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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Evening Training Highs & Hypos

I have always had a lot of trouble maintaining my BGLs when I am training in the afternoon. No matter how much I lower my basal insulin or how many carbs I consume, I always seem to end up having a sharp BGL drop during the session and if not that, then I end up with stomach issues from eating too much before/during the session. The combination of consuming carbs before/during a 1-1.5hr session and also reducing basal insulin, ultimately leads to a spike in BGLs after the session. Adding all of this up it’s 4hrs of worrying about BGLs every afternoon as I prepare, train and then recover.

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Getting levels stable can be very challenging, trying to balance; insulin, carbs and session duration is all important. Sometimes I do manage to get it close enough right though!

Especially with triathlon training where you need to squeeze in swim, ride and run sessions along with strength and recovery, you need to utilise all available sessions which including afternoons/evenings. With my challenges training in the afternoon I try to plan my sessions to get the most important ones in the morning (run and bike) and do other sessions in the evening (strength, swim plus lighter runs/rides). It takes some effort to get my planning right needing to consider; diabetes (am/pm), session requirements (hard/easy/length), pool availability, recovery time between sessions, weather and other personal commitments. Even so, but with a little stress, I manage to get 15 hours of training in most weeks.

So even though it’s a real challenge, I prepare myself most afternoons to head out and complete a training session know full well that there’s a high chance I’ll have a hypo. Recently I have had some success, my BGLs have been fairly stable and I’ve been able to complete some really good afternoon running sessions. The things which I am doing at the moment to give myself the best chance to complete these sessions include:

  • Reduce basal insulin 2 hours before training session and maintain reduced basal for first half of session. I need to reduce my basal rate by 70% for swimming and running session, and 50% for bike sessions in the afternoon. I do not require a reduction for strength sessions.
  • I do not start my session until after 2 hours post reducing my basal insulin rate to ensure that insulin levels in my system are reduced.
  • I try to start my sessions with BGLs around 10.0 mmol/l knowing that they will drop within the first 15 minutes
  • Consume between 20 and 40 grams of carbs about 30 minutes before the start of the session. This will usually be a supplement like Endura Optimizer or Hammer Recoverite mixed with water. I find that I respond well to these carb sources and they do no upset my stomach.
  • During a 1 hour session I will consume 25 grams of carbs at around the 30 minutes and this is usually a sports gel. It is important that whatever I consume does not upset my stomach and I also need to be able to carry it when running. When swimming or riding liquid carb sources are also an option.
  • I check my levels every 15 minutes during the session to make sure my levels are tracking OK and I can adjust things if needed. This does seem like a lot of testing but my levels are drop very quickly and when  you are covering a kilometre in around 4 minutes it can be a long walk home if you’ve missed a hypo!
  • I plan my sessions so that if something does go wrong, most likely a hypo and needing to walk back to the start, I am not too far away. A 20 minute loop is a good option and also provide for keeping provisions in your car for easy access.

I really work hard to get the most out of all of my training sessions and I do get upset when things don’t go to plan. I try to not let these incidents get to me but when you are trying your best and things still go wrong it is challenging to remain positive. Nevertheless, after many many incidents I continue to train and continue to work to get my diabetes management as close to perfect as possible. I know from experience that this will never be possible but the most important thing is to continue to strive to be better and in the end be healthy. Two afternoon run sessions week, one successful and one included a 20 minute walk back to the car in the rain, luckily I’m running first thing in the morning tomorrow!

What I learnt without my Insulin Pump

Friday morning after my run and swim session I was settling down for a big breakfast at my regular café when my insulin pump started vibrating. This was unexpected as my levels were good and the pump had been functioning fine up to this point, the vibration was also different to the standard pump warnings. Checking the pump and the screen read “SLEEP ERROR, CONTACT SERVICE”, the vibration had also changed to a consistent thump and the pump did not sound healthy. With that, and with perfect timing, my carbohydrate loaded breakfast arrived and I realised that I wouldn’t be eating it and my morning would now be a rush to get flex-pens to dose my insulin.

