TFM Around the Bay in a Day

This past Sunday I rode with the Freedom Machine team in their annual Around the Bay ride supporting Zagame Motors. The Zagame group was huge (over 200 people) and the weather conditions were terrible (50km/hr+ winds) but the ride was a great success.

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The TFM crew at the mid-ride stop, still smiling before the headwind return!

Details of the Ride

  • Distance: 150km including getting to the start
  • Time: 5:30am to 12pm including waiting at the start and mid-ride stop
  • BGL Checks: 20
  • BGL Range: 4.5 to 12.5mmol/L
  • Bolus doses required: none, adjusted basal program provided enough insulin
  • Carbs Consumed: approx. 150gr during ride (7am to 12pm) based on my BGLs and how I was feeling energy wise
  • Issues: ‘pump not primed’ warning which require a stop and re-prime

The evening before an event is very important, apart from organising all of my cycling kit I also figure out my diabetes plan which includes insulin (basal rate) and the food I’ll consume. For a ride like this I’ll usually take enough real food, sports bars and gels to provide up to 50gr of carbs for the first couple of hours after which I would restock. For hydration I prefer a no-carb mix as I can then always consume it no matter where my BGL’s are at (a carb loaded drink could not be consumed if BGL’s run high). With my basal rate I need to consider that although I was getting up at 5am to get to the start, the event wouldn’t actually start until 6:45am. I needed to increase basal a little for when I got up and then a little more for when the ride started. I obviously wanted to avoid a high or low whilst I was waiting for the event to start. In the end I set my basal to increase at 3am and 5am and then reduce at 8am and 10am to cover the ride duration. All in all, it’s a good hour to get things organised the night before an event.

On Sunday my alarm went off at 5am and I immediately checked my BGL’s which were running at 6.5mmol/l. A good start to the day! I usually try to get up and be training within 30 minutes so having to ride to the start of the event and then wait for around 1hr meant that I have to take extra care to maintain stable BGLs. Due to this I consumed a low carb protein bar whilst waiting at the start and I checked my BGLs every 15 minutes to ensure things remained stable, which they did. Setting off for the ride my BGLs were at 8.5mmol/L which was a good level with my increased basal rate and the cycling soon to kick in.

When cycling I usually check my levels every 30mins over the first hour, then every 20 minutes for the next couple of hours and for longer rides like this one I end up checking every 15 minutes as the risk of rapid BGL changes increases the longer I am riding for. With a strong tail wind, the first half of the ride was really fast and we were at the breakfast turn-around within 2hrs. I had consumed a muesli bar on the way down and my BGLs were dropping when we arrive. This was actually planned and I didn’t eat any carbs as we got close to the midway point know that there was food available there. I had a coffee, ate a banana and half a vegetable wrap at the stop which equated around 50gr of carb. For the 20 minute stop I would have checked my levels 4 times so that I ensure I did not go too high or low. The stop was only for 20 minutes so I did not give myself a bolus dose with any BGL increase to be limited when I started riding again. We ended up stopping for over 30 mins which meant that my BGL rose more than I would have liked to 12.5mmol/L. I decided not to give myself a bolus dose and after we started the ride back (into a 50km/hr+ headwind) I check my BGL every 15 minutes to make sure that this re-stabilised.

Riding back into such a strong and gusty headwind was really challenging. Obviously I was getting blown all over the road, the effort was high and the speed was slow, and in situations like this you can forget to check your BGLs and it’s easy to forget to eat. We were also responsible for getting the group to the finish line safely which meant constantly checking on how the group was going (not an easy task given the conditions). I was checking my BGLs consistently on the way back ate a sports bar and snickers bar (my treat on long rides) as well as mixing some Gatorade in my drink bottle for some extra carbs. I was able to keep my BGL’s stable on the way back and finished with a reading of 6.5mmol/L. After a quick shower I was able to have a good lunch with carbs (50gr), protein (omelette with extra egg white) and plenty of salad.

8-oct

Not perfect but very manageable, two spikes before the start and at the mid-way stop.

Overall the ride was not overly tough even though the wind made the return journey twice as long. From a diabetes point of view, it was a challenging ride having to manage a delayed start, riding with a group, at their pace, and generally not being in control of my own ride. Also having to monitor the group, provide assistance and battle the weather added to extra things to think about. I was able to manage my diabetes without an issue and to achieve this I made a point of doing what I needed to do, when I needed to do it (check BGL, eat and even re-prime my pump).

