T&D Feb 14

The post race recovery week is certainly one of the most enjoyable. You still get to train but the focus is on recovery and there’s no pressure to hit specific numbers. After a tough couple of weeks and my race DNF I was more than happy to absorb this recovery week and really enjoy myself.

A couple of sleep ins, only one session per day and a nice long coffee ride on Saturday all culminated in heading out for my girl friends birthday over the weekend. Great week! Now I am feeling refreshed and focussed for the next 10 weeks and preparation for Ironman 70.3 Port Macquarie.

After the issues with my CGM in Geelong I was happy this week to stick with finger prick tests and although I’ve been testing 15-20 times per day it has been refreshing to not be constantly looking at my levels. Also with easier training sessions it has been more straight forward to get my BGLs stable and this has also provided a good opportunity to assess my basal insulin rates without too many adjustments. From this easier week I’ve reinforced the following in my regime:

  • It is clear that the more consistent you keep you insulin rates this has a positive effect on BGL stability. Completing only one lower intensity session per day my basal insulin rate remained very similar for the entire week and my BGLs were very stable for the week. I am really going to try to minimise the adjustments I now make to my insulin patterns as training builds again.
  • During my ride and runs this week I have given small bolus insulin doses to assist with control BGL rises. I have previously been nervous about doing this due to the hypo risk but giving on a small dose (0.25 – 0.50 units) has been very successful.
  • Recovery really works and is very important! Focussing on my recovery for the last couple of weeks has given me a lot of clarity on the importance of recovery and I’ll admit that I am a sucker for extra training. Nutrition, rest, foam roller and stretching have all become part of my daily rituals and although they are often difficult to fit in I am making them a priority.
  • BGL testing is critical and always worth taking a minute during a session or a race to complete just to be sure that things are tracking well.

A couple of weeks of endurance work coming up and then it’ll be in to some high intensity training blocks. I am going to continue to focus on recovery and getting my body right so that I don’t have any issues as the intensity builds.

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Ironman Geelong 70.3 Race Review

This past Sunday I raced Ironman 70.3 Geelong event. This was my first race back after breaking my collar bone at Ironman 70.3 Port Macquarie race at the end of October 2015. It’s been a stressful 3 months getting through my surgery recovery, rehab and then getting back into training. My aim for the race was simply to test myself in competition and see where I was at before building to my next A-race in May. Unfortunately, my race was derailed by the failure of my continuous glucose monitor (GCM) which resulted in excessively high blood glucose levels (BGLs) and the end of my race at the 10km mark of the run. Although I was bitterly disappointed that I DNF’d, I later realised that there were many positives to take from the race and I was actually pretty satisfied with the race.

The two weeks leading up to Geelong were as close to disaster as I could handle. After a solid month of training post-surgery recovery and with my intensity building nicely, I was struck by an overwhelming fatigued, followed by a total loss of efficiency and comfort on the bike, and to top it off my diabetes decided to throw a hissy fit during the last week. Fatigue, poor BGLs and associated mental stress are not a great way to lead into a race. I wasn’t feeling 100% physically or with my diabetes plan. Luckily my coach and my girlfriend were able to put things into perspective and I was in a reasonable mental state and OK physically on the start line and despite all this I was excited to be racing again.

On the start line I was buzzing with nervous adrenaline, the field was packed with quality athletes and it was certainly going to be competitive especially with 70.3 world championship spots up for grabs. BGLs trending around 8.0mmol/L I was ready to race.

Being a strong swimmer I have never stressed too much about the swim and I quickly found a comfortable rhythm within the first couple of hundred meters swimming into some clear water with the stronger swimmers. In the back of my mind I was worrying about how I would feel on the bike so I didn’t push the swim too hard. I was out of the water in 26 minutes pulling my wetsuit off and heading to T1. My garmin showed a 2050m swim.