The Friday timing was particularly bad as well because the weekend would delay the delivery of a replacement pump until Monday which meant up to 4 days off the pump and back to short/long acting insulin injections to manage my diabetes. The pump supplier provided a fantastic service when I contacted them and although we were able to try a number of things to rectify the pumps issues, we were ultimately unsuccessful.

Having had T1D for over 20 years and only being on the pump for the last 2 years, I was pretty confident that I would be able to manage things over the weekend with short and long acting insulin (flex-pens). Annoyingly I didn’t have any long acting insulin left or an old script, so I needed to go to the doctors to get this sorted ($$$). When collecting my insulin, the pharmacist asked if I knew what my dosage was; sure, and if not then I’ll just figure it out. I did think that I had this under control but would find out that T1D isn’t easy to manage, control cannot be taken for granted and poor control has a significant impact on your daily well being.

Flex Pen

Back using flex-pens and there was a few funny looks when “shooting up” in the peloton

 

 

Over the subsequent four days until my new pump arrive I managed my levels fairly well with the short and long acting insulin but I did tend to run high and had some fairly uncontrollable hypo’s. I am a control freak when it comes to me levels and I really missed the fine control that you can achieve using a pump. Two long acting insulin doses over 24hrs didn’t seem to keep me stable and I was regularly giving adjustment short acting doses, all the time nervous that I would have a hypo by over-dosing. My sleep was affected, I wasn’t able to exercise very much and my eating patterns where all over the place as I tried to get my levels, doses and carbohydrates matched. By Monday morning I felt like I had been on a massive bender for the weekend and I had a huge hangover to now deal with. A few people commented about this at work from the way I was looking but then couldn’t understand it as I don’t really drink!? Feeling as I did I was in no mood to respond.

So nearly four days off my insulin pump and upon reflection this is what I have learnt.

  • Insulin dosing is serious business and no matter how long you have had T1D for you must be cautious when changing your insulin doses
  • It’s important to let others know what’s going on and how they can help you; hypo’s, feeling sick and changing your routine all need the support of those around you
  • There are serious risks with T1D and in situations like this you shouldn’t push yourself; as much as it pained me, going on a 100km ride and being hours from home would not have been smart
  • I have gained a real appreciation for newly diagnosed T1D’s, I was taking an educated guess with my insulin doses and there was some fear each time, especially at night, about what the result would be
  • When things are not going right (high/low BGLs, not feeling well) it’s important to try to continue to do things that energise you, even if these are only small. I managed to get out for a ride with my Dad on Saturday and although I felt average it did make me feel a little better and remain positive
  • It is really important to try to remain positive even when it seems like you just can’t make things work. For me, my mental state particularly negative, has a significant impact on my BGLs making any bad situation even worse

On Monday afternoon I was reconnected to my pump and after a better nights sleep I was feeling 100 times better on Tuesday morning. Without doubt I am now truly amazed at how great my insulin pump is and how much it helps me manage my T1D. It’s certainly not perfect and I am still looking forward to future developments, but it allows my levels to remain stable and for me to be as active as I want to be every day. I am also happy that my regular donations to JDRF contribute a small part to their pump program which provides the opportunity for more T1Ds to get access to an insulin pump.

My Healthy Diet Refocus

Time off from training is certainly enjoyable but as a type 1 diabetic my diet remains very important to me. Cutting back from 15hrs+ training per week to a few social mountain bike rides and walking the dog is a big change which requires some significant changes to my daily insulin plan (about a 25% increase). To help me manage this big change I have worked hard to keep my diet in check, counted my carbs closely and tried not to over indulge too often (which usually results in some challenging BGL fluctuations).

For me it’s all about eating healthy, getting in all of the macro nutrients that I need and feeling satisfied throughout the day. I usual think about food as fuel and follow a strict plan to eat what I need and also maintain stable BGLs. Fundamentally I still follow this approach as it is healthy, I feel good and allows me to easily track carbs and insulin requirements. I also keep to eating at regular times during the day (breakfast, lunch and dinner) and ensuring that my main meals are substantial and include all of my nutritionally requirements.

