are you the running guy?

I've always struggled with this blog to keep it consistent, this is in part a case of what do i want it to be and that i don't want it to be repetitive. The themes are running and diabetes so this felt like something to weave into the title. But the name of the blog?? 

It dawned on me yesterday when, at work, someone i had not met before asked me if i was "the running guy". this made me smile as i get asked it a lot and it is normally followed by a question about running.... so a new blog title "are you the running guy?"

I like it. It may stick. Now i just need to post more!

Freestylin' a fortnight with the Freestyle Libre

Just over a fortnight ago I was provided a freestyle libre CGM device. The session as run at Gloucester Royal hospital by a rep from the manufacturer, Abbott. At the end of the session we were each given a monitor and a patch. 

The patch is the size of a £2 coin and is secured to the arm with its own adhesive. To get a glucose reading you pass the monitor over it and bingo! The genius of the patch though is that it stores glucose data, when you scan it not only gives you that snapshot it also shows, on a line graph, the previous glucose levels. It is this that has proven invaluable to me and in a short period seen me make changes to my regimen. 

I was reticent about the patch as the blurb tells you it can be worn for sport, swimming, I'm the shower etc and so on. As a runner I was keen to know how valid this was and then test it myself. I run commute so shower at least twice a day if not more. I also cycle a little and go to the gym. 

In the fortnight I was wearing the patch (that's how long they last) I have probably

Had 34 showers

Run 60 miles

Cycled 40 miles and

Been to the gym 5 or 6 times

The patch has been secure and there has been no hint of it lifting. Not even a small amount. In fact when I went to remove it after it had expired it took some removing. 

Truly impressive adhesive!

As for the change to my regimen, I though I had good control. My hba1c is normally good. Actually I didn't have that good a control. What I had was a blood sugar that went from high to low and back again through the day. Boom and bust with an average in the middle. I also experience a pretty big dawn phenomenon. For example if I wake up and my blood sugar is 9 by the time I get to work around 8'ish having run or cycled my blood sugar will be pushing up towards 14/15. It then takes the remainder of the morning to come down, following breakfast and insulin. 

For the rest of the day I am more balanced. 

This highlighted a need to increase my background insulin, levemir, from 3 units twice daily to 6 units twice daily. Guess what I am now so much more consistently in the healthy band of 4-7mmol and not seeing the prolonged spikes that I was getting previously. This has transformed in a matter of a few days and is giving me so much more confidence in my diabetes control. 

It has been at the expense of a couple of hypos but in the same way as a change like this removed the higher numbers I need to regain that balance at the lower end too. 

The patch is self funded and at £50 for 2 weeks is not a cheap product. I understand that there is work taking place to reduce the price and or get it available via the nhs but no timeframes are available. 

My meter previous was the accuchek expert meter.  A quick google reveals the price to be £28'ish for a box of 50 test strips. This would last me normally between 7-10 days. I estimate 5 tests per day but if I am struggling this may increase to 10 or more. With the Libre I average around 30 tests a day. Extreme? I really don't think so, with that kind of data available so quickly I test between meetings at work, when I go to walk the dog, when I'm out and walking around - I do it because I can and because I care about where I am in that moment and more importantly to know if I need to do anything to address increasing or decreasing blood glucose levels. 

If I were to test that regularly with the accuchek it would be maybe £25 a day! The maths really does stack up for me so I can only imagine there are other issues to resolve. 

Looking longer term if the data the libre provides enables me to make the changes I have to improve things significantly I am a better risk to the NHS going forward. This will also save money. Basically put the better control I have now the less likely complications in the future. 

The libre is fantastic. I really love it and what it provides me and has enabled me to do I a very short space of time. It has become an essential piece of equipment in my diabetes management. For some the costs will make this prohibitive but if you can manage that then this quickly becomes indispensable. 

Hospitals aren't used to healthy people...

I say hospitals I mean nurses and doctors really. I have recently had cause to be in hospital for a few nights. This has meant among many other things having my blood pressure and pulse taken on average every 2 hours and I mean EVERY 2 hours. Whether it's 2am or 4am it's every 2 hours. Sometimes I don't think I was even awake when they did it. 

I'm used to having my blood pressure and pulse taken in hospitals. I have twice yearly diabetes check ups that involve this. Every time it's taken there's an alert on the machine as my pulse is low. Now I'm no Miguel Indurain but my resting pulse is in the low 40's. If I'm watching to it will be around 48-50, reading in bed around 44 or so and on waking around 38-42. All very low. 

In hospital it appears that the machine alerts sub 60bpm. It alerted every time they took my readings and with multiple nurses on different shifts I had to explain every time that "I am pretty fit", that I "run a lot". Still it was met with some sideways looks and on a couple of times was called out to the consultant. The consultant who knew and understood my background and was not concerned. 

Looking around me in hospital on the various wards and it occurred to me that I was in a very distinct minority. Not being overweight, it appeared, was quite unique. But I was still in hospital in spite of being pretty fit. 

As an observation it seems if you're overweight you are more likely to be in hospital this is based purely on what I saw. Also if you are unfit you are maybe more likely to be in hospital, this is based on the fact that all the nurses were surprised by a low heart rate. None of this is news, "overweight person in hospital" is not a headline you're going to see anytime soon as it's not a shock. 

I started to think that it's quite sad that healthcare professionals in the main are dealing with the unhealthy. There were people I was with that you have to wonder whether once their immediate issues are resolved that they will not be back there with either a recurrence or new health issue. 

Get fit, lose weight and give our healthcare professionals some healthy inspiring people to work with! 

Diabetes Cyborg Type 1

I'm trying to think of a character from a film that was human but part robot too. There's plenty of robots made to look human with, possibly the most famous being The Terminator.  Beyond that? There was Bladerunner, Humans (recently on Channel 4) and of course Ex-Machina. I guess Darth Vader meets what i am describing, a man with machine parts. There is also the DC Comic character Cyborg. The point being that there are men with machine parts. I am soon to join these ranks! Yes me. 

I won't be donning the lycra to fight crime or buying a light sabre to duel with my unwitting son. My implants will enable me to monitor my blood sugar and administer insulin. 

Not that exciting but imagine you had been Type 1 diabetic for more than a decade. Testing your blood with finger pricks maybe 5 times a day and injecting insulin anything from 5-7 times a day. In a decade that's more than 18,000 blood tests and maybe 22,000 injections. Now imagine you could remove all of that with a patch well two patches. 

