Thursday, November 23, 2017

WW50 with an insulin pump (OmniPod)

The Wendover Woods 50 miler on Saturday (25/11) will be my second ultra since being fitted with an OmniPod insulin pump.

The first was quite an experience. I had started on the pump only a few days before and was taking part in a charity run. The charity was MIND and the run was a 1/3 mile loop at work. We, there was a team of us, were to run a working day from 9-to-5 and complete as many laps as we could. This was on July 5th and was in the middle of a seriously hot spell that we were having. Temperatures were well into the 30’s for the day and there was no breeze and little shade.

At the start I felt great and was using a libre to monitor my blood sugars. I had been advised to reduce my basal rate for the duration but when I tried to do this via the pump it wouldn’t allow me as the doses were already very small. I know I have small doses of insulin generally so just assumed that this was correct. I started running and for the morning was ok. Energy and repair both doing ok. What was happening though was my blood sugars were going down too much and I was struggling to get them healthy. A combination of heat and exertion.

I actually suspended insulin for a period and as I went into the afternoon started to feel empty, incredibly weak and tired. I had to go  and take a lie-down at one point and am sure I nodded off. I was in much more of a state than I was expecting to be based on previous experience and figured it must just be the heat. My blood sugar levels then started to rise and I switched the basal back on. This made barely a dent and the trajectory continued through to the end of the event. I was quite broken at the end but had covered just short of 40 miles in that state.

A couple of days later I had a hospital appointment and one of the people I was with was describing that their pump had not been set-up correctly when they left the start-up appointment and had caused them some problems. I checked mine and it was the same. I wasn’t getting anything like the level of insulin I should have been as the set-up was just a low scale one. A default one I assume. I set-it properly and from that point on it worked! 

I had, though, managed to cover 40 miles with barely any insulin in me.

This Saturday will be different. The pump is set-up properly and I know how to manage things. On pens it would have been straight forward. I would have reduced my Levemir by 50% run and eaten all day and not had any issues! This will be different. My strategy will be to reduce my basal by 80% for 10hrs at the start. I will then monitor my sugars over the day using a libre and adjust as necessary. I still plan to eat everything I can and with barely a care as, frankly, ultra running is the closest thing I get to feeling like I did pre-diabetes.

I have been experimenting with reducing my basal in this way over the last few months and it works. It took me a while to accept this as a way forward as was contrary to what I would do on pens. What this has enabled me to do is where I am planning to run for a couple of hours, I reduce the basal by 80% and then I only need maybe one gel or one pack of shotbloks and my blood sugars are on the low side of 4-7 when I finish. When I extrapolate that across 10-12 hrs of running this weekend then I will be eating more and testing more. I also know that the line is not straight! It’s not a case of a gel every two hours and bingo I will need to be consuming more and more regularly than that schedule. I did reach out through the power of the web to Robin Arzon of Instagram fame who is type 1 and has run ultra’s including a 100 miler. I asked her what she does with her insulin over these events and reassuringly the answer was the same as what i have been advised to do and what I am planning.

With that in mind the libre will be key for me this weekend, faffing about with cold hands trying to squeeze blood onto a strip will not be easy and while I will do blood tests to be able to just scan my arm as I move will be great for on the move data.

It’s 2 days away now and I have gone from, at the beginning of the week, thinking that I’m not ready to actually feeling pretty good about it and actually a little excited. A day running in the woods? What’s not to like.

As someone with type 1 diabetes there is a risk attached to completing this type of event. There is for everyone but maybe for a type 1 you could argue they are more significant. I acknowledge the risk and am not gung-ho about this at all. What I do know is how to manage. I have lots of experience of training and taking part in events over a number of years and, in fact, realised recently that other than my first marathon (in 1997) everything I have done subsequently has been as a type 1 diabetic. That includes half marathons, marathons, ultra’s, a marathon swim and triathlon/duathlon. The key to this is knowledge; when I am training it is not only my physical well being in terms of muscle and endurance that I am training it is also my understanding of my diabetes. 

I am aware of it every step of the way and know how it feels and what to do. I know my responsibilities and do not ignore them. I sometimes even consider it an advantage as while other competitors don’t have that worry they are also unaware of a key part of their physiology that could affect their race. 

Hitting the wall is, after all, just a low blood sugar.