I have generally broken each of my meals down to the following:

  1. Protein – lean protein (100grams per meal)
  2. Carbohydrate – Unprocessed and low GI
  3. Fibre – Leafy vegetables which should also be used to fill you up
  4. Fat – healthy fats (only a small amount each meal)

As a rule of thumb I also vary my sources of each component with each meal and throughout the week; that is to not eating the same protein, carbohydrate or fat too many times. I do not count calories but eat a healthy portion of protein and fats with each meal, my carbohydrate intake is relatively low by nutritional standards but this assists with my BGL stability and I load up on fresh vegetables with every meal. Fruit is important but can be high in more High GI carbohydrates so I choose low GI fruits and keep them to two pieces per day.

When you break your meals down into these simple components it is then always easy to put together a healthy meal which ticks all of the boxes. The components are also not complicated making most meal quick to put together (<30mins). I have provided a very simple meal options plan below.

Breakfast

  • Eggs with whole grain toast, tomatoes, spinach and mushroom
  • Rolled oats with berries, seeds/nuts and yoghurt
  • Crumpets, natural peanut butter, low fat cottage cheese and fresh mashed blue berries
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An open steak sandwich cuts the carbs but is full of protein and salad.

Lunch

  • Lentil and vegetable soup
  • Roast chicken or tuna with mixed salad and legumes (chickpeas/kidney beans/four bean mix)
  • Whole grain sandwich or wrap with salad, cheese/avocado and lean meat (turkey/ham/chicken)
  • Vegetable frittata and fruit salad

Dinner

  • Grilled chicken with corn tortillas, avocado and salad
  • Seamed fish with potatoes and vegetables
  • Roasted vegetables with natural yoghurt dressing
  • Tofu/egg and vegetable stir fry with soba noodles
  • BBQ lamb/beef with roast sweet potato and salad/grilled vegetables
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One pot/pan meals are a favourite of mine and roasts are a perfect winter meal!

Snacks

  • Mixed unsalted nuts (30-50grams)
  • Low fat yoghurt with frozen berries (100grams)
  • Fresh fruit (banana, apple, pear, melons, etc)
  • Carrot and celery with hummus dip/natural peanut butter/low fat cottage cheese
  • Rice cakes with low fat cottage cheese, tomato/beetroot

I’ll admit that I keep myself on a pretty tight leash but during my current break from training I have been trying to indulge myself as much as possible. There’s been plenty of ice cream, some hearty winter pub meals and plenty of glasses of red wine. The thing for me though is that through both my diabetes and my years of training I have learnt to enjoy eating healthy and I now choose to eat this way because it really makes me feel great. Eating should be an enjoyable part of our lives, you should choose things that you and your family enjoy eating and you should create dishes that look, taste and smell amazing!

T&D June 19 – Time Off

A week of rest and recovery after Ironman 70.3 Cairns which included many hours in a deck chair, in the pool and at the dining table, it’s been a really different week for me. With no training on the cards for the time being I am reflecting on some of the big lessons I’ve learnt recently and allowing my mind and body to rejuvenate after a long 12 months. These things that I have learnt are all critically import to achieving my nest performances and they will form important checks for me next season so that all of my performances as good and better then my recent races.