The first device is the Freestyle Libre this enables blood testing without the need to prick the finger. I have an appointment at the hospital next week to get one of these on trial. A sensor is worn on the skin, when you need a blood test you pass the monitor over the scanner and it provides a reading. A bit like scanning your shopping at the Supermarket. The advantages of this are many, multiple tests without the need for multiple finger pricks or test strips. Discreet testing, really useful for work or some social situations. Easier testing at night!

The only issue with this is that it is quite expensive. A patch lasts 10-14 days and costs a little under £60. That is a lot of money over a year. There are moves to reduce this cost and potentially make it available on the NHS i believe but no timescales as yet. 

The second device, and i am more excited about this than perhaps the Libre, is an insulin pump and specifically the Omnipod. My diabetes care has been talking to me about pumps for sometime but i have always resisted as they need to be removed for showering and the way i live that is no good. I am an ultramarathoner and regularly run commute. 2 or 3 showers a day post workouts and commutes is not unheard of. The Omnipod gets around this by essentially being waterproof! I can wear this in the shower. This is as it is not connected to the insulin delivery mechanism by tubing but instead by Bluetooth. There is a patch worm on the skin that contains the insulin and the delivery is controlled by a Bluetooth control unit. 

I talked about this last week with my Diabetes consultant and am now on the list to get one. I also have an appointment with Dr Rob Andrews in Taunton mid-November and he is, by all accounts an advocate of this pump technology for his patients. 

So pretty soon i will have a couple of patches and devices that are doing something my body cannot do itself. I have managed pretty well for the past decade or so but the technology is now available to make this even simpler and more efficient and, hopefully, more balanced and less down to guess work. 

Exciting times ahead. Now to buy one of these... 

Not running makes my soul sore

It turns out that the blood in my urine is not dehydration related as
it happened again yesterday. I kind of knew it was dehydration when I
was at the doctors last week but I the absence of a diagnosis of what
it was went with it.

I ran to work yesterday morning and there it was again - IPA pee.

My thinking now is that this is footstrike hemolysis. Not least of all
because I have no other symptoms and actually my foot strike has been
a bit off to the point where my sole is sore.

Not running is making my soul sore.

Of course I am no doctor.

The other development is my left leg issue which is now excruciating.
Getting up from sitting takes me from 0 to 9 on the pain index. A
quick Google reveals this is likely piriformis syndrome - I am seeing
a musculoskeletal specialist next week.

This is all very demoralising as I was loving how this year was
shaping up and was aiming to do a 100k in the next month or so.

Plans once again onto the back burner. Hopefully not for too long...

I'm not very good when I'm injured and unable to run. It is as I have
said so many times what I do, what I love and what I am.

Peeing blood....update

On Monday this week, having returned from Portugal on Sunday, i contacted the Doctor and explained what i had experienced with regards to peeing blood post run. They asked me to deliver a urine sample and pick up a form to have blood taken for testing. I duly did this on Monday with an appointment on Thursday afternoon to get the results. 

This meant a week without running which was not pleasant as it just served to keep in my mind that i wasn't running and why. I continued to have no symptoms or further episodes of peeing blood during this period.

It was odd at the doctors as while they couldn't confirm what it was they could confirm that it wasn't rhabdomyolsis or kidney failure. Neither was i pregnant and it wasn't cancer. This was of course great news and led to a diagnosis that it was probably extremedehydration that took a while to recover from.

Lesson well and truly learned and, more importantly, i am back running :)

Adidas Ultraboost Uncaged - Simply the Best!

I have been a fan of the Adidas Ultra Boost for some time and am on my 3rd pair of the originals. What I like about them, fit and comfort aside is that they are durable. The outer rubber really does last and unlike other brands where I struggle to get 500 miles out of a pair of shoes I can easily get upwards of 700 miles out of the Boosts.

When I saw that Adidas had upgraded the Ultra Boost to the Ultra Boost Uncaged I was pretty excited. For me, like many, the Ultra Boost is the perfect shoe. Admittedly I don't have wide feet so that really helps as it is quite a narrow shoe but it just works.

The Ultra Boost Uncaged looks similar yet very different. I have not read the specs but superficially the changes are a removal of the 3 stripes cage that was attached to the laces and secured the shoe. The main change though is the fit and entry to the shoe. There is now a gaiter/sock instead of a tongue and heel cup. It's a little like the football boots that the top players now wear with the sock piece.

Out of the box I was a little concerned about the sock as it looked like it might be quite high and also how tight would it be? I needed have worried - it's deceptive and sits just under the ankle bone perfectly comfortably. You wouldn't know it was there. It just sits there secure. The heel cup is also more padded inside than the previous Ultra Boosts.

The lacing system is different with eyelets woven into the knitted upper rather than being part of the previous cage. The three strips are now contrasting and on the front of the shoe.

Underneath the shoe looks the same. Full length Boost sole and the Continental rubber outsole.

I used these shoes first time while on holiday in Portugal. I got changed and put the shoes on, as I was walking around the tiled floor of the villa the shoes were squeaking. The grip is insane! The sound is like a car in a car park making tight turns where the rubber just grips the surface.

Out on the road these shoes were brilliant. As comfortable as any Boost I have worn, this really is a performant shoe. I have run Ultra's in Boosts and parkruns, they provide comfort and can be fast too. While on holiday I used them on tarmac, compacted sand, stony pathways and even 5 miles on a treadmill. They coped absolutely fine with this no problem. I wouldn't use these for a wet trail run but that's just common sense!

As a final endorsement when I got them out of the box and showed my kids they were in awe and talked about wanting a pair themselves. It was a little like in Indiana Jones in Raiders of the Lost Ark when they find the Ark of the Covenant and just before things go a little Pulp Fiction everyone marvels at how beautiful it is.... it was just like that but without the bloodshed.

Great looking shoes, great performing shoes. I have had many false dawns with shoes where I say something like "I will only wear these from now on" only to change track as a problem emerges - with Adidas and Boost technology I will not change. These are my 4th Ultra Boosts and 6th pair of Boosts across the range.

Simply the best!

Peeing blood...

As a runner there's few things that will stop me running. With niggles or aches i do the equivalent of turning the radio up I the car to "fix" the engine noise. 