My CGM losing connection when in the water so a finger prick blood test is required in T1 to re-calibrate the CGM. My meter showed 5.4mmol/L which is a great level to be at heading into the like leg. As soon as I was on the bike I drank some Endura (6% CHO mix) and I was ready to go.

Being a little nervous about my bike form my aim for the 90km was to steadily build and not overcook my legs to early. I concentrated on keeping a smooth pedal stroke and maintaining my race power if I was feeling OK. The first 45km went really well and I was feeling great. My BGLs looked to be staying stable between 4.0 and 5.0mmol/L and I kept up my CHO intake consuming around 60 grams of CHO during the first hour (2 bars and fluid). During the second 45kms I started feeling a bit average and I was struggling to maintain my race power dropping 20W below. I didn’t stress and continued to focus on feeling smooth through my pedal stroke. I figured that as I wasn’t 100% this was just fatigue setting in. During the second half of the ride my CGM continued to show my BGLs around 4.0mmol/L so I continue to consume regular CHO, about 25 grams every 30 minutes. I rolled into T3 after 2hrs 22mins on the bike. I was happy to tick this off feeling the way that I was for the second 45km.

With my CGM still reading low 4.0’s near the end of the bike leg I consumed some extra CHO (around 40 grams) before T3. Being that low I was worried that the run would send me into a hypo. This extra intake gave me some indigestion during the first 2km of the run and it took me until the 3km mark to settle. As I settled in my stride I realised that I wasn’t feeling great but it wasn’t my legs that were the problem. Checking my CGM it continue to read in the low 4.0’s and I was now pretty sure I was heading for a hypo. I consumed from more CHO and continued on. My km splits were 4-4:30 and I was happy to sit at this pace the way I was feeling. I wasn’t worried about anyone around me and just wanted to focus on how I was feeling. As I went through the beach front for the second time I was really struggling starting to feel nauseous and a little unbalanced. I decided to do a finger prick test as I had grabbed my meter in T2. First test read “HI”, second test read “HI”, and the third test read 26.8! OK, there’s a problem here and this is not good. I check my pump; still connected and working. Check CGM, still stuck down but also still reading in the 4.0’s. Thinking through the situation as I walked/jogged I realised that there was nothing to gain in pushing on and it was more important to get my BGL’s down. At the 10km mark, heading back through the transition area I stopped and DNF’d. I’d complete the first 7km in 29 minutes and the next 3km in 20 minutes.

I was initially gutted that I’d had to pull the pin but as I walked through the crowd back to my family I realised that I’d achieved many things just to get to this race and my swim, bike and 7km’s of the run had been pretty solid. Giving myself a pat on the back:

  • I had recovered from broken collar bone and got to a competitive level within 3 months
  • I was close to my normal swim time
  • I was heading for a really good bike time until slowing in the latter stages due to diabetes
  • I was able to manage my mental state and emotions when things started going badly and I was able to make a calm decision to withdraw from the race

Before my next race I will be working on:

  • Getting my insulin plan more set before a race so that I am confident in it
  • Review CGM accuracy and look at extra finger prick tests during the bike leg
  • Build my higher intensity endurance to be at 100% for my next race
  • Work on my transitions including all the normal issues plus having to do a finger prick test

Thanks to all of my family and friends who supported me leading into the race and on the day. Whatever the result was going to be we were always going to be enjoying a burger and a beer after the race together. Good times.

T&D 7 Feb

Race week turned out to be a real challenge and ended with a DNF in my first race of 2016. With my diabetes not as controlled as I would like in the past two weeks and physically not being 100% I struggled with my preparation. I was also mentally struggling coming into an event not been 100% ready. It was a challenging week but having gotten through it I have learnt a lot and I think that I will be much better from the experience.

Geelong 70-3 2016 (4) Geelong 70-3 2016 (2)

Although my race didn’t go to plan on reflection I was happy to get through to the 10km mark of the run leg and I was able to test myself during all legs and take away some positives which I can build on for this next training block. I’ll be posting a full race report in the coming days but here a a few of the major things I’ve learnt from the week.