  1. Mental: I believe that this has the biggest impact on my performance, both diabetes and athletic performance. I cannot believe how greater my BGL/diabetes stability is when I have a positive mindset. This positive mindset also yields the best training and racing performances along with rest (sleeping) and recovery.
  2. Physical: Although I am good a pushing my body to the limit, I am not so good at adapting my training program when my body is not 100%. Taking days off, sleeping in or doing those small recovery and rehab things are as important as getting the kilometres in.
  3. Diabetes: It’s obvious but the control of my diabetes (BGLs) has a direct influence on my athletic performance (and the rest of my life). This is the most important part of my life which I must remain focused on. This is not something to be upset by, it should be used to provide the planning and structure which will help me be the best possible athlete.
  4. Nutrition: Closely linked with all other aspects I have a tendency to be really strict with my diet which does not always provide for the best overall outcomes. There is no point beating yourself up for eating a treat and enjoying the experience. With a more relaxed approach over the last 3 months where I have allowed myself to indulge a little more, my performance has not suffered and have actually ended up physically and mentally stronger.
  5. Racing: During the last 12 months I got to a place where I was only focused on the result and forgot to enjoy the journey. It sounds simple but I was training hard and racing well but would constantly focus on the negatives. Recently with the help of my girlfriend and my training partner (constantly reminding me of all of the positives) it finally sunk in and this really transformed me. When racing, you’ve got to enjoy it and not take everything to seriously; you’ve done the training, your’re ready to race and the performance will be what you deserve.
Bike Rack Photo

With loads of winter training miles on the cards I can share the love around to all of my bikes; which one have I taken out this morning?

This is the first time that I have had a real break for the last couple of years and it’s certainly a new experience which I am going to have to adapt to. I’ve had to make changes to my diabetes management including increasing my insulin doses (around +20%) to account for the lack of exercise I am doing. My diet has also changed and although it is still very healthy I am not eating as much and I am enjoying a few extra indulgences. If I am thinking about doing anything to strenuous I just remind myself that I am actually getting real benefits from this break and by doing nothing it will actually improve my training when I return. It’s also a great time to pay back my family for all of their support and putting up with a diabetic triathlete (thank you).

Without training to blog about I have a couple of pieces which I have been thinking about for sometime which I want to post over the coming weeks. Mental health, diabetes performance and stress and use of continuous monitors. T&D will be taking a break until training returns in July but plenty of diabetes stuff will be posted. Looking forward to all the things to come!

 

Light & Dark: Exercise Addiction

I’ve become increasingly interested in mental health and well-being, and its influence and importance to athletic performance. This interest has developed from personal experience and varying performance over the last 12 months.

Alex

I read this piece (Light & Dark) on CyclingTips provided further insight into one aspect of amateur training and racing which is particularly prominent to Ironman triathlon where the quantity and quality of training required is very high.

You can access the piece on the CyclingTips website – Light and dark: Exercise addiction, and the different forces of cycling

The Importance of Self-Awareness

One of the biggest things that I have learnt this year is the importance of having and acting on good self-awareness, both physical and mental. The mind and body gives us many signals both positive and negative and I have found that the more I listen to these the healthier I am and the better I perform. This is by no means a soft and fluffy approach to my health or training, but more a means to understand how my body is reacting to things; treatments, training, nutrition, etc. By having this understanding I can then make better decisions which result in better performances (diabetes, sport and just general well-being).

So what do I mean by self-awareness? It’s the sensations, feelings and thoughts you have many times a day about how you are feeling and performing. For me these are generally around fatigue and training performance (physical), blood glucose levels (diabetes), gut health (nutrition) and mindset (mental health). I’ll label myself a “competitive male” and as such I have generally taken the approach to push through with the mentality that the harder I push the better the result will be. This is certainly not the case and coincidently generally results in worse results for me. My most recent 70.3 race at Port Macquarie was a good example of this; a very good performance and leading into the race I made a concious effort to listen to what my body were telling me and adjust what I was doing accordingly (rest, recover, eat, etc.). I can attest from this that acting on this self awareness really helped my performance.

PMChart

I’ve found a good correlation between my self awareness, performance and what my Training Peaks data is telling me – best thing to do is listen.

How I apply this self awareness to my daily life is pretty simple, the difficult part is actually being aware of and interpreting what you mind and body are telling you. I have been calibrating how I am feeling with my data on Training Peaks and they align pretty well. When my body is telling me to rest and recovery, training peaks shows high fatigue and low form. It will be individual how you read your mind and body and it will take time for you to understand how best to react. Below I have listed some of the straight forward but very important signals and actions which I take.