This changed recently, after a run on holiday in the Algarve I came home and my pee was red. Not just a little, it looked like IPA. Now I like an IPA as much as the next man but not when it's leaving my body the same colour that it went in. Initially thinking it an anomaly I set about hydrating and with each passing toilet visit the colour diluted eventually returning to normal. Nothing to worry about, right?

Wrong.

Next run and the same outcome. Pee like cherry juice.

The runs I was doing were not long or hard efforts. They were around an hour or so and maybe 7-8 miles. The only difference was that it was hotter than I am normally used to, around 20-25 Celsius. To counter this I was drinking first thing and then carrying a litre with me that I was also drinking. 

After the second time this happened I took a break of a couple of days - my pee looked normal but post run was the same cherry red. I did some research and lots of things come up, more later, but I had/have no other symptoms. I am in no pain at all, I have no fatigue, I have nothing going on other then blood in my urine. 

I decided to put out a tweet tagging a couple of sources to see if they had any ideas as to what it could be; Ian Corless at @talkultra, Eric at @ultrarunnerpodcast along with @runnersworld. I included a picture of my we which is not something I ever imagined doing. 

The replies came in, the ultra community proving how supportive it is. It was scary reading. 

My research pointed to everything from dehydration, slapping bladder, urinary tract infection through to cancer. The advice from @ameliaboone to see a doctor is sound and was echoed by @ukrunchat but the response from Ian pointing towards rabdomyloysis was perhaps the most scary. 

.....kidney damage

.....dialysis

.....acute renal failure

<http://www.active.com/triathlon/articles/dehydration-the-worst-case-scenario>

Chilling and actually made me a little emotional. 

Eric then directed me to a podcast episode where he talked about kidney stones.  I listened to this and while much of his experience is mirrored by mine they are not exactly alike as I have no other obvious symptoms. Specifically I have zero pain. In fact other than pee that looks like beer there's nothing wrong with me. 

<http://ultrarunnerpodcast.com/sarah-and-eric-talk-about-iron-deficiency-and-kidney-stones/>

With the advice that this is almost certainly related to hydration I have increased my efforts with this. I am drinking far more than I was even a week ago in an effort to restore hydration, coffee is limited to first thing and evening beers have been Cast aside in favour of water and iced tea. I know that I don't drink enough but it's always been the same and never been a problem.

Until now. 

We fly home on Sunday, I will see the doctor on Monday. After that who knows? I think I may know too much and yet know nothing. The internet is a dangerous place with limited knowledge. 

What's different with this is that unlike a niggle where you can still run a bit this stops you in your tracks. Blood in your urine is grown up and needs a response as such. I am hoping it's a simple fix, that I was just very dehydrated - that a week or two of rest with good eating and good drinking will resolve the issue. Anything else is pretty scary and at this point not something I want to really think about. 

Without wishing my holiday over too quickly I need to see the doctor.

Hypo

I got in the front door and knew something wasn't right. I was too relieved to be home. I'd been feeling weak and lacking energy for the previous 15 minutes but put this down to a hard run this morning and a bad nights sleep. A rare Saturday night Indian takeaway wreaking havoc with my digestive system overnight. I went down to the kitchen looking for food, then it started.

Sweat, not a normal sweat that maybe leaves your armpits a bit sticky. This is a full on body sweat, from top of head to toe. It's also not sticky like normal sweat it's like water. Water bubbling out of my pores. So much water it drips down my head onto my nose and onto the floor and onto the worktop. I have my hands on the counter top and am hunched over. I try to think what I need to do. This is out of body, I know what I should do yet in these moments the clarity to execute runs away like the sweat down my nose. What I should do is eat sugar, the glucose tabs that I have in my pocket. What I do is eat a banana, then another. I have always had a reluctance to eat the glucose tabs that makes no sense. I have thought about this a fair bit and surmise that it is giving in, it is weakness in the face of diabetes that I will not allow to control me.

I eat a kiwi fruit. I am now sweating so profusely that it's running down my legs, my shorts are soaked through and my t-shirt looks like I have just come out from the gym. I call to Sue to come and help me. She takes a look at me and takes control. Within seconds I am chugging a can of coke - full sugar variety. She asks me what I need and tests my blood sugar, it is 2.7mmol. She then gets me some cereal, crunchy nut cornflakes.

The sweating is easing and I feel more aware. I am soaked through and head out into the garden to eat. My clothes are cold and wet and as it is sunny and warm I figure this will help me. I eat the cereal then slump in the chair. The waves of fatigue crash over me and I am gone. My sleep is fitful as the chair is not that comfortable and my clothes are wet, plus I feel totally out of it. As I wake to change my position I am aware that I should probably go indoors but cannot muster the energy or focus to do so.

Luca, my son, checks on me after 20minutes or so. He then comes out again after an hour. I wake up sufficiently to come inside the house. My clothes are dry but I feel awful. There is fatigue, immense fatigue, plus that hungover feeling you get after a nap sometimes.

I test my blood sugar and it's 11.4mmol. High but when I consider what I ate within a 2hr period it is around half what  was expecting. This is quite a relief. I go and shower and put on some warmer clothes when I come back down there's some dinner. I eat and feel massively improved, as we watch TV we eat a bag of salted crisps. Then I check my blood sugar - 22mmol.

The joys of a hypo where, for me at any rate, my blood sugar equilibrium is then really difficult to restore and I bounce from low to high and back again. I gave myself a correction dose of insulin and will keep a close eye on things as the evening progresses.

The key to this episode was an incorrect dose of insulin at lunchtime where I ate a very low carb salad. Having run quite hard this morning I should have reduced this significantly. On they way home the tell was my reducing energy although at this time I had none of the obvious symptoms and as I was tired put it down to this.

What is difficult to explain to a non-diabetic is how your mind plays tricks. I am having a hypo, I know this yet the obvious method of dealing with this eludes me. What makes this even harder to explain is that I always have glucose tabs on me. 100% of the time. If I leave the house and have forgotten them then I go back and get them. Yet I have this pathological reluctance to take them. Having people around you that know what is going on and how to help is so vital.

My diabetes rarely impacts my life, I do every thing I can to ensure that this is the case. I have really good blood sugar control and a fit and active lifestyle. I get caught out though just like every other diabetic. You cannot stop thinking about diabetes even for a little while, not totally - it can bite you whenever.

