised that I hadn’t eaten enough in the last hour and my BGL was down to 4.0mmol/L and dropping. I had to ease up at this point and find a more comfortable rhythm so that I could eat and get my BGLs back up to start the run leg. My last 15 kilometres were slower than I would have liked but I just focused on being smooth, eating and drinking, and then checking my BGLs every 10 minutes. When I got to T2 my BGLs were back up to 6.5mmol/L and having eased off for the last part of the ride was feeling great starting the run (in the pouring rain). I got a little extra boost from seeing Inge and Mum again as I ran out of the transition and I may have even given someone a high-five!

Having put extra hours into my running over the last month I was looking forward to seeing how this training would pay off. I wanted to set a 4-minute pace to start with and I looked to find someone of a similar pace to work off. I was able to stick with this pace until the 8km point where the hurt set-in and I needed to slow. This was a little mental hurdle to overcome and I told myself to stick tough and maintain a steady pace, picking it up if I could. For the remainder of the run I was pacing around 4:30/km with a couple of faster and slower kilometres as I pushed harder or checked my BGLs and sucked down a gel. The heavy tropical rain continued to come and go and there were plenty of big puddles to run through (sort of good to take your mind off the pain). With my BGLs being on track I also enjoyed a few pieces of watermelon. Being my weakest leg the run is always tough but having my BGLs under control meant that I could focus on the running and not my diabetes for the first time in several races. With the atmosphere at the turnarounds and the crowds spread out along the whole run course the kilometres did pass quickly and the Ironman red carpet was underfoot with my arms in the air (still in the rain) before midday! BGLs finished at 6.0mmol/L, treading slightly downwards which allowed me to indulge in the recovery tent with a few big slices of watermelon and a protein recovery drink.

I finished with a time of 4hrs 38mins in 9th place in my age and 35th place over all. This was the toughest 70.3 race that I have completed and not worrying about the time or the place I am ready happy with my performance. There is always room to improve but I raced with the best mindset and with excellent control of my diabetes. You couldn’t wipe the smile off my face after the race!

Finish - Cropped

Couldn’t be happier crossing the finish line!

I take some real positives out of this race. Firstly, my mental state leading into and during the race had the biggest impact on my performance including my diabetes. Being able to overcome several challenges and then keep going is a real strength that I am proud of. I have now learnt that my mental state is the most important thing for my performance and something that I will continue to work on for every race. Secondly, my diabetes plan worked perfectly with the basal program I set allowing me to eat and keep my BGLs stable. Finally, my swim and bike legs remained consistently strong and if not for the puncture I think that I would have been close to a bike PB for the 90km. With my diabetes plan working perfectly I did forget to eat during the bike leg (possibly because of the flat tyre) that led to a minor hypo. My nutrition and hydration are elements that I need to work on. Finally, although my run was OK I do want to improve this and be able to run consistently around 1hr 20-25 minutes for the run leg.

I actually feel like a different person to 12 months ago when I performance like this would have been picked apart negatively. Being positive really changes my whole performance and as hard as it has been to get to this point I am so glad that I was able to get here. I’ve had the best support from my partner Inge who has really shown me how important your mental condition is and how it impacts all other aspects of your body and your performance. Of course the rest of my family has been wonderful support and they’d enjoyed a few little trips away to support me. I’m now looking forward to a little break and then getting back into it for next season, new races and new goals.

Diabetes Race Plan Preparation

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.

Race Plan

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.

IM Melb BSL

CGM graph from IM Melb 2015. Arrows point to start and finish and BGLs stayed with 5-10mmol/L for the entire 9.5hr race. Note that a bit of a high due to celebrations is OK but I could have managed this beter

 

T&D June 5

After such a good week this was not such a good week. Recovery from my previous big training week didn’t go to plan and to get to the end of the week still feeling a bit fatigued and working on some BGL stability is a little disheartening. The catalyst for my not so successful week has been the instability of my BGLs particularly overnight where high’s and lows haven’t allowed me to get restful nights. Subsequently I haven’t fully recovered from my large run volume last week and with my legs feeling heavy all week I wasn’t able to complete my planned sessions fully. On top of this the mental demons and negativity started to creep in again over the week and by the weekend I was in a bad mood, training poorly and my BGLs were all over the place. It’s a vicious cycle for me and one that occurs more often than I would like.