Area

Signals

Actions

Fatigue

–    Tired during the day, falling asleep early at night

–    Feeling lethargic

–    Eyes hurting

–    Not alert or switched on during day

–    Allow body to rest, this can be for multiple days in a row to fully re-energise

–    Focus on diet and hydration (drink plenty of water)

–    Do nothing as oppose to active recovery

–    Get a minimum 8hrs sleep per night for several nights in a row (10hrs if possible is even better).

Performance –    Can’t hit session training targets (HR, Power, pace, etc.)

–    Feeling weak during training

–    Prolonged muscle soreness and not recovering as quickly as normal

–    Reduce training volume and stop intensity (try active recovery)

–    Takes a couple of days off completely

–    Get a massage and get on the foam roller/stretch every day

–    Ensure nutrition and hydration are adequate

Gut Health –    Uncomfortable stomach/pain

–    Bloated

–    Irregular trips to the toilet

–    Simplify diet and focus on foods which assist with digestion

–    Don’t over eat

–    Avoid foods which agitate your stomach including high fat, too higher protein, sugary and processed foods

–    Water, water and more water

BGLs –    Individual hypo or High symptoms –    Stay calm and go back to basics, count carbs and test your BGL regularly

–    I focus on being positive and doing things which assist BGL stability including walking, not stressing and eating sensible

Mental Health –    Lost motivation

–    No enjoyment

–    Procrastination

–    Negative mindset (can’t look at the positives)

–    Irritable and rude

–    Stop everything and speak to someone about how you are feeling

–    Assess what you may be stressing about

–    Work on things you can control and influence

–    Don’t worry about things which are not in your control

–    Do activities which energise you, for me this is exercising, relaxing with my girlfriend and walking the dog

–    Focus on single tasks, complete them and then move on

–    Review how you are going, continue to speak with someone and acknowledge when you achieve/do something well

Managing your mental condition is the most challenging of these for a number of reasons and it also may have the greatest performance implications. From recent personal experience this is an area which I have taken a special interest in and I will be writing a piece soon about how I have overcome the mental challenges and depression which I have faced.

It seems straight forward that we should listen to our bodies but it is surprising how difficult this actually is and how often we ignore the signals, ending up in a worse situation. The best performances comes when we are feeling at our best, both physically and mental. Feeling physically fit and strong, healthy and nourished and with a positive mindset shouldn’t be that hard to achieve. Use your mind and body as a guide and you will be able to achieve your goals.

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.

 

T&D May 22

I don’t know if it’s my diabetes or trying to fit in training around the rest of my life but every week seems like a big and challenging week upon reflection. Even with all of the little things that seem to happen in my life (which seems pretty significant at the time) I still manage to have great weeks! This week with work, 15hrs of training, away for the weekend, out on Saturday night, a broken rear wheel mid-ride on Saturday, some high and low BGLs and an irritating reaction to my freshly cleaned local pool it was busy.

Point Lonsdale

Sunday morning recovery ride is the most important of the week for body and soul; Inge, coffees, muffins, selfies and a bit of recovery thrown in for good measure.

We choose to fill our days doing the things that we enjoy, that energise us (maybe apart from working but hopefully there are some positives there to) and the challenges that we face are part of doing these things. I don’t necessarily want to get up at 5am on a Saturday morning but when I’m cresting a hill with Bells Beach to my left and a sunrise warming my back I’ve forgotten about getting up and I’m just looking forward to the next couple of hours of nirvana (for me). Trying to fit everything in is certainly a juggling act but it can be, and is manageable. Priorities and planning is the aim of the game here.