So some important things which helped me get through this ride:

  • Good organisation the night before the ride including setting insulin plan (basal) and laying out all the food I needed including calculating the nutrition/carb content and having some low carb options
  • Regularly checking BGLs throughout the event including every 15 minutes during critical times and later in the ride when insulin sensitivity increases
  • Making sure that I ate when I needed to which was not necessarily when the group stopped and eating only what I could best estimate the carb content of (no egg, bacon and relish rolls)
  • Letting people know when I needed to stop to re-prime my pump, confirming things were alright and then chasing back on to the group

Even with type 1 diabetes every event is achievable and all that is required is a little extra planning and following the process to maintain stable BGLs and performance.

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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.

Learning to Run

After my last Ironman race in June I took a couple of weeks completely away from any training and enjoyed what many would call a “normal” life. I am always active so there was plenty of time spent outdoors with my girlfriend and also plenty of social rides with a focus on coffee and donuts! Being active is such an important part of my life so I’ll always be doing something, but more importantly it forms a really important part of my diabetes management. During this time where I was less active it did have an impact on my diabetes and I did have to increase my insulin doses to account for this and monitor things a lot more closely to ensure my levels stayed stable.

MelbMara

There are only so many coffee shops you can ride to until you realise that you need a new goal and new challenge. For me, the triathlon season was a long way off and I needed a local event to train for between now and then (later in the year). The Melbourne Marathon is in October so the timing was good and I knew when I started thinking about racing the marathon and it made me a little nervous that it was a great challenge and goal. With running being the weakest of my triathlon disciplines, and understanding the physical toll which long run training takes on my body, this was going to be serious!

So back to some more structure training sessions and back to the same old diabetes issues; getting BGLs right for training, being able to get enough fuel and recovery food in and managing stress levels trying to get all of this right. A real positive from my break was that I have learnt to stress a little less about my BGLs when I am exercising and allow things to stabilise more steadily while continuing with my activity. Although erratic levels do hamper performance, you can work through them calmly and sensibly.

So to some of those challenges which I am looking forward to overcoming:

Physical challenges of running

  • Running is hard; no question about this
  • Extra stresses on the lower body from the high impact resulting is many combinations of muscle, tendon and joint soreness
  • Managing inflammation which can be one of the complications of diabetes; I usually require double the recovery time from any soft tissue injury than a non-T1D
  • There are no free kilometres like when cycling, you have “run” every kilometre and there a plenty of those

Diabetes challenges of running

  • For me, running has the biggest pull-down effect on my BGLs and this can occur very quickly
  • The need to keep BGL stable for 1.5 to 3hr sessions
  • Eating while running which is especially important for runs over 1hr and during afternoon/evening sessions
  • Carrying everything that I “may” need; BGL tester (Freestyle Libre at the moment), insulin pump, food (usually 2 x gels – approx.. 50gr carbs), phone and credit card/money (for emergencies)

I have had many annoying experiences when running due to my diabetes all of which have involved a hypo and then trying to get home; walking in the rain, taxi/uber, public transport without a ticket and even getting a dink from a cyclist. All of these are even more enjoyable at 5:30am in the morning or when I’ve heading into some remote location! Never-the-less I continue to head-off and challenge myself, and then have plenty of time to reassess when I am walking home (take 4-5 minutes to run a kilometre and 10-12 minutes to walk).

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My expressionless running face: not thinking about the pain, just ticking off the kilometres

Through social media and the great promotion which T1Ds are doing I have been able to meet some great people and new running buddies. From a performance perspective training with people at a similar level is great and being able to train with people at a higher level provide some fantastic benefits and improvements. Not only that, but training with people who also have and understand T1D is a new and enlightening experience. I recently had my first stop mid-session to allow my training partner to check their BGL and then have something to eat because they were trending low. Something that I do all the time but have never seen it form the other person point of view.

As my running has progressed I am enjoying it and feeling good when running. As expected my legs are feeling the sting after my longer runs and I’m having to put a lot of work in to strengthen and maintain good feeling in my legs. This is definitely a work in progress and I’ve got to watch that I don’t push things to hard and cause an injury. I’m lucky to have some great people to help me and bounce ideas off including Shaun Forrest (Elite marathoner and T1D). Unfortunately, there are some realities of running; it’s hard and there’s not cheating the kilometres! Fun times to come.

Diabetes Race Plan Preparation

After the weeks and months of training hard for an event and then battling through a week or two of taper the final piece to the preparation puzzle is figuring out my diabetes plan for the race. Since late 2014 I have used a similar formula for all of the races which is based on a basal program to deliver sufficient insulin throughout the event to allow me to maintain stable BGLs within a good range whilst consuming necessary carbohydrates and thus performing at my best. If you have been following my blog over this time you will have seen that this does not always work out, usually running high with a bolus correction dose required. With the various physiological and mental influences on you BGLs it is certainly a challenge to get things exactly right.

