Thursday, March 31, 2016

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...

Wednesday, March 9, 2016

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!