  • Don’t change what works: With the issues that I have been having with my diabetes I have been changing things regularly to find some better stability. In doing this I ended up not really understanding where things were at and went into the race with a diabetes strategy that wasn’t 100%. In the end it was a technical issue with my CGM that led to my DNF but a sounder diabetes strategy would have been far less stressful.
  • Check BGLs at the first sign of something going wrong: Especially when racing I find it difficult to take a moment to assess how I am feeling and I usually just push on (struggle on). I was feeling average at around the 60km mark of the bike leg and I should have checked my BGLs then rather than waiting another 1.5hours when I was near collapse. I would have been able to stabilise my BGLs then and finish the race if I had only taken a minute to check earlier.
  • Trial everything, constantly: With the regular changes to my pump settings I haven’t had a chance to properly trial a race plan. This is critically important so that a plan can be setup and then you can trust it during the race. The added mental stress and guessing what was going to happen during the race was the result this poor preparation.
  • Look at the positives: As I walked back along the run course to withdraw from the race I was initially very disappointed, but as I walked the 1km back to the transition area I realised that there were some great positive to come out of the race. All considered I was actually in a pretty good place to continue to build from this performance. It’s a simple saying to look on the bright side but keeping that positive attitude really does bring the best results.
  • There is no substitute for hard work: Coming back from my broken collar bone things just haven’t been right and my training has been up and down. I know that I haven’t done the work on the track nor spent the time getting my diabetes plan right for this race. No excuses, put in the work, get the preparation right, and the results will come. Simple.

It is onwards and upward from here. I am taking the positives out of my performance yesterday and I know that I can identify and work on certain areas to make a big improvement in my performance. I want to be better and I am motivated to put in the hard work to achieve my goals. Some recovery and planning coming up this week.

  • Review where I am at and design my next training block with my coach; Ironman 70.3 Port Macquarie is my next goal race at the beginning of May
  • Review race weekend diabetes performance and look at how I can manage my BGLs better
  • Set some short-term goals for my next training block focussing on where I want to improve in my race performance
  • Complete a full recovery and sort out all body issues so that these do not hold me back during this next training block

Diabetes Tips #2

A critical part of managing exercise and blood glucose levels (BGLs) is understand how your body and more specifically your BGLs react to exercise. This is a very complicated interaction as there are many physiological variables which impact our response and BGLs to exercise. Type of exercise, duration, intensity, time of day, insulin on-board, meals, previous activities and more all contribute. There is no magic formula and every persons BGLs will respond differently, however if you are going to exercise you need to understand how you BGLs are going to react so that you can maintain stable BGLs and exercise safely.

In my case I have learnt through trial and error what my BGLs need to be prior to exercise, what insulin I should have on board (basal and bolus) and who much carbohydrate (CHO) I need to consume before and/or during the session. My CGM unit has been a fantastic resource in this regard to monitor my levels during sessions and also review them later one. Keeping track of insulin and also CHO intake then always me to determine my insulin and CHO requirements for said session.

Unfortunately it is not that simple in reality and I have ended up with several different insulin and CHO requirements for different sessions which include:

  • Different basal insulin rates for AM and PM training sessions
  • Different basal insulin rates for different types sessions; swimming, running, cycling and gym sessions
  • Different basal insulin rates for different intensities; recovery (Zone 1), moderate (Zone 2 & 3) and high intensity (Zone 4 & 5)
  • CHO requirements also vary dependent on starting BGLs and the intensity of the session
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Diabetes running essentials – Pump & CGM, Food and Garmin

This may seem like a lot of effort but over time as you continue to exercise you will learn how your BGLs react and what you need to to do to maintain stable BGLs during and after your training sessions. My key messages are:

  • Learn from every session that you do and build your understanding of how your BGLs react to exercising
  • Always train in a safe environment where you can get home, get back to your car or get assistance if you need it
  • Always carry a blood glucose monitor with you and know where your sugars are at; testing every 15-30 minutes
  • Always carry food with you as you need CHO to maintain your BGLs and in case you experience low BGLs/Hypo

I like to train like an athlete but I’ve got to think like a diabetic. My diabetes control is the most import element to my training and if I have any issues then I will stop, get control and then continue. Safety first always!