I wish that I didn’t let things spiral out of control like this but trying to balance training, nutrition, diabetes and personal life can be difficult and one poor decision seems to lead to another and another. I do realise that this is happening but it still takes a couple of days for me to draw  line in the sand and really pull things back into line. To do this I go back to absolute basics, make a plan and follow it 100%. My plan for Sunday to get back on track included:

  • Wake up as naturally as possible around 7am
  • Set insulin for morning exercise (2hrs prior) and complete exercise within set time
  • Do about 2hrs moderate exercise (ride) including time with my girl friend in the morning
  • Enjoy one coffee in the morning begin aware that caffine is an insulin inhibitor and cosumption should be minised through the rest of the day
  • Eat a basic breakfast with known carb content and BGL response; for me this is oats with berries and yoghurt
  • Ensure plenty of incidental activity throughout th day like walking to the market, walking the dog, cleaning the house; I find that this assist with my BGL stability as oppose to speanding the day on the couch
  • Follow a strict meal plan throughout the day including lunch, dinner and snacks, all food to have known carb content and BGL response; it is critically important to count cards and bolus dose correctly, NO cheating today!
  • Don’t react too quickly to rising or dropping BGL’s, allow them to settle before treating correctly (bolus correction or sugars and BGL testing)
  • Check BGLs regularly during the day
  • Stay positive knowing that a lot of hard work has already been done, not further improvements can be made training so close to a race and by getting this right my performance will be the best that it can be

All of this is pretty simple and in hindsight I feel a little silly that I can’t stick to what I know works all of the time and make my life a little easier, but that is just one of the challenges of type 1 diabetes.

So it’s certainly not the end of the world and after a good day today I am feeling both refreshed and positive for the coming week and the race. Getting through work, training, packing up my race kit and my bike for trip up to Cairns will make this shortened week fly by. Winter has finally struck Melbourne and I am looking forward to some tropical weather in Cairns.

trisuit

New race suit from Scody with Type1Athletic, DSP and JDRF logo’s. Colour worked out perfectly with the prominent blue circle for diabetes!

On a really positive note this week I received my new race suit from Scody which I will be racing in at Ironman Cairns 70.3. As my first suit with logo’s I decided to support the diabetes organisations which I am associated and my local bike shop (The Freedom Machine) which is like my second home. The purpose of these logo’s is to promote type 1 diabetes within the community, get people asking questions and talking about type 1 diabetes. The organisations that I am support are:

I am looking forward to working with both organisations in the future promoting, educating and inspiring people with type 1 diabetes and I am proud to race with these logo’s on my chest.

Also a quick update on the Abbott Libre Flash Glucose monitor which I have now been using for two weeks. I have so far been really impressed with the unit, the accuracy has been spot on for me and the easy of use during every day life and also training is fantastic. I am really looking forward to racing with this device and I believe that it will provide one less thing to worry about come race day. The Flash Libre is now available in Australia and I can highly recommend it.

If you happen to be racing at Ironman Cairns please come and say hello, I will certainly be looking out for other type 1’s when I am up there!

T&D May 29

If you follow my instagram feed then you would have seen that the last 7 days have been big! I had planned a really testing week of training with a focus on running and from Sunday through Sunday I clocked up just short of 90km which is pretty significant for someone with a swimming and cycling background. With this sort of form I can actually say that I enjoy running (at the moment). I also received a new BGL unit from Abbott; the FreeStyle Libre Flash Glucose Monitoring System. This continuous monitoring device has some unique differences to Dexcom CGM, which suit my uses really well. I am excited to continuing using this device, especially in my upcoming Ironman 70.3 event where I think that it will able to provide me with the edge I have been missing in previous events this year.

May 29

The numbers don’t lie, it’s been a really solid week!

