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.

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Diabetes Sports Project

When I started this blog it was my first real look into the type 1 diabetes community. Although I had been a T1D for over 20 years, like many T1Ds I’d just gone about managing my diabetes on my own and was not interested in reaching out or promoting my diabetes. In 2014 when I got serious about my athletic performance and started researching how to get the best out of myself I found that there was a real lack of resources available for T1Ds on this topic. I started Type1Athletic as a means to note down everything that I was learning through my research and subsequent trials (and errors), and I found many fantastic people, groups and organisations who were trying to do the same thing. This was a really positive experience and helped me in a number of ways.

I came across the Diabetes Sports Project (DSP) when searching the web one day and I instantly felt like I was looking at what I wanted Type1Athletic to be in the future. Through similar experiences to my own and in achieving some amazing race results with T1D the co-founders of DSP, Casey Bowen and Eric Trozer, were showing that having T1D was no hurdle to achieving sporting success. I was not only impressed by the quality of the athletes who were part of the DSP team but also the fantastic public awareness and education that they were doing in America. Working with children and the broader community, and also getting support from some significant companies they were really making a difference for the diabetes community. I felt an instant affinity with the group and contacted them immediately.

DiabetesSportsProject

DSP is led by a group of world class athletes who thrive with diabetes, their stories, athletic accomplishments and community outreach empower other to live healthy, responsible and active lives.

It is truly fantastic when you meet people who have shared very similar experiences and are working towards similar goals as you are. My contact with everyone at DSP has been really positive and I have been introduced to other inspiring T1D athletes from around the world. With technology making it easy to communicate with others across the globe and getting instant updates through social media, being involved in a global network of like minded individuals is nothing but positive.

In July 2016 DSP launched their “Champions” who are everyday T1Ds doing amazing things in their chosen sports and whose stories will provide further inspiration to all T1Ds to not let T1D stop them from achieving their best. I am proud to have been chosen as a DSP Champion and I hope that my experiences can educate and inspire people. Being involved with DSP does not change my attitude to my sport or how I live my life, but I get great motivation from knowing that I might be inspiring someone to achieve their own goals and that others can learn from my experiences. Through the challenges that I have faced I know that it would have been a lot easier if there had been a resources like DSP available to me when I was struggling.

Champions

Diabetes Champions – Stories to educate and inspire

Although DSP is based in America they provide a fantastic resource for all T1Ds worldwide and I highly recommend visiting their website, facebook page and following them through social media on instagram and twitter. I guarantee that having a network of T1Ds will provide you with the information, support and motivation you need to achieve your best.

Diabetes Sports Project: www.diabetessportsproject.com

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!

 

Ironman 70.3 Cairns Race Report

Cairns was a fantastic race to end this block of training and racing for me. I’ve have many challenges over the last 12 months and to finish with a tough and successful race is really positive and has made me more enthusiastic to continue racing and improving. 12 months ago my mindset was all about the end result but I have learnt that there are many smaller victories along the way and enjoying the journey and the racing is the most important thing. I am now a better athlete for all that I have experienced.

Ironman 70.3 Cairns is a little more complicated than other races with the travel from Melbourne, organising my bike and kit, planning nutrition, different start, transition and finish locations, and of course keeping my diabetes under the best control possible. Cairns is a huge event that felt like it took over the whole region with the Ironman atmosphere. Getting that buzz when you arrive is great and gave me that little kick to get through to race morning.

Coming to Cairns with a season worth of training and racing under my belt I was focusing on the other important things including; nutrition, hydration, rest and of course my diabetes. Leading into the race I was in such a positive mindset that everything felt like it was running to plan and even my BGLs were stable and predictable. I had everything planned out and I just wanted to get to the start line and race. I have not felt like this for over 12 months and it was really energising to go into a race knowing that everything was under control. I was really enjoying this and being positive was also making me feel physically buzzing also.

Race day I was up at 3:30am to get to the bus terminal for transport up to the start at Palm Coves (45mins trip from Cairns). My BGLs were running perfectly at 6.0mmol/L from 3:30am to when I arrive at Palm Cove at 5:00am. My plan was to setup my transition, do a short warm-up, get into my wetsuit and then have something to eat about 30 minutes before the start. For the hour before the race start it was raining heavily and the winds were picking up making things a little awkward getting ready squeezed under the limited available shelter. With my BGLs still tracking at 6.5mmol/L I got down my carb/protein/coffee shake at 6am and was ready get on the beach for the start.