Type 1 Diabetes and fat adaption

I have been reading Natural Born Heroes by Chris Mcdougall.

There is a chapter that references Dr Phil Maffetone, the work he has done and continues to do. This really interested me because of some changes i have been experiencing recently. I am familiar with the Maff' Method from various podcasts (notably Endurance Planet) but have never really tried it, in the main, because i have Type 1 diabetes and could never rationalise the lack of carbs with my, perhaps misguided, need to consume carbs.

 

What interested me in the article in the book was the analysis of how to fat adapt and what it means to performance.

Most of my run training is as part of my commute. Monday-to-Friday i run between 5-12miles a day depedning on how i feel and how much time i have. Saturday's i do not run and sunday is a long run of anything between 2-4hours. I don't wear a heart rate monitor currently (it actually just needs batteries) but know by feel and experience that i am in the low zone. My heart rate does not get above 135/140 for 7:15/30 minutes per mile. Usiing the rudimentary max heart rate calculation (220-age) with an allowance for my physical condition i equate this to around 70-75% of max.

Where this gets interesting is that i have noticed a shift in my blood sugar readings when i run. I have noticed that now when i run my blood sugar is increassing and not decreasing as it used to. On a long run where taking it steady i would normally eat an energy bar or a gel or two and on getting back home my blood sugar would be on the low side.

Contrast this with yesterday where i ran 17.5 miles with 2,000ft elevation; i had a gel before i left the house (my blood sugar was 7.9mmol) and two on course. I would have expected, on getting back, that my blood sugar be low and between 4-7mmol. It was in fact 14mmol.

This got me thinking if the increase in blood sugar or rather the lack of decrease is due to being fat adapted? To use the language in the book; i was throwing gas soaked rags into the furnace but the flames were not touching them.

I have emailed Dr Phil Maffetone this very scenario to see if this is on the right lines but would be interested to hear from anyone else with thoughts on this.

Salomon Sonic Pro Shoes - First thoughts...

I got these shoes to replace the Salomon Sense 3's that i had and that were faulty. As the Sense 3's were not available in my size as a replacement i opted to upgrade and pay the difference to get a pair of the Salomon Sonic Pro's. I'd seen them in the emails that i get from various running organisation, blogs and shops. They looked to have a similar shape and styling but me more of a road shoe than a hybrid or trail. I then read the reviews from Ultrarunner Podcast and that was it - decision made.

They arrived last week and like a kid with a new anything i wanted to test them out. What better than a hilly 19 miler. Out of the box i did just that. Remember when you used to have to break shoes in before using them properly? Me neither. 

The fit was familiar, like i mention it is very similar to the Sense 3, but the shoe feels very different. It's super light and the lock lacing system seems better than i have had before. Just the right amount of 'lace' and really secure. Of course the toggle tucks away into the tongue as on all Salomons. 

Sunday's run ended up being 19 miles with 1,800ft of climb. I'm training for the Cheltenham Challenge Ultra so hills need to become part of my running life. The route was predominantly road but i did come down of Leckhampton Hill via a woodland trail path and some fields. 

The shoes were great, they are great. There were no rubs or issues with fit - they were secure and even though it was also warm and my feet were sweating they gave me zero issues. 

19.3 miles out of the box with not a single issue is really impressive.



Subsequent to Sunday i have run a further 26 miles or so in them this week entirely on tarmac. They still feel good but i am noticing that they are a little unforgiving compared to the Adidas Ultra Boost i normally wear. So much so that i think i will for 100% tarmac runs revert to the Boosts. The Sonic is a lovely shoe but, for me just not enough cushioning to make it a road shoe that i could wear exclusively. I will use it as a spring/summer trail shoe. I will also wear it in June for the Cheltenham Challenge ultra which will have a mix of terrain making this shoe the perfect choice. 

I'll review these again in a few weeks when they have done more mileage to see how durable they prove. 

Salomon S-Lab Sense 3 Trail Shoes

I should start by saying I'm a Salomon fan-boy. I love their stuff; caps, hats, jackets, calf guards, race vests, soft flasks everything. Oh and shoes. I've had a couple pairs of trail shoes, some Fell shoes that are so old I don't think they even have a name. Mission XR's that are awesome and recently some S-lab Sense 3's. 

The latter are what I am talking about here and this review will be a little mixed. 

The shoes look great, I mean really great. The styling is excellent. They are red with the white heel cap. I wear a size 9 and have my own orthotics that I use in every running shoe I have. 

I bought the shoes to wear at the Green Man ultra in March. That was 46 miles of trails and puddles and mud. It was a brutal course and the shoes were great. That I was able to wear them and not get a single blister or rub after only having run maybe 11 miles in them shows how incredible a shoe they are. There's no wearing in required, they were more or less box fresh and gave me zero issues. They were also solid on a very challenging mucky course. I did not slip or fall. 

After the Green Man I was so confident in the shoes that I decided to wear these for the W2C challenge in April. This was to be a 4 day ultra marathon challenge with the last 3 days being predominantly trail. Having run 29.5 miles on day 1 in some Ultraboosts I used the Salomon's for days 2, 3 and 4 which over the three days would be 112 miles of running. The shoes were fantastic; they were comfortable, coped with the terrain and felt solid throughout. They were fine on the Tarmac stretches and wonderful on the trails.

These shoes are so light they barely register. So light you imagine they cannot be durable. That was a little problem. 

By the end of day 2 of the W2C a hole had developed in the toe box where the mesh section joins to toe guard. I finished the W2C in the shoes but considered that after 208 miles in total this wasn't really acceptable. 

A perfect shoe that had an imperfection. I don't know if others have experienced this issue with these shoes or whether the ones I had were maybe faulty. It was disappointing though as the shoe is pure class. 

I contacted Sportsshoes.com who I had bought the shoes from. They provided impeccable service requesting that I return the shoes. They had them and contacted me by phone to advise that they were faulty but that they didn't have any more of that shoe in my size. I paid a little extra and am now awaiting a pair of the Salomon Sonics in blue. I know the colour isn't important but they look cool too!

Back to the Sense 3's, I loved the shoe and it was excellent in 4 ultra distance runs that I used them in. Genuinely no issues whatsoever. It is a shame they were not a little more durable as I'd still like to have them. I hope that the pair I had was faulty and that it's not an issue across that model. 