It’s also been a big week as I have been able to get control of my BGLs during my afternoon training sessions where hypo’s had been causing me issues. Some adjustments to the timing of my basal reduction and then when I start my training session (allowing 2hrs+ now), plus eating something a little more substantial about 30mins before the session (30-40gr CHO) has yield more stable BGLs. I am still working on how much CHO I need to consume during the session and this is highly dependent on the duration and intensity of the session. So far it’s around 30gr CHO at 20-30mins into the session get’s me through a 1hr plus session. A work in progress #type1diabeteslife.

Muffin

One of the bonuses of exercising is being able to enjoy foods that you would usually avoid as a diabetic – post ride refuelling.

I think that I have learnt this week that managing my diabetes shouldn’t be that stressful. I do have challenges to over come and these seem pretty regular, but a lot of these challenges are caused in part due to something that I have done. This could be; not counting carbs correctly, not eating a proper meal and then snacking, not setting my basal/BGLs properly before a training session, under eating or over bolus dosing or over treating a hypo, etc. These are all things that I am 100% in control of and if I do them correctly, then the risks of an erratic BGL response are significantly reduced. It is true that my life requires planning and structure but this should not be a burden and to be healthy and thus happy these are critical. This week I have gotten most things right and the results speak for themselves, success in all aspects of my week and still full of energy on a Sunday evening.

Speaking with another type 1 diabetic over the weekend who is also very active, we seemed to have similar approaches to our type 1 diabetes and this seemed to stem from our attitude towards it. It was not that we both had amazingly positive attitudes, but we both acknowledge that type 1 diabetes needed to be managed in a specific way to allow us to live the lives that we wanted to. Type 1 diabetes wasn’t something that needed to be beaten, it formed an important part of each of use and probably enhanced some strong traits which allowed up to achieve our goals. Structure, planning, better understanding of our bodies and excellent nutrition are just a few of the positives to come out of having type 1 diabetes. I was enthused by this chat to stay focussed and know that by doing the rights things and being positive, great results will come.

 

Ironman 70.3 Port Mac Race Report

On Sunday May 1st I completed Ironman 70.3 Port Macquarie finishing in a time of 4hrs 34mins, in 10th place in my age. This was a big event for me given 6 months ago I broke my collar bone at the same event and since then I have struggled with fatigue and mental well-being and my last event was a DNF due to diabetes issues. 6 weeks ago I made a big change to my training program and I was anxious to see if this had paid off, and if my diabetes would remain stable throughout the race. In the end I overcame some serious pre-race nerves and diabetes issues during the race to finish with a smile on my face (though nearly in a diabetic coma)!

PMac Race Summary

Ironman 70.3 Race Summary

Leading into the event I was confident that my condition was good enough to post a competitive race time and after not finishing my two previous events I really just wanted to get over the finish line strongly. As the weekend approached I started to get really nervous about the race which I think was a combination of; not finishing previous races, breaking my collar bone at this race 6 months earlier, my diabetes impacting my race as it did in Geelong and really wanting to do well. Although I tried not to put pressure on myself I think that I did the opposite and by Saturday I was so nervous and anxious that my BGLs were out of control and I was heading for a straight-jacket and padded room. Luckily my partner pulled me aside and did an hour of meditation with me. This really helped me relax and if not for her brilliance it would have likely been race over for me before it even started (xoxo).

Come race morning and conditions were perfect. As we were following the Ironman Australia event the 70.3 started a little later than usual at 8am. This later start along with the extra adrenalin from my nerves caused my BGLs to run high from 6am. I cautiously tried to bring my BGL down with small bolus doses (unsuccessfully) but in the end I started the race with a BGL of around 12mmol/L (possibly higher). My BGLs ran between 8.5 and 13.0mmol/L for the swim and bike legs and even with my high basal rates I was not able to consume my planned race nutrition. Leading into the run leg I did have a gel as I really needed the energy boost and this seemed to be OK for the first hour of the run where my BGLs stayed around 10.0mmol/L.

The swim passed without too many issues apart from not feeling great due to high BGL and the course possible being a little longer than normal (Garmin read 2130m). I’m always happy to get through T1, test my BGL and get onto the bike where I feel more in control of things. With plenty of rolling hills on the Port Macquarie course, which favours my cycling strengths, I quickly got into a good rhythm and set off on my way for the single 90km loop.