To prepare my plan I start with the race times (travel, prep, start, swim, bike, run and finish) and then work our what my BGL will be to start, what carbohydrates I’ll consume and when, what the exercise BGL pull-down will be and finally what basal rate I need over the race hours to keep my BGLs within a good range.

Race Plan

Excel is an excellent tool to develop an insulin plan; setup, make changes and review.

Critically important elements to the plan are if/when a pre-race meal will be consumed and allow enough time/amount of insulin so that you are OK to start the race and not hypo (during the swim). As I predominately train in the morning without eating before starting I don’t eat prior to a race and will only consume some protein in the hours before and then a small amount of liquid carbohydrates within 30 minutes of the start. This allows my BGLs to rise prior to the start and then stabilise once the race has started.

For me, I prefer to be cautious with regards to a hypo as having a bad hypo will almost certainly be the end of your race. It’s obviously a balancing act though as you don’t want to run too high either. My best advice is to trial an insulin plan during you longer training sessions and this will give you the best understanding of what is required. For Ironman events this will involve a swim followed by a ride or a ride followed by a swim. Be sure that the duration of these is long enough to reflect the event which you are competing in. Luckily most events start first thing in the morning so it’s easy to train for this.

When a diabetes plan does work perfectly it is an amazing feeling of relief which usually also results in amazing performance. My Ironman Melbourne in March 2015 was such an event and one of my proudest achievements.

IM Melb BSL

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

 

Ironman 70.3 Port Mac Race Report

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

PMac Race Summary

Ironman 70.3 Race Summary

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

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

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

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

Port Mac

My Port Macquarie race photo summary

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

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

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

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

T&D May 1

Race week and I was really nervous. Nervous because I’ve had a good block of training but mainly nervous because I wasn’t confident in having my diabetes 100% under control. With tamper, travel and then racing all happening this was going to be a big week and I really didn’t want to get anything wrong.

I had some real struggles before and during the race and in the end to walk away with 10th place was a great effort. Apart from the massive hypo I had in the last 2km of the run leg I was on track for a great time and result, and I take this as a real positive from the race. After the race I enjoyed as burger with my training buddy Matt (who PB again at the race!) and my family which quickly put everything into perspective. See my race report here.

Port Mac Walk

Post race walk and debrief in the rain at Port Macquarie

I have learnt a couple of really big things this week and I am surprised by what I have learned given that I thought everything was tracking perfectly leading into this race.

  • Your mental state and especially nervous energy, stress and adrenaline have a massive impact on you BGLs. I am usually really relaxed before an event but I was so nervous and anxious that my BGLs were out of control and I struggled to keep them stable over the race weekend. I am now going to work on my mental conditioning leading into a race to ensure this doesn’t happen again this was such a profound experience that I’m going to investigate it further in a future blog piece.
  • Diabetes control is the key to your best performance; taking the time to test your BGL during the race is worth it, that extra 30 seconds to do this won’t cost you a PB but if you don’t then it could cost you your whole race. Even with a CGM I tested my BGL multiple times during the race and although the numbers weren’t what I wanted to see, I did know where I was at.
  • Keep it simple: For both mental and diabetes performance keeping everything as simple as possible makes such a difference. Although I nearly lost my sh#t prior to the race if I didn’t have my race routine, food, bike setup, etc. already sorted then I would have been in a lot more trouble. Even though things didn’t go to plant I was able to ge thtrough the race but following the simple things which I had in place.
  • Don’t forget to enjoy it: I think that I have put too much pressure on myself over the last 6 months and my performances have suffered. During the race I reminded myself to enjoy it and with this mindset I didn’t let my diabetes issues get to me and my performance and times where good. No need to make a tough Ironman event any tougher.

I have six weeks now until my next race at Ironman Cairns 70.3 and with the success of my modified training program I am excited to get another solid 4-week block of training in and head to Carins ready for my best performance. I’ll be working on my mental conditioning and also my diabetes plan until then with the hope that everything comes together for this big race.

Diabetes Maketh The Man

I have had type 1 diabetes for just over 20 years which is two-thirds of my life. That being the case having T1D has had a profound influence on my life and on the person which I have become. Not long ago I meet with a sports doctor who asked me what I wanted to achieve out of seeing him and what I would change about myself if I could change anything. I said that I wanted to generally be better so that I could achieve my goals and personal bests. He responded by pointing out that I obviously would want to get rid of diabetes as that would make things a lot easier. Funnily enough, I didn’t even think about my diabetes and when I thought about it after the appointment I realised that I didn’t actually immediately wish to be rid of T1D as it has really made me the person that I am.