I'm still a Salomon fanboy though, if they are good enough for Killian...

Multi-day Ultramarathon with diabetes

I was diagnosed with Type 1 diabetes I September 2001, some 15 years ago. This coincided with the period of my life where I was the most active. In my 30's I took part in a number of triathlons and obviously needed to train to be fit enough to be on the start line and do them. Whenever I have done a race or event whatever the discipline I have always wanted to do my best. I have never had an expectation of winning but that has never stopped me being determined to do the best I can do.

As a Type 1 Diabetic one of the things I hear a lot, aside from being asked why i'm not overweight (because I am type 1 not type 2), is how do I manage my diabetes and isn't it dangerous to do these sports with diabetes. My response to this might seem flippant, but it is far from that. I am always reluctant to engage on the diabetes topic as a negative - I don't want to hide behind it or use it as an excuse or reason. It isn't one, at least it isn't for me. Diabetes has never given me a problem that has stopped me starting or finishing anything.

I have over the last couple of years turned my sporting attention to ultramarathons. A race of any distance over the marathon distance of 26.2 miles is called an ultra marathon.

On the weekend of 15th-18th April I did something I have not done before, a multi-day ultramarathon. Over a period of four days running 142 miles (29/35.5/45.5/31). It wasn't a race but a charity event raising money for Winston's Wish. This was the unknown for me, while I have run a couple of 50 miler ultra's and done some long back to back runs in training I have never done four days at distances close to those.

Prior to the W2C event i had arranged an appointment at my diabetes clinic, i wanted to discuss what i was planning and seek some advice. I didn't have specific questions i more wanted a discussion around it and some guidance. The team at Cheltenham General Hospital were excellent but admitted that what i was doing and planning to do was outside what they could reasonably advise on. They suggested a referral to Dr. Robert Andrew who operates out of Taunton Hospital and is the authority on sport and diabetes. 

They managed my expectations suggesting that an appointment before the W2C was unlikely. 

I committed to the W2C reassuring those around me that if i started to struggle or have complications i could and would simply withdraw. In my mind it is important to note that i never saw this happening. The closer it got to the event the more my nerves were being replaced by confidence. I started to visualise that i could and would do it. 

In the week before the W2C i received a phone call from the secretary of Dr Robert Andrew, there had been a cancellation and i was offered an appointment Tuesday of the following week. I snapped it up, my confidence could be transferred to those around me. I was pretty excited driving down to Taunton as Dr.Andrew is the authority on diabetes and sport. I arrived and was shown into his office, there was quite a crowd. Aside from Dr Andrews there were a number of dietitians, trainees and nurses. I think there were maybe 6 people and me in the room. 

We had a long conversation about the sport i do and how i manage it. Specifically the ratio's i use and how i adapt based on the exercise undertaken. There was a lot of interest in my diet as i explained that i eat a predominantly vegan diet and that this in itself was as a result of extensive reading around the sport of ultramarathon running and how it can be beneficial to recovery and durability. Something i have definitely experienced. what i really wanted was some guidance on how to manage blood sugars overnight after hard efforts. Previously after long and hard runs i have had hypo's overnight and have started to manage this by ensuring i go to bed with a high blood sugar of around 12-14mmol.

With advice regards how to adjust my levemir (slow acting) and how to approach my novorapid during an event like this i left reassured and with confidence high. Even more pleasing was that i was given really positive feedback on having gotten this far with my training by myself. Essentially without extensive medical support. 

The longer i run the less diabetic i am...

Diabetes is a condition that is always on your mind, when you get up, before you drive, before work meetings all the time you need to understand where you are with carbohydrate, insulin and blood sugar levels. This so that you can predict what will happen next and when. This is even more necessary before sport. The impact of sport on blood sugar levels is also something that you need to understand. This comes with experience. When i say the longer i run the less diabetic i feel this isn't that i can switch off from it, far from it, but more that i eat a significant amount and don't need any insulin. I have tried to quantify what i eat during a typical ultra but in the moment of running it is too hard. On the third stage of the W2C which was 45 miles from Reading to Swindon over the Ridgeway I ate more or less the following...

• Breakfast was a vegetarian full English with toast and cereal (with fruit juice poured over it rather than milk)
• I was on course for around 9 hours and probably ate the following, 7 or 8 gels, 2 Nine bars, 2 packets of crisps, half a dozen Jaffa cakes, 2-3 cookies, 500ml of SIS energy drink, half a loaf cake (Jamaica Ginger), a couple handfuls of jelly babies and liquorice allsorts.

When I tested my blood sugar at the end of the stage it was 6.8mmol. A day on the trails eating everything and anything and within tolerance when I stopped.

It doesn't last and immediately afterwards when I eat I administer insulin with a round a -50% adjustment to my ratio's in acknowledgement of the impact of exercise.

I managed my blood sugars over the W2C pretty well, I was higher overnight than I should have been waking up on the three days with blood sugars of around 12mmol. I took this as less problematic as during the day I was burning it up and struggling to keep pace. Imagine an old steam train going flat out (ok I wasn't going flat out) and the engineer struggling to get the coal into the burner quickly enough - that's me running an ultra.

I was acutely aware of this as I had experienced a low blood sugar during the Green Man Ultra in early March. It was easily treated but I was keen to avoid it happening again. I definitely opted for the eat what you want and deal with it afterwards.

W2C has given me such a lot of confidence to not only tackle more races but also to push myself a bit more in each of them. My running averages over the 4 days of W2C was 12:02 per mile - on shorter ultra's I want to try and up that not by going gung-ho but by being consistent in the early part of the races and finishing strong.

In the day or two after it was all over I felt invincible and could do anything. This has made me feel more like an ultra runner. I did it, I did it well, it never broke me and I know I can do better. Maybe I am just a little invincible afterall ;)

W2C Stage 1

W2C Stage 1 - Westminster to Slough

Friday 15th April

29 miles 

The day was finally here, after a significant amount of planning and preparation it was stage 1. It felt a little unreal, when you've been planning something like this I guess that's inevitable. But we were actually going to do it. It was happening.

On the coach to London there was a lot of nervous energy at least at the start of the journey. Spirits were high, they settled in the middle and as we got closer picked up again. It flew by. 