My main thought during the bike leg was to enjoy the ride and get to the run feeling OK. With the hilly course profile and a couple of sharp climbs I maintained my race power throughout the 90kms and worked steadily up each incline. With the mind set of enjoying it, the 2hr 20mins passed quickly with my only a few body aches from the really rough road surface and not a lot of fuel in the tank due to my higher BGLs. Not trusting my CGM I did a couple of finger prick tests during the ride which proved to be pretty challenging as the road was so rough that it was difficult to hold on, get a drop of blood on the test strip and let the meter process it. I managed to survive though and entered T2 in a good position ready to tackle the 21km run.

Port Mac

My Port Macquarie race photo summary

Really enjoying the race I started the run feeling OK albeit high BGL concerns. Looking at maintaining between 4min and 4:30min per km pace I settled in for 3 laps of the 7ish km course. Running is hard. Running is even harder in a triathlon. The first 15km were hard but enjoyable with plenty of athletes on the course to run with and plenty of spectators to entertain us. My BGLs came down to around 8.0mmol/L during the first 15km and I was able to down some Endura and watermelon at a couple of aid stations.

At around the 17km mark I really started to feel average and totally drained of energy. A quick BGL check revealed a reading of 19.9mmol/L. As I was feeling so average and with only 20 minutes left to run I decided to give myself a small bolus dose which I hoped would bring my BGL down by the end of the race. I continued on but things deteriorated very quickly and with less than 2km to go I was struggling to even walk. Testing my BGL again my level had dropped to 2.7mmol/L. I sucked down a gel and gingerly but determinedly made my way to the finish line. The last 2km of the run took me 14 minutes and when I finally ran under the Ironman banner I could barely stop my watch let alone raise my arms for a finish line photo. I was however absolutely ecstatic to have finished.

Port Macquarie is a fantastic event and I really like the combined Ironman and 70.3 experience. There was so much atmosphere around the whole course that it made for a really enjoyable time throughout no matter how much pain you were in. My training put me in great condition for the event by my mental state and diabetes was not controlled well. This is something that I can work on to get things more stable for my next event. Having gotten through this race I will be feeling a lot calmer next time.

Thanks to my support team for getting me through the weekend and taking some great snaps of me suffering during the race (I did try to smile every time I saw you). Well done to my training buddy and friend who notched up another PB in the event (#seriouslyjealous). I couldn’t have done it without you all. See you next time.

Getting Through Race Week

The week (or weeks) leading up to a race can be the most difficult of a training program to get right. All of the hard work has been done in the months leading up to this point and no further fitness can be gained this close to an event. The focus now shifts to tapering so that you are in the best possible physical and mental condition for the race. But with nothing to be gained there is much to lost to the detriment of your race day performance. For further information on tampering see advice from Training Peaks.

Getting your taper right is hard enough as you fight your emotions and constantly question if you’ve done enough; will an extra session help, am I losing fitness? Having type 1 diabetes makes these weeks even more challenging as you try to keep your BGLs stable whilst changing pretty much everything that has worked for you during the previous months of training. I find that stable BGLs are the most important factor for me to perform at my best and this is particularly the case leading into and during a race. Some of the major challenges for a T1D during a tapering period can include:

  • Reducing training volume and intensity changes insulin requirements (Basal and Bolus)
  • Carb-loading would require an increase in Bolus insulin doses
  • Changes in activity and sleep patterns can change Basal insulin requirements
  • Physiological adaptations often change insulin requirements
  • Mental and emotional states including stress may introduce unexpected rises and falls in BGLs

Essentially during a taper we are changing what are bodies have been used to (training and eating) and we are stressing about many things (BGLs, race performance, tapering/training, etc.), and this is a high risk cocktail for a T1D trying to maintain stable BGLs.