** This post is from the author own personal experience and should not be taken as medical advice. It is important to seek advice from your doctor about exercising with diabetes.

2016 Here I Come!

2015 was a big year for me. Diabetes, sporting and personal events, milestones and achievements all contributed to a fantastic year. Plenty of challenges and a setback or two (crashed bike,broken collar bone, pump issues) all added to the mix.

A couple of things that I was particularly proud of were:

  • 20 years with type 1 diabetes and no complications to report to date
  • Maintained HbA1c under 6.5 and under 7.0 for the past three years
  • Achieved better control on insulin pump and using continuous glucose monitor (changed from injections in October 2014)
  • Completed my first Ironman in under 10hrs and without any diabetes issues
  • Started Type1Athletic and begun blogging about my diabetes experiences
  • Found a loving and supportive partner whom I could not have achieved all of this without
IM Melb Finish

Finishing 2015 Ironman Melbourne – 9hrs 32mins

So what’s to come in 2016? There are so many things that I would love to be doing and after the reality of day to day life I’ll be working hard to achieve as many of them as possible. In the end this is meant to be fun and I want to get the most enjoyment out of my passion for exercise, racing and talking to people about type 1 diabetes.

Some of my aims and goals for 2016 include:

  • Qualify and race at the Ironman 70.3 World Championships on the Sunshine Coast
  • Complete some races with my partner; triathlons, mountain bike or cycling events
  • Continue to build content on Type1Athletic including more diabetes specific posts, reviews and video content
  • Connect with more type 1 diabetics including athletes who are facing similar challenges; there are groups around the world doing similar things and there’s a massive opportunity to build our collective knowledge base here
  • Take more photo’s of where I am and what I am doing; this is more about slowing down and enjoying the moment which I’m not very good at
  • Get more involved with the local diabetes community and attend more sessions with support groups, product seminars and diabetes events
  • Build my diabetes and exercise knowledge, especially the connection between the two, to better understand why things happen and how glucose levels can be maintained at the most stable level
  • Design some Type1Athletic sporting kit which may include running and cycling gear

Although Type1Athletic is still in its infancy and I am learning a lot about blogging, social media and online content, I have really enjoy working on this. Documenting my experiences with diabetes and exercise has allowed me to reflect on what I have achieved and also provided the best education for me as I review what I have done and why certain things have happened. I have also found countless other resources to follow and these have provided the most positive impact for me just by knowing that I am not experiences this alone.

I am looking forward to another fantastic year and absolutely pumped to get started achieving my goals. I really want to connect with more type 1 diabetics and work with other diabetic athletes. I’ll be seeking you out but please get in touch, hashtag your posts as you achieve your goals. Bring on 2016.

Pump Down!

After completing a short pool swim a couple of days ago I was rinsing my insulin pump (chlorine not great for plastics) when I got a black screen (of death) followed by the pump vibrating non-stop. There was no response when I pushed buttons and it was immediately apparent the there was something seriously wrong with the pump. This was confirmed when I got back to my car and using a 10 cent piece undid the battery cover (to disable the pump and stop the vibrating) and brownish liquid came out of the battery slot (all over my tan work pants).

IMG_20151212_102442

Possible leak into battery leading to pump failure, rusty battery pictured

In a situation like this it is important not to use the pump. We become accustomed to these units and can forget that they are a medical device which need to be treated with the utmost caution and respect. The pump went straight in my bag and I was on the phone to the Animas distributor in Australia immediately.