Once in London there was a coffee stop some photos and then we were off. Stage 1, next stop Slough. We quickly became two groups, Rob, Jez and I pushing on and Trevor, Dale and Malc travelling at a slightly slower pace. 

As the team left London the sun came out and it looked like it might be a great running day. This was short lived as within 6 miles or so the dark clouds gathered and what was a sunny day became a grey day and then an incredibly wet and rainy day. Thinking it just a shower we decided that it was not worth putting our jackets on. The rain persisted but wet through we decided that to put them on would just make us uncomfortable. Basically we would be wet inside and out. 

Followed the route out of London along the Thames Path what was most striking was the number of building developments. Flats overlooking the Thames clearly a premium business. That and the pubs. Lovely looking proper London puns on the river banks. There was temptation to stop but it was fleeting. 

As the path got more rural the designer flats were replaced by industrial units and derelict warehouses. Remnants of the time when rivers and canals were essential infrastructure. 

We were making good pace and had a nice rhythm. When we needed a walking break we took one, our pee stops became synchronous, it just flowed. Unfortunately so did the rain. It was constant with the only variable being the intensity. After about 20 miles we stopped under a bridge to put our jackets on. Accepting that however wet we were we needed an additional layer to provide some insulation. This worked and for a period after we picked up our pace a little. Perhaps a mental lift if not a physical one. 

We were now seeing lots of birds, moorhens, swans, ducks and geese. Most got out of way, the swans and geese were not phased by us In the least. There was lots of talk of shopping trolleys in canals and odd places, we saw two in the canal and one inside a house, mysterons, the hood, that bit in only fools and horses when they drop the chandelier. Talks of races, injuries, routes. 

Still the rain fell. 

There was a point on the route where we needed to exit the canal and take the Slough arm. We were struggling with the directions. We made a slight error and as we corrected there was a heart stopping moment. Jez, taking the lead, slipped on a sleeper that had been used to make a stair. He fell in a split second hard on his side. That it happened so quickly probably helped as it meant he could not try to break his fall possibly doing more damage. Luckily his run was not over but he'll be a bit bruised for a little while. A reminder that you need to concentrate as it can all be over that quickly.

The last part of the course was interminably long. There was a path that was flooded by long,  wide muddy puddles. So much water. Avoiding them was difficult and treacherous, Rob nearly took us all into the river a couple of times, so run through the we did. 

We reached the turning that was to take us into Slough. So close now it was frustrating to see that there was still a mile to go. We were now, cold wet and hungry. It had been a long day and conditions were awful. We just wanted it done. 

As we ran through the town we hit school run traffic, cars and kids in Blazers everywhere. The distance meter ticked slowly down and we reached the hotel. We'd done it. Stage 1 was complete. We were intact. 

Jen, one of the support team them appeared like an angel with bananas and red bull! 

As we approached the check in desk we were given a serious sideways look. We asked to check in and were asked if we had a car in the car park!

In the rooms hot showers, food and drink all making us human again.

It had been a cracking day of running, a great course and some good laughs along the way. The second wave came in not that long afterwards, Trevor came in followed by Dale and Malc. Our bags were then delivered by Rachel and Giselle who had driven down from Cheltenham with them. 

Team planning had worked a treat!

The team then had massages before an evening meal where the day's events were unravelled and retold. Great fun. 

Everyone knows it was only day 1 of 4 but rather than get to hung up about tomorrow we enjoyed today. 

W2C Ultramarathon Challenge

​Between 15th and 18th April I will be part of team "W2C".

A team of six runners that are planning to run from Westminster-to-Cheltenham (W2C). A distance of 138 miles over 4 days. This is not a relay we are each planning to cover every mile.

The itinerary is as follows... 

Day 1 Westminster to Slough - 28 miles
Day 2 Slough to Reading - 34 miles
Day 3 Reading to Swindon - 44 miles
Day 4 Swindon to Cheltenham - 30 miles

Whilst this is an undeniably tough challenge it is achievable. Training has gone incredibly well over the past few months with consistent mileage of >60 miles a week and no (touch wood) injury issues.

There are also plenty of stories to draw confidence and inspiration from not least of all Eddie Izzard's recent heroics in South Africa.

As a team we wanted to do something for a children's charity and decided to support Winston's Wish (http://www.winstonswish.org.uk) which is a charity supporting bereaved children. Many people now do many things all seeking to raise funds for incredibly worthy causes.

How do you decide which one to support or not? It would be great if you could support this but I don't want you to feel under any obligation to do so. Maybe a penny a mile - £1:38? That's less than a cup of coffee and if everyone did that it would soon mount up.

If you wish to donate then you can do so here http://uk.virginmoneygiving.com/team/w2c.

You can also tweet encouragement or incredulity to the team at http://twitter.com/w2cultra. We will be using this account to update our status on the road.

We also have real time tracking via racedrone whch will be active here.. http://www.racedrone.net/event/w2c-138-miles.

Thanks for reading this - see you on the road!

Type 1 Diabetes on a multi-day ultramarathon

Mid-April I am planning on being part of a team that will be running the whole way from London to Cheltenham, this will be 138 miles over 4 days.

As a Type 1 diabetic I need to be more prepared and also the people that I am doing this with need to understand what i am going through. With that in mind I have produced a crib-sheet that I am planning to give to each member of the running team and also the support team so that when they encounter me they can help me to help myself.

Whilst I do not forsee an issues that does not mean that there may not be any. While I have run ultramarathons before I have never run four on consecutive days.

The following is what I am proposing supplying to each of the running and support team - it would be great if ou have any comments that you either post them to this blog or contact me via twitter to discuss anything you consider would be valuable to this....

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Diabetes check List

I have type 1 diabetes which means i use insulin to control my blood sugar levels. I administer this via injection. There is a healthy blood sugar range which is between 4-7mmol. Below that is 'hypo' and significantly above that (around 14+) is 'hyper'. Both need treating although for this endeavour hyper is less problematic.

Without wishing to be patronising food increases blood sugar and insulin reduces it.

Diabetes plays tricks on your mind. Sometimes accepting that you are hypo or low is not easy. An intervention helps as it makes you have to say it out loud and deal with it. While i do not anticipate problems this is a checklist that can be used...