Trek Speed Concept

I love getting my bike ready for race day, a good opportunity to focus on the details to go fast

So for one of the most important weeks in my training program, that is also one of the most challenging and stressful, what do I do to keep things on track:

  • I don’t have an extended taper prior to a race and keep this to Monday to race day (Sunday) generally (one week).
  • Maintain a similar training schedule; I continue with my morning training sessions as these seem to have the biggest impact on my daily diabetes requirements and drop/alter may afternoon sessions.
  • As with a normal taper I keep some intensity in all of my sessions to remain sharp (neuromuscular) but also to keep BGLs similarly stable to previous weeks with the session excursion.
  • When focusing on recovery I like to complete active recovery sessions which also help stabilise BGLs (through the exercise).
  • I really focus on my diet and try to consume the highest quality nutrient dense foods so that I do not need to increase my carbohydrate intake too much and I still get the full benefits of tampering. By not changing my diet too much it minimises the risk of changes to my insulin requirements and possible hypos/high BGLs.
  • If I do consume more carbs then I monitor this closely and increase my bolus insulin accordingly. In most cases I find it easier to add small amounts of extra carbs throughout the day rather than load up during main meals.
  • Keep track of your BGLs; as important as ever, I keep track of my BGLs constantly throughout the week so that I know exactly where they are at.

Finally, two really important things which I always work on are; control the things that I can, and don’t stress. Things out of my control will happen but if I am on top of everything which I can be then these uncontrollable events will be much easier to manage – control the controllable. It is difficult not to stress during taper week but remember that you have gotten this far, have controlled your diabetes to this point and you are ready to race. I try to stay calm and work through any issues knowing that this will result in the best outcome for me.

basal work

Keeping track of BGLs and planning for race day (BGL, Basal rate and Carbs)

Managing diabetes is never simple but by really focussing on yourself and your control during the taper week you can get great results from it and feel fantastic on race day.

There are big events on in Port Macquarie and Busselton this coming weekend so good luck to everyone who is racing and I hope that any T1D’s are tracking well for their events and I wish them all the best for race day.

T&D April 17

It has been my biggest week of training in 2016! It certainly feels like it and Training Peaks also tells me that it is. This is a massive achievement after suffering from illness, a broken collar bone, mental fatigue and diabetes challenges over the last 6 months. With two weeks until Port Macquarie 70.3 I am feeling in a really good place and hoping that with my revised training methodology and my recent time-off this will result in a positive performance in the race. This may be positionally, a PB or just getting through the race with no diabetes complications or impacts on my performance.

It has been another challenging week managing my BGLs. After lats week regular hypo’s this week my overnight BGL’s kept running high and really affected my sleep. Multiple bolus corrections were required overnight and trying to get my BGLs to stay stable for morning training sessions was a real challenge. Luckily I got through all but one of my sessions without too many issues, the “one” resulted in a long slow hypo walk home.

T&D April 17 Image

TSS tells the story this week with some work still to do on the bike.

This past couple of weeks have present some of the biggest diabetes challenges, particularly trying to figure out unexpected BGL and subsequent basal pattern changes. Having essentially the same routine these variations are so frustrating and very difficult to control. Trying to manage them I’ve done a several things well and a couple of things badly. With hindsight the best management is easy to figure out but at the time getting it 100% is neigh impossible.

What I Did Well

  • Assessed high and low BGLs each day and adjusted basal rate accordingly (used CGM effectively for this)
  • Made adjustments that would be tracable the following day, that is I would be able to review if the changes worked or didn’t work (recorded basal changes and kept bolus the same)
  • Managed training sessions around high BGLs so that I still got something out of the training session (reduced effort sets when BGLs ran high)
  • Kept my diet really simple and avoided sugars and Hi-Gi carbs (expect when I over-treated a hypo).
  • Generally didn’t stress out when BGLs didn’t track as planned

What I Didn’t Do Well

  • Over-treated a couple of hypos and high BGL episodes which resulted in a see-saw of BGLs for the following hours. Hypo cravings can be difficult to manage especially when coming off a high where you haven’t eaten very much.
  • Drank too much coffee when BGLs were high, I find that coffee seems to reduce the effectiveness of my insulin doses in these situations. I also find that I drink more coffee when my BGLs are high because I don’t eat as much.
  • Made a bolus/basal plan for training and then didn’t follow it resulting in a significant hypo. I got scared by at rapidily rising BGL and gave a small bolus correction, BGLs stabilised and during the next part of the session I hypo’d.