The service from AMSL Diabetes was fantastic and although I felt completely in control and able to quickly change back on to insulin pens, their knowledge and support over the phone made me feel safe and confident. A replacement pump was sent out the next day and had it not been for the weekend (bad timing) I would have had the replacement pump within 24hrs. Including the weekend I had the new pump within 3 days.

The reason for the failure, unknown at this time but suspected to be a hairline crack in the pump casing which may have allowed water to seep into the pump. Having changed the battery cap about 4 months ago and the battery a couple of months ago it may have been seeping in for some time. You don’t want to think about the possibilities of the pump failing whilst connected to you but as I survived for several months without issue there must be some good fail safes within these devices.

So back on the pump and back to training. Also very happy to get my CGM back!

Afternoon session blues

Trying to get back from my broken collar bone at the moment and although the break and shoulder are healing ahead of schedule I am having great difficultly getting my blood sugar levels right for my afternoon/post work sessions. At the moment this is just cycling on the trainer or running but in both cases I can’t seem to keep my levels stable and over 30 minutes my levels are dropping 10-12 mmol/L to 4-5 mmol/L and then continuing to drop.

This is obviously super frustrating and yesterday I ended up having to walk nearly 4 kilometers back to my car when my levels dropped half way through my run! Not fun but on the plus side it a good time to think about things on the 30 minute walk back.

So what am I doing about this? Firstly I am trying not to stress about it and I am making sure that I am getting the most out of my morning sessions when my levels are stable. Secondly I am trying different insulin and CHO combinations including lower basal rate, increase CHO before session and increased CHO during session. The issue I am having with the first change is that my levels are then rising too much prior to the session, and with the second it is difficult to consume enough CHO prior to and during the session without feeling ill.

An individual issue which I have and which is especially prevalent in the afternoon is the very strong pull-down effect exercise has on by sugar levels. Even with a low basal does, no bolus insulin on board and having consume a prescribe amount of CHO my levels can drop between 5-10 mmol/L within 20 minutes. I do not seem to have this issue in the morning but it is a real challenge in the afternoon.

To help me get my training done at the moment I am now working on the following to manage my program.

  1. Putting all of my priority 1 sessions in the morning (and some priority 2 sessions) so I can get the maximum benefit from these
  2. Doing all of my run sessions in the morning; I have found trying to run in the after the most challenging with respect to my sugar levels
  3. Putting swim, strength and recovery sessions in the afternoon; I have previously been able to maintain more stable sugar levels when swimming in the afternoon which may be due to being able to sip on a high CHO drink (Gatorade) more easily during the session

As I am still in a recovery phase this is the perfect opportunity to get this right so that when I am fully recovered I can get the most out of my training immediately. With about 10 weeks until my next Ironman 70.3 event I have not time to waste.

**All details noted in this post are from the authors personal experience and should not be used as a treatment guide. See Disclaimer.

Blood Glucose Battles Continue

Having crashed badly during my last Ironman 70.3 event 4 weeks ago I have been focusing on my recovery which has been going really well but has meant very little physical activity. As all diabetics would know this means that I’ve needed to adjust my insulin regime, increasing my insulin doses and also reducing how much I am eating on account of being inactive. Now that I am 50% of the way to a full recovery I am starting to get back into training which means that I also need to adjust my insulin regime again to allow me to train (without hypo-ing).

I find this really challenging and super frustrating as I try to balance enough insulin to keep my blood sugar levels within a good range but also not too much insulin that I end up going low during my training sessions. Training in the morning and the afternoon means that I am trying to get this right twice a day. The training also impacts how my blood sugar levels track during the day and overnight which then means further changes to my basal insulin pattern.

BGBC Image

Summary of a day when my BSL’s just didn’t stick to the plan. I was new on the pump so there are a few basic errors i made and learnt from.

