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 ;)