After such a big week I’ve got a couple of days off to let my body recover and then it’s 12 days to get in some final race intensity work on the track, plenty of active recovery, finalise my diabetes and prepare for race day. Great opportunity to be physically and mental 100% for Port Macquarie 70.3 and I really want to get this one right.

Carrying Diabetes Equipment When Training

I am often asked how I deal with all of the diabetes paraphernalia when I am training and racing. With the risks associated with exercising and maintain BGLs I have learnt the importance of having all of my diabetes equipment with me at all times. These items can now include; insulin pump, CGM or blood testing kit, snacks for hypos/energy, mobile phone for emergencies and some money.  To carry all of these items can make things difficult but I have been able to find ways to do so and not hinder my training sessions or races. I have looked to carry everything so that when swimming, running or riding my technique and comfort is not affected.

Swimming

  • I just tuck the pump into my bathers. I have stitched a little pouch into the back of my bathers in the past but this is not necessary.
  • When swimming in a wetsuit I generally just do the same but you just have to be careful when putting on and taking off the wetsuit as you can knock the pump or push buttons which can cancel a temp basal or deliver an insulin dose accidentally.
  • When swimming in the pool I always have my testing kit on the pool deck in a waterproof bag and a small towel to dry my hands prior to doing a test during the session.
  • Remember to always rinse your pump off after swimming a salt or chlorine aren’t the friendliest to the pump.

Cycling

  • Cycling jerseys are great for carrying all the things that we need in the back pockets. Generally three pockets for my pump, blood test kit, food and mobile phone.
  • I always have my pump connected when I train and to keep it safely in my back pocket I cut a small hole in the back of the jersey and then run the pump tube through the jersey, under my cycling shorts and then connect to the cannula. This works a treat and also allows easy access to the pump whilst riding.
Run Pump Image

Pump tube (circled) with pump safely in the back pocket of my triathlon singlet

Running

  • Running is the most tedious of my sessions as carrying extra items can really impact your running technique and you can feel weighed down.
  • I wear a triathlon singlet-top which has two pockets in the back which I can place my items in. These tops are available from many brands and they usually have at least two pockets on the back.
  • I wear a pretty tight singlet so that the items do not bounce around too much. I can squeeze in my pump, test kit and food without issue.

Gym

  • Doing a session in the gym can be difficult as you are moving around a lot and the pump can easily get in the way or the tube can get caught on something.
  • I wear training shorts which have a small pocket on the inside at the front or side where I can safely keep my pump and have the tube tucked into my shorts. Safe, secure and out of the way.

The most important thing is that you carry all of the necessary items. It can be a pain at first but when you get caught out without your test kit, food or money it can quickly get serious. Lessons learnt here from experience, always carry you diabetes items.

T&D Feb 28

It’s been a big week for all of the wrong reasons at this time of the triathlon (The Physical Impact of Mental Stress). to quickly summarise I’m taking a couple of weeks off to recovery from some pretty bad fatigue which has plagued me for the past 6 weeks. Apart from when I’ve been recovering from injury, I can’t remember the last time I’ve done such little physical activity in a week. Amazingly I’m not stressed about it and I actually haven’t had any urge to get out and train. I also feel great.

Without training there have been some minor adjustments to my diabetes management to account for the lower activity levels and fewer carbs. I have been really focussing on my diet for the purposes of maximising my recovery and this has also helped keep my BGLs really stable. I have kept away from processed foods and sugars, and stuck to what I know works for me; low GI carbs, fresh fruit and vegetables and lean protein. Balanced meals of around 40-50 grams of carbs, 25 grams of protein and a plate full of vegetables. It’s pretty straight forward and cutting out the snacks has allowed my BGLs to stay really stable. Fantastic!

Without training and the need to be constantly checking my BGLs I have not used my CGM for the past two weeks. This has been refreshing and I am checking my BGLs (finger prick test) much less frequently (probably still 10+ times per day but that’s a 50% reduction for me). I have found this change of focus for me to be really refreshing and I would recommend to everyone to take advantage of a full recovery period and change things up. The positive response both mentally and physically are almost instantaneous and I know that when I do return to training I will be able to put 100% into it.