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.

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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.

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T&D Mar 13

It’s been a fantastic week. I actually forgot what it felt like to be energised for a training session and this week’s sessions have been thoroughly enjoyable. Nothing too exciting but for my first week back it’s been great to focus on one session per day, incorporate my new strength program and get plenty of recovery in. Sticking to my training plan for the up coming 7 weeks I am confident that I will have a successful trip to Port Macquarie 70.3 at the start of May including a bit of redemption for my broken collar bone.

My weeks away from training have also been great for my diabetes. Physical and mental stress definitely makes maintaining stable BGLs more difficult, not least because you are often caught trying to force your BGLs to where you want them to be (which never works out well). I have taken this more relaxed approached into my training this week and the results have been great. I have been able to complete all of my sessions with stable BGLs and no highs post training which I have previously experienced. My time off has changed my insulin sensitivity a little and I’ve had to readjustment my basal plan to avoid highs/lows throughout the day and night. These changes have also been successful.

T&D Mar 13

Week 1 – strength, low volume, technique and pure enjoyment!

I’ve learnt a couple of really fundamental things over the last couple of weeks. Most of all it’s been listening to my body and not just forcing it. Now if my BGLs are not quite right or I am not feeling 100% then I am going to take heed of this and make adjustments. These may include changing the training session or missing the session all together. More importantly I’m going to make sure that my BGLs are in the right place before I start a session. Too many times I’ve been low and loaded up on sugar, or I’ve been high and given a correction bolus dose and then tried to train. Both scenario’s rarely work out well and this not only affects me physically with poor BGLs and a wasted training session, but also mentally as I stress about the previous items. I missed two weeks and am feeling great. Missing one session won’t make any difference.

Actual training takes up most of your time, but all of the peripheral things (how you are feeling, fatigue, conditioning, nutrition, recovery, etc.) are even more important and they will be the ones that derail your performance the most, as I have personally found.

T&D Feb 28

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

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

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

T&D Feb 21

A benefit of doing these weekly reviews is that it has really made me think about my progress from week to week. For the last few weeks my post have had a similar feel; feeling average, feeling good, feeling up, feeling down, just struggling to get on top of little niggles. Being in the middle of the triathlon season and trying to build up to my most important races this is not a great way to feel. Considering this I’ve made the decision to restructure my training plan to hopefully allow me to get my body back in good condition for the remainder of the season and my A-races.

Through many consultations with various sports physicians I believe that my physical issues have developed through a lack of strength and my body not being able to cope with the training loads. As disappointing as this is you often have to step sideways to continue moving forwards. My new program will introduce 2-3 strength sessions per week for the immediate future and reduce the volume/intensity of my “on-the-track” sessions. I hope this change will reap benefits both physically and mentally.

As a type 1 diabetic athlete I focus a lot on the impact of my diabetes on my performance but as an athlete my physical and mental condition remains just as important and requires the same focus as my diabetes. Formalising a plan to get through this next period has been a very positive experience for me and I’ve learnt a lot this past week.

  • If you continue to do the same thing then you’ll get the same result; the consistent ups and downs of the past month are testament to this, trying to push through is sometimes not the best approach and you’ve got to change what you are doing to achieve a better result
  • Your training needs to be holistic; to be a complete athlete you have got to put time into all aspects of your training including “on-the-track”, strength, recovery, nutrition and mental aspects (not to mention diabetes)
  • Sticking to your diabetes management plan really works; since I have put a greater focus on getting my body right my diabetes management has taken a back seat. I certainly haven’t ignored it but I have just stuck to my management plan, eating the correct portions and not stressed about my BGLs. Low and behold things have run really smoothly and my BGLs have been very consistent.

T&D Feb 21

With such a big shift in my training program and mental approach, I am feeling really positive about the coming period. My training load last week was reasonable and I am happy with the endurance load consistency I achieved. This coming week will include:

  • Commence working with strength trainer focussing on rehab and functional strength including my right shoulder (broken collar bone)
  • Continue Z2 endurance work “on-the-track” with greater focus on pre-session activation exercises and post-session recovery
  • Get my nutrition back on track 100%; with the stresses of the previous weeks I’ve been sneaking in a few too many treats!

I have made contact with several local diabetic athletes and have wanted to catch-up with them recently but things always come up and organising a suitable time has been difficult. I really want to meet up them, have a good chat and hopefully learn a few things from each other’s experiences.

T&D Jan 24

I have spent a lot of this week trying to figure out why I have been feeling so fatigued for the last 10 days. Following a visit to the doctors and a blood test we determined that there was nothing physically wrong with me. Reviewing my last couple of weeks on holidays including training and nutrition I believe that a combination of diet and environment has led to this increased fatigue. Coming of my broken collar bone I trained hard to get back to racing fitness. During this time over the holidays my nutrition and recovery were not 100% and this contributed to my fatigue. I’ve been satisfied this week that I’ve done the right things with my nutrition and recovery and my body is starting to feel better for it. Some things that I have learnt this week the:

  • Fuelling your body; Without the correct diet and nutrition you are destined to fail. Although there was nothing hugely wrong with my diet I was missing key recovery meals (nutrients and timing) and over/under eating whilst attempting to navigate holiday festivities and diabetes. I managed for a while but it eventually caught up with me and I crashed badly.
  • Trust your training programme; I have historically been great at doing high volumes of training and not so good at doing the specific training. When you work with a coach you’ve got to trust them 100% and follow the training programme and especially get the intensity right. The quality over quantity mantra rings true here.
  • Carbs stores & BGLs; Managing blood glucose levels (BGLs) is difficult and it is sometimes easier to not eat before and during a session rather than try to manage insulin, food and then BGLs. I have been struggling to keep my BGLs stable and I fell into this trap. I wasn’t eating correctly around my training  session which intern caused high/low BGLs and the associated issues. Managing diabetes with correct nutrition is a critical part of training and although it can be very difficult you’ve got to stick with it.
  • Accept the diabetes challenges; The fact is that diabetes is never easy and it won’t always go to plan. You can’t get upset by this and you’ve just got to push on as best you can and get things right for your next session. An important thing that I have learnt is that support from you training partners is invaluable. When they understand what is going on they can support you and help you get through a session (and let you eat their last energy bar!).

Week 24-1

I was not able to definitively identify the reasons for my fatigue last week but through extra rest and focussing on my diet I am now feeling a lot better. In the pool and on the track things are progressing very well but I am still not feeling 100% on the bike. It’s really important this coming week that I continue working on this so that by the start of February I am back to normal and ready to race. I am happy that this week has been an improvement in volume and intensity over last week.

Things that I will be working on in the next week will be:

  • Continue to focus on fuelling and recovery including getting another massage to flush out my legs
  • Test out my shoulder (3 months post broken collar bone/surgery) with some hard swim sessions and race simulations
  • Trial insulin rates for every morning session to get something set for February race day, this will include swim/ride or run sessions which will be similar to racing

Last week of solid training before taper week for Ironman Geelong 70.3 (February 7th) so going to focus on my quality sessions and recovery to get the body cherry ripe for racing.

T&D Jan 17th

First training and diabetes (T&D) update post and on time!

It’s been a week of highs and lows both training wise (physically) and diabetes wise (blood glucose levels – BGLs). Following a strong couple of week of training and some good number from last weekends high intensity sessions I started the week full of enthusiasm to continue to build toward my next race in three weeks. Two and a half days in and the wheels totally fell off; tired, no strength and feeling like S#$t! I rested for a couple of days and then tried to push out a good session over the weekend with much success, although I was feeling better my BGLs had been affected by the two days off and did run as planned. Been a tough week but I’ve learnt a couple of things.

  • Understand your fatigue; I had been feeling tired for a week but pushed through thinking that it was just the training load, not the case and I should have taken a couple of days rest a week ago instead of falling in a heap this week.
  • Keep a good track of your diet; having reviewed the last couple of weeks I realised that due to holidays and travelling my diet was a little off, a lack of red meat (iron) and correctly refuelling post holiday sessions have probably contributed to this build-up of fatigue and eventual blow up.
  • Quality over Quantity; I’m a sucker for doing extra’s but the reality is it’s better to get the quality done rather than the below par quantity, this is especially the case when leading up to a race when high intensity sessions are very important.
  • Diabetes control continually changes; I’ve wrongly assumed that my insulin race plan would be the same as it was 6 & 12 months ago, this is not the case and the weekends sessions proved that I got to be vigilant in reviewing my insulin and food requirements for training and racing. I will be assessing if basal insulin alone will be sufficient to fuel and maintain stable BGLs during a race.

Jan 17 Training

Due to fatigue and the late week diabetes issues where I has a couple of uncontrollable highs I wasn’t able to complete my full training program this week missing or not completing 4 days worth of sessions. Thankfully with 3 weeks until my next 70.3 Ironman event in Geelong I have time to pull things back together and be in good condition for the race.

Things that I will be working on in the next week will be:

  • Get over this fatigue with another rest day and then hopefully build up from there
  • Focus on my diet and getting the right quality fuels in (a couple of steak dinners coming up for me!)
  • Test more basal and Bolus insulin rates for race day which will include race specific training sessions where I’ll set insulin rates, eat and then swim/bike/run and then assess BGLs

Another big week to come and I’m looking forward to it being a productive and positive one!!

I would love to hear some feed back on my T&D posts and what specific aspect would be most beneficial to other Type 1’s.

Diabetes Tips #2

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

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

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

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

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

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

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

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

2016 Here I Come!

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

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

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

Finishing 2015 Ironman Melbourne – 9hrs 32mins

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

Some of my aims and goals for 2016 include:

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

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

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

Team Novo Nordisk

I have been inspired by the Novo Nordisk cycling team since it became a purely type 1 diabetic team. Seeing these cyclists racing at the highest level with type 1 diabetes really showed me that my diabetes was no obstacle to competing in all the endurance events that I wanted to.

Further inspiration this morning through these images of members of the 2016 roster going through a Navy Seal style training camp in California. I’ve sometime thought that I’d make a good Seal, now I know that I can!

Novo Nordisk training on the beach in San Diego, California

I really like the Novo Nordisk messages – Inspire Educate Empower #diabetesempowered #changingdiabetes. I think that these sum up a fantastic message so simply.

Photo’s of the training camp can be found on the Cycling News website.