As a sub-30 minute swimmer I started in the first couple of groups off the rolling start. I was relaxed and enter the water calmly duck diving a couple of times and then swimming to some clear water around the first buoy. It was a little funny when I realised that I hadn’t done a swim in the “ocean” for a long time with all of my recent races in protected water. The ocean swells and choppy conditions were certainly a little challenging but the swim course was straightforward and passed pretty quickly. I was able to swim in clear water and sighted the buoys clearly. 29 minutes out of the water, feeling great and even giving my support team (Inge, Mum and Ken) a quick smile as I started the long long long run to my bike in T1 (I’m guessing this was about 500m and a pretty unique transition).

I am always happy to get onto the bike as I feel relaxed riding and it gives me plenty of time to check my BGLs and adjust if need be. Starting on the bike leg my BGL was at 10.0mmol/L that was a little higher than I thought it would be after the swim but still in a good range. Using the new Freestyle Libre Flash glucose monitor for the first time in a race it really made checking my BGLs easy and I trusted that the reading would be accurate. I wasn’t wrong and I honestly thing that this little device relieve the one of the stresses from previous races when my CGM wasn’t accurate I was finger prick testing during the race.

BikeRun

Not needing to eat straight away I got in plenty of fluids (no carbs Endura) and settled into a steady rhythm (aiming for 85 cadence at 250 watts). There had been plenty of chatter about the drafting enforcement and there were a lot of TA official’s on the bike course. I had ended up in a group of 4 riders with each trying to push away but all seeming to remain together generally at a legal distance. The Captain Cook Hwy is a beautiful stretch of road and with the rolling hills and the ocean almost within reach the kilometres passed really quickly. The rain was pretty constant and at times so heavy that I couldn’t hear myself think as the massive tropical raindrops hammered into my helmet. After the turn-around point at the 30km mark I was feeling great and still in the group of four. There was now a slight head wind and the heavy rain continued. At around the 50km mark just as I had pushed to the front of the group I noticed my front end go wobbly and looking down I could immediately see that I had a flat tyre. Having had not handling issues on the wet and slippery roads to this point I nearly came off when trying to come to a stop now. Heart racing and legs pounding I was immediately annoyed but quickly got off, flicked off my front wheel and changed the tube. It may have taken 5 minutes all up but I didn’t worry and I was quick to get back into my rhythm heading to Cairns back past Palm Cove.

With 15 kilometres to go I was feeling the power draining from my legs and after checking my BGL realised that I hadn’t eaten enough in the last hour and my BGL was down to 4.0mmol/L and dropping. I had to ease up at this point and find a more comfortable rhythm so that I could eat and get my BGLs back up to start the run leg. My last 15 kilometres were slower than I would have liked but I just focused on being smooth, eating and drinking, and then checking my BGLs every 10 minutes. When I got to T2 my BGLs were back up to 6.5mmol/L and having eased off for the last part of the ride was feeling great starting the run (in the pouring rain). I got a little extra boost from seeing Inge and Mum again as I ran out of the transition and I may have even given someone a high-five!

Having put extra hours into my running over the last month I was looking forward to seeing how this training would pay off. I wanted to set a 4-minute pace to start with and I looked to find someone of a similar pace to work off. I was able to stick with this pace until the 8km point where the hurt set-in and I needed to slow. This was a little mental hurdle to overcome and I told myself to stick tough and maintain a steady pace, picking it up if I could. For the remainder of the run I was pacing around 4:30/km with a couple of faster and slower kilometres as I pushed harder or checked my BGLs and sucked down a gel. The heavy tropical rain continued to come and go and there were plenty of big puddles to run through (sort of good to take your mind off the pain). With my BGLs being on track I also enjoyed a few pieces of watermelon. Being my weakest leg the run is always tough but having my BGLs under control meant that I could focus on the running and not my diabetes for the first time in several races. With the atmosphere at the turnarounds and the crowds spread out along the whole run course the kilometres did pass quickly and the Ironman red carpet was underfoot with my arms in the air (still in the rain) before midday! BGLs finished at 6.0mmol/L, treading slightly downwards which allowed me to indulge in the recovery tent with a few big slices of watermelon and a protein recovery drink.