1. How do i seem and sound?Indicators of low blood sugar are disorientation, slurred speech and short temper. Often diabetics in this state are dismissed as being drunk. If i seem drunk through this i am more than likely not!
2. What is my current blood sugar level?
   Ask me to test my blood sugar and watch me as i do so (the healthy range is between 4-7mmol)
• If it is below 4 i MUST eat sugar immediately - i will have a pack in my race vest and will also have given you a couple of packets to have to hand for this eventuality.
• if it is between 4-7mmol this is good - i should eat something and then will be ok to continue. If it is towards the lower end of this scale i should gve it 5-10 minutes before setting off.
• If it is above 14mmol i should administer a small amount of insulin (0.5 units)
3. Check before i leave that i have sufficient food and gels for the next leg.

An issue is unlikely this is just an explanation of what i will need to be thinking about at each checkpoint or stop.

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Thanks for taking the time to review this and if you have any comments or thoughts on the content please do contact me...

Green Man Ultra - 5th March 2016

Only one person can win a race we all know that yet so many of us enter races knowing we have little chance of being within the same hour as the winner let alone top the podium. Running is different, people run for so many different reasons and winning isn't necessarily one of them. Nowhere is this more true than in ultra marathons. So it was on the morning of Saturday 5th March that 184 hardy souls almost exclusively clad in Salomon running gear nervously prepared kit, checking and double checking the details. Chatting excitedly with friends or just pensive waiting for it to start. The it being the Green Man Challenge, a 46mile ultra marathon with in excess of 4,000ft of climbing using the Community Forrest Path and Frome Valley Way path that circumvent Bristol. 

The route was predominantly on trail and with the weather that we have experienced over the previous week was a boggy, muddy mess. There were puddles that were knee deep, fields of thick mud that made running impossible, fields with thick mud and then a covering of freezing rain water across the top creating something akin to a paddy field. From the start the route went up hill, knowing this I decided to start very cautiously, this is good advice in any ultra. It's a long way, you will be out there a long time and a lot can happen. 

After a slog up through muddy fields in the cold morning, the race started at 8am, there were then runnable sections across fields and through wooded sections. After starting cautiously this did feel a bit like having the leash let off. I was though very aware of my effort and trying to keep under control. Running slow when you are not used to it feels like you are not really moving. The field was quite bunched at the start, once it became runnable it strung out. 

I settled into a pace that was matched by a lady from Northern Ireland, Susan. We ran together for quite a few miles chatting about running and the races we have done. That's the other thing about an ultra you're generally running at a pace where talking is easy, if you can't talk then you're going too fast. We hit the first checkpoint quite quickly, it was only 9 miles after the start, there was drinks and malt loaf. A quick grab and off again. The next checkpoint was a further 7 miles away. 

Off again and there was a self imposed target to get to the next checkpoint ahead of the start of the 30 mile race. The GMU has two races the 45 miler and 30 miler. Both use the same course with the 30 miler starting 15 miles into the course. The checkpoint here was better stocked, coke, lots of cake and sandwiches. I grabbed a handful of food and it was, once more, off again. At this point I was feeling great and got a little carried away, I started running quicker, the ground was now compacted trail more akin to the tarmac that I normally run on. Checkpoint 3 was 12 miles along and i started to lose my zip. 

I was in a group of runners and as we passed a pedestrian we were told that the next aid station was just around the corner. As it came into view there was relief, it turned out though that this was not an official aid station. I stopped and asked for some help retrieving my blood test kit out of my race vest. The lady that helped me asked if I needed anything, i replied that I might do and would know shortly. She hovered around me as I tested my blood. It was 4mmol which is at the bottom of the good range which is between 4-7. she asked me what I needed then got me food - a lot of sugary calorific food. With a handful of mini-eggs and flapjack I set off walking towards the next official checkpoint. Whilst this interaction may seem trivial it wa actually very significant. 

When you have diabetes your brain plays tricks on you, you can have a low blood sugar and yet not deal with it or not want to deal with it. It's the ultimate in denial. I have been in this position before and it does take an intervention sometimes. The action of asking me if I needed anything or if there was anything I needed to do made me do it. Without that I might have been tempted to just continue. that would have been a mistake. 

At the next checkpoint, which was at 28 miles, I went to town with the food. A red bull (which I later found out was sugar free!), a handful of sandwiches, a stack of cake all carried and eaten. I also grabbed some gels and a couple of 9-bars which I stashed for later. I was feeling revitalised for having eaten and set about running again. The next section of the course felt weird in that it was the footpath but woven around the Bradley Stoke housing estates. We were sharing the footpaths with dog walkers, kids on scooters and bikes, everyone was encouraging but interacting with normal people was a little surreal. A reminder that it was a Saturday and people were going about their business. 

At this point I settled in running wth a couple of Welsh chaps that were going at a pace I could maintain. We helped each other out, chatting, taking the mickey and passing the time. It made the running feel easy. We continued to walk the uphill sections and run where we could. 

As we got closer to the 4th checkpoint at Blaise Castle they pushed on stronger than me and the elastic snapped. At the checkpoint I made a decision to be quick through. As I entered I saw Matt, he was volunteering and knocking off, we had a quick chat and he was going to run the final 10km with me. I set off, we were now being followed by the 9hr timelord and a further group of runners. Over that final 10k I must have a lost maybe 8-10 places but I didn't care. My quads were trashed and it was just about finishing. I couldn't have responded even if I had wanted to.

Across the Downs and towards the Clifton Suspension Bridge. It was now a glorious sunny afternoon so there were tourists, day trippers, dog walkers and kids on scooters. All gave me and the other runners a wide berth. Across the bridge and then down into Ashton Court. The finish was insight.

I crossed the line so pleased to finish and be in daylight. Once across the line there's a lift in spirits that's almost euphoric. Not 5 minutes earlier I had been struggling and heading towards a dark place, now it was all smiles and a return of energy. Relief, happiness and adrenaline all combining. 

I was helped out of my muddy shoes, took off my socks and calf guards and went inside the race HQ to get my t-shirt and bag. A change of clothes, some vegetarian chilli and a cup of tea and I felt like me again. My legs and feet were sore but in no way was I broken. 

Some numbers...

Total distance run - 47.6miles (race is advertised as 46 so I clearly went wrong somewhere!)