Over the last week I have been trying to increase my sessions on the bike (indoor trainer) and also include some jogging. My morning sessions have been relatively successful in terms of getting through the session but my levels have risen which has required a bolus dose post session and then careful consideration of my breakfast bolus doses shortly afterwards to avoid a hypo later in the morning.  My evening sessions have been a disaster! Trying to reduce my basal rate during the afternoon to allow me to train for 30 minutes to 1hr has led to late afternoon high levels which have required a bolus dose. This bolus dose has then lead to a hypo during my session. On other occasions I have had too much basal insulin in my system and I have also hypo’d during the training session.

Making these adjustments is a real balancing act and they do take time to get right. It is very frustrating when things don’t go to plan as I cannot train or a session ends without completing it, and then I have to manage the subsequent high or low blood sugars. This does get me a little depressed and wishing that it was easier but it does not stop me trying again the next day. Every diabetics management is different and trialing what works for you is the best way to figure out how you can get the most out of your activity.

I guess the purpose of this post is to acknowledge that managing diabetes and exercise/sport is difficult and sometimes it just does not work out as you planned. It doesn’t matter who you are or how long you have had diabetes for the challenges are the same for every one of us. Don’t let this stop you getting active because after these short moments of frustration the rewards when you get it right are massive for your diabetes, your body and your mental health.

Diabetes Tips #1

I have had type 1 diabetes for nearly 20 years and I’ve faced many challenges over this time and learnt plenty about how to manage my diabetes in my everyday life. My passion for health and fitness has most recently made me adapt my diabetes control so that I can consistently train and race just as a non-diabetic would. Although the requirements to train 15-20hrs per week and race for up to 10hrs are particularly rigorous, the basics are simple and applicable to all diabetics.

I apply many little “rules” to my everyday diabetes life to help me keep my blood sugar levels stable but some of these “rules” are a little OCD! For everyone else I’ve broadly summarised these in the points below which can be applied to your everyday diabetes management.

  1. Test your bloody frequently – it is critical to know where your blood sugar levels are to effectively keep them stable throughout the day and especially when eating, insulin dosing and exercising. The use of a continuous glucose monitor provides an excellent monitoring tool and I find this to improve blood glucose control significantly.
  2. Don’t overreact to high and low blood sugar levels – it is important not to give too much insulin when treating high blood sugar levels as this increases the risk of stacking insulin and hypo-ing. You must give an insulin dose sufficient time to work (can be 1-2 hrs). Equally it is important to treat low blood sugar levels correctly and not over eat/drink (the dreaded hypo munchies) which then cause’s higher blood sugar levels.
  3. Maintain a consistent routine – I find that keeping a consistent routine really helps my diabetes control; meal timing would be the most important but when you sleep and when you exercise also impacts your insulin regime and thus your blood sugar levels.
  4. Avoid refined sugars and simple carbohydrates – If you can, just don’t eat refined sugars as they are not only more difficult to match with an insulin dose but they are not good for your general health and well being. Sugars are contained in many foods and drinks so you need to be really vigilant to avoid these, but the results are significant for your blood glucose control.
  5. Include low GI carbohydrates in your diet – Low GI carbohydrates form a large part of my diet and due to their longer absorption time which greatly assist with maintaining stable blood sugars post meals.
  6. Use exercise as part of your diabetes management – exercise is an excellent way to keep healthy and regular exercise may allow you to reduce your total daily insulin requirements which then reduces the risks of hypoglycemia by having less insulin in your system.
  7. Always be prepared – it doesn’t matter what you are doing you’ve always got to be diabetes prepared; blood testing kit, insulin, snacks and mobile phone are things I carry with me everywhere. Carrying these things  can be annoying, especially when training, but it’s a small price to pay for being safe and able to look after yourself if something goes wrong which always happens at the worst time and place.

Although these are only simple tips they do have a big impact on my diabetes control and I hope they can provide similar positive responses for you.

These tips can also be found on the Tips Page for your future reference.

**The advice and information provided in this post is from the authors experience only and should not be used as medical treatment without consulting your doctor. Please refer to disclaimer.