I finished with a time of 4hrs 38mins in 9th place in my age and 35th place over all. This was the toughest 70.3 race that I have completed and not worrying about the time or the place I am ready happy with my performance. There is always room to improve but I raced with the best mindset and with excellent control of my diabetes. You couldn’t wipe the smile off my face after the race!

Finish - Cropped

Couldn’t be happier crossing the finish line!

I take some real positives out of this race. Firstly, my mental state leading into and during the race had the biggest impact on my performance including my diabetes. Being able to overcome several challenges and then keep going is a real strength that I am proud of. I have now learnt that my mental state is the most important thing for my performance and something that I will continue to work on for every race. Secondly, my diabetes plan worked perfectly with the basal program I set allowing me to eat and keep my BGLs stable. Finally, my swim and bike legs remained consistently strong and if not for the puncture I think that I would have been close to a bike PB for the 90km. With my diabetes plan working perfectly I did forget to eat during the bike leg (possibly because of the flat tyre) that led to a minor hypo. My nutrition and hydration are elements that I need to work on. Finally, although my run was OK I do want to improve this and be able to run consistently around 1hr 20-25 minutes for the run leg.

I actually feel like a different person to 12 months ago when I performance like this would have been picked apart negatively. Being positive really changes my whole performance and as hard as it has been to get to this point I am so glad that I was able to get here. I’ve had the best support from my partner Inge who has really shown me how important your mental condition is and how it impacts all other aspects of your body and your performance. Of course the rest of my family has been wonderful support and they’d enjoyed a few little trips away to support me. I’m now looking forward to a little break and then getting back into it for next season, new races and new goals.

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

 

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&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 9

I’ve said it before and I’ll say it again, recovery weeks are the best! No pressure, still training and feeling great. After leaving Port Macquarie with some mixed feelings I really tried to focus on the positives from the race (which there were many) and identify a few items which I can improve on. My partner said “no training and only positive thoughts until Wednesday, then you can get back to training and focusing on those improvements”. Good advice to follow with the benefits of a positive mindset and enjoying your achievements all too important as I now know.

Happy

Positive attitude, now always smiling – training buddy Mate & I living it up before the Port Mac 70.3 start

So being a recovery week my diabetes hasn’t been much of a highlight. I continue to monitor things closely and have noted a few adjustments which I will make this week for my morning training sessions to keep my BGL stable. I have reaffirmed this week how important my regular daily schedule and consistent meals are to my BGLs. Having fine tuned everything, even small changes can blow my BGLs out. It’s really important for me to understand my basal rate, previous bolus dose, time of day, what I am eating and what I am doing to keep my BGLs stable and give a correct insulin dose. No cheats here unfortunately.

I know that I am very hard on myself and I don’t like to accept anything but my best performance. Working on keeping a positive attitude I made a conscious effort this week to acknowledge the great achievement which my Port Macquarie race was. Excluding the hypo near the end of the race (costing me 10mins), the performance would have been amazing considering only 6 weeks ago I was too physically and mentally fatigued to train or even function normally. I see now how important it is to enjoy all of your achievements and focus on the positives which bring untold benefits to the rest of you life (including diabetes). It’s so simple and it is repeated in nearly all performance articles which I have read. Why I have neglected this aspect for so long now seems a little silly.

So my take away message this week is all about being positive and enjoying your achievements. Being a T1D and being active is so beneficial for you, training everyday with your mates makes you feel great, and racing with the support of family and friends is a really positive experience. There’s not a lot there to be negative about! I also find that my attitude and how I am feeling influences by BGLs. Having that positive attitude and being happy does seem to align with when my BGLs are very stable, and vice versa.

Feeling great, now for a big 4-week block of training before Ironman Cairns 70.3 in early June (and then a short holiday).

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.

20160320_092538

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.

T&D Feb 14

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

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

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

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

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

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.