Pump it up - Adventures of a type 1 triathlete with insulin pump
Pump it up - Adventures of a type 1 triathlete with insulin pump
Please visit my new blog here: Pump it up - Adventures of a type 1 triathlete with insulin pump

Diagnosed at the age of 5, I have been a type 1 Diabetic for over 29 years; being on an insulin pump for 11 years now. I took up triathlon in 2011 and am hooked ever since! Being diabetic doesn't stop me from doing what I love - swimming, cycling and running!

Lessons learnt: Glucose management on the bike

Eva29by Eva29Jun 19th 2013
I am actually laughing about myself writing this.

I think I said before that as diabetics we have 5 disciplines to train for in triathlon: Swim, Bike, run, transition and managing diabetes.
By that I don't just mean keeping sugar levels at bay but being organised, having spares of glucose meters, enough food, spare infusion set, testing strips with you for all eventualities (read my blog about the intricacies of racing as a diabetic).

I am pretty organised, for example, I have 3 glucose metres, one has a sticker �Bike�, the second has a T for transition and the other one is labelled S for the special needs bag or as a spare. I am pretty confident now testing glucose levels on the aero bars without slowing down too much and maybe that�s why Sunday�s experience thought me a lesson in several ways:

I did the Cotswold 113 (Middle Distance) as a practise race for my �big event� in September on Sunday.
My pre-race glucose management routine worked pretty well and I did my usual basal rate adjustment to 40% about 1.5 hours before the race. I had to take on a banana and half a gel when 45 min before the start my sugar levels had dropped from 117 to 93 (6.5 to 5.1 mmol) (no sign of adrenalin kicking in which normally make sugar levels rise!)
The swim was quite pleasant - I hadn�t swum that distance before with my new waterproof pump but worked out that the combination of the banana and half a gel as well as the reduced basal rate should get me through the swim without a hypo. Just to be sure I had a gel in the sleeve of my wetsuit.
All went smoothly and I got out after 31min, with a sugar level of 140 (7.7mmol)! Bingo spot on!

After completing the first lap of two on the bike it was time for another glucose check. I got my glucose meter out whilst continuing to cycle, pricked my finger and tested still keeping an eye on the road. The result showed 199 (11mmol) which was good because it meant that I didn�t need to worry about going into a hypo too much. Deciding that I would leave my basal rate at 40% for the remaining hour and 15 min which was roughly how long it would take me to complete the bike course but not to have anything to eat.
I packed away my meter in my bento box and realised after a few minutes that my finger was still bleeding from my finger prick. It didn�t stop to the point that blood was running down my finger every time I held on to my aero bar. I remembered I had a tissue in the plastic bag with my glucose meter. Busy trying to retrieve the tissue without letting go of the glucose meter and my nutrition in the bento box, I hadn�t given much attention to the road and before I knew it I had come off the road to the left into the greenery next to the road at full speed. It turned out to be a huge field of stinging nettles. I somehow managed to stay on my bike and I think it was only the sheer fear of falling right into the nettles that kept me pedalling on and eventually steering back on to the road. After the initial shock was over I realised that during my little excursion into the stinging nettles my glucose meter had been catapulted out of the bento box into the depth of the nettles bushes. It took a split second for me to decide NOT to stop and look for it. I knew I had to just get on with it. Needless to say that my cold feet no longer pre-occupied my mind but the stinging, itching sensation and the rash going down my legs�

With the glucose meter no longer with me, I had to listen to my body even more and rely on my own judgement to work out what my sugar levels were doing. This can be quite difficult in a race situation. I am sure most diabetics agree that having the comfort of a glucose meter is much better than having to listen to your body to recognise the signs of an oncoming hypoglycaemia (low sugar levels) or even the signs of hyperglycaemia (high sugar levels). However, I stuck to my plan:
I had only taken on another half a muesli bar during the first lap of the bike and two liquorice until I tested so with my experience from previous races and a number of training rides at the intensity I was riding at I worked out that I would probably be OK not to eat anything for the second lap and just keep the basal rate at 40%.

It worked! I briefly checked with my other glucose meter which I had in transition and the result showed 134 (7.3mmol). Phew!

On the run, I didn�t test my glucose levels either (I had organised a special needs bag with a meter at one of the aid stations in case ) but didn�t make use of it. My run was steady at an intensity I knew was OK for me to keep going for sometime without immediately falling into a hypo. I went with gut feel and had half a gel during the entire half marathon leg, had the basal rate running in 80% for the 10km and then on 100% for the last. Crossing the finish line the meter read 109 (6.0mmol)!

This experience has taught me a few useful things that I think anyone can apply to him or herself, not just diabetics:

Lesson 1:
Keep focussed and concentrate! No matter how long or dull the bike or run course is or how tired you are or busy eating and drinking � or checking sugar levels on the bike � keep focussed! My race could have easily ended in the stinging nettles because I wasn�t paying attention. I was lucky to have managed to not come off the bike. This little incident won�t stop me from checking levels again on the bike but has made me realise how important it is to have your mind focussed and not let it wonder off which is so easy to do. On the run I noticed that my mind just wandered off and I automatically slowed down; when I re-focussed I was picking up pace again.

Lesson 2:
Use training to work out what and how much nutrition your body requires at a given intensity. I was able to use the experience I had gained from training and other races to make reasonable assumptions about my nutritional requirements and how my blood sugar levels would behave. It worked. The danger of �bonking� which is effectively low sugar levels can be reduced significantly.

Lesson 3:
Give yourself some credit � It was my second ever half Ironman distance race and for the second time my glucose levels had been absolutely spot on. Yet, I wasn�t very happy with my performance overall. However, when breaking down the race into smaller chunks, actually, I had a pretty good swim and my transition times have improved a lot (thanks to actually practising transitions in training � see lesson 2!). My pacing was good because I was able to maintain the same split times in each lap and when I crossed the finish line, I knew I could have continued (it�s reassuring to know that when I will need to do double the distance in September)!

Instead of being annoyed and disappointed with my time, overall, I should be pleased with myself for managing glucose levels so well which to me is half of the battle ;-)

P.S I went back after the race and retrieved the glucose meter I lost on the bike - I had remembered where I had diverted off the road into the stinging nettles...:-)
Lessons learnt: Glucose management on the bike
fannyjaneby member: fannyjane, Sep 26th 2013 11:32
Well done Eva29 and good luck with your big race. I can't imagine trying to test your blood sugar while racing along on your bike, let alone having to process all that extra information. It's just about all I can do to make sure I don't ride off the road without having to worry about all that!
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