Diabetes does add another dimension to this puzzle with the most difficult part being that diabetes often runs its own course and things happen even when you try your best to control them. My weekend for instance including perfect BGLs during my Saturday morning ride, good BGLs during my afternoon swim, high BGLs in the late afternoon and evening, high BGLs Sunday morning which turned into good BGLs for my ride and then run. I was able to complete my training sessions and enjoy a muffin on Sunday morning but I felt terrible on Saturday night and struggled to enjoy my evening out as I tried to bring my BGLs down. Pretty stressful I think and that’s by no means a bad 48 hours.

Think about this further I think on average 25% of my training sessions would be impacted by my BGL levels to some degree. Be that by a hypo stopping a session early, a high not allowing me to push out a quality session or a combination of BGLs and food making me feel ill. After so many years constantly planning and adjusting things occurs without me really thinking about it but it is very stressful and something which I am working to manage better and remain in a good mindset.

T&amp;D

A planned and altered weekend (Saturday run missing) from a mechanical and BGLs. Overall though it’s been a great week of training!

The lesson which I have learned this week, and over recent weeks probably, is that things don’t need to run perfectly for me to achieve a great end result. This week for example was nearly derailed on a few occasions but from a training perspective turned out to be a really positive week. Even greater than this is possibly 25% of my training being impacted by my diabetes and even with this I continue to improve and perform well. I feel like diabetes is something which we can strongly influence buy never fully control and we need to be open minded to this. The uncontrollable diabetes events should not become the focus points of our day to day existence as even with these events so much is achievable. I will be reminding myself of this next time things don’t go to plan, maybe even today.

T&D May 15

I was struck down with a vicious head cold and sinus bug this week which put my training on the back burner and required a real focus to keep my BGLs within a good range. Illness always makes managing my diabetes a little more challenging and this week required the usual effort to keep my BGLs within a good range. Generally I require 20% more insulin (basal and bolus) when I am sick which may be due to the illness and/or spending most of the day on the couch (which is unusual for me).

In the past I have often gotten really frustrated when I have been ill and thought about what I can’t do, what sick leave I have to take and my BGLs are right. With my recent attitude adjustment I focused this week on what was the best things I could do whilst I was sick. I couldn’t change being sick but I could influence how and when I would recover. So the things which I focused on where:

  • Rest: I know that it is important to rest when I am sick as my body is fatigued from both the illness and also from my higher and more variable BGLs. Although I really struggle to just lay around I know that this is the best thing that I can do to recover. I try to enjoy this time as well as it’s not something that I often so.
  • Nutrition: I take the same approach when I am sick as I do when I am in full training. I eat the highest quality meals to fuel my body to overcome the illness the same as I would do to fuel my body for hard training sessions and recovery. Without have much else to do there’s a opportunity to create some fantastic healthy meals when home sick.
  • Hydration: You can’t underestimate how important adequate hydration is and it’s importance only increases when your body is under stress (training, racing or illness). Hydration is pretty simple; water, hydration formula’s and minimise consumption of caffeine which sadly means fewer coffees.
  • Diabetes: This can be really challenging as you are trying to balance higher BGLs, less activity, increased insulin and high risk of hypo’s. For me, a 20% increase in insulin generally keeps my BGLs under 10mmol/L and although this is higher than I’d like I accept that this is acceptable when sick.

I also try to get outside during the day when I am home sick to get some fresh air, sunshine and a little walk around which all benefit how I am feeling.

T&amp;D May 15

Revised training program with strength component (last 8 weeks)

Recovering after a couple of days of rest I can now focus on getting back into training. The graphic above shows the breakdown of my training over the last 8 weeks since I introduced specific strength and conditioning sessions into my program. This yielded great results at Port Macquairie and I will be continuing with this program. I am pretty happy with the spilt but I may work on a small increase in the run percentage as this is the leg which I really want to improve on.

A challenge for the coming weeks will be getting my BGLs right in the evenings so that I can complete a productive PM session. I have struggled recently to maintain stable BGLs late in the afternoon and then I have been hypo-ing during my evening training sessions. Balancing insulin and CHO for these sessions has been the challenge with a post session high BGL the result if not a hypo during the session. Plenty to work on but we enjoy the challenges don’t we? #T1D