Total elevation - 4,006ft / 1,221m

Avg. pace - 10:59 per mile 

Slowest mile - mile #5 in 14:40 with 459ft of climb

Fastest mile - mile #20 in 08:01

Calories burned - 6,600

Position - 32nd/184 (there were 168 finishers)

Finish time - 08:42:59.

Diabetes Management...

I use levemir (taking 3 units at 0830 and 2030 daily) and novorapid insulin (with meals). For this race I had 1 units of novorapid with breakfast for which I would normally have used 5 units. This meant that just before the start of the race at 8am my blood sugar was at 19mmol, this is very high but I knew it would be reducing steadily all day, plus the insulin was still active in my system. Before the race start, at around 7:30, I took 1.5 units of levemir. 

I tested my blood sugar once on course, a little over half way, where it was 4mmol. At the finish my blood sugar was 11.5mmol.

Where I struggled was in the hours and days after the race. I would expect to need vey little insulin for quite a period afterwards yet seemed to need more. I was running much higher than expected. This race seeming to have little effect. I got this back under control around 3-4 days post race. 

Kit...

I always stress about kit but got it right for this race. If anything I was probably wearing a little too much. It is though, of course, easier to take stuff off than put on what you don't have! 

All my kit had been used before but I took a bit of a risk with, of all things, my shoes. A little while ago I bought some Salomon Sense 3 S-Lab shoes. I have worn Salomon before and never had any issues with them. I wore these shoes on two training trail runs that together were maybe 11 miles. The shoes fit like a slipper, weigh nothing and so I was confident they would be ok come race day. Conditions were perfect for this shoe, it was soft and muddy and these shoes coped admirably with the terrain. I had zero issues and for the first time ever not a single blister following an ultra. They were a little hard underfoot when running on Tarmac but we're really an excellent shoe. I made a good choice if a little risky. 

The rest of my kit was pretty much my standard running kit. Inov-8 Ultra socks, Compressport calf guards, The North Face trail shorts, an Adidas Techfit compression t-shirt, Nike running fleece, Salomon S-Lab Hybrid jacket, Buff reflective, Salomon beanie, topped off with a Salomon race cap. To carry my gear I wore my 5ltr Salomon race vest. 

The success of the shoes aside the biggest plus was the Salomon hybrid jacket. This is the one that fits over the race vest so everything is kept under cover. The best thing though is the elastic waist band that when you don't need it you can roll the jacket into. With changing conditions this is a really great feature. While it didn't really rain on Saturday it was windy, particularly early on, I used the jacket as a wind cheater and then as it warmed up tucked it away into its waist band. 

Nutrition...

I was carrying enough food to feed a small army mainly in the form of gels. I had Gu and SIS gels. The Gu gels were packed with caffeine, electrolyte and amino acids so a great gel for an ultra. I packed the SIS gels that are the ones you don't need water with.  I was also carrying a couple of energy bars and some glucose tablets. 

On course there were sandwiches, cake, squash, coke, red bull and some salty goodies too. I ate an increasing amount at each aid station and had no issues with the stomach at any point despite the amount of sugary junk I had thrown into it!

Tapering for the Green Man Ultra...

This week is a tapering week. I hate tapering, I don't know anyone who likes it really. You go from running miles and miles to suddenly nothing or more of less nothing. It feels like nothing.

A couple of weeks ago I was chatting to a colleague that runs, he really runs, he's done something like 180 marathons and ultra's. He was describing how he runs around 80-100 miles a week by running long runs to work and then long runs home. I do the same but had always stopped short of running proper longer commutes. Inspired and motivated by this I upped my game and did a couple of weeks of 60+ miles without any really issue or impact at home. Longer runs in the morning and afternoon easily giving me 10'ish miles a day with then longer runs at weekends. So simple I don't know why I didn't think of it myself really. It was a bit like I needed permission. I had a mental block on going beyond 50 miles. Hearing someone in a similar position to me talk about regularly getting close to doubling that gave me the drive to push through an artificial ceiling.

Why do we continually constrain what we are capable of for no good reason?

After a couple of 60+weeks last week was a gentle climb down to 38 miles last week, this week will be 4/3 and 2miles on Tues/Weds/Thurs ahead of 45miles on Saturday at the Green Man Ultra.

My third ultra. It took me a couple of years to do my first as injury took its inevitable toll. in my second ultra I injured myself, damaging my hip flexor in a fall. That knocked out the rest of the year and more. In fact the GMU is 13 months after my last ultra. When I hear about people running races and events every weekend I don't know how they do it.

I am feeling strong and I am feeling fit. I've changed a number of things over the last 13 months.

I took a break from running with structure and just ran how far I felt like and with the intensity that I felt like. That was quite liberating and, if anything, made me understand just how much I want to run and maybe even need to run. With nothing to run for I still ran regularly, rain or shine.

I've also moved to a much more plant based diet. I'd like to say i'm vegan but I'm not 100%. I'd say I'm predominantly vegan not that it really needs a label. I was already vegetarian but eating lot of dairy - removing that was easier than I expected as there are a stack of alternatives and I don't really miss it. OK, I miss custard but there are Alpro alternatives and you can make it just as good with soya or almond milk.  What is hard is that there is milk powder in a lot of products and while I try and make choices to avoid them it's not always possible. Hence predominantly vegan.

Since making this dietary change I have dropped around 10lbs in weight. I don't want for energy at all and genuinely feel great. It's difficult to quantify how great you feel or if it is even different to before. I have to think that it is different and that the impact is positive. I'm having blood tests in a few weeks, it will be interesting to see what my cholesterol numbers are compared to the last set as they straddle the dietary change.  

The other change has been yoga! I bang on about this all the time and have blogged about it more than once. It's been great for me. I feel stronger and feel like I have something like core strength which I haven't really had before! I've never done strength training or stretching, I love the rigour of going to the session weekly and the benefits have been and continue to be huge.

All of which means there's an ultra marathon on Saturday! I'm excited about it but nervous too. Maybe a little more nervous than excited. When it's so close I just want it to be here and to be over. When I'm in the run I'm fine. I just need it to happen and get going. The last few days are torture. I stress about kit choices and what I should pack incessantly. Will it be wet or cold or both? It drives me mad, too many variable and too many choices. Maybe it's the project manager in me wanting to control everything and being in control of nothing!

The next few days will be spent watching the weather, stressing over kit and not running. It will be hell. Perhaps I should get some perspective.