Although T1D can be a big challenge and there are plenty of moments where I wish that I wasn’t a T1D, it’s hard to imagine where I would be and what I would be doing if I didn’t have the condition. In 20 years T1D has never stopped me from doing anything with all aspects of the condition being manageable. In many instances I believe that having T1D has actually benefited me through better thought and planning about events, taking a greater interest in my health and wellbeing and having a very sound knowledge of my own body.

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Hi, I’m Alex and I am a Type 1 Diabetic. Out on a solo training riding in the middle of no where. 

Considering my life with T1D I have come up with some of the positives influences and traits which I believe the condition has given me and which have helped me in other parts of my life.

Planning: With T1D life needs to be planed and when trying to work full-time and also train 15hrs per week that planning goes to the next level. Each week I plan out my training around my work and family commitments and then each day I plan my meals and insulin plan so that my BGLs are right for my training sessions. Planning for these sessions can be up to 12hrs in advance to ensure I have eaten and have the correct BGLs to train.

Consistency: I believe that consistency is really important for maintaining stable BGLs. I generally wake, sleep, work, train and sleep at similar times each day. My meals are pretty consistent with my carb intake at each meal very consistent. Overall the number of times I test my BGLs and my daily dose of insulin are the same each day. Through this I have a good understanding of where my diabetes should be at each day and I can plan things accordingly around this.

Control: T1D causes a significant shift in the way we approach life, I believe that we need to have serious control of ourselves and what we do otherwise we can face some very serious immediate and also longer term consequences. Even with these serious consequences it’s often difficult to oneself especially around our weakness; chocolate or over exercising are two of mine.

Education and Understanding: T1D is a unique condition where the individual has such control of their treatment (as opposed to a medical professional) and the consequences of poor management can be catastrophic. To be able to do this effectively we need to be well educated on diabetes and have a good understanding of how we individually need to treat the condition. Even more difficult is that every T1D is different and thus need to determine their own methods to manage their condition. For such a serious condition it is amazing to think that the best manage can come from trial and error. This is a serious responsibility and forces all T1D’s to take the time to research and understand the condition and its treatments.

Take Action: I have learnt that assuming things will just sort themselves out usually guarantees that they won’t. BGLs won’t just go up or down by themselves, not eating a proper meal and just snacking is never a good idea and assuming you BGLs are ok and not testing is a big risk. I simply take the actions I need to ensure my diabetes is controlled. I ask for a special meal at an event or take my own food, I stop and test my BGL whenever I need to and I change my plans if things aren’t tracking right. If you don’t look after yourself then nobody else will.

Risk Management: There are certain risks associated with T1D which need to be managed every day. The most serious of these is hypoglycaemia which can strike at any time day or night and the consequences can be very serious. Being very active and not wanting to let T1D stop me from doing anything I always need be thinking about these risks. I must make sure I have all my diabetes items with and sufficient supplies to treat a fuel up and/or treat a hypo. Having an exit strategy is also very important be that being able to contact someone or being able to catch a lift home from a training run if things don’t go right. I have many times had to walk home mid-way through a run when I have been 5km from home and had a bad hypo.

Health and Wellbeing: With the inherent risks and complications associated with T1D keeping healthy is very important to me and it has really become part of my lifestyle. Through T1D have learnt a lot about health and nutrition and as I have become more into endurance racing and Ironman this has become a real focus for me. The active and healthy lifestyle which I have developed holds me in good stead for the rest of my life.

Finish 2

A great achievement crossing Ironman Melbourne finish line in 9hrs 20mins conquering all mental, physical and diabetes challenges!

 

Having type 1 diabetes has definitely influenced my lifestyle, development strengths and attributes. It may be a bit of the chicken before the egg scenario but I do feel that whatever characteristics I may have inherently had have been amplified by living with T1D for the last 20 years. So back to my original thought, do I wish that I never had T1D or could be cured now? There’s clearly not a straight forward answer to this but I would not change having T1D and I really think that having T1D has made be a better person and a stronger athlete. I will still be strongly supporting find a cure as this will certainly make my life easier but I have plenty of other things to working on to continue to improve my performances.

Carrying Diabetes Equipment When Training

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

Swimming

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

Cycling

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

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

Running

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

Gym

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

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

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.