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.

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.